Terapêutica cardiovascular com bloqueadores beta: ponto da situação
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bloqueadores beta, terapêutica cardiovascularResumo
Os bloqueadores fl (b-fl) permanecem agentes terapêuticos de grande importância na terapêutica cardiovascular. Constituem um grupo terapêutico vasto, de razoável complexidade, com novos agentes ainda em desenvolvimento e indicações alargadas para agentes já conhecidos.
Foram revistas as principais características farmacológicas e farmacocinéticas dos b-fl, com particular ênfase para noções importantes na prática clínica diária: potência, relação estrutura-actividade, selectividade, actividade sim paticomimética intrínseca, capacidade bloquedora a e variabilidade da relação dose-eficácia terapêutica destes fármacos.
As indicações terapêuticas para cada entidade foram analisadas, pondo em relevo o efeito protector de mortalidade dos b-fl em sobre viventes de enfarte de miocárdio, a capacidade anti-hipertensora destes agentes, que continuam a ser agentes de primeira linha no tratamento da hipertensão arterial, e a promissora utilização de sotalol - único agente com actividade antiarrítmica de classe III - no tratamento as disritmias. Promissor, também, parece ser o uso de b-fl no tratamento da miocardiopatia dila tada.
Finalmente, foram revistos os efeitos adversos e contra-indicações dos fl-b, controvérsias a cerca do seu uso em doentes com diabetes mellitus, doença vascular periférica e no contexto de dislipidémia de particular relevância.
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