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pregnancy and metoprolol

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https://www.readbyqxmd.com/read/27593227/beta-blockers-and-fetal-growth-restriction-in-pregnant-women-with-cardiovascular-disease
#1
Kayo Tanaka, Hiroaki Tanaka, Chizuko Kamiya, Shinji Katsuragi, Masami Sawada, Mitsuhiro Tsuritani, Masashi Yoshida, Naoko Iwanaga, Jun Yoshimatsu, Tomoaki Ikeda
BACKGROUND: The effects of β-adrenergic blockers on the fetus are not well understood. We analyzed the maternal and neonatal outcomes of β-adrenergic blocker treatment during pregnancy to identify the risk of fetal growth restriction (FGR). METHODS AND RESULTS: We retrospectively reviewed 158 pregnancies in women with cardiovascular disease at a single center. Maternal and neonatal outcomes were analyzed in 3 categories: the carvedilol (α/β-adrenergic blocker; α/β group, n=13); β-adrenergic blocker (β group, n=45), and control groups (n=100)...
September 23, 2016: Circulation Journal: Official Journal of the Japanese Circulation Society
https://www.readbyqxmd.com/read/27512472/coronary-artery-disease-secondary-to-familial-hypercholesterolaemia-an-infrequent-cause-of-increasingly-common-pregnancy-co-morbidity
#2
Nicla A Varnier, Franzisca Pettit, David Rees, Steven Thou, Mark Brown, Amanda Henry
BACKGROUND: Cardiovascular disease affects 0.2-4% of pregnancies. Coupled with the physiological stress of pregnancy, cardiovascular disease may present significant management challenges including appropriate risk:benefit analysis of medical and surgical management options. CASE: A 33-year-old gravida 4 para 1 miscarriage 2 presented at 18 weeks' gestation to the high-risk pregnancy service with a history of coronary artery disease and homozygous familial hypercholesterolaemia...
September 2015: Obstetric Medicine
https://www.readbyqxmd.com/read/26877477/p-171-pregnancy-induced-hypertension-in-patients-with-mitral-stenosis
#3
N Benatta, L Hamou, D D Batouche, T Merzouk, M Benbouabdellah
OBJECTIFS: La prise en charge du rétrécissement mitral (RM) associé à l'hypertension gravidique continue à poser un défi au médecin particulièrement dans les pays en voie de développement. Le but de cette étude était d'étudier le profil clinique, thérapeutique et évolutif des RM accompagnés hypertension gravidique. MéTHODES: 83 patientes atteintes d'un rétrécissement mitral suivis durant la grossesse dont 7 patientes ont compliqué d'une Hypertension gravidique. RéSULTATS: Le diagnostic de l'Hypertension gravidique a été posé par la MAPA, le RM était serré dans les 7 cas avec une surface mitrale anatomique entre 1 et 1,5cm(2)...
December 2015: Annales de Cardiologie et D'angéiologie
https://www.readbyqxmd.com/read/26461463/pharmacokinetics-of-metoprolol-during-pregnancy-and-lactation
#4
Rachel J Ryu, Sara Eyal, Thomas R Easterling, Steve N Caritis, Raman Venkataraman, Gary Hankins, Erik Rytting, Kenneth Thummel, Edward J Kelly, Linda Risler, Brian Phillips, Matthew T Honaker, Danny D Shen, Mary F Hebert
The objective of this study was to evaluate the steady-state pharmacokinetics of metoprolol during pregnancy and lactation. Serial plasma, urine, and breast milk concentrations of metoprolol and its metabolite, α-hydroxymetoprolol, were measured over 1 dosing interval in women treated with metoprolol (25-750 mg/day) during early pregnancy (n = 4), mid-pregnancy (n = 14), and late pregnancy (n = 15), as well as postpartum (n = 9) with (n = 4) and without (n = 5) lactation. Subjects were genotyped for CYP2D6 loss-of-function allelic variants...
May 2016: Journal of Clinical Pharmacology
https://www.readbyqxmd.com/read/26158653/pregnancy-induced-hypertension
#5
REVIEW
Evangelia Kintiraki, Sophia Papakatsika, George Kotronis, Dimitrios G Goulis, Vasilios Kotsis
Pregnancy-induced hypertension (PIH) complicates 6-10% of pregnancies. It is defined as systolic blood pressure (SBP) >140 mmHg and diastolic blood pressure (DBP) >90 mmHg. It is classified as mild (SBP 140-149 and DBP 90-99 mmHg), moderate (SBP 150-159 and DBP 100-109 mmHg) and severe (SBP ≥ 160 and DBP ≥ 110 mmHg). PIH refers to one of four conditions: a) pre-existing hypertension, b) gestational hypertension and preeclampsia (PE), c) pre-existing hypertension plus superimposed gestational hypertension with proteinuria and d) unclassifiable hypertension...
April 2015: Hormones: International Journal of Endocrinology and Metabolism
https://www.readbyqxmd.com/read/25111318/peripartum-cardiomyopathy-definition-incidence-etiopathogenesis-diagnosis-and-management
#6
REVIEW
Jalaj Garg, Chandrasekar Palaniswamy, Gregg M Lanier
Peripartum cardiomyopathy (PPCM) is a serious pregnancy-associated disorder of unknown etiology. The precise cellular and molecular mechanisms underlying PPCM are unclear. A heightened awareness among health care providers can result in early diagnosis of heart failure in late pregnancy and the early postpartum period. Though the symptoms of dyspnea and fatigue can result from normal physiologic changes during pregnancy, an electrocardiogram and brain natriuretic peptide level should be obtained in these patients, in addition to baseline laboratory tests such as a complete blood count, and basic metabolic and hepatic function panels...
March 2015: Cardiology in Review
https://www.readbyqxmd.com/read/25010869/combination-of-tocolytic-agents-for-inhibiting-preterm-labour
#7
REVIEW
Joshua P Vogel, Juan Manuel Nardin, Therese Dowswell, Helen M West, Olufemi T Oladapo
BACKGROUND: Preterm birth represents the single largest cause of mortality and morbidity for newborns and a major cause of morbidity for pregnant women. Tocolytic agents include a wide range of drugs that can inhibit labour to prolong pregnancy. This may gain time to allow the fetus to mature further before being born, permit antenatal corticosteroid administration for lung maturation, and allow time for intra-uterine transfer to a hospital with neonatal intensive care facilities. However, some tocolytic drugs are associated with severe side effects...
July 11, 2014: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/24505967/-takayasu-s-arteritis-in-pregnancy-a-case-report
#8
Dorota Darmochwał-Kolarz, Anita Chara, Michał Korzeniewski, Bozena Leszczyńska-Gorzelak, Jan Oleszczuk
We present a case report of pregnant woman with Takayasu's arteritis diagnosed in childhood. The treatment was modified owing to the fact that the patient wished to get pregnant and she conceived spontaneously within the first year after that. Vasculitis activity was low during pregnancy Hypertension was treated with methyldopa and metoprolol. After the confirmation of pregnancy daily administration of prednizone and enoxaparin (at a dose of 5 mg and 40 mg, respectively) has been started. In the third trimester of pregnancy the values of blood pressure increased...
January 2014: Ginekologia Polska
https://www.readbyqxmd.com/read/24360330/management-of-labour-and-delivery-in-a-woman-with-refractory-supraventricular-tachycardia
#9
A T Dennis, M D Gerstman
Supraventricular tachycardia is uncommon in pregnancy. It is defined as intermittent pathological and usually narrow complex tachycardia >120 beats/min which originates above the ventricle, excluding atrial fibrillation, flutter and multifocal atrial tachycardia. It is usually self-limiting or relatively easily treated with most cases responding to physical or pharmacological therapies. We describe a case of a woman in the third trimester of pregnancy who developed treatment-resistant supraventricular tachycardia and required induction of labour and delivery to stop the arrhythmia...
February 2014: International Journal of Obstetric Anesthesia
https://www.readbyqxmd.com/read/24273912/-electrical-cardioversion-in-the-treatment-of-cardiac-arrhythmias-during-pregnancy-case-report-and-review-of-literature
#10
REVIEW
Krzysztof Gałczyński, Beata Marciniak, Janusz Kudlicki, Zaneta Kimber-Trojnar, Bozena Leszczyńska-Gorzelak, Jan Oleszczukz
The incidence of cardiac arrhythmias is estimated et 1.2 per 1000 pregnancies, usually in the third trimester and 50% of them are asymptomatic. They may appear for the first time in pregnancy or have a recurring character An important risk factor related to their appearance is the presence of structural heart disease, which complicates < 1% of pregnancies. Generally the symptoms are mild and the treatment is not necessary but in some cases pharmacotherapy is necessary Pharmacotherapy must be a compromise between the potentially adverse effects of drugs on the fetus and the beneficial effects on the cardiovascular system of the mother...
October 2013: Ginekologia Polska
https://www.readbyqxmd.com/read/24009805/a-missed-diagnosis-or-a-masquerading-disease-back-to-the-basics
#11
Rejani Lalitha, Christopher Kenneth Opio
A 23-year-old gravid Ugandan female at 26 weeks was admitted to the maternity ward with sweats, abdominal pain, feeling of apprehension and palpitations. A diagnosis of pre-eclampsia was made and treatment with magnesium sulphate initiated. She was later transferred to intensive care unit for monitoring and control of blood pressure. Due to her labile blood pressures despite intravenous hydralazine and metoprolol, the pregnancy was terminated. However, she continued to have labile blood pressures. Better control of blood pressure was achieved on oral prazocin and nifedipine...
2013: Pan African Medical Journal
https://www.readbyqxmd.com/read/23937302/-rescue-ablation-of-electrical-storm-in-arrhythmogenic-right-ventricular-cardiomyopathy-in-pregnancy
#12
Sebastian Stec, Tomasz Krynski, Jakub Baran, Piotr Kulakowski
BACKGROUND: Radiofrequency ablation (RFCA) became a treatment of choice in patients with recurrent ventricular tachycardia, ventricular fibrillation, and appropriate interventions of implanted cardioverter-defibrillator (ICD), however, electrical storm (ES) ablation in a pregnant woman has not yet been reported. CASE PRESENTATION: We describe a case of a successful rescue ablation of recurrent ES in a 26-year-old Caucasian woman during her first pregnancy (23rd week)...
2013: BMC Cardiovascular Disorders
https://www.readbyqxmd.com/read/23569481/successful-electrical-cardioversion-of-supraventricular-tachycardia-in-a-pregnant-patient
#13
Fevzi Yılmaz, Inan Beydilli, Cemil Kavalcı, Serkan Yılmaz
BACKGROUND: Pregnancy can precipitate cardiac arrhythmias not previously present in seemingly well individuals. Atrial and ventricular premature beats are frequently present during pregnancy and are usually benign. Supraventricular tachycardia and malignant ventricular tachyarrhythmias occur less frequently. Maternal and fetal arrhythmias occurring during pregnancy may jeopardize the life of the mother and the fetus. CASE REPORT: A 32-year-old pregnant women at 26 weeks gestation presented to the emergency department with palpitation...
2012: American Journal of Case Reports
https://www.readbyqxmd.com/read/23430858/primary-carnitine-deficiency-presents-atypically-with-long-qt-syndrome-a-case-report
#14
Irene De Biase, Neena Lorenzana Champaigne, Richard Schroer, Laura Malinda Pollard, Nicola Longo, Tim Wood
Primary carnitine deficiency (PCD) is an autosomal recessive disorder of fatty acid oxidation caused by mutations in the SLC22A5 gene encoding for the carnitine transporter OCTN2. Carnitine uptake deficiency results in renal carnitine wasting and low plasma levels. PCD usually presents early in life either with acute metabolic crisis or as progressive cardiomyopathy that responds to carnitine supplementation. PCD inclusion in the newborn screening (NBS) programs has led to the identification of asymptomatic adult patients ascertained because of a positive NBS in their offspring...
2012: JIMD Reports
https://www.readbyqxmd.com/read/23383565/-treatment-of-arterial-hypertension-in-pregnancy-in-relation-to-current-guidelines-of-the-polish-society-of-arterial-hypertension-from-2011
#15
REVIEW
Ludwina Szczepaniak-Chicheł, Andrzej Tykarski
Arterial hypertension concerns 7-10% of pregnancies and leads to an increased risk of complications for both, the mother and the child. This rate will probably rise in the years to come due to the notable tendency among women to delay the decision to become pregnant - values of blood pressure and occurrence of arterial hypertension increase with age, as well as due to the growing problem of obesity resulting from inappropriate dietary habits and lack of regular everyday physical activity. Difficulties with management of that clinical condition are partly related with lack of unified and widely accepted guidelines...
October 2012: Ginekologia Polska
https://www.readbyqxmd.com/read/23355638/a-physiologically-based-pharmacokinetic-model-to-predict-disposition-of-cyp2d6-and-cyp1a2-metabolized-drugs-in-pregnant-women
#16
Alice Ban Ke, Srikanth C Nallani, Ping Zhao, Amin Rostami-Hodjegan, Nina Isoherranen, Jashvant D Unadkat
Conducting pharmacokinetic (PK) studies in pregnant women is challenging. Therefore, we asked if a physiologically based pharmacokinetic (PBPK) model could be used to evaluate different dosing regimens for pregnant women. We refined and verified our previously published pregnancy PBPK model by incorporating cytochrome P450 CYP1A2 suppression (based on caffeine PK) and CYP2D6 induction (based on metoprolol PK) into the model. This model accounts for gestational age-dependent changes in maternal physiology and hepatic CYP3A activity...
April 2013: Drug Metabolism and Disposition: the Biological Fate of Chemicals
https://www.readbyqxmd.com/read/23316059/heart-rate-changes-mediate-the-embryotoxic-effect-of-antiarrhythmic-drugs-in-the-chick-embryo
#17
Radka Kockova, Jarmila Svatunkova, Jiri Novotny, Lucie Hejnova, Bohuslav Ostadal, David Sedmera
A significant increase in cardiovascular medication use during pregnancy occurred in recent years. Only limited evidence on safety profiles is available, and little is known about the mechanisms of adverse effect on the fetus. We hypothesized that drug-induced bradycardia is the leading mechanism of developmental toxicity. Embryotoxicity was tested in ovo after administration of various doses of metoprolol, carvedilol, or ivabradine. Embryonic day (ED) 4 and 8 chick embryos were studied by video microscopy and ultrasound biomicroscopy ex ovo after intraamniotic injection of the drug for a period of 30 min...
March 15, 2013: American Journal of Physiology. Heart and Circulatory Physiology
https://www.readbyqxmd.com/read/23133787/pregnancy-complicated-with-severe-recurrent-aortic-coarctation-a-case-report
#18
Celal Yavuz, Hatice Ender Soydinc, Güven Tekbaş, Oguz Karahan
A 23-year-old primigravida was referred to our clinic for evaluation of high blood pressure (BP) in her 16th week of gestation. She had an operation to repair congenital aortic coarctation and patent ductus arteriosus 8 years ago. On physical examination the blood pressure in upper extremity was 155/95 and in lower extremity was 90/55 mmHg, and heart rate was 93 beats/min. Transthoracic echocardiography showed narrowing of the descending aorta, the diameter of the aortic arch was 10.60 mm and an echocardiographic gradient was 96 mmHg...
2012: Case Reports in Vascular Medicine
https://www.readbyqxmd.com/read/23097090/stereoselective-determination-of-metoprolol-and-its-metabolite-%C3%AE-hydroxymetoprolol-in-plasma-by-lc-ms-ms-application-to-pharmacokinetics-during-pregnancy
#19
Natalícia De Jesus Antunes, Ricardo Carvalho Cavalli, Maria Paula Marques, Vera Lucia Lanchote
Metoprolol is available for clinical use as a racemic mixture. The S-(-)-metoprolol enantiomer is the one expressing higher activity in the blockade of the β(1)-adrenergic receptor. The α-hydroxymetoprolol metabolite also has activity in the blockade of the β(1)-adrenergic receptor. The present study describes the development and validation of a stereoselective method for sequential analysis of metoprolol and of α-hydroxymetoprolol in plasma using high-performance liquid chromatography with tandem mass spectrometry (LC-MS/MS)...
January 2013: Chirality
https://www.readbyqxmd.com/read/23090536/pharmacogenetics-and-other-reasons-why-drugs-can-fail-in-pregnancy-higher-dose-or-different-drug
#20
David M Haas, Mary DʼAlton
Changes in maternal physiology during pregnancy can alter the absorption, distribution, and clearance of many drugs. When presented with a clinical situation in which it does not appear that a prescribed drug is working, clinicians must either change drugs or increase the dose of the current drug to achieve the desired clinical effect. A case highlighting antihypertensive medication in pregnancy and the effect of changed drug-metabolizing enzymes is presented. Understanding pregnancy's effect on drug-metabolizing enzymes, transporters, and receptors can help clinicians make individualized pharmacotherapeutic decisions for patients...
November 2012: Obstetrics and Gynecology
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