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CARDIOVASCULAR NOTES – BNF Chapter 22.1 POSITIVE INOTROPIC DRUGS
Definitions:
1. Positive Inotropic Drugs – Stimulate heart muscle contractions and cause the
heart rate to increase.
2. Negative Inotropic Drugs – Reduce heart muscle contractions and cause the
heart rate to decrease.
3. Arrythmias – Any deviation from the normal rhythm of the heart
4. Supraventricular Tachycardia – A fast heart beat stemming from an abnormal
area of the atria, it may be so fast that it reduces the pumping efficiency of the
heart.
5. Atrial fibrillation – Rapid and irregular heart and pulse rates caused by
disorganised electrical activity. Symptoms: Breathlessness, reduced exercise
tolerance, angina, palpitations and dizziness. Causes: Hypertension and
ischaemic disease.
2.1.1 Cardiac Glycosides
Cardiac Glycosides increase the force of contraction of the myocardium and
reduce conductivity within the AV node.
Cardiac glycosides are most useful in treating supraventricular tachycardias
(particularly atrial fibrillation and atrial flutter).
Cardiac Glycosides
DRUG INDICATIONS SIDE EFFECTS NOTES
Digoxin Heart Failure Nausea Has a long half life.
and Supraventricular Vomiting Renal function is important
Digitoxin arrythmias (atrial Diarrhoea determinant of dosing for digoxin.
fibrillation/artial flutter Dizziness Special care in elderly who may be
Blurred or particularly susceptible to digitalis
yellow vision toxicity.
Rash Hypokalaemia predisposes the
patient to digitalis toxicity. Can be
managed by giving potassium
sparing diuretic or potassium
supplements.
Digitalis Toxicity can be suspected if
patient develops nausea, vomiting,
diarrhoea, confusion or blurred vision.
Symptoms are SLOW and SICK.
DIGIBIND = digoxin specific antibody
fragments indicated for digoxin
overdose or strongly suspected
toxicity.
1
, 2.2 DIURETICS
Definitions:
Diuretic – Drugs that increase the volume of urine produced by promoting the
excretion of water and salts from the kidneys. They increase the flow of urine.
For Hypertension: People younger than 55 years and Caucasians respond better to an
ACE inhibitor or Angiotensin II Receptor Antagonists. People aged over 55 years and
afro-Caribbean first line treatment is thiazide diuretics or calcium channel blockers.
2.2.1 Thiazide and Thiazide Related Diuretics:
DRUG INDICATIONS SIDE EFFECTS NOTES
Bendroflum Oedema GI disturbance Moderately potent diuretic.
ethiazide (mild to Postural hypotension Inhibit sodium reabsorption at the
moderate Hypokalaemia beginning of the distal convoluted
heart failure) Hyponatraemia (low tubule.
Hypertension sodium in the blood) They act within 1-2 hours of oral
Gout administration.
Altered plasma lipid Duration of action 12-24 hours.
concentrations Usually administered in the
Hypomagnesaemia morning so that diuresis does not
Hypercalcaemia affect sleep.
Hyperglycaemia Continual loss of potassium occurs
Hyperuricaemia from the body with prolonged use.
Rare: Impotence Hypokalaemia is dangerous in
severe CVD and in patients treated
with cardiac glycosides.
Indapamide Essential GI disturbance Same as with Bendroflumethiazide
Natrilix Hypertension Postural hypotension except it is a thiazide related
Hypokalaemia diuretic.
Hyponatraemia (low Indapamine claimed to lower BP
sodium in the blood) with less metabolic disturbance
Gout particularly less aggravation of
Altered plasma lipid diabetes mellitus.
concentrations
Hypomagnesaemia
Hypercalcaemia
Hyperuricaemia
Palpitations
2
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