Chapter 2
Cardiovascular system
Index:
Positive inotropic drugs
Diuretics
Anti-arrhythmic drugs
Beta-adrenoceptor blocking drugs
Drugs affecting the renin-angiotensin system and some other antihypertensive drugs
Nitrates, calcium-channel blockers and potassium-channel activators
Sympathomimetics
Anticoagulants and protamine
Antiplatelet drugs
Myocardial infarction and fibrinolysis
Antifibrinolytic drugs and haemostatics
Lipid-regulating drugs
Local sclerosants
Diuretics
- Potassium sparing: triamterene
Counselling: Urine may look slightly blue in some lights! (p76)
- Potassium sparing diuretics with other diuretics:
It is preferable to prescribe thiazides and potassium sparing diuretics separately. The use
of combination products may be justified if compliance is a problem
Potassium sparing diuretics are not usually necessary in the routine treatment of
hypertension, unless hypokalemia develops (p76)
Anti-arrhythmic drugs
- The introduction of this chapter gives a description about some types of arrhythmias (p78)
- Brief classification of antiarrhythmics (p79)
- Drugs used in Supraventricular arrhythmias (p79)
- Drugs used in Supraventricular and ventricular arrhythmias (p79)
- Amiodarone monograph detailing side effects (p80)
, Beta-adrenoceptor blocking drugs
- Monograph: beta-blockers block beta-receptors in the heart, peripheral vasculature,
bronchi, pancreas and liver (p83)
- Monograph explains the differences between the available types of beta-blockers, and
when they are used (p83-84)
- Beta-blockers with a relatively short duration of action have to be given 2 or 3 times a day.
Many of these are however available in MR formulations, so that administration once daily
adequate for hypertension. For angina twice daily treatment may sometimes be needed
even with a MR preparation (p84)
- Beta blocker and calcium channel blocker combinations should only be used when
individual components prove inadequate, where clinically appropriate. (p86)
- Labetalol – Severe hepatocellular damage reported after both short-term and long-term
treatment…Labetalol should be stopped at first symptom of liver damage and not
restarted (p88)
Sotalol- CSM advice – Use limited to the treatment of ventricular arrhythmias or
prophylaxis of supraventricular arrhythmias (p89)
Drugs affecting the renin-angiotensin system and some other antihypertensive
drugs
- Thresholds and targets for hypertension treatment (p91)
- (All) Drug treatment of hypertension, some indications and contra-indications (p91)
- Unless it is necessary to lower the BP urgently, an interval of at least 4 weeks should be
allowed to determine response, before addition of another agent (p91)
- Other measures to reduce cardiovascular risk
- e.g. aspirin as secondary prevention in patients with cardiovascular complications
(see section) and primary prevention for those over 50 with controlled BP
(systolic < 150mmHg and diastolic <90mmHg) who have end organ damage, type
2diabetes or a CHD risk – see section
Cardiovascular system
Index:
Positive inotropic drugs
Diuretics
Anti-arrhythmic drugs
Beta-adrenoceptor blocking drugs
Drugs affecting the renin-angiotensin system and some other antihypertensive drugs
Nitrates, calcium-channel blockers and potassium-channel activators
Sympathomimetics
Anticoagulants and protamine
Antiplatelet drugs
Myocardial infarction and fibrinolysis
Antifibrinolytic drugs and haemostatics
Lipid-regulating drugs
Local sclerosants
Diuretics
- Potassium sparing: triamterene
Counselling: Urine may look slightly blue in some lights! (p76)
- Potassium sparing diuretics with other diuretics:
It is preferable to prescribe thiazides and potassium sparing diuretics separately. The use
of combination products may be justified if compliance is a problem
Potassium sparing diuretics are not usually necessary in the routine treatment of
hypertension, unless hypokalemia develops (p76)
Anti-arrhythmic drugs
- The introduction of this chapter gives a description about some types of arrhythmias (p78)
- Brief classification of antiarrhythmics (p79)
- Drugs used in Supraventricular arrhythmias (p79)
- Drugs used in Supraventricular and ventricular arrhythmias (p79)
- Amiodarone monograph detailing side effects (p80)
, Beta-adrenoceptor blocking drugs
- Monograph: beta-blockers block beta-receptors in the heart, peripheral vasculature,
bronchi, pancreas and liver (p83)
- Monograph explains the differences between the available types of beta-blockers, and
when they are used (p83-84)
- Beta-blockers with a relatively short duration of action have to be given 2 or 3 times a day.
Many of these are however available in MR formulations, so that administration once daily
adequate for hypertension. For angina twice daily treatment may sometimes be needed
even with a MR preparation (p84)
- Beta blocker and calcium channel blocker combinations should only be used when
individual components prove inadequate, where clinically appropriate. (p86)
- Labetalol – Severe hepatocellular damage reported after both short-term and long-term
treatment…Labetalol should be stopped at first symptom of liver damage and not
restarted (p88)
Sotalol- CSM advice – Use limited to the treatment of ventricular arrhythmias or
prophylaxis of supraventricular arrhythmias (p89)
Drugs affecting the renin-angiotensin system and some other antihypertensive
drugs
- Thresholds and targets for hypertension treatment (p91)
- (All) Drug treatment of hypertension, some indications and contra-indications (p91)
- Unless it is necessary to lower the BP urgently, an interval of at least 4 weeks should be
allowed to determine response, before addition of another agent (p91)
- Other measures to reduce cardiovascular risk
- e.g. aspirin as secondary prevention in patients with cardiovascular complications
(see section) and primary prevention for those over 50 with controlled BP
(systolic < 150mmHg and diastolic <90mmHg) who have end organ damage, type
2diabetes or a CHD risk – see section
