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Cardiovascular Drugs (See Digoxin)


Definition


  • Cardiovascular drugs include the antiarrhythmics, the anticoagulant warfarin, and antihypertensives, as well as the Ž ²-adrenergic antagonist propranolol and the drug digoxin.
  • Normal therapeutic values: see Table 16.15.

‚  
TABLE 16 " “15Cardiovascular DrugsView LargeTABLE 16 " “15Cardiovascular Drugs Drug Name Used to Treat Therapeutic Level Potential Toxic Level* Generic Brand Antiarrhythmics Amiodarone Cordarone Supraventricular and ventricular arrhythmias "   1.5 " “2.5 Ž ¼g/mL ≥3.0 Ž ¼g/mL Flecainide Tambocor Ventricular arrhythmias 0.2 " “1.0 Ž ¼g/mL [trough] >1.0 Ž ¼g/mL Lidocaine Xylocaine Ventricular arrhythmias (also prevention) 1.4 " “6.0 Ž ¼g/mL >6.0 Ž ¼g/mL Mexiletine Mexitil Arrhythmias 0.5 " “2.0 Ž ¼g/mL [trough] >1.5 Ž ¼g/mL Procainamide (active metabolite: NAPA) Pronestyl Supraventricular and ventricular arrhythmias Procainamide: 4 " “10 Ž ¼g/mL NAPA: 6 " “20 Ž ¼g/mL Procainamide: ≥12 Ž ¼g/mL NAPA: >30 Ž ¼g/mL Quinidine Duraquin Supraventricular and ventricular arrhythmias 1.5 " “4.5 Ž ¼g/mL >10.0 Ž ¼g/mL Verapamil (calcium channel blocker) Calan Supraventricular dysrhythmias, angina pectoris, and hypertension 50 " “200 ng/mL [peak serum] ≥400 ng/mL [peak serum] Anticoagulant Warfarin Coumadin Blood clotting; drug, a synthetic vitamin K antagonist, is an anticoagulant " ¡ 7 mg/L 10 mg/L Antihypertensives Diltiazem (calcium channel blocker) Cardizem Angina pectoris and hypertension ‚ § 40 " “200 ng/mL Nifedipine Procardia Angina pectoris and hypertension ‚ ¶ 25 " “100 ng/mL >100 ng/mL Beta " “adrenergic Antagonist Propranolol Inderal Arrhythmias and hypertension 30 " “250 ng/mL *Toxic concentrations have not been established. "  Monitor TSH and T4 values during therapy. " ¡Prothrombin time is used to assess efficacy as target INR: 2.0 " “3.0. Consider long-term, low-intensity (INR 1.5 " “2.0), or standard-intensity (INR 2 " “3) warfarin therapy for patients with idiopathic events. ‚ §Effect on platelets may increase bleeding time. ‚ ¶Decreased glucose tolerance.

Use


  • To treat arrhythmia, hypertension, blood clotting, and angina.
  • The majority of these drugs are not routinely monitored as clinical effects do not generally correlate with serum or plasma levels. Notable exceptions are digoxin and procainamide.
  • Where concentrations are required, specific gas chromatography and HPLC procedures have been developed (e.g., procainamide/N-acetylprocainamide [NAPA], quinidine, mexiletine, diltiazem, verapamil, amiodarone, and metabolite, warfarin). Limits of quantitation vary according to the drug and methodology.
  • Immunoassay tests (e.g., FPIA) are available for procainamide, quinidine.
  • In addition, lidocaine, diltiazem, verapamil, and quinidine are qualitatively detectable in urine with a simple alkaline liquid " “liquid or solid-phase extraction followed by GC/MS analysis. Limits of detection range from 50 to 250 ng/mL.

Interpretation


  • Rifampin may decrease verapamil serum concentrations.

Limitations


  • With procainamide, separate cells from plasma as soon as possible to prevent loss of drug during storage.
  • Hemolyzed samples are unacceptable.
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