Therapie Mit Beta-Rezeptorenblockern
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Betarezeptorenblocker sind zum festen Bestandteil der medika- mentosen Moglichkeiten bei der Therapie zahlreicher Erkran- kungen geworden. Grundlegende Untersuchungen und thera- peutische Studien wurden vorzugsweise anfangs mit Propranolol durchgefiihrt. Ausgehend von diesem Pharmakon sind zahlreiche chemische Modifikationen erzeugt worden. Sie sind gemeinsam gekennzeichnet durch eine Betarezeptoren-blockierende Wir- kung, unterscheiden sich aber durch zahlreiche Eigenschaften, die in therapeutischer Hinsicht zum Teil nicht unwesentlich sind: Affinitat zum Rezeptor, Kardioselektivitat, intrinsiche Aktivitat, Pharmakokinetik, Metabolisierung, Elimination, Kumulation bei Niereninsuffizienz, Wirkdauer u. a. Obwohl die zahlreichen kommerziell verfiigbaren Betarezep- torenblocker (etwa 20) hinsichtlich der Auswahl beim einzelnen Patienten gelegentlich differentialtherapeutische Erwagungen ratsam erscheinen lassen, gilt dennoch die allgemeine Regel, daB der praktizierende Arzt mit einer oder zwei dieser Substanzen auskommt, nachdem er auch eigene Erfahrungen hinsichtlich der Anwendung erworben hat. Das Schrifttum iiber Betarezeptorenblocker ist in den letzten Jahren in vielfaltiger Weise angewachsen. So liegt insbesondere in zahlreichen Tagungsberichten eine Fiille von Detailinforma- tionen vor. Fiir die therapeutische Praxis bedarf es aber einer sorgfaltigen Sichtung des Bekannten mit einem besonders engen Bezug zu der Krankheit, die eine Indikation zur Behandlung darstellt. Es wurde deshalb der Versuch untemommen, geordnet nach Krankheiten die Therapie mit Betarezeptorenblockem dar- zustellen. Dabei wurde in dem vorliegenden Buch besonderer Wert auf eine Auswahl des Wissensstoffes nach praktisch-thera- peutischen Gesichtspunkten gelegt.
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