Cardiac Pharmacology: Difference between revisions

|Losartan. Candesartan

|Hypertension

| Congestive Heart Failure Prazosin: 4-20mg daily

Raynaud’s Syndrome Prazosin: 1-2mg daily

Beta Blockers Atenolol, Propranolol Hypertension Atenolol: 25-50mg daily Gastro-intestinal disturbances (2-4%); bradycardia, heart failure, hypotension, conduction disorders, peripheral vasoconstriction, bronchospasm, dyspnoea; headache, fatigue, sleep disturbances (2-5%), paraesthesia, dizziness (2-5%), vertigo, psychoses; sexual dysfunction; purpura, thrombocytopenia; visual disturbances; exacerbation of psoriasis, alopecia; rarely rashes and dry eyes  

Angina Atenolol: 100mg once/twice daily ESC and EASD Guidelines (European Heart Journal doi: 10.1093/eurheart/ehl261)

Arrhythmias Atenolol: 50-100mg daily ESC Guidelines (European Heart Journal (2012) 33, 2569–2619

Migraine Atenolol: 50-200mg daily

Calcium Channel Blockers Nifedipine, Verapamil, Diltiazem Hypertension Nifedipine: 20-30mg once daily ESC Guidelines (European Heart Journal

Hypertension in symptomatic (NYHA class II-IV) HF and LVD: Class IA gastro-intestinal disturbance (2-11%); hypotension (1-5%), oedema (7-29%), vasodilatation, palpitation; headache (7-35%), dizziness (3-27%), lethargy (4-6%), asthenia (10-12%); less commonly tachycardia (<1-7%), syncope (<1%), chills, nasal congestion, dyspnoea (<3%), anxiety, sleep disturbance (<2%), vertigo (<3%), migraine, paraesthesia, tremor (1-8%), polyuria, dysuria, nocturia, erectile dysfunction (<2%), epistaxis, myalgia, joint swelling, visual disturbance (<2%), sweating (<2%), hypersensitivity reactions (<1%); rarely anorexia, gum hyperplasia, mood disturbances, hyperglycaemia, male infertility, purpura (<1%), and photosensitivity reactions (<1%); also reported dysphagia, intestinal obstruction, intestinal ulcer, bezoar formation, gynaecomastia, agranulocytosis, and anaphylaxis;

Raynaud’s Syndrome Nifedipine: 5-20mg 3 times daily

Angina (prophylaxis) Nifedipine: 5-20mg 3 times daily ESC Guidelines (European Heart Journal

Anti-Arrhythmics Class I (sodium channel blockers) Flecainide, Lidocaine, Procainamide Ventricular Arrhythmias Flecainide: 50-100mg twice daily ESC Guidelines(European Heart Journal (2012) 33, 2569–2619

Prophylaxis of SVT during pregnancy: Class IIbB Oedema, pro-arrhythmic effects (1-13%); dyspnoea; nervous-system side-effects including dizziness, asthenia, fatigue, fever; visual disturbances (13-28%); rarely pneumonitis, hallucinations, depression, confusion, amnesia, dyskinesia, convulsions, peripheral neuropathy; also reported gastro-intestinal disturbances (1-4%), anorexia, hepatic dysfunction, flushing, syncope, drowsiness, tremor, vertigo, headache, anxiety, insomnia, ataxia, paraesthesia, anaemia, leucopenia, thrombocytopenia, corneal deposits, tinnitus, increased antinuclear antibodies, hypersensitivity reactions (including rash, urticaria, and photosensitivity), increased sweating

Class II (Beta blockers) (See above) (See above) (See above) (See above)

Class III (Potassium channel blockers) Amiodarone,

Sotalol Ventricular Arrhythmias Amiodarone: 200mg 2-3 times daily ESC Guidelines(European Heart Journal (2012) 33, 2569–2619

Prophylaxis of SVT during pregnancy: Class IIIC Gastro-intestinal disturbances (2-20%)), taste disturbances, hepatic disturbances (up to 50%); bradycardia; pulmonary toxicity (1-17%); tremor (9-59%), sleep disorders; hypothyroidism (5-10%), hyperthyroidism (5-10%); reversible corneal microdeposits (up to 98%); phototoxicity, persistent slate-grey skin discoloration (1-7%), injection-site reactions; less commonly onset or worsening of arrhythmia, conduction disturbances, peripheral neuropathy (1-105) and myopathy; very rarely sinus arrest, bronchospasm, ataxia (2-37%), benign intracranial hypertension, headache, vertigo, epididymo-orchitis, impotence, haemolytic or aplastic anaemia, thrombocytopenia, rash, hypersensitivity including photosensitivity (2-20%), anaphylaxis on rapid injection, hypotension (10-30%), respiratory distress syndrome, sweating, and hot flushes

Class IV (Calcium channel blockers) (See above) (See above) (See above) (See above)

- Digoxin Supra-ventricular Arrhythmias Acute: 0.75-1.5mg over 24 hours

Maintenance: 125-150µg daily ACC/AHA/ESC Guidelines (Blomström-Lundqvist and Scheinman et al. 2003):

Prophylaxis of SVT during pregnancy: Class IC Gastro-intestinal disturbances (vomiting, diarrhoea, anorexia, abdominal pain) (25%); arrhythmias (up to 50%), AV conduction disturbances (50%); nervous system disturbances (dizziness, apathy, confusion, headache, fatigue, weakness) (25%); blurred or yellow vision; rash, eosinophilia, depression, anorexia, intestinal ischaemia and necrosis, psychosis, gynaecomastia on long-term use, and thrombocytopenia

Heart Failure 62.5-125 µg daily ESC Guidelines (European Heart Journal

Anti-platelet Drugs - Aspirin Prevention of thrombotic cerebro- or cardio-vascular disease 75mg once/day ESC and EASD Guidelines (European Heart Journal doi: 10.1093/eurheart/ehl261)

Bronchospasm (10-30% in asthmatics); gastro-intestinal irritation (up to 83%), gastro-intestinal haemorrhage (occasionally major), also other haemorrhage (e.g. intracranial (0.5%), subconjunctival), chest pain (8.3%), oedema (4.5%), hypertension (4.3%).

Pain / pyrexia 300-600mg every 4-6 hours as necessary

- Clopidogrel Prevention of thrombotic events (esp. when warfarin not tolerated) 75mg once/day ESC and EASD Guidelines (European Heart Journal doi: 10.1093/eurheart/ehl261)

Non-cardioembolic cerebral ischaemic events: Class IA Dyspepsia (5.2%), abdominal pain (5.6%), diarrhoea (4.5%); bleeding disorders including gastro-intestinal (2.0%) and intracranial (0.4%), nausea (3.4%), vomiting, gastritis, flatulence, constipation, gastric and duodenal ulcers, headache (7.6%), epistaxis (2.9%), dizziness (6.2%), paraesthesia, leucopenia, decreased platelets (very rarely severe thrombocytopenia), eosinophilia, rash (4.2%), pruritus (3.3%), vertigo, colitis, pancreatitis, hepatitis (<1%), acute liver failure, hypertension (4.3%), chest pain (8.3%), oedema (4.1%), vasculitis, confusion, hallucinations, taste disturbance, cough (3.9%), fatigue (4.8%) stomatitis, bronchospasm, interstitial pneumonitis, pyrexia (2.2%), blood disorders including thrombocytopenic purpura (5.3%), agranulocytosis, neutropenia (0.04%) and pancytopenia and hypersensitivity-like reactions (<0.1%)including fever, glomerulonephritis, arthralgia, Stevens-Johnson syndrome, toxic epidermal necrolysis, lichen planus

Acute myocardial infarction 300mg daily initially then 75mg once/day ESC Guidelines(European Heart Journal (2012) 33, 2569–2619

Post STEMI: Class IA

Acute coronary syndrome 300mg daily initially then 75mg once/day ESC and EASD Guidelines (European Heart Journal doi: 10.1093/eurheart/ehl261)

ACS: Class IIaC

- Prasugrel Prevention of thrombotic events. 60mg bolus then 5-10mg once daily ESC Guidelines (European Heart Journal

Haemorrhage (11.3%) (including gastro-intestinal (1.5%) and intracranial), haematoma, haematuria, hypertension (7.5%), hypotension (3.9%), headache (5.5%), back pain (5.0%), dyspnoea (4.9%), nausea (4.6%), dizziness (4.1%), cough (3.9%), fatigue (3.7%), chest pain (3.1%), arrhythmias including atrial fibrillation (2.9%) and bradycardia (2.9%), rash (2.8%), pyrexia (2.7%), oedema (2.7%), diarrhoea (2.3%), hypercholesterolaemia/hyperlipidaemia (7.5%), anaemia, rash,hypersensitivity reactions including angioedema (0.06%), thrombocytopenia (0.06%), thrombotic thrombocytopenic purpura

- Ticragelor Prevention of thrombotic events. 180mg bolus then 90mg twice daily ESC Guidelines (European Heart Journal

 

dyspnoea (13.8%), haemorrhage, bruising; nausea (4.3%), vomiting, diarrhoea (3.7%), hypertension (3.8%), hypotension (3.2%), back pain (3.6%), abdominal pain, dyspepsia, gastritis, dizziness (4.5%), chest pain (3.7%), headache (6.5%), cough (4.9%), rash, pruritus, fatigue (3.2%),  constipation, arrhythmias including atrial fibrillation (4.2%), paraesthesia, confusion, hyperuricaemia, raised serum creatinine (7.4%), vertigo

Vitamin K Antagonists - Warfarin Prevention of thrombotic/ embolic events (esp. after prosthetic valve insertion) 5-10mg initially then tailored to individual (usually 3-9mg once daily at the same time) haemorrhage, nausea, vomiting, diarrhoea, jaundice, hepatic dysfunction, pancreatitis, pyrexia, alopecia, purpura, rash, ‘purple toes’, skin necrosis (increased risk in patients with protein C or protein S deficiency)

- Acenocoumarol Prevention of thrombotic/ embolic events (esp. after prosthetic valve insertion) 4mg initially, followed by 1-8mg daily haemorrhage, nausea, vomiting, diarrhoea, jaundice, hepatic dysfunction, pancreatitis, pyrexia, alopecia, purpura, rash, ‘purple toes’, skin necrosis (increased risk in patients with protein C or protein S deficiency)

Lipid-Lowering Drugs Statins Simvastatin, Atorvastatin Primary hyper-cholesterolaemia, combined hyperlipidaemia Simvastatin: 10-20mg once daily ESC and EASD Guidelines (European Heart Journal doi: 10.1093/eurheart/ehl261)