Cardiovascular agents, congestive heart failure

The Class I agents have many similar side effects and toxicities. The anticholinergic side effects include dry mouth, constipation, and urinary hesitancy and retention. Common gastrointestinal (GI) side effects include nausea, vomiting, diarrhea, and anorexia. Cardiovascular adverse effects are hypotension, tachycardia, arrhythmias, and myocardial depression, especially in patients with congestive heart failure. Common central nervous system (CNS) side effects are headache, dizziness, mental confusion, hallucinations, CNS stimulation, paraesthesias, and convulsions. 

Edema and specific drugs for its treatment have long been problems of the physician and of the chemist interested in medicinal products. Digitalis and the many related cardiac glycosides were the first effective agents for the treatment of dropsy associated with congestive heart failure. However, it was soon recognized that the mobilization of the excess tissue fluid associated with this condition was due to a primary action on the heart with improved cardiovascular hemodynamics and only secondarily to an action upon the kidney. 

C. Toxicity Cardiovascular adverse effects, which are extensions of the beta blockade induced by these agents, include bradycardia, atrioventricular blockade, and congestive heart failure. Patients with airway disease may suffer severe asthma attacks. Premonitory symptoms of hypoglycemia from insulin overdosage, eg, tachycardia, tremor, and anxiety, may be masked, and mobilization of glucose from the liver may be impaired. CNS adverse effects include sedation, fatigue, and sleep alterations. Atenolol, nadolol, and several other less lipid-soluble beta-blockers are claimed to have less marked CNS action because they do not enter the CNS as readily as other members of this group. 

Cardiovascular toxicities have been observed in patients with a number of anticancer agents. These toxicities have included hypertension, cardiomyopathy, left ventricular dysfunction, congestive heart failure, infarction, and thrombosis. In most cases, the standard repeated-dose toxicology studies conducted in normal animals have failed to predict these clinical toxicities. One reason may be that other comorbidities need to be present before the treatment-related cardiovascular... 

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