SEMINAR on Drugs Used in Cardiac Diseases

7/29/2019 SEMINAR on Drugs Used in Cardiac Diseases

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CLASSIFICATION OF DRUGS USED IN

CARDIAC DISEASES


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Anti-arrhythmic agent

Class 1 sodium channel blocker e.g. flecanide,quinidine

Class 2 beta adrenoreceptor blocker e.g.

metoprolol, propanolol Class 3 sodium channel blocker e.g. amiodarone

Class 4 calcium blocker e.g. diltiazem, verapamil,nifedipine

Other Anti-arrhythmic drug e.g. adenosine,digoxin


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Anti-anginal drug

Organic nitrates e.g. isosorbide dinitrate,

nitroglycerin

Beta blocker e.g. propanolol

Calcium channel blocker e.g. diltiazem,

verapamil, nifedipine


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Drugs affecting blood

Platelet inhibitor e.g. aspirin, ticlopidine

Anticoagulant e.g. enoxaparin, warfarin,heparin.

Thrombolytic agent e.g. urokinase,streptokinase

Treatment of bleeding e.g. aminocaproic acid,

vitamin k, tranexamic acid Treatment of anemia e.g. folic acid,

cyanocobalamine, iron


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Antihypertensive drug

Diuretics e.g. hydrochlorothiazide, frusemide,spirolactone

Alpha blocker e.g. doxazosin, prazosin

Beta blocker e.g. metoprolol, propanolol ACE inhibitor e.g. catopril, analapril, ramipril

Angiotensin II antagonist e.g losartan

Calcium channel blocker e.g. diltiazem, verapamil,nifedipine, amlodipine

Vasodilators e.g sodium nitropruside


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Inotropic agents

Positive inotropic agent e.g. dobutamine

Negative inotropic agent e.g. dopaamine


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Cardiac glycosides e.g. digoxin, digitoxin

Hypolipidemic agents e.g. statin


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FLECANIDE

Group of drug antiarrhythmic agent, sodium

channel blocker

Pharmacological name- flecanide

Trade name Almarytm, Apocard, Ecrinal,

Flcaine

Dose of drug 1-2.5mg/kg/body wt


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Indication:

Prevention of paroxysmal supraventricular tachycardias (PSVT),including atrioventricular nodal reentrant tachycardia, atrioventricularreentrant tachycardia and other supraventricular tachycardias of

unspecified mechanism associated with disablin

Contraindication: hypersensitivity, cardiogenic shock, CHF, pre-existingsinus node dysfunction or 2nd or 3rd degree heart block (without apacemaker), renal impairment, pregnancy, lactation or children.

Adverse effect Nausea and vomiting, convulsions, hypotension, bradycardia, syncope,

extreme widening of the QRS complex, widening of the QT interval,widening of the PR interval, ventricular tachycardia, AV nodal block,asystole, bundle branch block, cardiac failure, and cardiac arrest.

CNS dizziness, anxiety, fatigue, headache, mental depressin. tremor,Blurred vision,

Chest pain, CHF


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QUINIDINE

Group of drug - antiarrhythmic agent (class 1 A),

sodium channel blocker

Pharmacological nameQuinidine

Dose of drug

PO (Adults): 324972mg q 812 hr. IV (Adults): 200400 mg given at a rate


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Contraindication

hypersensitivity, conduction defects (without a pacemaker)

CHF, severe liver dosease, Hypokalemia or hypomagnesemia( riskof torsades de pointes);

Bradycardia (risk of torsades de pointes), pregnancy, lactation orchildren.

Adverse effect CNS: dizziness, confusion, fatigue, headache,syncope, vertigo

EENT: blurred vision, diplopia,mydriasis, photophobia, tinnitus. CV: hypotension,torsades de pointes, arrhythmias, palpitations,

tachycardia

GI: anorexia, abdominalcramping, diarrhea, nausea, vomiting, drug-induced hepatitis.

Derm: rash. Neuro: ataxia, tremor.Misc: fever. Hemat: agranulocytosis, hemolytic anemia, thrombocytopenia.


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METOPROLOL Group of drug - antiarrhythmic agent, beta adrenoreceptor blocker

Pharmacological name - metoprolol

Trade name - tartarate 25, 50, 100mg

Dose of drug

PO (Adults): Antihypertensive/antianginal25100 mg/day as a single dose initially or 2

divided doses, 450 mg/day (for angina, give in divided doses)

MI2550 mg (starting 15 min after last IV dose) q 6 hr for 48 hr, then 100 mgtwice daily for a minimum of 3 month.

Heartfailure

12.525 mg once daily Migraneprevention50100 mg 24 times daily

IV (Adults): MI5 mg q 2 min for 3 doses, followed by oral dosing

Action

Blocks stimulation of beta1(myocardial)-adrenzinergic receptors. Doesnot usually affect beta2 (pulmonary, vascular, uterine) adrenergicreceptor sites. decreases blood pressure and heart rate. De creasedfrequency of attacks of angina pectoris. Decreased rate of cardiovascularmortality and hospitalization in patients with heart failure


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Indication - Hypertension. Angina pectoris. Prevention of MI, heartfailure due to ischemic, ventricular arrhythmias/tachycardia,Migraine, tremors, drug induced akathesia, anxiety

Contraindication - Uncompensated CHF, Pulmonary edema, Cardiogenicshock, Bradycardia or heart block

Adverse effect

CNS: fatigue, weakness, anxiety, depression, dizziness, drowsiness,

insomnia,memory loss, mental status changes, nervousness,nightmares.

EENT: blurred vision, stuffy nose.

Resp: bronchospasm, wheezing

CV: bradycardia, CHF, pulmonary edema, hypotension, peripheral

vasoconstriction. GI: constipation, diarrhea, drug induced hepatitis, drymouth,

flatulence, gastricpain, heartburn.

GU: erectile dysfunction

MS: arthralgia, back pain, joint pain


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PROPANOLOL Group of drug - antiarrhythmic agent, beta adrenoreceptor blocker

Pharmacological name - Propanolol Trade name - novopropranolol

Dose of drug

Oral Antianginal 80-320mg/day in 2-4 divided doses.(childrens 0.5-1mg/kg/day in 2-

4 divided doses)

Antihypertensive 40mgtwice daily (usual range 120-240mg/day)

Antiarrhythmia 10-30mg/day

Intravenous

Adults 1-3 mg repeated after 2 min and again in 4 hr if needed Children 0.01-0.1 mg/kg repeated after 6-8 hr

Action: Blocks stimulation of beta1(myocardial) and beta2 (pulmonary,vascular, and uterine)-adrenergic receptor sites. Decreases heart rate and

blood pressure, suppresses arrhythmia and prevents MI

I di i M f h i i h h i


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Indication Management of hypertension, angina, arrhythmias,hypertrophic cardiomyopathy, thyrotoxicosis, essentialtremors, pheochromocytoma. Also used in the preventionand management of MI and prevention of vascular headaches

Contraindication

Uncompensated CHF, Pulmonary edema; Cardiogenic shock;Bradycardia or heart block

Adverse effect

CNS: fatigue, weakness, anxiety, dizziness, drowsiness, insomnia,

memory loss, mental depression, mental status changes,nervousness, nightmares.

EENT: blurred vision, dry eyes, nasal stuffiness. Resp:bronchospasm, wheezing

CV: arrhythmias, bradycardia, CHF, pulmonary edema

GU: erectile dysfunction


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AMIODARONE

Group of drug - antiarrhythmic class III

Pharmacological nameAmiodarone

Trade name - cardarone, pacerone

Dose of drug: 1ml contains 50 mg amiodarne

Oral Adults 800-1600mg/day in 1-2 doses for 1-3 wk, then 600-800mg/day in

1-2 doses for 1 month then 400mg maintenance dose

Children 10mg/kg/day for 10 days, then 5 mg/day for several weeksthen 2.5 mg/kg/day maintenance dose.

Intravenous Adults: 150 mg over 10 min, followed by 360 mg over the next 6 hr

Continuous infusion at 0.5 mg/min until oral therapy is initiated

ACLSguidelines for pulseless ventricular fibrillation or ventricular

tachycardia 5 mg/kg as bolus


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Action

Prolongs action potential and refractory period. Inhibits adrenergic

stimulation. Slows the sinusrate,increases PR and QT intervals, and decreases

peripheral vascular resistance (vasodilation). Ths suppresses arrhythmia

Indication

Life threatening ventricular arrhythmia, Supraventricular tachycardia, ACLS

ContraindicationCardiogenic shock, SA node dysfunction, 2nd and 3rd degree AV block, syncope,

hypersensitivity.

Adverse effect

CNS: confusional states, disorientation, hallucinations, fatigue, malaise, dizziness,

headache, insomnia.

EENT: corneal micro-deposits

Resp: adult respiratory distress syndrome (ards), pulmonary fibrosis, pulmonary

toxicity.

CV: CHF, worsening of arrhythmias, bradvcardia, hypotension.


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DILTIAZEM Group of drugantiarrhythmia class IV, antihypertensive,

antianginals, calcium channel blocker.

Pharmacological name - diltiazem

Trade namecardiazem, taztia XT

Dose of drug Oral: 30-120 mg 3-4 times daily or 60-120 mg twice daily or 180-240

mg once a day (max 360mg/day)

Intravenous: 0.25 mg/kg repeat in 15 min with 0.35mg/kg

Continuous infusion at 10 mg/hr for 24 hr (5-15mg/hr)

ActionInhibits transport of calcium into myocardial and vascularsmooth muscle cells, resulting in inhibition of excitationcontraction coupling and subsequent contraction, results indecreased blood pressure, coronary vasodilatation and

suppresses arrhythmias


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Indication

Hypertension, Angina pectoris and vasospastic angina,Supraventricular tachycardia and rapid ventricular rates inatrial flutter or fibrillation.

Contraindication

Hypersensitvity, 2nd or 3rd degree AV block, recent MI,pulmonary congestion, blood pressure


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VERAPAMIL

Group of drug: antianginals, antiarrhythmiac agents

class IV, antihypertensive, vascular headachesuppressants, calcium channel blocker

Pharmacological name: verapamil

Trade name : apo-verap, isoptin, verelan

P0 (Adults): 80-1 20 mg 3 times daily

Extended-release preparations 120-240 mg/day as asingle dose

IV (Adults): 5-10mg (75-150 mcg/kg); may repeat with

10mg (150 mcg/kg) after 15-30 min.


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Contraindication


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Contraindication

Hypersensitivity, sick sinus syndrome, 2nd or 3rd degreeAV block,

BP


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NIFEDIPINEGroup of drug:- antianginals, antihypertensive, calcium channel blocker.

Pharmacological name:- NifedipineTrade name:- Adalat XL, procardia

Dose of drug

PO (adults):- 10-30mg 3 times daily (not to exceed 180mg/day) or 30-90 mg

once daily as sustained release form (CC, XL) (not to exceed 90-120 mg/day)

Action

Inhibits the transport of calcium into myocardial and vascular smoothmuscle cells, resulting in inhibition of excitation-contraction coupling and

subsequent contraction. Systemic vasodilatation, resulting in decreased blood pressure.

Coronary vasodilatation resulting in decreased frequency and severity ofattacks of angina

Indication


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Indication Management of hypertension(extended release only), angina pectoris,

vasospastic angina.

Prevention of migraine headache

Management of CHF or cardiomyopathy.

Contraindication Hypersensitivity, sick sinus syndrome, 2nd or 3rd degree AV block, BP


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ADENOSINE Group of drug:- antiarrhythmic

Pharmacological name:- adenosine

Trade name:- adenocard, adenoscan

Dose of drug:-IV (adult and children>50kg):-

Antiarrhythmic- 6mg by rapid bolus; if no result repeat 1-2 minlater as 12 mg rapid bolus (dose can be repeated not more than

12mg). Diagnostic:- 140 mcg/kg/min for 6 min (0.84m/kg)

IV (children


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Action

Restores normal sinus rhythm by interrupting re-enterant pathway inAV node. Slows conduction time through the AV node, also producescoronary vasodilatation.

Indication

Paraoxymal Supraventricular tachycardia(PSVT) when vagal maneuversare unsuccessful.

To asses myocardial perfusion defect occurring as a result of coronary

artery dIsease.

Contraindication

Hypersensitivity, 2nd or 3rd degree AV block or sick sinus syndrome

Patient of asthama (induces bronchospasm), unstable angina

Adverse effect

Resp:- shortnessofbreath, hyperventilation

CVS:- facial flushing, transient arrhythmias, chest pain, palpitation.

GI:- metallic taste, nausea

CNS:- dizziness, headache


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DIGOXIN

Group of drug:- antiarrhythmic, inotrope, digitalis

glycoside

Pharmacological name:- digoxin

Trade name:- lanoxin

Action

Increases the force of myocardial contraction. Prolongsrefractory period of the AV node. Decreases conductionthrough the SA & AV nodes. Increases cardiac output(positive inotropic effect) and slowing of heart rate

(negative inotrope).

Indication


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Indication CHF, tachycardia, Atrial fibrillation and atrial flutter, paraoxysmal

atrial tachycardia.

Contraindication Hypersensitivity, uncontrolled ventricular arrhythmias, AV block

Idiopathic hypertrophic subaortic stenosis, constrictivepericarditis,

Alcohol intolerance

Adverse effect

CNS:-fatigue, headache, weakness. CVS:- arrhythmia, bradycardia, ECG changes, AV block, SA block.

GI:- anorexia, nausea, vomiting, diarrhea.

Thrombocytopenia, digoxin toxicity with electrolyte imbalance.

Role and responsibility of nurse


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Role and responsibility of nurse Monitor apical pulse for 1 full minute before administration. Withhold dose and

notify physician if pulse rate is


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Assess for symptoms of electrolyte depletion: lassitude, apathy,

mental confusion, anorexia, decreasing urinary output, azotemia.

Monitor the patient for factors that increase the risk of toxicity:

Oral antibiotics, quinidine, amiodarone, calcium channelblocker

therapy.

Decreased potassium level (hypokalemia), which increases

theaction of digoxin and which may be caused by

malnutrition,diarrhea, vomiting, or prolonged muscle wasting

Impaired renal function, particularly in patients age 65 andolder

with decreased renal clearance.

Monitor for gastrointestinal side effects: anorexia, nausea,

vomiting,abdominal pain and distention. Monitor for neurologic side effects: headache, malaise,

nightmares,forgetfulness, social withdrawal, depression,

agitation,confusion, paranoia, hallucinations, decreased visual

acuity,Yellow or green halo around objects (especially lights),

orsnowy vision.


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ISOSORBIDE DINITRATEGroup of drug:- antaniginal

Pharmacological name:- isosorbide dinitrate

Dose of drug

ISOSOBIDE DINITRATE

SL (ADULTS): Acute attack of anginapectoris: - 2.5-5mg repeated after 5-10 min for3 doses in 15-3 min

PO (ADULTS): Prophylaxis of angina :- 5-

20mg 2-3 times daily

ISOSORBIDEMONONITRATE

PO (ADULT): 5-20mg twice daily with 2

doses given 7 hours apart

Action


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Produces vasodilation (venous greater than arterial), decreases leftventricular end diastolic pressure and left ventricular end diastolicvolume (preload). Net effect is reduced myocardial oxygen consumption,increases coronary blood flow by dilating coronary aarteries and

improving collateral flow to ischemic region and thus relieves andprevents angina attacks.

Indication

Acute treatment of angina attack

Prophylactic management of angina pectoris Unlabeled CHF

Contraindication

Hypersensitivity

Concurrent use of sildenafil, verdanefil

Adverse effect

CNS: dizziness, headache

CV: hypotension, tachycardia, paradoxic bradycardia, syncope

GI: nausea and vomiting


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NITROGLYCERINGroup of drug:- antianginals

Pharmacological name:- nitroglycerin

Trade name:- nitrocard,nitrol, nitrostat

Dose of drug SL (adults):- 0.3-0.6mg, subligual spray1-2 sprays, 5-10 min

before activities that may precipitate an caute attack.

BUCCAL (adults):- 1mg every 5 hourly

PO (adults) extended release capsules:- 2.5-9mg every 8-112hr

IV (adult):- 5mcg/min to 20mcg/min, then increase by 10-20mcg/min

TRANSDERMAL (adults):- ointment 1 inch = 15mg, 1-2 inchesevery 8hrly (transdermal patch 0.1-0.6 mg/hr upto 0.8mg/hr)

Action


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ActionProduces vasodilation (venous greater than arterial), decreases left ventricular

end diastolic pressure and left ventricular end diastolic volume (preload). Net effect isreduced myocardial oxygen consumption, increases coronary blood flow by dilatingcoronary aarteries and improving collateral flow to ischemic region and thus relievesand prevents angina attacks, increases cardiac output and reduces blood pressure.

Indication Prophylactic management of angina pectoris

Acute MI

Adjunct treatment of CHF

Contraindication Hypersensitivity

Severe anemia

Pericardial tamponade

Constrictive pericarditis

Alcohol intolerance

Cerebral hemorrhages

Adverse effectDizziness, headache, hypotension, tachycardia, syncope, abdominal pain, alcohol

intoxication(in case of large IV dose)

TICLOPIDINE


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TICLOPIDINEGroup of drug:- antiplatelet agent, platelet aggregation factor

Pharmacological name:- ticlopidine

Dose of drug

PO (adult):- 250mg twice a day with food

Availability: - 250mg

Action

Inhibitsplatelet aggregation by altering the function of plateletmembranes. Prolongs bleeding time & decreases incidence of

stroke in high risk patients

Indication

Prevention of stroke in patients who have completed thromboticstroke or precursor of stroke and unable to tolerate aspirin

Prevention of early restenosis in intra-coronary stents

WARFARIN


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WARFARINGroup of druganticoagulant

Pharmacological name - warfarinTrade namewarfiline, coumadin

Dose of drug

PO or IV (adults) : 2.5-1.mg/day for 2-4 days and then adjust by result ofprothrombin time or international normalized time (INR).

Availability tablets 1mg, 2.5mg, 4mg, 5mg.

Action

It interferes with the hepatic synthesis of vitamin K dependent clotting factors (2, 7,9 and 10), and prevents the thrombus formation and thus decreases the density of

blood. It decreases risk of subsequent MI

Indication

Prophylaxis and treatment of venous thrombus, pulmonary thrombus, pulmonaryembolism, atrial fibrillation with embolization.

Prevention of thrombus and embolization after prosthetic valve placement

Contraindication


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Contraindication Uncontrolled bleeding, active ulcer disease,

Severe liver or kidney disease,

Uncontrolled hpertension

Adverse effect Uncontrolled bleeding(internal or external), cramps, nausea, dermal

necrosis, fever.

Role and responsibility of nurse Asses the patient for signs of bleeding and hemorrhage (gums, nose, tarry

black stool, hematuria, hypotension)

Monitor Prothrombin time or INR before the drug therapy and 3-5 daysafter therapy to evaluate the required dose

Liver function should be monitored before and after therapy. Instruct the patient to avoid use of sharp metals or articles, protect him

from injury to avoid hemorrhage, use of soft bristle tooth brush, useelectric razor for shaving

Avoid IM injections

Instruct the patient to avoid alcohol, NSAIDs intake during the therapy

LOW MOLECULAR WEIGHT HEPARIN


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LOW MOLECULAR WEIGHT HEPARINGroup of drug:anticoagulant, antithrombotic, low molecular

weight heparin

Pharmacological name:enoxaparin, dalteparinTrade name: fragmin, lovenox

Dose of drug Fragmin - Unstable angina or non STEMI 120IU/kg (subcutenous)

Enoxaparin - Unstable angina or non STEMI 1mg/kg with aspirin.

STEMI 30mg + 1mg/kg IV

Action Potentiate the inhibitory effect of anti-thrombin on factor Xa &

thrombin and thus prevents thrombus formation.

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Indication Prevention of ischemic unstable angina & non STEMI

Treatment of acute STEMI with percutenous coronary intervention

DVT

Venous thromboembolism

Contraindication Contraindications with specific agent or pork products

Active major bleeding

History of heparin induced thrombocytopenia Severe liver or kidney diseases

Adverse effect Anaemia, thrombocytopenia

Headache, insomania Constipation, nausea

Ecchymoses, pruritis, rash urticaria

Bleeding from injured site, haematoma.



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Asses the patient for signs of bleeding and hemorrhage(gums, nose, tarry black stool, hematuria, hypotension)

Monitor for hypersensitivity reaction.

Monitor Prothrombin time or INR before the drug therapyand 3-5 days after therapy to evaluate the required dose

Liver function should be monitored before and after therapy.

Instruct the patient to avoid use of sharp metals or articles,protect him from injury to avoid hemorrhage, use of softbristle tooth brush, use electric razor for shaving

Avoid IM injections

Instruct the patient to avoid alcohol, NSAIDs intake during the

therapy Observe subcutenous injection site for hematomas,

ecchymosis or inflammation

During administering subcutenous injection use alternatesites (ant. Abdominal wall, upper thigh or buttocks)

UROKINASE STREPTOKINASE


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UROKINASE STREPTOKINASEGroup of drug: thrombolytic agent, plasminogen activator

Pharmacological name: urokinase, streptokinase

Dose of drug

Streptokinase

IV (adults): 1.5 million units is given as a continous infusion over 60 min.

Intracoronary: 20,000 unit bolus followed by 2000-4000 units/ min infusion

for 30-90 min Urokinase

IV (adults): 4400 nits/kg loading dose, followed by 4400 unit/kg/hr for 12 hr

Action

Convert plasminogen to plasma, which is then able to degrade fibrinpresent in clots. Urokinase directly activates plasminogen, streptokinasecombines plasminogento form activator or complexes, which then convertsplasminogen into plasmin. Which results in lysis of thrombi withpreservation or improvement of ventricular function (decreases the rish ofCHF or death).


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Indication Urokinase: acute massive pulmonary emboli.

Streptokinase: acute arterial thrombi(MI)

Contraindication Active internal bledding

History of cerebrovascular accident(can case intracranial bleeding),

Recent intracranial or intraspinal injury or trauma, intracranial neoplasm, AVmalformation

Severe uncontrolled hypertension, hypersensitivity

Adverse effect Intracranial haemorrhage

Gastrointestinal, retroperitoneal, genitourinary bleeding

Hypotension

Phlebitis, epistaxis, bronchospasm



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p y

History collection of CVA, head trauma

Monitor the vital signs before during and after the therapy.

Check for hypesensitivity reaction.

Do not administer bolus proper dilution should be shouldbe done, intracranial bolus should be administered for over15-90 seconds

Flush IV line before infusion Asses the patient for bleeding for every 15 min during 1st

hour of therapy, every 1-2 hourly after the drugadministration, if bleeding occurs stop the drug

immediately. Monitor ECG continuously

If local bleeding occurs apply pressure to site anddiscontinue the infusion

HYDROCHLOROTHIAZIDE


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HYDROCHLOROTHIAZIDEGroup of drug: antihypertensive, thiazide diuretics

Pharmacological name: hydrochlorothiazide

Dose of drug

PO(adults): 12.5-100mg/day in 1-2 divided doses, should notexceed 50mg/day for hypertension, (doses >25mg areassociated to have electrolyte imbalance abnormality)

PO(children): 1-3mg/kg/day in 1-2 divided doses max37.5mg/day

Action

Increases excretion and sodium and water by inhibitingsodium reabsorption in distal tubule. Promotes excretion ofchloride, potassium, magnesium and bicarbonate. It producesarteriolar dilation and thus reduces blood pressure inhypertensive patients and mobilizes oedema.

Indication


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Indication Management of mild to moderate hypertension

Oedema assocoiated with CHF, renal dysfunction, cirrhosis,glucocorticoid therapy, estrogen therapy.

Contraindication Hypersensitivity with thiazide or sulfonamides

Some products contain tartazine and should be avoided inpatient with anuria, intolerance, lactation.

Adverse effect

Electrolyte imbalance: Hypokalaemia, dehydration,hypercalcemia, hypomagnesia

Thrombocytopenia, hyperuricemia

Dizziness, weakness

Hypotension, cramping, hepatitis

FRUSEMIDE


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FRUSEMIDEGroup of drug: Loop diuretic

Trade name: lasix

Dose of drug:

PO (adults): 20-40mg q6-8hr until desired responsein hypertension

In case of CCF max. 2.5mg/day

Hypercalcemia: 120mg/day in 2-3 doses

PO (childrens): 2mg/kg/day max. 6mg/kg/day

IV (adults): 20-40mg/day and can be repeated, forcontinous infusion bolus- 0.1mg/kg followed by 0.1-

0.4mg/kg/hr

Action:


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Action:

Inhibits the absorption of sodium and chloride from loop of henle and distalrenal tubule, increases renal excretion of water,sodium, chloride magnesium,potassium, and calcium. Inturn causes diuresis and lowers down the bloodpressure

Indication

Oedemadue to heart failure, hepatic impairment or renal disease

Hypertension

Contraindication Hypersensitivity with thiazide or sulfonamides may cause hepatic coma or

anuria

Some products contain alcohol and should be avoided in patient with alcoholintolerance

Adverse effect Dehydration and Electrolyte imbalance: Hypokalaemia, dehydration,

hypercalcemia, hypomagnesia

Thrombocytopenia, hyperuricemia

Dizziness, weakness, headache

Hypotension, cramping, hepatitis, excessive urination.

SPIROLACTONE


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SPIROLACTONEGroup of drug: spatassium sparing diuretic

Pharmacological name: SpirolactoneTrade name: novospartin, aldactone

Dose of drug

PO (Adults): HTN510mg/day (up to 20mg)

PO (Adults): Edema

25200 mg/day in 12 divided doses

Diagnosis of primary hyperaldosteronism- 100400 mg/day in 12 divideddose.

CHF: 12.525 mg/day (unlabeled use)

Action

Inhibition of sodium reabsorption in the kidney while saving potassium andhydrogen ions (spironolactone achieves this effect by antagonizingaldosterone receptors). Weak diuretic and antihypertensive response whencompared with other diuretics but conserves potassium.

Indication


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Indication

To counteract potassium loss caused due to otherdiuretics

Primary aldosteronism Management of CCF

Contraindication

Hypersensitivity Hyperkalaemia

Anuria, acute renal insufficiency (sr. creat >2.5mg/dl)

Adverse effect Clumsiness, headache

Hperkalemia, hyponatremia

Erectile dysfunction

Increases hypotension with ingestion of alcohol

ACE INHIBITOR


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ACE INHIBITORGroup of drug: ACE INHIBITOR

Pharmacological name: enalapril, ramipril, captopril

Trade name: vasotec, monopril, altace

IV (adults): 0.625-1.25mg/kg/day if receivingdiuretics

CHF

2.5 mg 12 times daily, Asymptomaticleftventriculardysfunction2.5mg

twice daily,

PO (Adults): Hypertension2.55 mg once daily

Action: it blocks the conversion of anfiotensin I to thevasoconstrictor angiotensin II and also prevents the degradation of


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vasoconstrictor angiotensin II and also prevents the degradation ofbradykinin and other vasodilatory prostaglandins. It increases theplasma rennin levels and reduces aldosterone

Indication Primary Hypertension

Development of CCF followed by MI

Reduction in MI, Stoke

Diabetic neuropathy

Contraindication Hypersensitivity

Previous angioedema caused by ACE inhibitors

Womans with child bearing

Adverse effect Cough, taste disturbances, GI disturbances

Hypotension

Angioedemaproteinuria, renal dysfunction

DOBUTAMINE


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DOBUTAMINEGroup of drug: inotropic, adrenergic

Trade name: dobutrex

Dose of drug

IV (Adults and Children): Start with low infusion rates (0.51mcg/kg/min), titrated at intervals of a few minutes, guided by the

patients response (range 220 mcg/kg/min, up to 40 mcg/kg/min)

Action

Dobutamine (Dobutrex) produces inotropic effects bystimulating myocardial beta receptors, increasing the strength of

myocardial activity and improving cardiac output. Myocardialalpha-adrenergic receptors are also stimulated, resulting indecreased pulmonary and systemic vascular resistance (decreasedafterload). Dobutamine enhances the strength of cardiaccontraction, improving stroke volume ejection and overall cardiac

output without significant increased heart rate.


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Indication: cardiac decompensation caused by heartdisease or surgical procedures

Contraindication:

Hypersensitivity to dobutamine

Idiopathic hypertrophic subaortic stenosis

Adverse effect

Shortness of breath

Hpetension

Premature ventricular contracture

Angina

Palpitations

DOPAMINE


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DOPAMINE

Group of drug: inotropic, vasopressor, adrenergic

Pharmacological name: dopamine

Dose of drug

Small doses (0.53 mcg/kg/min) stimulatedopaminergic receptors, producing renal vasodilation.

Larger doses (210 mcg/kg/min) stimulatedopaminergic and beta1-adrenergic receptors,

producing cardiac stimulation and renal vasodilation. Doses greater than 10 mcg/kg/min stimulate alpha-

adrenergic receptors and may cause renalvasoconstriction.

Indication


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Indication

Adjuvant measures to improve blood pressure,cardiac output, urine otput, shock unresponsive to

fluid replacement.

Contraindication

Tachycardia Pheochromocytoma

Hypersensitivity

Adverse effect

Arrhtmias, hypotension, angina, ECG changes,palpitations, vasoconstriction


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USE OF CARDIAC DRUGS RELATES TO DAMPENED BLOOD PRESSURECHANGES AND REDUCED MORTALITY IN INCIDENT HEMODIALYSIS


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CHANGES AND REDUCED MORTALITY IN INCIDENT HEMODIALYSISPATIENTS

Abstract

INTRODUCTION AND AIMS: It has been shown that both absolute bloodpressure levels and changes in blood pressure over time relate to mortalityin hemodialysis (HD) patients (pts). We aimed to study the associationbetween cardiac drug (CD) use, blood pressure changes over time andmortality in incident HD pts.

METHODS: Renal Research Institute in-center incident HD pts between Jan

1, 2000 and Feb 28, 2010 were followed for 1 year each. Pre HD systolicblood pressures (SBPs) were averaged for each pt over the first 30 days onHD (starting SBP); the slope of SBP was computed by linear regressionusing all SBP values in the first year of HD. Pts were grouped by (a) startingSBP, and (b) first year SBP slope (increased: >1 mmHg/month, decreased:


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white, 54% diabetic, ageSD 62.115.6 years).

CONCLUSIONS: These results suggest that use of CD is linked

to a 28% risk reduction for mortality in incident HD pts. Giventhat pts with a stable SBP slope in the first year on dialysisshow lower mortality rates than those with increasing ordecreasing SBP (Usvyat, WCN/ASN 2011), our finding of CDuse being related to dampened SBP changes suggests a

possible mechanism by which these drugs may mediateimproved survival. Prospective randomized trials arewarranted to help discern cause and effect.

CD use was significantly associated with a dampened SBPslope in both SBP increasers and decliners, even afteradjustment for relevant covariates. In SBP decliners, thedecline was less steep by 1.02 mmHg per month in pts on CD,while in SBP increasers, the increase was smaller by 0.81mmHg per month in those on CD


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