C A R D IO V A S C U LA R

P H A R M A C O LO G Y (2)

dr. Agung Nova Mahendra, M.Sc.

Department of Pharmacology & Therapy
Faculty of Medicine, Udayana University

TO PICS  Antiarrhythmic agents  Drugs used in heart failure .

W hat is arrhythm ia?  Disturbance of heart rhythm due to:  Abnormalities of pacemaker activity (impulse generation)  Abnormalities of cardiac conduction (impulse conduction) .

AN TIARRH YTH M IC AG EN TS (AAA) .

AAA Classifi cation  Group I: blocks Na+ channels  Group II: blocks beta (β) receptors  Group III: blocks potassium IKr channels  Group IV: blocks L-type Ca2+ channels  Group V: miscellaneous drugs  Adenosine  K+  Mg2+ .

thyroid dysfunction. torsade de pointes  Flecainide  novel arrhythmias  Procainamide  Lupus (reversible).G roup IAAA  Amiodarone  corneal & skin deposits. pulmonary fibrosis  Disopyramide  antimuscarinic. HF. torsade de pointes  Quinidine  Cinchonism. torsade de . thrombocytopenia.

AV block. AV block  Propranolol  Bradycardia. HF .G roup IIAAA  Esmolol  Bradycardia.

Dofetilide  torsade de pointes  Sotalol  torsade de pointes .G roup IIIAAA  Amiodarone  Ibutilide.

G roup IV AAA  Verapamil: AV block. constipation . HF.

WARNINGS!  Very low therapeutic index  Can provoke new arrhythmias and heart failure .

D RU G S FO R H EART FAILU RE .

Therapeutic targets in compensatory responses for reduced cardiac perfo . Cardiac output Positive inotropics Carotid sinus firing Renal blood flow Sympathetic outflow Renin release Β-blockers ACEIs Ang II Force All Rate antagonists Preload Afterload Remodelling Diuretics Vasodilators eme 1.

Positive Inotropics  Beta adrenoceptor agonist  Dobutamine: beta1-selective  Increases cardiac contractility & reduces afterload  Short acting  IV .

may induces arrhythmia.Positive Inotropics  Cardiac glycosides  Digoxin (from Digitalis purpurea)  Blocks Na+. GI upset. cardiac arrest  Tx for toxicity: digoxin antibodies (Digibind) .K+-ATPase  Cardiac parasymphatomimetic effect  Toxicity: very toxic.

hypotension. Metoprolol  prolong life in chronic HF  PD: unclear  Toxicities: worsening of HF. AV blockade. sedation .Beta Blockers  Carvedilol.

ACEIs  First line agents (+ diuretics) in HF  Little or no effect to cardiac contractility .

D iuretics  Useful in almost all cases  Loop diuretics (ex: Furosemide)  acute pulmonary edema & severe chronic HF  Thiazides (ex: Hydrochlorothiazide)  mild chronic HF  Aldosterone antagonists (ex: Spironolactone )  reduces morbidity & mortality .

TH A N K YO U .