Cardiovascular agents antiarrhythmics

Cervoni P, Crandall DL and Chan PS (1993) Cardiovascular agents - antiarrhythmic agents. Kirk-Othmer Encyclopedia of Chemical Technology, 4th edn, Vol 5. Wiley, New York, pp 207-238. 

Cardiovascular agents - The metabolism of guinidine, a naturally occurring alkaloid with antiarrhythmic properties, was studied in man as the gluconate salt. Metabolites isolated from urine were found to be oxygenated on either the quinoline or guinuclidine portions of the molecule uncharacterized polyoxygenated derivatives were also found. Commercially available supplies of quinidine consistently contained 10 to 30 percent of an impurity. 

Cardiovascular antiarrhythmic agents Enhances drug toxicity... 

Cardiovascular System Following systemic absorption, local anesthetics decrease electrical excitabdity, conduction rate, and force of contraction. Most local anesthetics also cause arteriolar dilation. Untoward cardiovascular effects usually are seen only after high systemic concentrations are attained and effects on the CNS are produced. However, on rare occasions, lower doses of some local anesthetics wUl cause cardiovascular collapse and death, probably due to either an action on the pacemaker or the sudden onset of ventricular fibrillation. Ventricular tachycardia and fibrillation are relatively uncommon consequences of local anesthetics other than bupivacaine. The use of local anesthetics as antiarrhythmic drugs is discussed in Chapter 34. Untoward cardiovascular effects of local anesthetic agents may result from their inadvertent intravascular administration, especially if epinephrine also is present. 

Amiodarone is a Type III antiarrhythmic agent. It has been shown in several clinical trials to be safe and effective in the treatment of supraventricular and ventricular arrhythmias in patients with cardiovascular disease. Amiodarone is also associated with fewer proarrhythmic effects compared with other antiarrhythmic drugs. Amiodarone is empirically dosed and adjusted based on efficacy and toxicity. 

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