page101
2 Cardiovascular system
2.1
Positive inotropic drugs
81
2.1.1
Cardiac glycosides
81
2.1.2
Phosphodiesterase type-3 inhi-
bitors
83
2.2
Diuretics
83
2.2.1
Thiazides and related diuretics
84
2.2.2
Loop diuretics
86
2.2.3
Potassium-sparing diuretics and
aldosterone antagonists
87
2.2.4
Potassium-sparing diuretics with
other diuretics
89
2.2.5
Osmotic diuretics
89
2.2.6
Mercurial diuretics
90
2.2.7
Carbonic anhydrase inhibitors
90
2.2.8
Diuretics with potassium
90
2.3
Anti-arrhythmic drugs
90
2.3.1
Management of arrhythmias
90
2.3.2
Drugs for arrhythmias
92
2.4
Beta-adrenoceptor blocking
drugs
97
2.5
Hypertension and heart failure
104
2.5.1
Vasodilator antihypertensive
drugs
107
2.5.2
Centrally acting antihypertensive
drugs
110
2.5.3
Adrenergic neurone blocking
drugs
111
2.5.4
Alpha-adrenoceptor blocking
drugs
112
2.5.5
Drugs affecting the renin-angio-
tensin system
114
2.5.5.1
Angiotensin-converting enzyme
inhibitors
115
2.5.5.2
Angiotensin-II receptor antago-
nists
121
2.5.5.3
Renin inhibitors
124
2.6
Nitrates, calcium-channel block-
ers, and other antianginal drugs
124
2.6.1
Nitrates
125
2.6.2
Calcium-channel blockers
128
2.6.3
Other antianginal drugs
134
2.6.4
Peripheral vasodilators and
related drugs
135
2.7
Sympathomimetics
137
2.7.1
Inotropic sympathomimetics
137
2.7.2
Vasoconstrictor sympatho-
mimetics
138
2.7.3
Cardiopulmonary resuscitation
139
2.8
Anticoagulants and protamine
139
2.8.1
Parenteral anticoagulants
140
2.8.2
Oral anticoagulants
146
2.8.3
Protamine sulphate
149
2.9
Antiplatelet drugs
149
2.10
Stable angina, acute coronary
syndromes, and fibrinolysis
154
2.10.1
Management of stable angina
and acute coronary syndromes
154
2.10.2
Fibrinolytic drugs
157
2.11
Antifibrinolytic drugs and
haemostatics
159
2.12
Lipid-regulating drugs
161
2.13
Local sclerosants
169
This chapter also includes advice on the drug man-
agement of the following:
angina,
p.
154
arrhythmias,
p.
90
cardiovascular disease risk,
p.
104 and p.
161
heart failure,
p.
114
hypertension,
p.
104
myocardial infarction,
p.
154
phaeochromocytoma,
p.
113
stroke,
p.
150
2.1
Positive inotropic drugs
2.1.1 Cardiac glycosides
2.1.2 Phosphodiesterase type-3 inhibitors
Positive inotropic drugs increase the force of
contrac-
tion of
the myocardium;
for
sympathomimetics with
inotropic activity see section 2.7.1.
2.1.1
Cardiac glycosides
Digoxin is a cardiac glycoside that increases the force of
myocardial contraction and reduces conductivity within
the atrioventricular (AV) node.
Digoxin
is
most
useful
for
controlling
ventricular
response in persistent and permanent atrial
fibrillation
and atrial flutter (section 2.3.1). For reference to the role
of digoxin in heart failure,
see section 2.5.5.
BNF 61
81
2
Cardiovascular system