Medical, Drugs, Pharmaceuticals And Diseases Information

QUINIDINE:  It is an alkaloid from Cinchona bark-the dextroisomer of quinine & has been noted to suppress ‘rebellious palpitation.’ Quinidine increases threshold for excitation and reduces conduction velocity, thus limits the spread of arrhythmia. Quinidine is used to treat  Atrial fibrillation or flutter, paroxysmal supra ventricular tachycardia. Ventricular prema¬ture beats & ventricular tachycardia. Maintenance of sinus rhythm following electro conversion.

Dosage : 200-300 mg 3-4 times daily. Initially give test dose.

Contra indications of  quinidine:  It Not recommended for children and Myasthenia gravis.  Intolerance or idiosyncrasy to quinidine, heart block, C.H.F. and hypo-tensive states.  History of embolism. Special Precautions:   Renal dysfunctions. Paediatric:

Quinidine is Not recommended in Pregnancy: No serious effect reported. Lactation: Not recommended. Elderly: Reduced dosage necessary. Side-effects:  Higher doses can cause A.V. dissociation, nausea, vomiting, diarrhoea, cinchonism (ringing in ear, deafness, vertigo, headache, visual disturbances),, angioedema, asthma & vascular collapse. Drug Interactions:  Cimetidine, erythromycin inhibits the hepatic metabolism of quinidine, interaction with beta-blockers causes sinus bradycardia. Amiodarone may increase the plasma concentration of quinidine. Phenobarbitone and rifampicin decreases its effects.  Hyperkalemia increases effect of quinidine.

Metolazone is a diuretic with actions and uses similar to those of the thiazide diuretics even though it does not contain a thiazide ring system. Metalazone is available under brand names  Zaroxolyn and Mykrox. It is mainly  used to treat congestive heart failure and high blood pressure.

Metolazone is used in the treatment edema,  including that associated with heart failure and for hypertension. For edema usual dose is 5 to 10mg, in some cases doses of 20mg or more but nor more than 80mg to be given in 24 hrs.For  Hypertension:- 2.5 to 5 mg daily either alone or with other anti hypertensives.

Metolazone aggravates  hypersensitivity to other thiazides and sulfonamide derivatives. It is contraindicated in  anuria, hepatic coma, severe renal and hepatic dysfunction, refractory hypokalaemia, hyponatraemia, hypercalcaemia, symptomatic hyperuricaemia and Addison’s disease.

Metolazone  Drug Interactions: In drugs like Furosemide, ACE inhibitors and  glibendamide. Preacaustiosn should be taken while using Metolazone in cases of  Diabetes mellitus; gout; electrolyte,disturbances; lupus erythematosus; hepatic and renal impairment;

Side effects on using Metolazone (zaroxolyn ) include dizziness, headache, or heart arrhythmias (palpitations).The  Serious, though rare, side effects include aplastic anemia, pancreatitis, agranulocytosis, and angioedema. Metolazone, like other thiazide diuretics, may unmask latent diabetes mellitus or exacerbate gout, especially by interacting with medicines used to treat gout.

Esmolol drip is a cardiovascular system medicine used in the treatment of Supraventricular, tachycardia, perioperative tachycardia and hypertension. It is rapid Acting Blood Pressure Medicine

Esmolol hcl is a beta 1-selective (cardioselective) adrenergic receptor blocking agent available under brand name of Brevibloc. It can rapidly control ventricular rate.

The normal dosage is 500 mcg/kg/min for 1 min, in case of Perioptachy-1000 meg/kg within 30 sees. Maintenance - for SVT & perioptachycardia: Initiate with 50 mcg/kg/min for 4 mins increasing maximum up to 300 mcg/kg/min. Every increment of 50 meg/ kg/min in maintenance should be preceded by the same loading dose.

Contra indication of Esmolol includes sinus bradycardia, heart block, cardiogenic shock or overt heart failure. Special precaution has to be taken for use in pregnancy, nursing mothers, and in children. Side effects of esmolol include hypotension, dizziness, headache, confusion, fatigue, paresthesia, asthenia, depression, anxiety, anorexia and bronchospasm. No significant drug interaction is seen with with digoxin, warfarin and morphine.

Bisoprolol available under brand name  Zabeta is a beta blocker drug for the treatment in cardiovascular system. It is a competitive antagonist of the beta-adrenergic receptors. It has high beta, selectivity. There is no membrane-stabilizing or partial agonist action. The reduction in heart rate and blood pressure action lasts for 24 hrs. Bisoprolol is used in the treatment of Hypertension and Coronary artery disease.

Dosage of Bisoprolol starts at 2.5 or 5mg/day and build up to10 -20mg/day.Dose reduction is done in case of severe renal impairment.

Centra-Indications of Bisoprolol include: Bradycardia, second or third degree heart block, conduction abnormalities, congestive heart failure, chronic obstructive pulmonary disease, peripheral vascular insufficiency, pregnancy and lactation.

Special precautions: while administering Bisoprolol should be taken in case of poor L.V function, bronchial asthma, diabetes, thyrotoxicosis, M.I, severe renal impairment and abrupt withdrawal. Bisoprolol is not recommended for children and is not recommended in pregnancy as safety is not established. During lactation it has to be used with caution also caustion advised for elderly.
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Side effects of Bisoprolol include giddiness, headache, fatigue, bradycardia, nausea, dyspnoea, sleep disturbances, cold extremities, and reduced libido.

Drug Interactions of Bisoprolol: It enhances the action of anesthetic agents, clonidine, calcium antagonists,    hypoglycemic agents & NSAIDs. Rifampicin cause
Reduction in plasma concentration & elimination.

Labetalol is a beta blocker group of drugs and is unique among adrenergic blockers as it blocks the adregenic receptors thereby decreasing blood pressure, heart beat rate and vascular resistance. Labetalol   is   orally   effective   and   undergoes considerable first pass metabolism.

Labetalol is used for treatment of all grades of hypertension and especially useful in pheochromocytoma and clonidine withdrawal hypertension.

The typical dosage can be started with 50mg twice daily and increased at fortnightly intervals to 100-200mg twice daily. Usual dose being  labetalol 400 mg daily for those with predisposition to  bronchospasm,   right ventricular   failure, and secondary   to   pulmonary  hypertension.  Special precautions to be taken while using labetalol in cases of sinus bradycardia shock, pregnancy, lactation and anesthesia with agents producing myocardial depression.  Common side effects of labetalol include abrupt withdrawal, diabetes, cardiac failure, hyperthyroidism, postural hypotension, eye and skin reaction, liver dysfunction, failure of ejaculation in males, headache, angina, jaundice, dreams, nightmares.

The commonly available brand names of Labetalol are Normodyne and  Trandate.

Metoprolol is a beta blocker type of drug. It is the prototype of cardio selective blockers. It blocks cardiac stimulation similar to propranolol but is less likely to worsen asthma. But Metoprolol is not entirely safe. It may also be preferred to propranolol in diabetics receiving insulin or oral hypoglycaemics.It is used for the treatment of Hypertension, angina pectoris and acute myocardial infarction.

It is available under the brand names Lopressor  -metoprolol tartrate  and Toprol XL - metoprolol Succinate from Mylan . Other brand or generic formulations of this medication may also be available.

Adults are administered  100-200 mg in two divided doses for Children:  1-5 mg/kg/day in two divided doses. Metoprolol is contra indicated in Bradycardia, cardiogenic shock, 2nd or 3rd degree A.V. block, cardiac failure. Verapamil therapy and Asthma/COPD. Special Precautions should be taken during General anaesthesia, pregnancy and reduced cardiac reserve. In Pregnanant women Metoprolol May effect the foetus and during  Lactation: it may pass in breast milk. Hence use only if clearly indicated.

 
  Side-effects of Metoprolol inlcude headache, nightmares, hypotension, eye and skin reactions. The Drugs that interact are: Cimetidine which potentiate metoprolol and it has negative ionotropic effect with general anesthetics. Bioavailability is increased by food and there is enhancement of antihypertensive effect with    diuretics and vasodilators. Metoprolol is very useful in combination with digitalis.

Metoprolol is available under the brand names Lopressor and Toprol XL. Other brand or generic formulations of this medication may also be available.

Common brands  are

Lopressor 50 mg–pink, capsule-shaped, scored tablets
Lopressor 100 mg–light-blue, capsule-shaped, scored tablets
Toprol XL 50 mg extended-release tablets–white, round, film-coated, scored tablets
Toprol XL 100 mg extended-release tablets–white, round, film-coated, scored tablets

DIGOXIN is a CARDIAC  GLYCOSIDES type of drug. It has direct effects on myocardial contractility and electrophysiological conduction properties i.e. 1. Negative chronotropic effect (Reduces heart rate & A.V. conduction). 2. Positive inotropic effect i.e. there is a dose dependent increase in force of contraction of myocardium. The above two effects thereby make it an ideal drug for treatment of cardiac failure of diverse aetiologies without increasing the oxygen demand of the failing myocardium. There is also a mild direct vasoconstrictor action thereby increasing peripheral resistance mildly. Diuresis is seen promptly in C.H.F. patients owing to improved renal perfusion which was previously compromised but at times an addition of diuretic may be considered to improve the patients hypoxic and hypervolemic condition rapidly if need arises.

DIGOXIN is used in Congestive heart failure, cardiac tachyarrhythmias (Paroxysmal supraventricular tachycardia, atrial flutter & fibrillation). Dosage : Initially 0.25-1.5 mg daily. Maint; 0.25-0.5 mg daily. For Children : initially 10-20 meg/kg body wt. 6 hrly. Maint 10-20 meg/kg body wt. in single or divided doses daily. 

Contra-lndicatlons of DIGOXIN : Hypokalemia, ventricular tachycardia, partial A.V.    block, acute myocarditis. Wolf-Parkinson-White Syndrome. Special Precautions has to be taken in Elderly, renal or severe hepatic disease, myocardial infarction and  thyrotoxi-cosis patients.

Common Side-effects that can be expected with DIGOXIN are Anorexia, nausea, vomiting, ab¬dominal pain, fatigue, headache, mental confusion, restlessness.

PROPRANOLOL is a BETA  BLOCKERS group of medicines for heart ailments. It decreases heart rate, force of contraction & cardiac output. On prolonged administration BP gradually falls in hypertensives but not in normotensives.

PROPRANOLOL is used in Hypertension, angina pectoris, cardiac arrhythmias, post M.I. tachycardia,migraine and anxiety. the common  Dosage is 10 mg B.D. to 160 mg Q.I.D (average 40-160 mg/day)

Contra-lndicatlons of PROPRANOLOL are Obstructive COPD like asthma. Partial or complete heart block, C.H.F. Acute M.I. Cardiogenic shock and those taking Digitalis & verapamil therapy.

Special Precautions have to be taken while taking PROPRANOLOL in Impaired renal & hepatic functions, pregnancy, cardiac failure. Myocardial insufficiency and  reduced cardiac reserve. Side-effects include Tiredness, lack of drive, G.I. upsets, nightmares, forgetfulness, rare cases of  hallucinations, muscle fatigue.

PROPRANOLOL can interact with other drugs and can cause Hypertension & bradycardia with adrenaline, reduced heart rate & output with anaesthetic agents. Also Severe bradycardia may occur with digitalis and calcium channel blockers. PROPRANOLOL causes elevated blood levels with cimetidine .

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