Nitrates, Calcium Channel Blockers and Other Antianginal Drugs
July 3, 2017Angiotensin-Converting Enzyme Inhibitors
July 3, 2017Inotropic Sympathomimetics:
Dobutamine:
Indications: inotropic support in infarction, cardiac surgery, cardiomyopathies, septic shock, and cardiogenic shock.
Contraindications: in patients with idiopathic hypertrophic subaortic stenosis and in patients who have shown previous manifestations of hypersensitivity to dobutamine.
Dose and Administration: By intravenous infusion, 2.5–10 micrograms/kg/minute, adjusted according to response.
Dopamine:
Indications: indicated for the correction of hemodynamic imbalances present in the shock syndrome due to myocardial infarctions, trauma, endotoxic septicemia, open heart surgery, renal failure, and chronic cardiac decompensation as in congestive failure.
Contraindications: not be used in patients with pheochromocytoma also should not be administered in the presence of uncorrected tachyarrhythmias or ventricular fibrillation.
Dose and Administration: By intravenous infusion, 2–5 micrograms/kg/minute initially.
ISOPRENALINE:
Indications: For mild or transient episodes of heart block that do not require electric shock or pacemaker therapy. For serious episodes of heart block and Adams-Stokes attacks. For use in cardiac arrest until electric shock or pacemaker therapy. For bronchospasm occurring during anesthesia.
Contraindications: in patients with tachyarrhythmias; tachycardia or heart block caused by digitalis intoxication; ventricular arrhythmias which require inotropic therapy; and angina pectoris.
Dose and Administration: Rates over 30 mcg per minute have been used in advanced stages of shock. The rate of infusion should be adjusted on the basis of heart rate, central venous pressure, systemic blood pressure, and urine flow. If the heart rate exceeds 110 beats per minute, it may be advisable to decrease or temporarily discontinue the infusion.
Vasoconstrictor Sympathomimetics:
Ephedrine:
Indications: treatment of allergic disorders, such as bronchial asthma. The drug has long been used as a pressor agent, particularly during spinal anesthesia when hypotension frequently occurs. In Stokes-Adams syndrome with complete heart block, ephedrine has a value similar to that of epinephrine. It is indicated as a central nervous system stimulant in narcolepsy and depressive states. It is also used in myasthenia gravis.
Contraindications: Allergic reactions to ephedrine sulfate are rare. The hypersensitivity, if known, is a specific contraindication.
Dose and Administration: Adults: The usual parenteral dose is 25 to 50 mg given subcutaneously or intramuscularly. Intravenously, 5 to 25 mg may be administered slowly, repeated in 5 to 10 minutes, if necessary. Children: The usual subcutaneous or intramuscular dose is 0.5 mg/kg of body weight or 16.7 mg/square meter of body surface every 4 to 6 hours.
Noradrenaline:
Indications: For blood pressure control in certain acute hypotensive states (e.g., pheochromocytomectomy, sympathectomy, poliomyelitis, spinal anesthesia, myocardial infarction, septicemia, blood transfusion, and drug reactions). As an adjunct in the treatment of cardiac arrest and profound hypotension.
Contraindications: hypertension (monitor blood pressure and rate of flow frequently); pregnancy.
Dose and Administration: Acute hypotension, by intravenous infusion, via central venous catheter, of a solution containing acid tartrate 80 micrograms/mL (equivalent to base 40 micrograms/mL) at an initial rate of 0.16–0.33 mL/minute, adjusted according to response. Cardiac arrest, by rapid intravenous or intracardiac injection, 0.5–0.75 mL of a solution containing acid tartrate 200 micrograms/mL (equivalent to base 100 micrograms/mL)
Cardiopulmonary Resuscitaction:
Adrenaline/Epinephrine:
Indications: emergency treatment of acute anaphylaxis; angioedema; cardiopulmonary resuscitation and priapism.
Contraindications: Epinephrine is contraindicated in narrow angle (congestive) glaucoma, shock, during general anesthesia with halogenated hydrocarbons or cyclopropane and in individuals with organic brain damage. Epinephrine is also contraindicated with local anesthesia of certain areas, e.g., fingers, toes, because of the danger of vasoconstriction producing sloughing of tissue; in labor because it may delay the second stage; in cardiac dilatation and coronary insufficiency
Dose and Administration: Acute anaphylaxis, by intramuscular injection (preferably midpoint in anterolateral thigh) of 1 in 1000 (1 mg/mL) solution. Acute anaphylaxis when there is doubt as to the adequacy of the circulation, by slow intravenous injection of 1 in 10 000 (100 micrograms/mL) solution
