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Cardiovascular acting agents 

Cardiovascular acting agents
Cardiovascular acting agents

D Nicholas Bateman

, Robert D Jefferson

, Simon HL Thomas

, John P Thompson

, and J Allister Vale

Page of

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date: 23 October 2019

Poisoning with drugs acting on the cardiovascular system may cause major toxicity, and they are increasingly a cause of serious poisoning. The mechanisms by which this occurs arekey to understanding how to approach management and are dealt with in this chapter. Beta antagonists, digoxin, antidysrhythmics, and phosphodiesterase inhibitors principally act on myocardial rhythm and function. Digoxin may cause bradycardia and/or cardiac tachyarrhythmias. Calcium channel antagonists produce a mixed picture in overdose, with direct effects on the heart, including bradycardia and negative inotropic effects, combined with peripheral vasodilatation and metabolic effects such as hyperglycaemia caused by drug effects on insulin release. Hypotension is seen in angiotensin-converting enzyme antagonists,angiotensin-II antagonist, and nitrate poisoning. Newer therapies, including insulin and glucose, are now superseding older treatments for the management of some of these poisonings, in particular calcium channel blocker poisoning. Theophylline is a phosphodiesterase antagonist but poisoning is less common. Cardiac arrhythmias and fits are the usual cause of death after theophylline poisoning.

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