Cardiotonic and Hemostatic Drugs: Mechanisms, Effects, and Applications
FCOS CARDIOTONIC:
Digoxin
, Digitoxin, Strophanthins, ouabain, betametil-digoxin desnalosido, lanata c.
Mechanism of action:
positive inotropism. Actions: contractility, automaticity, excitability, conduction velocity, refractory period. Net effects on Ins. Heart:
Increased systolic volume and cardiac output, cardiac silhouette size Reduction, Decreased heart rate, decreased venous pressure, disappearance of edema, increased diuresis.
EI:
Cardiac
Arrhythmias: Sinus bradycardia, premature atrial, paroxysmal tachycardia, ventricular extrasystoles, ventricular tachycardia, AV block.
Extracardiac GI:
Anorexia, nausea, vomiting, diarrhea. CNS: Drowsiness, headache, delirium, agitation, mental confusion, hallucinations. Visuals: Flashes, color vision. Allergic: Urticaria, eosinophilia, thrombocytopenia. Endocrine: Gynecomastia.
Digitalis toxicity:
Delete digoxin Admón k, anti-digoxin antibody, Tx. Symptomatic: antiarrhythmics (lidocaine, phenytoin, beta-blockers), Atropine. Comments:
Before digoxin Admin – take less than 60/min pulse if medical advise, monitor onset arrhythmias, symptoms of poisoning Monitor, Monitor weight, edema appearance Monitor, Dar K-rich foods, monitor the voltage, Warn patient important tto.
ANRINONA, MILRINONE: Mechanism of action:
promote the entry of Ca + + into the myocardial cell, and present a vasodilator effect. Catecholamines, dobutamine and dopamine:
can only be given through an IV, oxygen consumption increases by the myocardium.
EI:
own sympathetic hypertonia
FCOS DIURETICS:
Classification according to their effectiveness: Light:
Osmotic Diuretics:
Mannitol, glucose and urea (proximal tubule).
Carbonic anhydrase inhibitors:
Acetazolamide (proximal tubule).
K + Sparing:
Spironolactone, amiloride and triemterene (Last segment distal tubule).
Medium:
Thiazide diuretics:
hydrochlorothiazide, Clopamide, chlorthalidone, indapamide, mebutizida, Xipamide (First segment distal tubule).
Maximum:
High ceiling diuretics or the Handle:
Furosemide Bumetanide, Indacrinona and Piretanida (ramus diluting segment).
Phases of Hemostasis: Hemostasis Primary-phase local contraction: Release of 5-HT vasoconstrictor factors, A, NA, TXA2-phase endothelial trombocitaria: Activation of platelets.
Coagulation:
-Phase formation of thrombin: activation cascade of enzymes and factors. -Phase formation of fibrin: Production of insoluble protein network.
Fibrinolysis:
Healing the injured vascular tissue. Enzymatic destruction of the fibrin network.
Anticoagulants:
Heparin:
liver, lungs, intestines, cel. Barley. It inhibits coagulation in vivo and in vitro. It binds to antithrombin III. It inhibits thrombin. Evil crosses the MB. Admon. Sc or iv, 1-2 h. Half-life low toxicity: haemorrhage, thrombocytopenia, alopecia, hypersensitivity, osteoporosis.
Contraindications:
enf. Hemorrhagic, threatened abortion, active TB, surgery, antiplatelet.
Uses:
venous thrombosis, pulmonary embolism, cardiopulmonary bypass, thromboembolism after stroke.
Protamine:
haemorrhage.
Molecular weight heparins:
Dalteparin, Enoxaparin, Nadroparin, Ardeparin.
Minors union to
Plasma proteins, macrophages, Endothelial Cell, platelets, osteoblasts. Longer shelf life than standard heparin.
High index of subcutaneous bioavailability.
Oral anticoagulants:
COUMARINS warfarin, acenocoumarol, warfarin. Indandione: Phenindione, difenadiona. Prevent activation vit. K1, inhibit clotting in vivo 12-24 h latency period, 3-5 days maximum effect, disappears 10-20 days.
Pharmacokinetics:
good oral absorption, high protein binding (99%), pass into the placenta and milk. Bhe not.
EI hemorrhage (vit K1 or fresh blood), mild gastrointestinal disturbances, hypersensitivity.
Contraindications:
bleeding disorders, ulcers, open wounds, recent surgery, pregnancy, lactation, chronic alcoholism.
Antiplatelet agents:
Aspirin:
irreversible inhibition platelet cyclooxygenase, inhibits cyclooxygenase vessels.
Uses:
transient cerebral ischemia, cardiac valve prostheses. Interacts with warfarin may cause bleeding ticlopidine, clopidogrel: clopidogrel more powerful and less unwanted effects, when there is an alternative to ASA intolerance, 3-5 days maximum effect.
EI:
GI, urticaria, pruritus serious blood. Broad-spectrum anti-platelet activity.
Use:
Prevention of recurrent thrombotic stroke.
Fibrinolytic agents:
streptokinase, anistreplase, urokinase, alteplase. “Active role in the dissolution of the fibrin clot. Activates plasminogen passing plasmin, which degrades fibrin.
Indications:
acute myocardial infarction, tto. Pulmonary embolism, thrombosis, infarction, thrombosis, central retinal vein, cerebral ischemic process.
EI:
bleeding, allergic phenomena, hypotension, fever.
Antifibrinolytic drugs:
AC. EPSILON AMINO Caproico (EACA), AC. TRANEXAMIC (AMCHA). Directly inhibit plasmin, are well absorbed po, prevention of bleeding after treatment. Thrombolytic, when a massive release of Plasmin, Nausea, vomiting and risk of thrombosis, ac. Tranexamic is 10 times more potent, longer-acting.