Other Cardiovascular Agents

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10 mg 3 times daily. Dosing should take place during the daytime hours when the patient needs to be upright, pursuing the activities of daily life. Recommended that treatment of patients with abnormal renal function be initiated using 2.5 mg doses. 

Provide thyroid hormone that is structurally and functionally to equivalent an endogenously produced thyroid hormone 

Diagnosed, but uncorrected adrenal cortical insufficiency Untreated thyrotoxicosis Hypersensitivity to any component of drug Myocardial infarction 

Weightless, palpitation, ner vousness, diarrhea or abdominal cramps, sweating, tachycardia, cardiac arrhythmias, angina pectoris, tremors, headache, insomnia, intolerance to heat, and fever 

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Other Cardiovascular Agents Effecting Atherosclerosis. A large amount of clinical data is available concerning semm Upid profiles in patients subjected to dmg therapy for other cardiovascular diseases. Atheroma, for example, may be the underlying cause of hypertension and myocardial infarction. There are on the order of 1.5 million heart attacks pet year in the United States (155). 

Dunn NR, Freemantle SN, Mann RD. Cohort study on calcium channel blockers, other cardiovascular agents, and the prevalence of depression. Br J Clin Pharmacol 1999 48(2) 230-3. 

Selman Waksman s commitment to the isolation and screening of soil bacteria in the search for bioactive small molecules, especially potential antibiotics, was validated by the discovery of streptomycin. This led to the creation of the modem biopharmaceutical industry and the subsequent isolation of tens of thousands of bioactive small molecules from soil bacteria and other environments. A proportion of these compounds have become highly successfnl therapeutics, not only for all types of infectious diseases, but also in the treatment of many other human and animal ailments and as anticancer, immnno-modnlatory, and cardiovascular agents. Waksman and Fleming could be considered the fathers of chemical biology (Figure 1.1). 

After highlighting the present top ten pharmaceuticals, let us now cover a number of other important drugs, both prescription and over-the-counter. We will attempt to categorize them by physiological action but will emphasize chemical structure and synthesis where appropriate. Our first type will be drugs affecting the heart. Cardiovascular agents are used for their action on the heart or on other parts of the vascular system. They modify the total output of the heart or the distribution of blood to certain parts of the circulatory system. 

Isoflurane has a dose-dependent depressant effect on the myocardium. In vitro studies indicate that it reduces myocardial contractility to a similar extent as halothane. In vivo, isoflurane appears to be less of a cardiovascular depressant than other volatile agents. 

The use of propofol is associated with a feeling of well-being during early recovery and nausea and vomiting is less common in the postoperative period than with some other intravenous agents. Subanaesthetic doses of propofol have been used to treat early postoperative nausea and emesis. Cardiovascular system... 

Adjunctive use of potent opioids (eg, fentanyl and related compounds) contributes cardiovascular stability, enhanced sedation, and profound analgesia. Other intravenous agents such as the benzodiazepines (eg, midazolam, diazepam) have slower onset and recovery features and are rarely used for induction of anesthesia. However, preanesthetic administration of benzodiazepines can be used to provide a basal level of sedation and amnesia when used in conjunction with other anesthetic agents. 

Etomidate is a carboxylated imidazole that can be used for induction of anesthesia in patients with limited cardiovascular reserve. Its major advantage over other intravenous agents is that it causes minimal cardiovascular and respiratory depression. Etomidate produces a rapid loss of consciousness, with minimal hypotension. The heart rate is usually unchanged, and the incidence of apnea is low. The drug has no analgesic effects, and coadministration of opioids may be required to decrease cardiac responses during tracheal intubation and to lessen spontaneous muscle movements. Following an induction dose, recovery is rapid (< 5 minutes). 

Table I provides a summary of the principal photoreactive agents that have been investigated clinically or are currently undergoing industry-sponsored development for endovascular use. A small number of other photoreactive agents (including various porphyrin and phthalocyanine derivatives) have been investigated in basic cardiovascular research studies or in in vivo models of cardiovascular disease.

Q10 Other bronchodilator agents include nebulized ipratropium. Ipratropium is a muscarinic receptor antagonist that helps to relax bronchial smooth muscle which has contracted via parasympathetic stimulation. The xanthines theophylline and aminophylline (theophylline ethylenediamine) are alternative bronchodilator agents. These agents may act as phosphodiesterase inhibitors and, although they have been used as bronchodilators for many years, adverse CNS, GI and cardiovascular effects may limit their usefulness. 

Standardization of medications can be an effective method to reduce errors. High-risk medications can often be standardized to minimize confusion, streamline ordering, and allow preprinted rate charts to be available to staff. Insulin, heparin, cardiovascular agent infusions, and other high-risk medications lend themselves to this safety step. 

Because tropicamide is reported to be devoid of vasopressor effects in adults, it is one of the safest mydriatic agents for use in patients with systemic hypertension, angina, or other cardiovascular disease. Tropicamide has also been shown to be the safest agent (as indexed by changes in blood pressure and heart rate) for dilated retinal examinations in neonates. Additional information on pupil dilation in infants may be foimd in Chapter 8. 

Systemic beta-blockers are used extensively far the treatment of hypertension and other cardiovascular disorders. Of the available oral beta-blockers, atenolol, metoprolol, nadolol, pindolol, propranolol, and timolol have been documented to produce a dose-dependent reduction in lOP. The ocular hypotensive effect associated with systemically administered beta-blockers can be compared with that achieved with topically applied beta-blockers such as timolol. Although specific studies have not been conducted with most of the remaining systemic beta-blockers, these agents might also be expected to reduce lOP at clinically useful doses. 

Pharmacodynamic interactions. Many TCAs cause sedation and therefore co-prescription with other sedative agents such as opioid analgesics, antihistamines, anxiolytics, hypnotics and alcohol may lead to excessive drowsiness and daytime somnolence. The majority of TCAs can have undesirable cardiovascular effects, in particular prolongation of the QT interval. A similar risk of QT prolongation arises with many other cardiovascular drugs including amiodarone, disopyramide, procainamide, propa-... 

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