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Cardiac Pharmacology: Difference between revisions
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AF (Poorly tolerated): Class IIbC | AF (Poorly tolerated): Class IIbC | ||
AF (Stable flutter): Class IIbC | AF (Stable flutter): Class IIbC | ||
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 | 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) | |Class IV (Calcium channel blockers) | ||
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|Digoxin | |Digoxin | ||
|Supra-ventricular Arrhythmias |Acute: 0.75-1.5mg over 24 hours | |Supra-ventricular Arrhythmias | ||
Maintenance: 125-150µg daily |ACC/AHA/ESC Guidelines (Blomström-Lundqvist and Scheinman et al. 2003): | |Acute: 0.75-1.5mg over 24 hours | ||
Maintenance: 125-150µg daily | |||
|ACC/AHA/ESC Guidelines (Blomström-Lundqvist and Scheinman et al. 2003): | |||
SVT: Class IIbC | SVT: Class IIbC | ||
WPW Syndrome: Class IIIC | WPW Syndrome: Class IIIC | ||
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Acute HF with AF and VT: Class IC | Acute HF with AF and VT: Class IC | ||
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|Anti-platelet Drugs | |Anti-platelet Drugs | ||
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|Aspirin | |Aspirin | ||
|Prevention of thrombotic cerebro- or cardio-vascular disease | |Prevention of thrombotic cerebro- or cardio-vascular disease | ||
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|Clopidogrel | |Clopidogrel | ||
|Prevention of thrombotic events (esp. when warfarin not tolerated) |75mg once/day | |Prevention of thrombotic events (esp. when warfarin not tolerated) | ||
|75mg once/day | |||
|ESC and EASD Guidelines (European Heart Journal doi: 10.1093/eurheart/ehl261) | |ESC and EASD Guidelines (European Heart Journal doi: 10.1093/eurheart/ehl261) | ||
Prevention in diabetic patients: IIaB | Prevention in diabetic patients: IIaB | ||
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|Acute myocardial infarction |300mg daily initially then 75mg once/day | |Acute myocardial infarction | ||
|300mg daily initially then 75mg once/day | |||
|ESC Guidelines(European Heart Journal (2012) 33, 2569–2619 | |ESC Guidelines(European Heart Journal (2012) 33, 2569–2619 | ||
doi:10.1093/eurheartj/ehs215): | doi:10.1093/eurheartj/ehs215): | ||
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|Acute coronary syndrome |300mg daily initially then 75mg once/day | |Acute coronary syndrome | ||
|300mg daily initially then 75mg once/day | |||
|ESC and EASD Guidelines (European Heart Journal doi: 10.1093/eurheart/ehl261) | |ESC and EASD Guidelines (European Heart Journal doi: 10.1093/eurheart/ehl261) | ||
ACS: Class IIaC | ACS: Class IIaC | ||
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|Prasugrel | |Prasugrel | ||
|Prevention of thrombotic events. |60mg bolus then 5-10mg once daily | |Prevention of thrombotic events. | ||
|60mg bolus then 5-10mg once daily | |||
|ESC Guidelines (European Heart Journal | |ESC Guidelines (European Heart Journal | ||
doi:10.1093/eurheartj/ehs104): | doi:10.1093/eurheartj/ehs104): | ||
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|Ticragelor | |Ticragelor | ||
|Prevention of thrombotic events. |180mg bolus then 90mg twice daily | |Prevention of thrombotic events. | ||
|180mg bolus then 90mg twice daily | |||
|ESC Guidelines (European Heart Journal | |ESC Guidelines (European Heart Journal | ||
doi:10.1093/eurheartj/ehs104): | doi:10.1093/eurheartj/ehs104): | ||
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|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) | |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 | |Lipid-Lowering Drugs | ||
|Simvastatin, Atorvastatin |Primary hyper-cholesterolaemia, combined hyperlipidaemia |Simvastatin: 10-20mg once daily |ESC and EASD Guidelines (European Heart Journal doi: 10.1093/eurheart/ehl261) | |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) | |||
Dyslipidaemia: Class IA | Dyslipidaemia: Class IA | ||
Low HDL-C: Class IIbB | Low HDL-C: Class IIbB | ||
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|Familial hyper-cholesterolaemia |Simvastatin: 40mg once daily |ESC and EASD Guidelines (European Heart Journal doi: 10.1093/eurheart/ehl261) | |Familial hyper-cholesterolaemia | ||
|Simvastatin: 40mg once daily | |||
|ESC and EASD Guidelines (European Heart Journal doi: 10.1093/eurheart/ehl261) | |||
HeFH: Class IC | HeFH: Class IC | ||
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|Fibrates | |Fibrates | ||
|Gemfibrozil |Hyperlipidaemias of types IIa, IIb, III, IV and V | |Gemfibrozil | ||
|Hyperlipidaemias of types IIa, IIb, III, IV and V | |||
|Gemfibrozil: 0.9-1.2mg daily | |Gemfibrozil: 0.9-1.2mg daily | ||
|ESC and EAS Guidelines (European Heart Journal (2011) 32, 1769–1818 | |ESC and EAS Guidelines (European Heart Journal (2011) 32, 1769–1818 | ||
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Transplant patients (with high LDL-C): Class IIbC | Transplant patients (with high LDL-C): Class IIbC | ||
|Gastro-intestinal disturbance including diarrhoea (4.1%) and abdominal pain (3.0%); headache, fatigue (2.4%); myalgia, arthralgia (3.0%), sinusitis (3.6%), pharyngitis (2.3%), viral infection (2.2%), coughing (2.3%), hypersensitivity reactions including rash, angioedema, and anaphylaxis, hepatitis,pancreatitis, cholelithiasis, cholecystitis, thrombocytopenia, raised creatine kinase, myopathy, and rhabdomyolysis | |Gastro-intestinal disturbance including diarrhoea (4.1%) and abdominal pain (3.0%); headache, fatigue (2.4%); myalgia, arthralgia (3.0%), sinusitis (3.6%), pharyngitis (2.3%), viral infection (2.2%), coughing (2.3%), hypersensitivity reactions including rash, angioedema, and anaphylaxis, hepatitis,pancreatitis, cholelithiasis, cholecystitis, thrombocytopenia, raised creatine kinase, myopathy, and rhabdomyolysis | ||
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