1. Cariovascular pharmacology for primary care physician: cardiotonics, antiarrhytmics, vasodilatators
Domina Petric, MD

2. digoxinum (Lanicor 0,25 mg tbl.) metildigoxinum (Lanitop 0,1 mg tbl.)
1.) Cardiotonic drugs
digoxinum (Lanicor 0,25 mg tbl.)
metildigoxinum (Lanitop 0,1 mg tbl.)

3. Digoxinum, metildigoxinum
Indications:
acute and chronic heart failure
chronic heart failure with permanent atrial fibrillation
supraventricular tachycardias (atrial fibrillation and undulation, paroxismal supraventricular tachycardia)

4. Digoxinum
Fast oral saturation (if patient was not taking digitalis glycosides for two weeks):
0,5-0,75 mg at once per os
0,25 mg every 6-8 hours
average dose during 24 hours is 1-1,5 mg

5. Slow oral saturation: 0,125-0,5 mg per os a day Maintenance dose:
Digoxinum
Slow oral saturation:
0,125-0,5 mg per os a day
Maintenance dose:
0,25 mg per os a day

6. Metildigoxinum Fast oral saturation:
0,2 mg per os three times a day during 2 to 4 days
Slow oral saturation (digitalisation):
0,4 mg per os a day during 3-5 days
Maintenance dose is 0,15-0,2 mg a day.

7. Metildigoxinum Atrial fibrillation:
0,2-0,3 mg per os a day in one or two doses
Heart failure:
0,2 mg three times a day during 1-5 days
0,15-0,2 mg a day is maintenance dose

8. Contraindications: hypersensitivity digitalis intoxication
ventricular tachycardia or fibrillation
AV block of II. or III. degree
WPW syndrome, escpecially with atrial fibrillation

9. Contraindications: hypokalemia hypocalcemia hypomagnesemia
hyperthrophic obstructive cardiomyopathy
thoracal aorta aneurism

10. carotid sinus syndrome sick sinus syndrome
Contraindications:
carotid sinus syndrome
sick sinus syndrome
Healio.com

11. 2.) Antiarrhythmic drugs Ia
fast sodium channel blockers
depress fase 0
prolong repolarisation
quinidine
procainamide
disopyramide

12. 3.) Antiarrhythmic drugs Ib
fast sodium channel blockers
depress phase 0 selectively in abnormal/ischemic tissue, shorten repolarization
 lidocaine, phenytoin, mexiletine 

13. Lidocainum for iv. application
ventricular extrasystoles and tachycardias, especially after acute myocardial infarction
mg iv. during 2-3 minutes
dose can be repeated after 5 minutes, if necessary
maximum dose is mg within one hour

14. 4.) Antiarrhythmic drugs Ic
fast sodium channel blockers
markedly depress phase 0, minimal effect on repolarization
flecainide, propafenone moricizine

15. Propafenonum 150/300 mg tbl. AV node tachycardia
supraventricular tachycardia in patients with Wolff-Parkinson-White syndrome
paroxysmal atrial fibrillation
treatment starts in hospital (cardiologist)

16. Wp.vcu.edu

17. Lown-Ganong-Levine Syndrome
short PR interval, normal QRS
AliveCor.com

18. 5.) Antiarrhythmic drugs II
beta blockers
decrease slope of phase 4
antihypertensive drugs

19. 6.) Antiarrhythmic drugs III
potassium chanel blockers
amiodarone (prolongs phase 3; also acts on phases 1, 2, and 4)
sotalol (prolongs phase 3, decreases slope of phase 4)
ibutilide (prolongs phase 3)
dofetilide (prolongs phase 3)

20. prevention of repetition of severe arrhythmias
Amiodaronum 200 mg tbl.
prevention of repetition of severe arrhythmias
treatment is started in hospital conditions

21. 7.) Antiarrhythmic drugs IV
slow calcium channel blockers
verapamil (prolongs phase 2)
diltiazem (prolongs phase 2)

22. 8.) Antiarrhythmic drugs V.
variable mechanisms
adenosine
digoxin
magnesium sulfate

23. 9.) Vasodilatator drugs isosorbidi mononitras (20, 40, 60 mg tbl.)
glyceroli trinitatis solutio
isosorbidi dinitras

24. Isosorbidi mononitras
Tablets are indicated for prevention of angina pectoris.
Dose can vary from 30 mg up to 120 mg per os and it is taken at once in the morning!
Titration of the dose can prevent headaches (30 mg for 2-4 days and then the augmentation of the dose up to maximum daily dose of 120 mg).

25. Contraindications: hypersensitivity shock, vascular decompensation
myocardial infarction
heavy heart operation in anamnesis
cardiogenic shock
severe hypotension (RRs<90 mmHg)
severe anemia
cerebrovascular insult in anamnesis

26. Interactions:
Isosorbid mononitrate can not be applicated together with 5-phosphodiesterase inhibitors!

27. Glyceroli trinitatis solution for sublingual application
Nitrolingual 0,4 mg/dose is indicated for:
treatment of acute angina pectoris
prophylaxis of angina pectoris before physical exertion
treatment of acute myocardial infarction
treatment of acute left ventricle failure
prevention of coronary spasm (during coronary angiography)

28. Contraindications: hypersensitivity
acute shock, hypotension (RRs<90 mmHg)
hypertrophic obstructive cardiomyopathy
elevated intracranial pressure
severe anemia

29. Isosorbidi dinitras Tinidil 5 mg tbl. are indicated for:
angina pectoris
silent heart ischemia
heart failure
Maximum dose is 60 mg every six hours!

30. 10. Ivabradinum (5 mg or 7,5 mg tbl.)
symptomatic treatment of chronic stable angina pectoris when the heart rate is more than 70 bmp in patients that can not take beta-blockers or the beta-blockers are not enough
chronic heart failure NYHA class II-IV with systolic disfunction in patients with synus rhythm and heart rate 75 bpm or more (≥75 bmp) with or without beta-blockers

31. Mediately, HALMED Healio ClevelandClinic Medscape
Literature:
Mediately, HALMED
Healio
ClevelandClinic
Medscape
Wp.vcu.edu, AliveCor.com