M

ho-ch2 ch2-oh hno3 / h2so4

o2no-ch2 ch2-ono2

o2no-ch2 ch2-ono2

Pentaerythritol tetranitrate is used for chronic cardiac insufficiency. It prevents angina pectoris attacks and eases their course. Synonyms of this drug are nitropentan, nitrinal, vaso-cor, vasolat, pentilan, erinit, and many others.

Isosorbide Dinitrate: Isosorbiddinitrate, 1,4:3,6-dianhydrosorbate-2,5-dinitrate (19.1.4), is synthesized by intermolecular dehydration of D-sorbite into isosorbide (19.1.3) using para-toluenesulfonic acid and subsequent nitration of the two hydroxyl groups by nitric acid [5-7].

ch2—oh i h-c-oh ch2-oh so3h oh so3h o hno3 / h2so4

oh ono2

o hno3 / h2so4

ono2

ono2

ono2

Isosorbide dinitrate is also used in chronic cardiac insufficiency for preventing angina pectoris attacks. It is a long-lasting drug. Synonyms of this drug are isordil, metronitron, vascardin, and others.

19.2 ¡-ADRENOBLOCKERS

Possessing the ability to reduce the heart's need for oxygen, /¡-adrenoblockers, in particular atenolol, metoprolol, propranolol, and nadolol, are recommended for treating chronic angina pectoris, which frequently develops after a myocardial infarction takes place. The reduction of the heart's need for oxygen using ¡-adrenoblockers is achieved by lowering the heart rate, blood pressure, and contractability of the myocardium. It should be noted that severe angina pectoris attacks are alleviated best with nitroglycerol. However, therapy with ¡-adrenoblockers is undoubtedly complemented by therapy with nitrates. Moreover, nitrates often counteract a few undesirable effects of ¡-adrenoblockers, and therefore combination therapy using nitrates and ¡-adrenoblockers are frequently used.

Propranolol: Propranolol is 1-(i^o-propylamino)-3-(1-naphthoxy)-2-propanol (12.1.2). The synthesis of this drug is described in Chapter 12.

Propranolol is a nonselective /¡-adrenoblocker that affects both the mechanical and electrophysiological properties of the myocardium. It lowers myocardial contractibility, heart rate, blood pressure, and the myocardial need for oxygen. These properties make propra-nolol and other ¡-adrenoblockers useful antianginal drugs.

Propranolol is used for treating hypertension, angina pectoris, supraventricular arrhythmia, ventricular tachycardia, migraines, hypertrophic subaortal stenosis, and pheochromo-cytosis. It is used following a myocardial infraction. Generally accepted synonyms of this drug are anaprilin, obsidan, inderal, novapranol, and defensol.

Metroprolol: Metroprolol is 1-(i^o-propylamino)-3-[4' (2-methoxyethyl)phenoxy]-2-propanol (12.1.5). The synthesis of this drug is described in Chapter 12.

ch30

0h ch3

Unlike propranolol, which blocks both ¡i1 and ^2-adrenoreceptors, metroprolol exhibits cardioselective action, i.e. in therapeutic doses, it blocks /¡radrenoreceptors with insignificant effects on ^2-adrenoreceptors. Metroprolol is used for myocardial infarctions, for preventing cardiovascular tissue death, and in angina pectoris. The most common synonym of this drug is lopresor.

Acebutol: Acebutol is 3'-acetyl-4'-[2-hydroxy-3-(i,ro-propylamino)propoxy] butyranilide (12.1.6). The synthesis of this drug also is described in Chapter 12.

ch3c0

0h nh-co-c3h7

nh ch ch

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