Mechanism of Action ZOCOR is a lipid-lowering agent derived synthetically from a fermentation product of Aspergillus terreus. After oral ingestion, ZOCOR , which is an inactive lactone, is hydrolyzed to the corresponding -hydroxyacid form. This principal metabolite is a specific inhibitor of A HMG-CoA ; reductase.This enzyme catalyzes the conversion of HMG-CoA to mevalonate, which is an early and rate-limiting step in the biosynthesis of cholesterol. Pharmacodynamics ZOCOR reduces cholesterol production by the liver and induces some changes in cholesterol transport and disposition in the blood and tissues. The mechanism s ; of this effect is believed to involve both reduction of the synthesis of Low-Density Lipoprotein LDL ; , and an increase in LDL catabolism as a result of induction of the hepatic LDL receptors. Pharmacokinetics ZOCOR has complex pharmacokinetic characteristics see DETAILED PHARMACOLOGY ; . Metabolism: Simvastatin is metabolized by the microsomal hepatic enzyme system cytochrome P-450 isoform 3A4 ; . The major active metabolites present in human plasma are the -hydroxyacid of simvastatin and four other active metabolites see DETAILED PHARMACOLOGY, Pharmacokinetics.
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A study done by researchers at UCLA has found that when people have high calcium scores in their coronary arteries they are more likely to adhere to cholesterol-lowering medication programs and healthy diet recommendations. The article was published in the April 2006 issue of Atherosclerosis. The study population was 505 patients on statin therapy for lowering cholesterol ; who came in for heart scans. They were then followed for an average of three years. In the group with the lowest calcium scores, only 52% were still on statins. In the group with the highest scores, 91% were taking their statins. Likewise, in the lowest calcium group, 41% were adhering to the recommended diet, while in the high calcium group 64% were adhering. Both of these results were highly statistically significant. Here at the LifeScore Clinic, Dr. Michael Wright analyzes all the data collected, including plaque scores, lab results, weight, blood pressure and lifestyle habits, and educates patients on what steps are needed to prevent plaque progression. It is clear that this one on one educational process is very successful in motivating patients. Often, there is a perception on the part of the patient that statins are dangerous. Please see the article on statin safety in this issue. Statins have an excellent safety record, and need to be the cornerstone therapy for everyone with high plaque scores. The major statins are Pravachol, Zocor, Lipitor and Crestor. Vytorin combines the statin Zocoor with Zetia, another cholesterol-lowering medication that works by blocking cholesterol absorption in the stomach. See the article in this issue on the ASTEROID study for some exciting news about plaque regression.
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Patient and Illness Characteristics Most patients entering the study were Caucasian and female, with a wide range of ages represented Table 4 ; . There were no statistically significant differences between patients who were randomized and patients who were not randomized with respect to age, racial origin, or sex. Furthermore, there were no statistically significant differences between treatment groups with respect to age, racial origin, and sex Table 5 ; . Table 6 presents patient characteristics for patients who participated in the open-label phase. Table 7 presents psychiatric illness characteristics for patients who participated in the double-blind period. There were no statistically significant differences between treatment groups in the number of previous episodes of MDD total and in the past 24 months ; , mean length of the current episode, or age at onset of first episode.
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Testing the level of the liver enzymes alanine aminotransferase ALT ; and aspartate aminotransferase AST ; in the blood is one way to tell if liver cells are dying. When liver cells die, ALT and AST are released into the blood. After an abnormal amount of liver cell death, ALT and AST levels rise over a period of 7-12 days and then slowly return to normal. If liver cells continue to die, ALT and AST levels will stay elevated. ALT and AST levels tell your health care provider how much damage is happening in your liver. However, having elevated ALT and AST levels does not necessarily mean your disease is getting worse. Although these tests can detect liver damage, they cannot determine how much liver repair is taking place. Studies show that liver enzyme levels are good markers of disease progression, but they do not necessarily predict disease outcome. Liver enzymes also provide no information about how well your liver is functioning. Your liver can maintain its many functions despite a remarkable amount of damage. Continued - LEFT ; Hepatitis C Awareness News 7.
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Figure 9. Blood Levels of the Anesthetic Drug Midazolam in Mestizos from Mexico and Caucasians from the U.S. and Europe and abilify.
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Related articles: conference report: statin use halves risk of advanced prostate cancer conference report: zetia-zocor combination lowers ldl deeper than lipitor additional preventive care coverage primary source: canadian medical association journal source reference: zhou z, et al effectiveness of statins for secondary prevention in elderly patients after acute myocardial infarction: an evaluation of class effect.
Committee that all strengths of the following single-entity brand name drugs be granted preferred drug status: pravastatin Pravachol ; simvastatin Zocor ; No brand name bile acid sequestrants, immediate or extended or controlled-release niacin or niacin combinations, immediate or extended release statin combinations, cholesterol absorption inhibitors or single-entity immediate or controlled-release statins, other than single-entity brand name pravastatin and simvastatin, are recommended for preferred drug status at this time because of the lack of compelling evidence of significant clinical advantage relative to safety and or efficacy. Multisource versions of cholestyramine and immediate and extended-release niacin are available to complement statin therapy or to be used in the rare instance when a statin may not be tolerated. No brand name bile acid sequestrant or brand name immediate or extended-release niacin product offers any significant or compelling clinical advantage relative to safety and or efficacy over multisource versions of bile acid sequestrant or immediate or extended-release niacin. Because of a procedural matter, no recommendation s ; regarding the fibric acid derivatives e.g., gemfibrozil, fenofibrate ; will be made at the September 17, 2003 meeting. The fibric acid derivatives will be addressed at the December, 2003 P&T Committee meeting and accutane.
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Changes in C T fluorescence seen during stimulation result from a release of Ca 2 from some intracellular c o m This release could provide a source of calcium for triggering secretion, since it is initiated at appropriate agonist concentrations and occurs rapidly. The present study, to o u r knowledge, is the first to use C T C "online" p r o for calcium redistribution during stimulus-secretion coupling, b u t it clear already that this p r o may be of use in o t secretory systems. A l t this t e c most easily carried out with isolated or dissociated cells, it could in the future be e x intact tissue by use of reflectance fluorometry. T h e advantage of C T fluorescence is that it allows continuous monitoring of m e and Mg 2 during secretion in the living ceils. We thank Drs. Juan Korenbrot, John Heuser, and Regis Kelley for their useful comments. This study was supported by grants from the National Cystic Fibrosis Research Foundation and from the U. S. Public Health Service GM 19998 and GM 00927 ; . Received for publication 18 August 1977. REFERENCES.
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Been described by Lai et al. [15] in which they found that embolization of the cervicovaginal branches may cause injury to the uterovaginal plexus or the vascular supply to the cervix or both, leading to potential sexual dysfunction. In our study, both uterine arteriographic examinations before and during embolization failed to show thick cervicovaginal branches; however, we think that a similar mechanism might occur as a result of embolization. Several reports have described the relationship between improvements in menorrhagia and initial tumor volume. Pron et al. [16] reported that improvements in menorrhagia were unrelated to initial uterine size. Spies et al. [17] reported that reduction in bleeding at 3 months was not related to baseline-dominant tumor volume. In our study, the improvements in menorrhagia at 4 months and 1 year after embolization in group 1 were significantly inferior to those in group 2, although statistical difference between the groups was not seen at 2 years after embolization. We do not know the reason for the discrepancy between other reports and ours. However, in our study, menorrhagia improved markedly or moderately in 32 89% ; of 36 women of group 1 at 4 months after embolization and in 24 100% ; of 24 women of group 1 at 1 year after embolization. We believe these findings reveal that uterine artery embolization is effective in improving menorrhagia in women with fibroids of 10 cm larger diameter. We used gelatin sponge particles as embolic agents in our study. This is because other embolic agents such as polyvinyl alcohol particles or tris-acryl gelatin microspheres Embosphere, Biosphere Medical, Rockland, MA ; were not available commercially in Japan, although most investigators in other countries reported that they used other embolic agents. If we had used other embolic agents in our study, different results might have been obtained. Our study has limitations. Patient numbers were limited, and we have not performed uterine artery embolization for uterine fibroids of more than 19 cm in diameter. If much larger tumors were included in our study, different results might have been obtained. In addition, we defined large tumors as being 10 cm or larger in diameter; however, if the definition was different, the results might also have been different. Moreover, because this study was performed at one institution, a multicenter prospective study is required. However, we conclude that there is no increased risk to patients undergoing uterine artery embolization for fibroids on the basis of tumor size. Successful outcomes can be obtained for such lesions.
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