By Leonard S. Dreifus, Joel Morganroth (auth.), Leonard S. Dreifus, Albert N. Brest (eds.)
During the earlier decade huge, immense growth has been made within the improvement of latest cardiovascular medicines and in our figuring out of the scientific pharma cology and the pharmacokinetics of outdated medicinal drugs. additionally, more recent purposes of older brokers have emerged. for instance, vasodilators resembling nitroglycerin are actually being hired within the remedy of congestive center failure, and anti hypertensives comparable to bretylium are utilized in the administration of ventricular arrhythmias. person chapters during this booklet specialize in (1) the medical pharmacology and pharmacokinetics of the person medicinal drugs, and (2) the medical functions of those medications, with cognizance additionally to serum concentrations, pathophysiology, and drug interactions the place applicable. The members to this article have worked to supply the reader with a significant, functional replace at the medical makes use of and usability of cardioactive medications. we're deeply thankful to every of them for his or her beneficiant participation during this pastime. LEONARD S. DREIFUS, M.D. ALBERT N. BREST, M.D. 1. ANTIARRHYTHMIC brokers LEONARD S. DREIFUS and JOEL MORGANROTH preferably, the administration of cardiac arrhythmias has to be predicated on (1) whole elucidation of the genesis of a few of the rhythm disturbances, and (2) an entire knowing of the pharmacologic motion of person antiarrhythmic brokers. in simple terms with this designated info does it develop into attainable to manage a specific agent or brokers in particular potent opposed to a given arrhythmia.
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Extra resources for Clinical Applications of Cardiovascular Drugs
Pharmacokinetics The modern history of digitalis begins in 1775 when William Withering demonstrated in his classic studies the usefulness of purple foxglove in the presence of dropsy. An account about the foxglove and some of its medical uses, with practical remarks on dropsy and other diseases, is cited in Cardiac Classics (145). However, in 1542 Fuchsius had already recognized the existence of the plant and named it 'digitalis'. It is well known that the Egyptians used derivatives of digitalis, derived from the sea onion, and the Chinese, even centuries before, had used the dried skin of their potter toad, Bufo gargarizanes, which is similar to digitoxigenin, the simplest genin in the cardiac glycoside configuration.
This agent is only available in oral form at present. Therapeutic plasma blood levels obtained one hour after dosing appear to be around 400-1500 mg/ml. In the Soviet Union, the incidence of side effects attributable to ethmozin ranged from 0-14/~ and include mild gastrointestinal upset and neurological symptoms including dizziness, headache, vertigo and changes in vision. Studies conducted in the United States employing up to five times the dose used in the Soviet Union have demonstrated infrequent side effects, usually limited to mild nausea or dizziness.
Some of the more important are the age of the patient, degree and type of heart disease, manner and rapidity of administration and the concentration of serum electrolytes, especially potassium. The observations by Bigger et al. indicate an enhancement of digitalis toxicity when used in combination with quinidine (178). Hence, a redyction in digitalis dosage should be considered when these agents are used in combination. The management of digitalis toxicity mandates discontinuation of the drug. Potassium salts are still the most effective antagonist to digitalis excess.
Clinical Applications of Cardiovascular Drugs by Leonard S. Dreifus, Joel Morganroth (auth.), Leonard S. Dreifus, Albert N. Brest (eds.)