Class cardiotonic

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CARDIOTONIC DRUGS Dr. RAGHU PRASADA M S MBBS,MD ASSISTANT PROFESSOR DEPT. OF PHARMACOLOGY SSIMS & RC. 1

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Transcript of Class cardiotonic

Page 1: Class cardiotonic

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CARDIOTONIC DRUGS

Dr. RAGHU PRASADA M SMBBS,MDASSISTANT PROFESSOR DEPT. OF PHARMACOLOGYSSIMS & RC.

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Inotropic Definition

Force of myocardial contractionAn ideal cardiotonic agent should not

increase heart rate & should be devoid of toxic effects.

Positive inotropic drug: increases force of contractions

Increase force of myocardial contractionCauses improved heart’s pumping abilityNegative inotropic drug: decreases force

of contraction

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Positive inotropic drugs

Cardiac glycosides: Digitoxin, Digoxin

β-adrenergic agonists (New dopamine receptor agonist): dopamine, Dobutamine, Dopexamine

Phosphodiesterase inhibitors : Amrinone Milrinone

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Source & Chemistry of CG

SOURCE GLYCOSIDES

1.D.PURPUREA - Digitoxin, Gitoxin, Gitalin 2.D.Lanata - Digitoxin, Gitoxin

Aglycon consist of cyclopentanoperhydrophenanthrene (steroid) ring 5 or 6 membered unsaturated lactones ring.

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Mechanism 0f action

Digitalis increase force of cardiac contraction by a direct action independent of innervations.

It selectively binds to extra cellular face of membrane associated NA+K+ ATPase of myocardial fibres & inhibits this enzyme.

Inhibition of this cation pump results in progressive accumulation of NA+ intracellularly.

This indirectly results in intracellular Ca+ accumulation.

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Therapeutic use

CHF Cardiac Arrhythmias :

Atrial fibrillation, Atrial flutter (AFL) Proxysmal supraventricular tachycardia (PSVT

Precaution & contraindications :-HypokalemiaThyrotoxicosis

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Adverse effects

Extra cardiac – anorexia, nausea, vomiting, abdominal pain

are usually reported first , are due to gastric irritation, mesenteric vasoconstriction & CTZ stimulation.

Cardiac -- almost every type of arrhythmia can be

produced by digitalis ; pulses big minus , nodal & ventricular extra systoles, ventricular tachycardia & terminally fibrillation.

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β -Adrenoceptor agonists They are used intravenously in CHF emergencies Example of β -Adrenoceptor agonists Dobutamine • Exciting β1 Adrenoceptor → positive inotropic

action →the volume of output↑• Exciting β2 Adrenoceptor→dilate the vascular →

afterload↓

have benefits within short time

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Phosphodiesterase- inhibitorsⅢ

Inodilator / inodilating drugsInhibiting the activity of PDE → cAMP↑→ causes an Ⅲincrease in myocardial contractility and vasodilatation →total peripheral resistance →cardiac output ↑ Examples: Amrininone: Inhibits the excess product of NO, TNF and affects the neurohormone, anti-the forming of thrombus Milrinone: stronger 20 time

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Uses

Congestive heart failure Shock conditions-hypovolumic,

septic, cardiogenic Cardiac emergencies

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