A.

Cardioactive Drugs
● Class I (rapid sodium blockers) - Quinidine, Procainamide, Lidocaine
● Class II (Beta receptor blockers) -Propranolol
● Class III (K+ channel blockers) - amiodarone
● Class IV (calcium channel blockers) - verapamil

1.Digoxin
- a cardiac glycoside for treating CHF
- inhibits membrane NA-K-ATPase, thus it ⬇️K+, Mg+, and ⬆️Ca+
- GIT absorption is variable, change in GFR affect serum concentration
- elimination: renal filtration of plasma free form
- Peak serum level: 8 hrs after an oral dose
- Half life: 38 hrs (average adult)
- Toxic level: >2 ng/mL
- Toxic effects: nausea, vomiting, visual disturbances, premature ventricular contractions
and atrioventricular node blockage

2. Lidocaine
- used to correct ventricular arrhythmia and to prevent ventricular fibrillation
- administered by continuous IV infusion after loading dose and it can’t be administered
orally
- elimination: hepatic metabolism; changes in renal function have little effect
- primary product of hepatic metabolism: monoethylglycinexylidide (MEGX)
- Therapeutic range 1.5-4.0 ug/ mL
- toxicity range: >4.0 ug/mL
- CNS depression: >4-8 ug/mL
- seizure and decrease bp and cardiac output: >8 ug/mL

3. Quinidine
- treatment of arrhythmia
- Oral administered; GIT absorption sulfate
- 85% protein-bound; eliminated: hepatic metabolism
- Common formulation: quinidine sulfate and quinidine gluconate
- Peak serum level: 2 hrs after an oral dose(sulfate); 4-5 hrs(gluconate)
- Therapeutic range: 2.3-5 ug/mL
- Toxic range: >5ug/mL
- Toxic effects: nausea, vomiting, abdominal discomfort,cardiovascular toxicity

4. Procainamide
- used to treat cardiac arrhythmia
- Administered orally; GIT absorption is rapid and complete
- 20% protein-bound; eliminated: renal filtration and hepatic metabolism
- Hepatic metabolite: NAPA
- Peak serum level: 1 hr after the dose
 - Toxic effects: reversible lupus-like syndrome, nephrotic syndrome, and urticaria

5. Disopyramide
- treat cardiac arrhythmias; use as substitute for quinidine
- Administered orally; GIT absorption is rapid and complete
- binds to several plasma proteins; eliminated: renal filtration
- It has anticholinergic effects - dry mouth and constipation (>4.5 ug/mL)
- Therapeutic range: 3-5 ug/mL
- Toxic range: 10 ug/ mL
- Toxic effects: bradycardia and atrioventricular node blockage

6. Propranolol
- treatment of angina pectoris, hypertension, coronary artery disease
- toxic effects: bradycardia, arterial insufficiency, pharyngitis

7. Amiodarone (cordarone)
- use for treatment of ventricular arrhythmias
- an iodine-containing drug which can cause hyperthyroidism or hypothyroidism
- therapeutic range: 1.0-2.5 ug/mL
- toxic effects: bradycardia, hepatitis, photodermatitis

8. Verapamil
- treatment of angina, hypertension and supraventricular arrhythmias
- therapeutic range: 80-400 ng/mL
- toxic effects: hypertension, peripheral edema, ventricular fibrillation

B. Antibiotics
1.Aminoglycosides (gentamicin, tobramycin, amikacin, kanamycin, neomycin, streptomycin)
- treatment of gram(-) bacterial infection; not given to outpatient
- Administered IM or IV; not well absorbed from the GIT
- eliminated: renal filtration
- It may cause hearing loss
- Toxic range: >30 ug/mL (amikacin and kanamycin)- peak levels
- 12-15 ug/mL (gentamicin and tobramycin)- peak level
- toxic effects: nephrotoxicity and ototoxicity

2. Vancomycin
- Is a glycopeptide effective against gram(+) cocci and bacilli
- poor oral absorption, administered by IV infusion
- toxic side effects occur in the therapeutic range (5-10 ug/mL)
- eliminated: renal filtration and excretion
- toxic effects: red-man syndrome, nephrotoxicity and ototoxicity
- toxic levels: >10 ug/mL - nephrotoxicity
> 40 ug/mL - ototoxicity
3. Chloramphenicol
- it distributes to all tissues and it concentrates in the CSF
- 50% protein bound; rapidly absorbed in the GIT
- toxic effects: blood dyscrasia, cytoplasmic vacillation (erythroid & myeloid cells)
- toxic level: >25 ug/mL