Last update: 2nd Jan., 2008.
| Drug Information (Cardiology) |
Last update: 2nd Jan., 2008.
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Adenosine (ATP)
Antiarrhythmic, first line drug used for termination of Supraventricular Tachycardias (SVT) involving the AV node or the accessory pathways (WPW).It can also block the AV node transiently to facilitate the interpretation of the surface ECG.
Dose: 10mg-20mg iv push
Side effects: flushing, chest discomfort, asthmatic attack
Contra: asthma, COAD/COPD, heart blocks
Aldactone
A diuretic to treat heart failure, fluid retention due to cirrhosis of liver. Recent stuyd (RALES) showed that it is useful for heart failure patients and increase their chance of survival.
Dose: 25mg om - 50mg tds
Side effect: hyper K
Alteplace tPA (t-PA)
Thrombolytics, used to lyse the clot inside the coronary vessels in acute myocardial infarction, can also be used for pulmonary embolism
Dose: 10mg bolus then 50,20,20mg q1h. Accerelated: 5mg bolus then 50mg over 30 minutes, 35mg over 1 hour
Side effects: bleeding
Contra: recent surgical operation, recent GI bleeding, cerebral haemorrhage, pregnancy, bleeding tendency, severe hypertension
Amlodipine
Calcium Channel Blocker (CCB), 2nd generation. Use for hypertension, ischemic heart disease and angina.
Dose: 5-10mg per day
Side effect: dizziness, headache, peripheral edema, congestive heart failure
Amiodarone
Class III anti-arrhythmic. Used for terminating and preventing supraventricular arrhythmias (SVT) including atrail fibrillation and ventricular arrhythmias (VT)
Dose: loading 5mg/kg then 15mg/kg/day, tail off
Sie effect: pulmonary fibrosis, visual disturbance, thyroid dysfunction, heart failure, rash, GI upset, amny drug interactions (digoxin, anti-arrhythmics, warfarin)
Anistreplase (APSAC)
Thrombolytic for lysis of clot in the coronary vessels in acute myocardial infarction.
Dose: 30U over 2-5 mins iv
Side effects: bleeding
Contra: see tPA
Aspirin
Analgesic, used also for reducing risk of myocardial infarction and risk of death after infarction or angina. Also used for reducing risk of thromboembolism in high risk patients
Dose: 80-325mg P.O.
Side effect: GI upset, bleeding, ulcer
Contra: bleeding tendency
Atenolol
Beta blocker. Used for treatment of hypertension, ischemic heart disease, angina, post myocardial infarction, heart failure
Dose: 50-200mg/day
Side effect: heart failure, heart block, bradycardia, reduce exercise tolerence, prolong QT
Contra: asthma, COAD/COPD, heart block, severe heart failure, peripheral vascular disease
Atropine
Anticholinergic. Treatment of bradycardia nad heart blocks
Dose: 0.6-2.0mg (max) iv
Side effect: dry mouth, urinary retention, confusion
Contra: myocardial ischemia, asthma, ileus, glucoma,
Abciximab (Reopro)
A new Glycoprotein IIb/IIIa receptor antagonist. Use for complicated PTCA/PTCS procedures, also studied for use in unstable angina and acute myocardial infarction.
Dose: bolus + infusion
Side effects: allergic reactions, bleeding tendency
Captopril
Angiotensin Coverting Enzyme Inhibitor (ACEI). Used for treatment of hypertenison, heart failure and post myocardial infarction remodelling
Dose: 25-150mg tds PO
Side effect: impair renal function, cough, headache, anaemia
Contra: hyperkaelemia, renal artery stenosis, pregnancy, outflow obstruction
Carvedilol
Alpha & Beta-blocker with vasodilor activity. Used for treatment of congestive heart failure. Start at low dose and titrate up slowly in 2 weekly time. New studies showed that it reduce mortality in Class II-IV heart failure patients.
Side effect: asthmatic attack, bradycardia, worsening of heart failure
Chlorothiazide
diuretic. Used for treatment of hypertension, heart failure
Dose: 0.5-1g PO/IV
Side effects: hypotension, hypokalemia, impaired renal function
Cholestyramine
bile acid sequestrant. Treamtment of hyperlipidaemia
Dose: 12-24gm PO
Side effect: decrease absorption of Vit A,D,E,K., constipation
Contra: Complete biliary obstruction
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Clofibrate
Fibric acid derivative. treatment of hyperlipideamia
Dose: 2G PO
Side effect: nausea, diarrhoea, myopathy
Clopidrogel
A new anti-platelet (acts on ADP receptor) with similar action to ticlodipine. Use for angina, PTCA/S procedures and strokes. New studies showed that it useful for unstable angina and myocardial infarction. Especially important after stenting to keep the stents patent. Recently, studies have shown that longer term use of this drug will help in the patency of the drug eluting stents.
Side effects: bleeding tendency, allergic reaction, GI upset, TTP.
Digoxin
Digitalis. Use for the control of ventricular rate in atrial fibrillation, heart failure and PAF
Dose: 0.0625-0.3125mg /day
Side effect: atrial and ventricular arrhythmias, heart blocks, GI upset
Contra: ventricular fibrillation
Dipyridamole
Antiplatelet. Use for prevention of thromboembolic disease, cardiac valvulaer replacement, stenting.
Dose: 75-100mg BD PO
Side effect: hypotension
Disopyramide
Class Ia anti-arrhythmic. Treatment of atrial and ventricular arrhythmias
Dose: 300-600mg/day PO
Side effect: heart failure, hypotension, prolong QT, heart block
Dobutamine
inotopic agent. Use for blood pressure support, hypotension.
Dose: 2-40ug/kg/min iv
Side effect: increase heat rate, myocardial ischemia, increase risk of arrhythmia
Contra: hypertrophic heart disease, severe aortic stenosis
Dofetilide
to treat AF and restoration of normal cardiac rhythm.
Side effect: TdP arrhythmia
Dopamine
inotopic agent. Use for blood pressure support, hypotension, renal vascular perfusion (low dose)
Dose: 2-50ug/kg/min iv
Side effect: increase heat rate, myocardial ischemia, increase risk of arrhythmia
Contra: pheochromocytoma, tachyarrhythmia
Enalapril
ACEI. see Captopril
Dose: 2.5-40mg/day
Side effect & Contra: see captopril
Epinephrine
Vasopressor. treatment of hypotension and shock, ventricular fibrillation, asystole, cardiac arrest, bradycardia, analyphylactic shock
Dose: 1-20ug/min
Side effect: sweating, headache, increase heart rate, peripheral vasocontriction with necrosis of tissue
Felodipine
Calcium Channel blocker (CCB). see amilodipine
Dose: 5-10mg/day
Flecainide
Class Ic antiarrhythmic. Treatment of atrial and ventricular arrhythmias.
Dose: 100-400mg/day
Side effect: heart failure, heart block, increase mortality in post myocardial infarction with ventricular ectopics
Furosemide
Loop diuretics. Treatment of hypertnsion and heart failure
Dose: 20-600mg/day
Side effect: GI upset, sensivity, hypotension,
hypokalemia
Heparin
Anticoagulant. Treatment of deep vein thrombisis, pulmonary embolism, acute myocardial infarction, unstable angina, peripheral vessel embolism.
Dose: 5,000U iv bolus and 500-2,000U/hour. Adjusted by APTT time.
5,000-20,000U S.C. for prophylaxis
Side effect: bleeding, low platelets, osteoporosis
Contra: severe thrombocytopenia, bleeding tendency
Heparin (low molecular weight)
Anticoagulant. Prophylaxis of deep vein thrombosis, pulmonary embolism. Also used after PTCA/S.
Dose: 0.2-1.0 ml S.C. every 12 hours
Side effect: same as heparin
Hydralazine
direct vasodilator. Treatment of malignant hypertension, heart failure, pre-eclampsia, eclampsia
Dose: 10-400mg/day PO, iv 10mg bolus with 200-600mg/day maintaince
Side effect: edema, hypotension
Contra: myocardial ischemia, severe mitral valve disease
Ibutilide
Class III antiarrhythmic. IV preparation for acute conversion of atrial fibrillation or flutter.
Dose: 1mg in 2 divided dose over 30mins
Side effect: ventricular arrhythmias
Isosorbide dinitrate
Nitrate. treatment of angina and ischemic heart disease
Dose: 5-20mg PO
Side effect: headache, hypotension, tolerance to drug, flushing
Contra: hypertrophic cardiomyopathy, severe anaemia
* Drug expires if container opened for more than 3 months
Labetalol
alpha and beta blocker. Treatment of hypertension, pheochromocytoma and dissecting aortic aneurysm
Dose: 100-400mg BD PO. 20mg iv bolus
Side effect and contra: see atenolol
Lidocaine
Class Ib anti-arrhythmic. Treatment of ventricular arrhythmiac, ventricular fibrillation
Dose: 50-150mg iv bolus 1-4mg/min infusion maintaince
Side effect: confusion, dizziness, hypotension
Contra: severe SA or AV nodal disease
Lisinopril
ACEI. see captopril
Dose: 10-40mg/day
Losartan
Ang II receptor antagonist. Treatment of hypertension, may be heart failure
Dose: 50mg qd
Side effect: hypotension, hyperkalemia, renal impairment
Lovastatin
HMGCoA reductase inhibitor. Treatment of hyperlipidemia
Dose: 20-40mg/day PO
Side effect: myopathy, myalgia, liver impairment, rhabdomyolysis
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Methydopa
Alpha-blocker (central). Treatment of hypertension
Dose: 250-500 tds-qid PO
Side effect: sedation, headache, liver impairment, haemolytic anaemia
Contra: hepatitis (acute)
Metoprolol
beta-1-selective blocker. Treatment of hypertension, ischemic heart disease and post myocardial infarction decrease in mortality.
Dose: 50-450mg/day BD PO.
Side effect and contra: see atenolol
Minoxidil
direct vasodilator. treatment of hypertension and heart failure
Dose: 2.5-40mg/day
Side effect: edema, tachycardia, hypotension, pericardial effusion, hypertrichosis
Nifedipine
CCB- see amlodipine
Dose: 5-20 tds PO
Nimodipine
CCB
Dose: for subarachnoid haemorrhage 60mg q4h for 3 weeks
Nitroglycerin
Nitrate. treatment of angina and ischemic heart disease
Dose: 0.15-0.6mg SL
Side effect and contra: see isosorbide dinitrate
Nitropusside
direct vasodilator. Treatment of hypertension, heart failure and dissecting aorta aneurysm
dose: 0.3-10ug/kg/min iv infusion. titrate with BP
Side effect: hypotension, thiocyanide posioning, tachycardia, shock
Pravastatin
HMGCoA reductase inhibitor. see lovastatin
Dose: 10-40mg/day
Procainamide
Class Ia antiarrhythmoc. treatment of atrail and ventricular arrhythmias
Dose: 50mg/kg/day q3h
Side effect: hypotension, rash, SLE like syndrome, agranulocytosis
Propranolol
beta-blocker. see atenolol
Dose: 10-30 tds/qid PO
Protamine
heparin antagonist. Reversal of heparin anticoagulation and treatment of overdose
Dose: 10-50mg iv
Side effect: hypotension, allergy, heparin rebound
Rosuvastatin
a new HMGCoA reductase inhibitor. It has been shown to be the strongest statin to lower LDL.
Dose: 5-40mg PO
Side effect: see other statins
Simvastatin
HMGCoA reductase inhibitor. see lovostatin
Dose: 5-40mg/day PO
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Sotalol
Class II and III anti-arrhythmic. Treatment of supraventricular arrhythmia and ventricular arrhythmia
Dose: 20-240 BD PO
Side effect: see atenolol, also prolong QT and risk of Torsade de Pointes
Streptokinase
thrombolytic. Treatment of acute myocardial infarction (onset of chest pain less than 12 hours) and pulmonary embolism
Dose: 1.5MU over 30-60 mins iv
Side effect and contra: see tPA
Ticlodipine
antiplatelet agent. Stroke prevention and thromboembolic disease, also used for PTCA and stenting procedures (less used now because of the side effects.
Dose: 250mg BD PO
Side effect: GI upset, decrease platelet and white cell, impair liver function, TTP
Contra: neutropenia, bleeding tendency
Urokinase
thrombolytic. see streptokinase
Dose: 2-3MU over 60 minutes
Verapamil
CCB. treatment of hypertension, angina and atrial arrhythmias.
Dose: 40-120mg tds PO 5-10mg iv
Side effect: heart block and heart failure (esp. with beta blocker), edema
Contra: heart block, heart failure, hypotension, AF with accessary pathway, iv beta blocker.
Warfarin
anticoagulant. Prophylaxis and treatment of thromboembolic disease, pulmonary embolism
Dose: 1-10mg/day PO titrate according to INR
Side effect: bleeding, allergy
Contra: pregnancy, bleeding tendency, suspected
Protein
C,S deficiency
Ximelagatran
first oral treatment in a new class of direct thrombin inhibitors (DTIs) to prevent and treat thrombosis
no need for INR monitoring
Side effect: bleeding
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