Cardiac Pharmacology: Difference between revisions

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AF (Poorly tolerated): Class IIbC
AF (Poorly tolerated): Class IIbC
AF (Stable flutter): Class IIbC
AF (Stable flutter): Class IIbC
Prophylaxis of SVT during pregnancy: Class IIIC |Gastro-intestinal disturbances (2-20%)), taste disturbances, hepatic disturbances (up to 50%); bradycardia; pulmonary toxicity (1-17%); tremor (9-59%), sleep disorders; hypothyroidism (5-10%), hyperthyroidism (5-10%); reversible corneal microdeposits (up to 98%); phototoxicity, persistent slate-grey skin discoloration (1-7%), injection-site reactions; less commonly onset or worsening of arrhythmia, conduction disturbances, peripheral neuropathy (1-105) and myopathy; very rarely sinus arrest, bronchospasm, ataxia (2-37%), benign intracranial hypertension, headache, vertigo, epididymo-orchitis, impotence, haemolytic or aplastic anaemia, thrombocytopenia, rash, hypersensitivity including photosensitivity (2-20%), anaphylaxis on rapid injection, hypotension (10-30%), respiratory distress syndrome, sweating, and hot flushes
Prophylaxis of SVT during pregnancy: Class IIIC
|Gastro-intestinal disturbances (2-20%)), taste disturbances, hepatic disturbances (up to 50%); bradycardia; pulmonary toxicity (1-17%); tremor (9-59%), sleep disorders; hypothyroidism (5-10%), hyperthyroidism (5-10%); reversible corneal microdeposits (up to 98%); phototoxicity, persistent slate-grey skin discoloration (1-7%), injection-site reactions; less commonly onset or worsening of arrhythmia, conduction disturbances, peripheral neuropathy (1-105) and myopathy; very rarely sinus arrest, bronchospasm, ataxia (2-37%), benign intracranial hypertension, headache, vertigo, epididymo-orchitis, impotence, haemolytic or aplastic anaemia, thrombocytopenia, rash, hypersensitivity including photosensitivity (2-20%), anaphylaxis on rapid injection, hypotension (10-30%), respiratory distress syndrome, sweating, and hot flushes
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|Class IV (Calcium channel blockers)
|Class IV (Calcium channel blockers)
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|Digoxin
|Digoxin
|Supra-ventricular Arrhythmias |Acute: 0.75-1.5mg over 24 hours
|Supra-ventricular Arrhythmias
Maintenance: 125-150µg daily |ACC/AHA/ESC Guidelines (Blomström-Lundqvist and Scheinman et al. 2003):
|Acute: 0.75-1.5mg over 24 hours
Maintenance: 125-150µg daily
|ACC/AHA/ESC Guidelines (Blomström-Lundqvist and Scheinman et al. 2003):
SVT: Class IIbC
SVT: Class IIbC
WPW Syndrome: Class IIIC
WPW Syndrome: Class IIIC
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Acute HF with AF and VT: Class IC
Acute HF with AF and VT: Class IC
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|Anti-platelet Drugs - |
|Anti-platelet Drugs
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|Aspirin
|Aspirin
|Prevention of thrombotic cerebro- or cardio-vascular disease
|Prevention of thrombotic cerebro- or cardio-vascular disease
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|Clopidogrel
|Clopidogrel
|Prevention of thrombotic events (esp. when warfarin not tolerated) |75mg once/day
|Prevention of thrombotic events (esp. when warfarin not tolerated)
|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
Prevention in diabetic patients: IIaB
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|Acute myocardial infarction |300mg daily initially then 75mg once/day
|Acute myocardial infarction
|300mg daily initially then 75mg once/day
|ESC Guidelines(European Heart Journal (2012) 33, 2569–2619
|ESC Guidelines(European Heart Journal (2012) 33, 2569–2619
doi:10.1093/eurheartj/ehs215):  
doi:10.1093/eurheartj/ehs215):  
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|Acute coronary syndrome |300mg daily initially then 75mg once/day
|Acute coronary syndrome
|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
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|Prasugrel
|Prasugrel
|Prevention of thrombotic events. |60mg bolus then 5-10mg once daily
|Prevention of thrombotic events.
|60mg bolus then 5-10mg once daily
|ESC Guidelines (European Heart Journal
|ESC Guidelines (European Heart Journal
doi:10.1093/eurheartj/ehs104):
doi:10.1093/eurheartj/ehs104):
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|Ticragelor
|Ticragelor
|Prevention of thrombotic events. |180mg bolus then 90mg twice daily
|Prevention of thrombotic events.
|180mg bolus then 90mg twice daily
|ESC Guidelines (European Heart Journal
|ESC Guidelines (European Heart Journal
doi:10.1093/eurheartj/ehs104):
doi:10.1093/eurheartj/ehs104):
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|Haemorrhage, nausea, vomiting, diarrhoea, jaundice, hepatic dysfunction, pancreatitis, pyrexia, alopecia, purpura, rash, ‘purple toes’, skin necrosis (increased risk in patients with protein C or protein S deficiency)
|Haemorrhage, nausea, vomiting, diarrhoea, jaundice, hepatic dysfunction, pancreatitis, pyrexia, alopecia, purpura, rash, ‘purple toes’, skin necrosis (increased risk in patients with protein C or protein S deficiency)
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|Lipid-Lowering Drugs |Statins
|Lipid-Lowering Drugs
|Simvastatin, Atorvastatin |Primary hyper-cholesterolaemia, combined hyperlipidaemia |Simvastatin: 10-20mg once daily |ESC and EASD Guidelines (European Heart Journal doi: 10.1093/eurheart/ehl261)
|Statins
|Simvastatin, Atorvastatin
|Primary hyper-cholesterolaemia, combined hyperlipidaemia
|Simvastatin: 10-20mg once daily
|ESC and EASD Guidelines (European Heart Journal doi: 10.1093/eurheart/ehl261)
Dyslipidaemia: Class IA
Dyslipidaemia: Class IA
Low HDL-C: Class IIbB
Low HDL-C: Class IIbB
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|Familial hyper-cholesterolaemia |Simvastatin: 40mg once daily |ESC and EASD Guidelines (European Heart Journal doi: 10.1093/eurheart/ehl261)
|Familial hyper-cholesterolaemia
|Simvastatin: 40mg once daily
|ESC and EASD Guidelines (European Heart Journal doi: 10.1093/eurheart/ehl261)
HeFH: Class IC
HeFH: Class IC
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|Fibrates
|Fibrates
|Gemfibrozil |Hyperlipidaemias of types IIa, IIb, III, IV and V
|Gemfibrozil
|Hyperlipidaemias of types IIa, IIb, III, IV and V
|Gemfibrozil: 0.9-1.2mg daily
|Gemfibrozil: 0.9-1.2mg daily
|ESC and EAS Guidelines (European Heart Journal (2011) 32, 1769–1818
|ESC and EAS Guidelines (European Heart Journal (2011) 32, 1769–1818
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Transplant patients (with high LDL-C): Class IIbC
Transplant patients (with high LDL-C): Class IIbC
|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
|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
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