467
edits
Cardiac Pharmacology: Difference between revisions
no edit summary
No edit summary |
No edit summary |
||
| Line 341: | Line 341: | ||
|Resistant Hypertension | |Resistant Hypertension | ||
|Furosemide: 40-80mg once daily | |Furosemide: 40-80mg once daily | ||
| | | | ||
|Mild gastro-intestinal disturbances, pancreatitis, hepatic encephalopathy, postural hypotension, temporary increase in serum-cholesterol and triglyceride concentration, hyperglycaemia, acute urinary retention, electrolyte disturbances, metabolic alkalosis, blood disorders, hyperuricaemia, visual disturbances, tinnitus and deafness, and hypersensitivity reactions (including rash, photosensitivity, and pruritus).<cite>Esc1</cite> | |||
|Mild gastro-intestinal disturbances, pancreatitis, hepatic encephalopathy, postural hypotension, temporary increase in serum-cholesterol and triglyceride concentration, hyperglycaemia, acute urinary retention, electrolyte disturbances, metabolic alkalosis, blood disorders, hyperuricaemia, visual disturbances, tinnitus and deafness, and hypersensitivity reactions (including rash, photosensitivity, and pruritus). | |||
|- | |- | ||
| | | | ||
| Line 352: | Line 350: | ||
|Hypertension | |Hypertension | ||
|Captopril: 12.5mg twice daily | |Captopril: 12.5mg twice daily | ||
| | | | ||
|Hypotension (2.4%), renal impairment, persistent dry cough, angioedema, rash pancreatitis, upper respiratory-tract symptoms (2-10%), gastro-intestinal symptoms (1-2%), altered liver function tests, cholestatic jaundice, hepatitis, fulminant hepatic necrosis and failure, hyperkalaemia (2%), hypoglycaemia, blood disorders including thrombocytopenia, leucopenia, neutropenia, headache (3%), dizziness (2-12%), fatigue, malaise, taste disturbance, paraesthesia, bronchospasm, fever, serositis, vasculitis, myalgia (3%), arthralgia, positive antinuclear antibody, raised erythrocyte sedimentation rate, eosinophilia, leucocytosis, and photosensitivity.<cite>Esc2</cite><cite>Esc3</cite><cite>Esc4</cite> | |||
|Hypotension (2.4%), renal impairment, persistent dry cough, angioedema, rash pancreatitis, upper respiratory-tract symptoms (2-10%), gastro-intestinal symptoms (1-2%), altered liver function tests, cholestatic jaundice, hepatitis, fulminant hepatic necrosis and failure, hyperkalaemia (2%), hypoglycaemia, blood disorders including thrombocytopenia, leucopenia, neutropenia, headache (3%), dizziness (2-12%), fatigue, malaise, taste disturbance, paraesthesia, bronchospasm, fever, serositis, vasculitis, myalgia (3%), arthralgia, positive antinuclear antibody, raised erythrocyte sedimentation rate, eosinophilia, leucocytosis, and photosensitivity. | |||
|- | |- | ||
| | | | ||
| Line 367: | Line 357: | ||
| | | | ||
|Heart Failure | |Heart Failure | ||
|Captopril: 12.5mg 3 times daily | |Captopril: 12.5mg 3 times daily<cite>Esc5</cite><cite>Esc6</cite><cite>Esc7</cite> | ||
| | |||
| | | | ||
|- | |- | ||
| Line 403: | Line 382: | ||
|Hypertension | |Hypertension | ||
|Losartan: 50mg once daily | |Losartan: 50mg once daily | ||
| | | | ||
|Gastro-intestinal disturbances (<3%), dizziness (14%), angina, palpitation, oedema, dyspnoea, headache (14%), malaise, urticaria, pruritus, rash;<cite>Esc5</cite><cite>Esc8</cite><cite>Esc9</cite> | |||
| | |||
|- | |- | ||
| | | | ||
| Line 637: | Line 611: | ||
|Heart Failure | |Heart Failure | ||
|62.5-125 µg daily | |62.5-125 µg daily | ||
|ESC Guidelines (European Heart Journal | |ESC Guidelines (European Heart Journal doi:10.1093/eurheartj/ehs104): Symptomatic (NYHA class II-IV) HF: Class IIbB | ||
doi:10.1093/eurheartj/ehs104): | ESC Guidelines Symptomatic (NYHA class II-IV) HF, LVD and AF: Class IB; Acute HF with AF and VT: Class IC | ||
Symptomatic (NYHA class II-IV) HF: Class IIbB | |||
ESC Guidelines Symptomatic (NYHA class II-IV) HF, LVD and AF: Class IB | |||
Acute HF with AF and VT: Class IC | |||
| | | | ||
|- | |- | ||
| Line 649: | Line 620: | ||
|Prevention of thrombotic cerebro- or cardio-vascular disease | |Prevention of thrombotic cerebro- or cardio-vascular disease | ||
|75mg once/day | |75mg once/day | ||
|ESC and EASD Guidelines (European Heart Journal doi: 10.1093/eurheart/ehl261) | |ESC and EASD Guidelines (European Heart Journal doi: 10.1093/eurheart/ehl261): Prevention in AF: Class IC; Prevention in diabetic patients: IIaB | ||
Prevention in AF: Class IC | |||
Prevention in diabetic patients: IIaB | |||
ESC Guidelines (European Heart Journal | ESC Guidelines (European Heart Journal doi:10.1093/eurheartj/ehs104): Prevention in Symptomatic (NYHA class II-IV) HF and AF: Class IIA | ||
doi:10.1093/eurheartj/ehs104): | |||
Prevention in Symptomatic (NYHA class II-IV) HF and AF: Class IIA | |||
ESC Guidelines: (European Heart Journal | ESC Guidelines: (European Heart Journal doi:10.1093/eurheartj/ehs092): Prevention in hypertensive patients with CV events: Class IA; Prevention in hypertensive patients without CV history but with reduced renal function/high risk: Class IIbA | ||
doi:10.1093/eurheartj/ehs092): | |||
Prevention in hypertensive patients with CV events: Class IA | |||
Prevention in hypertensive patients without CV history but with reduced renal function/high risk: Class IIbA | |||
ESC Guidelines: (European Heart Journal | ESC Guidelines: (European Heart Journal doi:10.1093/eurheartj/ehs092): Post-MI: Class Ia | ||
doi:10.1093/eurheartj/ehs092): | |||
Post-MI: Class Ia | |||
|Bronchospasm (10-30% in asthmatics); gastro-intestinal irritation (up to 83%), gastro-intestinal haemorrhage (occasionally major), also other haemorrhage (e.g. intracranial (0.5%), subconjunctival), chest pain (8.3%), oedema (4.5%), hypertension (4.3%). | |Bronchospasm (10-30% in asthmatics); gastro-intestinal irritation (up to 83%), gastro-intestinal haemorrhage (occasionally major), also other haemorrhage (e.g. intracranial (0.5%), subconjunctival), chest pain (8.3%), oedema (4.5%), hypertension (4.3%). | ||
|- | |- | ||
| Line 680: | Line 642: | ||
|Prevention of thrombotic events (esp. when warfarin not tolerated) | |Prevention of thrombotic events (esp. when warfarin not tolerated) | ||
|75mg once/day | |75mg once/day | ||
|ESC and EASD Guidelines (European Heart Journal doi: 10.1093/eurheart/ehl261) | |ESC and EASD Guidelines (European Heart Journal doi:10.1093/eurheart/ehl261): Prevention in diabetic patients: IIaB; Primary and secondary prevention of stroke: Class IB | ||
Prevention in diabetic patients: IIaB | |||
Primary and secondary prevention of stroke: Class IB | |||
Prevention in Symptomatic (NYHA class II-IV) HF and AF: Class IIA | ESC Guidelines (European Heart Journal doi:10.1093/eurheartj/ehs104): Prevention in Symptomatic (NYHA class II-IV) HF and AF: Class IIA; Prevention in Symptomatic (NYHA class II-IV) HF and AF: Class IIA | ||
ESC Guidelines: (European Heart Journal | ESC Guidelines: (European Heart Journal doi:10.1093/eurheartj/ehs092): Acute phase of coronary artery syndrome: Class IB; Non-cardioembolic cerebral ischaemic events: Class IA | ||
doi:10.1093/eurheartj/ehs092): | |||
Acute phase of coronary artery syndrome: Class IB | |||
Non-cardioembolic cerebral ischaemic events: Class IA | |||
|Dyspepsia (5.2%), abdominal pain (5.6%), diarrhoea (4.5%); bleeding disorders including gastro-intestinal (2.0%) and intracranial (0.4%), nausea (3.4%), vomiting, gastritis, flatulence, constipation, gastric and duodenal ulcers, headache (7.6%), epistaxis (2.9%), dizziness (6.2%), paraesthesia, leucopenia, decreased platelets (very rarely severe thrombocytopenia), eosinophilia, rash (4.2%), pruritus (3.3%), vertigo, colitis, pancreatitis, hepatitis (<1%), acute liver failure, hypertension (4.3%), chest pain (8.3%), oedema (4.1%), vasculitis, confusion, hallucinations, taste disturbance, cough (3.9%), fatigue (4.8%) stomatitis, bronchospasm, interstitial pneumonitis, pyrexia (2.2%), blood disorders including thrombocytopenic purpura (5.3%), agranulocytosis, neutropenia (0.04%) and pancytopenia and hypersensitivity-like reactions (<0.1%)including fever, glomerulonephritis, arthralgia, Stevens-Johnson syndrome, toxic epidermal necrolysis, lichen planus | |Dyspepsia (5.2%), abdominal pain (5.6%), diarrhoea (4.5%); bleeding disorders including gastro-intestinal (2.0%) and intracranial (0.4%), nausea (3.4%), vomiting, gastritis, flatulence, constipation, gastric and duodenal ulcers, headache (7.6%), epistaxis (2.9%), dizziness (6.2%), paraesthesia, leucopenia, decreased platelets (very rarely severe thrombocytopenia), eosinophilia, rash (4.2%), pruritus (3.3%), vertigo, colitis, pancreatitis, hepatitis (<1%), acute liver failure, hypertension (4.3%), chest pain (8.3%), oedema (4.1%), vasculitis, confusion, hallucinations, taste disturbance, cough (3.9%), fatigue (4.8%) stomatitis, bronchospasm, interstitial pneumonitis, pyrexia (2.2%), blood disorders including thrombocytopenic purpura (5.3%), agranulocytosis, neutropenia (0.04%) and pancytopenia and hypersensitivity-like reactions (<0.1%)including fever, glomerulonephritis, arthralgia, Stevens-Johnson syndrome, toxic epidermal necrolysis, lichen planus | ||
|- | |- | ||
| Line 701: | Line 654: | ||
|Acute myocardial infarction | |Acute myocardial infarction | ||
|300mg daily initially then 75mg once/day | |300mg daily initially then 75mg once/day | ||
|ESC Guidelines(European Heart Journal (2012) 33, | |ESC Guidelines(European Heart Journal (2012) 33, 2569-2619 doi:10.1093/eurheartj/ehs215): Post STEMI: Class IA | ||
doi:10.1093/eurheartj/ehs215): | |||
Post STEMI: Class IA | |||
| | | | ||
|- | |- | ||
| Line 711: | Line 662: | ||
|Acute coronary syndrome | |Acute coronary syndrome | ||
|300mg daily initially then 75mg once/day | |300mg daily initially then 75mg once/day | ||
|ESC and EASD Guidelines (European Heart Journal doi: 10.1093/eurheart/ehl261) | |ESC and EASD Guidelines (European Heart Journal doi: 10.1093/eurheart/ehl261): ACS: Class IIaC | ||
ACS: Class IIaC | |||
| | | | ||
|- | |- | ||
| Line 720: | Line 670: | ||
|Prevention of thrombotic events. | |Prevention of thrombotic events. | ||
|60mg bolus then 5-10mg once daily | |60mg bolus then 5-10mg once daily | ||
|ESC Guidelines (European Heart Journal | |ESC Guidelines (European Heart Journal doi:10.1093/eurheartj/ehs104): Prevention in Symptomatic (NYHA class II-IV) HF and AF: Class IIA | ||
doi:10.1093/eurheartj/ehs104): | |||
Prevention in Symptomatic (NYHA class II-IV) HF and AF: Class IIA | |||
ESC Guidelines: (European Heart Journal | ESC Guidelines: (European Heart Journal doi:10.1093/eurheartj/ehs092): Acute phase of coronary artery syndrome: Class IB | ||
doi:10.1093/eurheartj/ehs092): | |||
Acute phase of coronary artery syndrome: Class IB | |||
|Haemorrhage (11.3%) (including gastro-intestinal (1.5%) and intracranial), haematoma, haematuria, hypertension (7.5%), hypotension (3.9%), headache (5.5%), back pain (5.0%), dyspnoea (4.9%), nausea (4.6%), dizziness (4.1%), cough (3.9%), fatigue (3.7%), chest pain (3.1%), arrhythmias including atrial fibrillation (2.9%) and bradycardia (2.9%), rash (2.8%), pyrexia (2.7%), oedema (2.7%), diarrhoea (2.3%), hypercholesterolaemia/hyperlipidaemia (7.5%), anaemia, rash,hypersensitivity reactions including angioedema (0.06%), thrombocytopenia (0.06%), thrombotic thrombocytopenic purpura | |Haemorrhage (11.3%) (including gastro-intestinal (1.5%) and intracranial), haematoma, haematuria, hypertension (7.5%), hypotension (3.9%), headache (5.5%), back pain (5.0%), dyspnoea (4.9%), nausea (4.6%), dizziness (4.1%), cough (3.9%), fatigue (3.7%), chest pain (3.1%), arrhythmias including atrial fibrillation (2.9%) and bradycardia (2.9%), rash (2.8%), pyrexia (2.7%), oedema (2.7%), diarrhoea (2.3%), hypercholesterolaemia/hyperlipidaemia (7.5%), anaemia, rash,hypersensitivity reactions including angioedema (0.06%), thrombocytopenia (0.06%), thrombotic thrombocytopenic purpura | ||
|- | |- | ||
| Line 734: | Line 680: | ||
|Prevention of thrombotic events. | |Prevention of thrombotic events. | ||
|180mg bolus then 90mg twice daily | |180mg bolus then 90mg twice daily | ||
|ESC Guidelines (European Heart Journal | |ESC Guidelines (European Heart Journal doi:10.1093/eurheartj/ehs104): Prevention in Symptomatic (NYHA class II-IV) HF and AF: Class IIA | ||
doi:10.1093/eurheartj/ehs104): | |||
Prevention in Symptomatic (NYHA class II-IV) HF and AF: Class IIA | |||
ESC Guidelines: (European Heart Journal | ESC Guidelines: (European Heart Journal doi:10.1093/eurheartj/ehs092): Acute phase of coronary artery syndrome: Class IB | ||
doi:10.1093/eurheartj/ehs092): | |||
Acute phase of coronary artery syndrome: Class IB | |||
|Dyspnoea (13.8%), haemorrhage, bruising; nausea (4.3%), vomiting, diarrhoea (3.7%), hypertension (3.8%), hypotension (3.2%), back pain (3.6%), abdominal pain, dyspepsia, gastritis, dizziness (4.5%), chest pain (3.7%), headache (6.5%), cough (4.9%), rash, pruritus, fatigue (3.2%), constipation, arrhythmias including atrial fibrillation (4.2%), paraesthesia, confusion, hyperuricaemia, raised serum creatinine (7.4%), vertigo | |Dyspnoea (13.8%), haemorrhage, bruising; nausea (4.3%), vomiting, diarrhoea (3.7%), hypertension (3.8%), hypotension (3.2%), back pain (3.6%), abdominal pain, dyspepsia, gastritis, dizziness (4.5%), chest pain (3.7%), headache (6.5%), cough (4.9%), rash, pruritus, fatigue (3.2%), constipation, arrhythmias including atrial fibrillation (4.2%), paraesthesia, confusion, hyperuricaemia, raised serum creatinine (7.4%), vertigo | ||
|- | |- | ||
| Line 764: | Line 706: | ||
|Primary hyper-cholesterolaemia, combined hyperlipidaemia | |Primary hyper-cholesterolaemia, combined hyperlipidaemia | ||
|Simvastatin: 10-20mg once daily | |Simvastatin: 10-20mg once daily | ||
|ESC and EASD Guidelines (European Heart Journal doi: 10.1093/eurheart/ehl261) | |ESC and EASD Guidelines (European Heart Journal doi:10.1093/eurheart/ehl261); Dyslipidaemia: Class IA; Low HDL-C: Class IIbB; Elderly patients with CVD: IB; Elderly patients with no CVD but CV risk factors: IIbB; Type I diabetes: IC; Patients with CKD: IIaC; Transplant patients: Class IIaB; PAD: Class IA; HIV patients: IIaC | ||
Dyslipidaemia: Class IA | |||
Low HDL-C: Class IIbB | |||
Elderly patients with CVD: IB | |||
Elderly patients with no CVD but CV risk factors: IIbB | |||
Type I diabetes: IC | |||
Patients with CKD: IIaC | |||
Transplant patients: Class IIaB | |||
PAD: Class IA | |||
HIV patients: IIaC | |||
ESC Guidelines: (European Heart Journal | ESC Guidelines: (European Heart Journal doi:10.1093/eurheartj/ehs092): Hypertension in diabetics: Class IA; ACS: Class IA | ||
doi:10.1093/eurheartj/ehs092): | |||
Hypertension in diabetics: Class IA | |||
ACS: Class IA | |||
|Oedema (2.7%), abdominal pain (5.9%), nausea (5.4%), atrial fibrillation (5.7%), constipation (2.2%), gastritis (4.9%), diabetes mellitus (4.2%), myalgia (3.7%), headache (2.5%), insomnia (4.0%), vertigo (4.5%), bronchitis (6.6%), sinusitis (2.3%), eczema (4.5%), urinary tract infection (3.2%) | |Oedema (2.7%), abdominal pain (5.9%), nausea (5.4%), atrial fibrillation (5.7%), constipation (2.2%), gastritis (4.9%), diabetes mellitus (4.2%), myalgia (3.7%), headache (2.5%), insomnia (4.0%), vertigo (4.5%), bronchitis (6.6%), sinusitis (2.3%), eczema (4.5%), urinary tract infection (3.2%) | ||
|- | |- | ||
| Line 786: | Line 716: | ||
|Familial hyper-cholesterolaemia | |Familial hyper-cholesterolaemia | ||
|Simvastatin: 40mg once daily | |Simvastatin: 40mg once daily | ||
|ESC and EASD Guidelines (European Heart Journal doi: 10.1093/eurheart/ehl261) | |ESC and EASD Guidelines (European Heart Journal doi: 10.1093/eurheart/ehl261): HeFH: Class IC | ||
HeFH: Class IC | |||
| | | | ||
|- | |- | ||
| Line 794: | Line 723: | ||
| | | | ||
|Prevention of cardiovascular events | |Prevention of cardiovascular events | ||
|20-40mg once daily | |20-40mg once daily<cite>Esc3</cite> | ||
| | | | ||
| | | | ||
|- | |- | ||
| Line 804: | Line 732: | ||
|Hyperlipidaemias of types IIa, IIb, III, IV and V | |Hyperlipidaemias of types IIa, IIb, III, IV and V | ||
|Gemfibrozil: 0.9-1.2mg daily | |Gemfibrozil: 0.9-1.2mg daily | ||
| | | | ||
|Gastro-intestinal disturbances including dyspepsia (19.6%), nausea (4%), abdominal pain (9.8%), diarrhoea (7.2%), vomiting (1.2%); headache (1.2%), fatigue (3.8%), vertigo (1.5%), eczema, rash (1.7%), atrial fibrillation (0.7%), pancreatitis, appendicitis, disturbances in liver function including hepatitis and cholestatic jaundice, dizziness, paraesthesia, sexual dysfunction, thrombocytopenia, anaemia, leucopenia, eosinophilia, bone-marrow suppression, myalgia, myopathy, myasthenia, myositis accompanied by increase in creatine kinase, blurred vision, exfoliative dermatitis, alopecia, and photosensitivity<cite>Esc2</cite> | |||
|Gastro-intestinal disturbances including dyspepsia (19.6%), nausea (4%), abdominal pain (9.8%), diarrhoea (7.2%), vomiting (1.2%); headache (1.2%), fatigue (3.8%), vertigo (1.5%), eczema, rash (1.7%), atrial fibrillation (0.7%), pancreatitis, appendicitis, disturbances in liver function including hepatitis and cholestatic jaundice, dizziness, paraesthesia, sexual dysfunction, thrombocytopenia, anaemia, leucopenia, eosinophilia, bone-marrow suppression, myalgia, myopathy, myasthenia, myositis accompanied by increase in creatine kinase, blurred vision, exfoliative dermatitis, alopecia, and photosensitivity | |||
|- | |- | ||
| | | | ||
| Line 816: | Line 740: | ||
|Primary and familial hyper-cholesterolaemia | |Primary and familial hyper-cholesterolaemia | ||
|10mg once daily | |10mg once daily | ||
| | | | ||
|Gastro-intestinal disturbance including diarrhoea (4.1%) and abdominal pain (3.0%); headache, fatigue (2.4%); myalgia, arthralgia (3.0%), sinusitis (3.6%), pharyngitis (2.3%), viral infection (2.2%), coughing (2.3%), hypersensitivity reactions including rash, angioedema, and anaphylaxis, hepatitis,pancreatitis, cholelithiasis, cholecystitis, thrombocytopenia, raised creatine kinase, myopathy, and rhabdomyolysis<cite>Esc1</cite> | |||
|Gastro-intestinal disturbance including diarrhoea (4.1%) and abdominal pain (3.0%); headache, fatigue (2.4%); myalgia, arthralgia (3.0%), sinusitis (3.6%), pharyngitis (2.3%), viral infection (2.2%), coughing (2.3%), hypersensitivity reactions including rash, angioedema, and anaphylaxis, hepatitis,pancreatitis, cholelithiasis, cholecystitis, thrombocytopenia, raised creatine kinase, myopathy, and rhabdomyolysis | |||
|} | |} | ||
==References== | |||
<biblio> | |||
#Esc1 ESC Guidelines (European Heart Journal doi:10.1093/eurheartj/ehs104): Hypertension in symptomatic (NYHA class II-IV) HF and LVD: Class IC | |||
#Esc2 ESC and EASD Guidelines (European Heart Journal doi: 10.1093/eurheart/ehl261): Hypertension: Class IA | |||
#Esc3 ESC Guidelines (European Heart Journal doi:10.1093/eurheartj/ehs104): Hypertension in symptomatic (NYHA class II-IV) HF and LVD: Class IA | |||
#Esc4 ESC Guidelines: (European Heart Journal doi:10.1093/eurheartj/ehs092):Hypertension in diabetics: Class IA | |||
#Esc5 ESC Guidelines (European Heart Journal (2012) 33, 2569–2619 doi:10.1093/eurheartj/ehs215): Post STEMI: Class IA | |||
#Esc6 ESC and EASD Guidelines (European Heart Journal doi: 10.1093/eurheart/ehl261): Diabetic patients: Class IC | |||
#Esc7 ESC Guidelines (European Heart Journal doi:10.1093/eurheartj/ehs104): Symptomatic (NYHA class II-IV) HF: Class IA; Acute heart failure with ACS: Class IA | |||
#Esc8 ESC and EASD Guidelines (European Heart Journal doi: 10.1093/eurheart/ehl261): Hypertension: Class IA | |||
#Esc9 ESC Guidelines: (European Heart Journal doi:10.1093/eurheartj/ehs092): Hypertension in diabetics: Class IA | |||
#Esc3 ESC and EASD Guidelines (European Heart Journal doi: 10.1093/eurheart/ehl261): HeFH: Class IC | |||
#Esc2 ESC and EAS Guidelines (European Heart Journal (2011) 32, 1769–1818 doi:10.1093/eurheartj/ehr158): Low HDL-C: Class IIbB; Transplant patients (with HTG, low HDL-C): Class IIbC | |||
#Esc1 ESC and EAS Guidelines (European Heart Journal (2011) 32, 1769–1818 doi:10.1093/eurheartj/ehr158): Transplant patients (with high LDL-C): Class IIbC | |||
</biblio> | |||