Cardiovascular drugs essential

Cardiovascular drugs generally exert their aetion on the heart or blood vessels in a direct or indirect manner thereby affecting the distribution of blood to certain specified portions of the circulatory system. Therefore, they essentially embrace a rather wide spectrum of such drugs which possess cardiovascular actions. 

Stibophen is not a cardiovascular drug, but the proposed mechanism by which stibophen induces anemia would also fit the data generated by Freedman et al. (1956) for quinidine anemia and be compatible with Shulman s passive bystander hypothesis for drug-induced thrombocytopenia (Shulman 1958). The essential feature of the mechanism is the formation of a drug-antibody complex which passively adheres to red cells. Complement is fixed by the complex and the cells are lysed as a result. 

More broadly, timolol therapy should be considered with caution in patients with any significant sign, symptom, or history for which systemic beta-blockade would be medically imwise.This includes disorders of cardiovascular or respiratory origin (e g., asthma, chronic bronchitis, and emphysema) as well as many other conditions. Spirometric evaluation after institution of timolol therapy may help to identify patients in whom bronchospasm develops after commencement of therapy. In general, however, patients with asthma and other obstructive pulmonary diseases should avoid this drug. Sympathetic stimulation may be essential to support the circulation in individuals with diminished myocardial contractility, and its inhibition by P-adrenoceptor antagonists may precipitate more severe cardiac feilure. 

Modern monitoring by both invasive and non-invasive techniques is complex and is undertaken in units dedicated to and, equipped for, this activity. The present comment is an overview. Monitoring will normally require close attention to heart rate and rhythm, blood pressure, fluid balance and urine flow, pulmonary gas exchange and central venous pressure. The use of drugs in shock is secondary to accurate assessment of cardiovascular state (especially of peripheral flow) and to other essential management, treatment of infection and maintenance of intravascular volume. 

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