心內科常用藥小結（Summary of commonly used drugs in Department of Cardiology）

1、心內科常用藥小結（Summary of commonly used drugs in Department of Cardiology）Source of commonly used medicine in Department of Cardiology: Tao Yus DiaryPhentolamine mesylate 1.Function and useThis product is a blocker of alpha - blockers, which can rapidly dilate peripheral blood vessels by blocking the acti

2、vation of alpha - adrenoceptor and indirectly activating beta - receptor. It can significantly reduce peripheral vascular resistance, increase peripheral blood volume and improve microcirculation. This product has an exciting effect on the heart, increases the contractility of the myocardium, increa

3、ses the heart rate and increases the cardiac output. The main clinical treatment for acute heart failure, pulmonary congestion or pulmonary edema, vascular spasm, acrocyanosis, perceptual toxic shock and test in the diagnosis of pheochromocytoma. It is also used for ventricular premature beat.Dosage

4、 and usage1 treatment of vascular spasm of intramuscular injection or intravenous infusion, 5mg/ times, 12 times / day.2 intravenous infusion of 0.3mg per minute can increase the cardiac output.3 the diagnosis of pheochromocytoma by intravenous injection of 5mg, 1 blood pressure measurement every 30

5、 seconds after injection, can be continuously measured for 10 minutes, such as in 24 minutes the blood pressure decreased by 4.67/3.33kPa (35/25mmHg) above and maintained for 35 minutes as the positive results.2. dopamineFunction and useThis product is a precursor of norepinephrine in vivo. It has t

6、he function of the activation of the beta receptor and the activation of the alpha receptor. Can enhance myocardial contractility, increased cardiac output, heart rate effects are slight (as isoproterenol significantly); mild contraction of peripheral vessels, increased arterial pressure on the spla

7、nchnic vascular (kidney, mesentery, coronary artery) to expand, increase blood flow; the renal blood flow and glomerular filtration rate to increase the urine volume and sodium excretion. For various types of shock, including toxic shock, cardiogenic shock, hemorrhagic shock, central shock, especial

8、ly for patients with renal insufficiency, reduced cardiac output, peripheral vascular resistance and low blood volume of patients has been up more meaningful. There are three variants of the DARPP-32 gene: TT, TC, and CC, which determine the level of dopamine in the brain.IndicationApplicable caused

9、 by myocardial infarction, trauma and endotoxin sepsis, cardiac surgery, renal failure, congestive heart failure and shock syndrome; supplement the blood volume after the shock is still not correct, especially shock oliguria and peripheral vascular resistance is normal or low. Because this product c

10、an increase cardiac output, it is also used for digitalis and diuretic ineffective cardiac dysfunction.3. Isosorbide Mononitrate TabletsIndicationLong term treatment of coronary heart disease; prevention of angina pectoris; treatment of persistent angina pectoris after myocardial infarction; combine

11、d with digitalis and / or diuretics in the treatment of chronic congestive heart failure.Adverse reactionAt the initial stage of the medication, there may be a vasodilator headache caused by nitrates, which usually disappear after a few days of continuous administration. Facial flushing, vertigo, or

12、thostatic hypotension and reflex tachycardia may also occur. Occasionally, the blood pressure decreased significantly, bradycardia, angina aggravated and syncope.Contraindications: acute circulatory failure (shock, circulatory collapse); severe hypotension (systolic blood pressure 90 mmHg); acute my

13、ocardial infarction with low filling pressure (unless there is continuous hemodynamic monitoring conditions); hypertrophic cardiomyopathy; constrictive pericarditis or cardiac tamponade; severe anemia; glaucoma; intracranial hypertension; allergy of nitro compounds4. sodium nitroprussideAdaptive sym

14、ptomsAs for hypertensive emergencies, such as before and after hypertensive crisis, hypertensive encephalopathy, hypertension, malignant pheochromocytoma and paroxysmal hypertension emergency lowering blood pressure, but also for surgical anesthesia during controlled hypotension;(2) for acute heart

15、failure, including acute pulmonary edema. It should be used for acute myocardial infarction or valveAcute heart failure in patients with mitral regurgitation or mitral regurgitation.Pharmacodynamic theoryThis product is a quick acting and short acting vasodilator. The arteries and veins smooth muscl

16、e expansion, but does not affect the uterus, duodenum or myocardial contraction; change the local blood flow distribution is not much. Vasodilation reduces the resistance of peripheral blood vessels, thereby reducing blood pressure. Vasodilation can reduce the preload and afterload of the heart and

17、improve the cardiac output, so it is beneficial to heart failure. Afterload reduces the impedance of the aorta and the left ventricle during valve regurgitation and reduces regurgitation.Immediately after intravenous drip, the peak value of blood concentration was reached, and the level was determin

18、ed by dose. This product is metabolized by red blood cells into cyanide, the cyanide metabolism in the liver is thiocyanate, the metabolites have no expansion of vasoactive activities; cyanide can also be involved in the metabolic process of vitamin B12. This product almost immediately acted and rea

19、ched its peak after administration, and the effect was maintained for 110 minutes after the cessation of intravenous drip. The half-life of the patients with normal renal function was 7 days (determined by thiocyanate), prolonged renal function or hyponatremia, and excreted by the kidney.Adverse rea

20、ctionShort term use of appropriate dose does not cause adverse reactions.(1) the toxicity of its metabolite from cyanide and thiocyanate cyanide is an intermediate metabolite of thiocyanate as final metabolites, such as cyanide cannot be converted to normal thiocyanate, then the thiocyanate concentr

21、ation is normal also poisoning.(2) when the blood pressure is controlled during the operation, the drug is stopped suddenly, especially when the blood concentration is high and the drug is stopped abruptly. Rebound blood pressure may increase.(3) adverse reactions occurred in the following three cas

22、es:The blood pressure drop too fast play, dizziness, sweating, headache, muscle twitching, nervousness or anxiety, irritability, stomachache, reflex tachycardia or arrhythmia, the occurrence of symptoms associated with intravenous administration of speed, and not the total relationship;(2) when the

23、thiocyanate poisoning or excessive dose, can appear movement disorders, blurred vision, delirium, dizziness, headache, loss of consciousness, nausea, vomiting, tinnitus, shortness of breath;The cyanide poisoning or supramaximal, can appear reflex, coma, heart sounds distant, hypotension, pulseless,

24、skin pink, shallow breathing, mydriasis. Nausea, vomiting, headache, loss of appetite, rash, sweating, drug fever, excessive dose of blood pressure, can cause insufficient blood supply to important organs. Long term use of thiocyanate poisoning symptoms, severe overdose can cause coma and death.Exce

25、ssive hypotension can cause severe coronary artery or cerebral vascular hypoperfusion with severe consequences. Therefore, it is unwise to use this medicine without continuous monitoring of the heart. Other adverse reactions were related to the degradation of the drug to cyanide. If the dose is larg

26、e or long-term high speed drops, cyanide accumulation can lead to tissue hypoxia, metabolic acidosis and death, especially in patients with decreased renal function. Vitamin B12 is also added to prevent these adverse reactions. Small doses of this drug for a few days can lead to thiocyanate poisonin

27、g, manifested as hypothyroidism, headache, loss of appetite, nausea, vomiting and weakness, and the development of coma and death. Methemoglobin is rareFive Salviae Miltiorrhizae Liguspyragine Hydrochloride and Glucose Injection.IndicationFor cardiovascular disease, angina, myocardial infarction, ca

28、rdiopulmonary bypass surgery, heart failure, myocarditis, hypertension; cerebral vascular disease such as transient ischemic attack (TIA), cerebral thrombosis, cerebral embolism, lacunar infarction, vertebrobasilar insufficiency, cerebral arteritis, stroke sequelaePeripheral vascular diseases, such

29、as thrombosis obliterans, vasculitis, etc. Other: pulmonary heart disease, pneumonia, chronic obstructive pulmonary disease, interstitial lung disease; acute and chronic hepatitis, liver fibrosis, liver cirrhosis, fatty liver, digestive system inflammation; acute and chronic nephritis, nephrotic syn

30、drome, renal insufficiency, acute and chronic renal failure; diabetic vascular nerve complications; sudden deafness and tinnitus; fracture, trauma; migraine, hypertrophic scar,Swelling of the sores, herpes zoster, and prevention of ischemia reperfusion injury after various operationsSix dyphylline.I

31、ndicationIt is suitable for bronchial asthma, asthmatic bronchitis, obstructive emphysema and so on to relieve wheezing symptoms. It is also used for asthma caused by cardiogenic pulmonary edema.Adverse reactionSimilar to theophylline, when the dose is too large, nausea, vomiting, irritability, inso

32、mnia, tachycardia and arrhythmia can occur. Even fever, dehydration, convulsions and other symptoms, severe and even respiratory and cardiac arrest.Contraindications are contraindicated in patients who are allergic to this product, active peptic ulcer and untreated convulsive disease.Note 1, patient

33、s with acute severe asthma is not the first choice of this product. 2, theophylline drugs can cause arrhythmia and / or worsen the original arrhythmia; if the patients heart rate is too high and (or) any abnormal changes in heart rhythm, we should pay close attention to. 3. Patients with hypertensio

34、n or peptic ulcer history should be careful with this product. 4, large dose can cause central excitement, pre sedation can prevent.Digoxin sevenIndication1. Acute and chronic cardiac insufficiency, such as hypertension, valvular heart disease, congenital heart disease, etc. It is especially suitabl

35、e for heart failure with atrial fibrillation accompanied by rapid ventricular rate; for pulmonary heart disease and myocardiumSevere ischemia, active myocarditis and extra cardiac factors, such as severe anemia, hypothyroidism and heart failure due to vitamin B1 deficiency, are of poor efficacy;2. T

36、o control ventricular rate and supraventricular tachycardia in patients with atrial fibrillation and atrial flutter accompanied by rapid ventricular rate.Adverse reaction(1) the common side effects included arrhythmia, poor appetite, nausea and vomitingThe central nervous system), lower abdominal pa

37、in, abnormal weakness and weakness.(2) rare reactions include blurred vision or color vision, such as yellow vision, green vision, diarrhea, and the central nervous systemNervous system reactions, such as depression or confusion.(3) rare reactions include somnolence, headache and rash, and hives (an

38、aphylaxis).(4) in the intoxication of digitalis, arrhythmia is the most important, and ventricular premature beat is the most common,About 33% of the adverse events associated with arrhythmias. The second is atrioventricular block, paroxysmal or accelerated sexual intercourseTachycardia, paroxysmal

39、atrial tachycardia with atrioventricular block, ventricular tachycardia, sinus arrest, heartVentricular fibrillation, etc. Children with central arrhythmia are more common than other reactions, but ventricular arrhythmias are less common than adults. newbornThere is a prolongation of P - R interval

40、in infants.Eight (Cediland) desacetyldigilanideIndication(1) mainly used for heart failure. Because of its fast acting, it is suitable for acute cardiac insufficiency or chronic cardiac insufficiencySexual aggravated patients.(2) it can also be used to control the ventricular rate in patients with a

41、trial fibrillation and atrial flutter accompanied by rapid ventricular rate. (3) termination of supraventricular tachycardia has a slow onset and has been used less frequently.Adverse reactionDigoxinNine furosemide.IndicationClinically, it is used to treat peripheral edema caused by cardiac edema, r

42、enal edema, ascites of cirrhosis, dysfunction or vascular obstruction, and can promote the discharge of upper urethral calculi. The diuretic action is rapid and powerful, and is used for severe patients with other diuretics ineffective. Due to the obvious loss of water and electrolyte, it is not sui

43、table for routine use. Intravenous administration (20 to 80mg) can treat pulmonary edema and cerebral edema. Drug poisoning can be used to accelerate the excretion of toxicant.Matters needing attention1. mild nausea, diarrhea, drug eruption, itching, blurred vision and other adverse reactions may oc

44、cur, sometimes standing dizziness, fatigue, fatigue, muscle spasm, thirst,A small number of patients had reduced WBC, thrombocytopenia, erythema multiforme, and orthostatic hypotension in individual patients. Long term use can cause gastric and duodenal ulcers. 2. because it can reduce uric acid exc

45、retion, so many times after application can produce uric acid excessive disease, individual patients long-term application can produce acute gout. 3. patients with diabetes can increase blood sugar after application; although their ascending blood glucose is much weaker than that of thiazide diureti

46、cs, there is still possibility of increasing blood sugar when combined with hypoglycemic drugs. 4. because of the rapid and powerful diuresis, we should pay attention to the beginning dose, prevent excessive diuresis, and cause dehydration and electrolyte imbalance. 5. hepatitis patients after takin

47、g, because of electrolyte (especially potassium ion) excessive loss, easy to produce liver coma. 6. when long-term use of large amounts of drugs, should pay attention to check the concentration of electrolyte in the blood. Patients with refractory edema are particularly prone to hypokalemia, and mor

48、e attention should be paid to potassium supplementation while using digitalis or potassium releasing steroid hormones. 7. reversible blood urea nitrogen levels may occur at the same time of dehydration. If the level of creatinine is not significant and renal function is not damaged, this product can

49、 be continued. 8. use first months, regular examination of serum electrolytes, carbon dioxide and blood urea nitrogen levels. Like other diuretics, when the progression of renal disease is associated with increased serum urea nitrogen and oliguria, medication should be discontinued immediately. 9.,

50、can enhance the role of antihypertensive drugs, so when combined medication, the amount of antihypertensive drugs should be appropriately reduced. 10. because the structure of the product is a kind of similar type of sulfanilamide hydrochlorothiazide compound in the structure, can reduce artery of p

51、ressor amine (norepinephrine) reaction, muscle relaxation and paralytic effect and can increase the tubocurarine, so 1 weeks prior to surgery should be discontinued. 11. hypokalemia, excessive use of digitalis, hepatic coma patients banned. Careful use of patients with advanced cirrhosis. Hearing lo

52、ss or transient deafness can occur when the 12. doses are too fast. The application and compatibility of aminoglycoside antibiotics, more likely to cause hearing loss10. enalaprilPharmacodynamic theoryThe blood pressure in the liver, this product is hydrolyzed to enalaprilat, become a kind of compet

53、itive vesselAngiotensin converting enzyme (ACE) inhibitor angiotensin converting enzyme (Zhang Su converting enzyme inhibitor) does not convert angiotensin II to angiotensin II, which results in increased plasma renin activity, decreased aldosterone secretion, and decreased vascular resistance. Enal

54、aprilat also interfere with degradation of bradykinin phthalide, also decreased vascular resistance. Although this product is thought to reduce blood pressure mainly by inhibiting the renin angiotensin aldosterone system, it is also effective for hypertension with low renin activity.The reduced load

55、 on the heart, the expansion of the artery and vein heart failure, reduce peripheral vascular resistance after load, reduce pulmonary capillary wedge pressure or pre load, reduce pulmonary vascular resistance, thereby improving cardiac output, prolong the time of exercise tolerance.This product is a

56、n angiotensin converting enzyme inhibitor. After oral administration in vivo hydrolysis of enalaprilat on angiotensin converting enzyme, a strong inhibitory effect, reduce the content of angiotensin II, causing systemic vasodilation, decreased blood pressure, for the treatment of hypertension.pharma

57、cological actionThis product is an angiotensin converting enzyme inhibitor, which is hydrolysed into the liver in the liver after oral administrationAnd play a role. The inhibitory effect of the latter on angiotensin converting enzyme was more than 8 times higher than that of Kato Pury. The mechanis

58、m of hypotensive action is the same as that of Kato Pury, but the action time is long. It can keep the contractility of the myocardium and not affect the cardiac output. In patients with congestive heart failure, peripheral blood vessel resistance and pulmonary capillary wedge pressure can be reduce

59、d, thereby reducing cardiac preload and afterload, and improving cardiac function. This product can increase the renal blood flow, and has no significant influence on blood glucose, uric acid and cholesterol metabolism.11. valsartanIndicationsHypertension and mild to moderate essential hypertension

60、are especially suitable for secondary hypertension due to renal damage.Adverse reaction2316 cases of Diovan (Diovan) patients after placebo test showed that the overall incidence of adverse reactions of the drug similar to the placebo group. The results of placebo-controlled trials of 10, Diovan (Di