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Cardiovascular Disorders
Cardiovascular Disorders
Rate & Rhythm
Patient Complain Fatigue
Rate Normal 60-100 beat/min
Tarchy >100
beat/min
Dyspnea Brady < 60 beat/min Othopnea Rhythm Peripheral Edema Regular vs Irregular
Cardiovascular Disorders
Blood Pressure Patient Complain Dizziness Syncope Lightheadedness Headache
mmHg mmHg
mmHg
with symptom
NSAID
Mech.
Focus on Drugs
MI
Heart failure *** Increase BP
Decrease Renal Perfusion Decrease Renal Blood flow Increase Angiotensin II Na retention
Increase SNS activity Increase contractility &Heart Rate Increase Renin release
Volume Overload/Edema
Sidenafil+ Nitrates (:ISDN SL ) > 24 hr. (Sidenafil half life =3-5 hrs, duration = 4-6+ hrs.)
QT interval Prolongation
Prolongation of Ventricular repolarization (cause arrhythmias,esp. torsades de pointes) Factors Affecting QTc Interval
Sex : women > men Age : elderly > young Electrolyte imbalance :Hypo K ,Hypo Mg Presence of CVD D/I Genetics Concomitant use of dugs prolonging QTc interval
Not cases of QTc prolongation will develop Torsade Torsade case mostly occurred when QTc> 500 ms Symptoms of torsade :Dizziness, lightheadedness, palpitations, presyncope, syncope
Drug
Risk
Rare or Uncertain Worst Problematic Rare or Uncertain Rare or Uncertain Worst Rare or Uncertain Worst
MgSO4 infusion may effectively terminate arrhythmia ,even in presence of normal Mg levels. Antiarrhythmic drugs may worsen the problem and should be avoided
Myocarditis/Cardiomyopathy
Clozapine is only drug implicated (incidence : 0.29%) Myocarditis occur relatively soon after therapy start (2.-3 wks) Histopathology suggests immunological process Cardiomyopathy :Time to onset =12 month Signs/symptoms of Myocarditis/Cardiomyopathy Shortness of breath Dyspnea on exertion Orthopnea, paroxysmal dyspnea Fatigue Peripheral edema
Myocardial Ischaemia
Adrenosine Amphetamines Beta-agonists Caffeine Dipyridamole Ergotamine Nifedipine(short acting) Theophylline Thyroxine Verapamil Fluorouracil Vincristine Vinblastine
Impaired erythropoiesis related anemia Incidence , onset, severity Clinical feature *Hb,Hct +/- abnormal RBC indices *blood smear:less RBC +/- abnormal morphology (microcytic, microchromic,anisocytic)
Management
Hb < 10 gm/dl Hypoxia Erythropoietin
Management
folic Severe or High risk case Folinic acid or rescuvolin
Clofazimine
Dapsone Paraquat Phenazopyridine High dose Sulfa Nitrate/Nitrite
Management
Methylene blue 1-2 mg/kg over 5 min
If G6PDHemolytic ***
1. 2.
Dark urine
RBC
G6PD Deficiency
sudden onset
severe Hemolytic+/- renal fail.
Clinical feature +/- +/- Dark urine RBC count ,Hb.Hct Indirect billirubin,% reticulo count
Management
G6PD def. Immune type Hemolytic anemia rechallenge PRC Hb Active renal failure steriod Autoimmune
Mech.
management
Immune complex-Platelet
Platelet-Heparin-PF4 IgG
Splenic macrophages
Thrombocytopenia
Thrombosis
Stroke, arterial occlusion*
*HEP treatment failure ?
Incidence :Abciximab alone < 1%,Hep alone 0.3-0.7% ,Abciximab+Hep 1.3-1.6% Mech:Non-immune dose-dependent Hapten-type: [Abciximab-GPIIb/IIIa]-Ab
Fever
Drug induced TTP management Ticlopidine/ Clopidogrel Penicillin plasma recovery Some antineoplastics Oral contraceptive drugs
Mech. Dose dependent, reversible direct damage Idiosyncratic possibly from toxic metabolite Immune Type AA
Supportive treatment similar to anemia, thrombocytopenia & agranulocytosis Major treatment to BM aplasia including 1.immunosuppressant: methyprednisolone 1-2 mg/kg in severe case or > 45 years 2.Alternative treatments: ATG , ALG, Cyclosporin, androgen
Antiviral drugs
Anti-infective ag. Anticonvulsants Drug related to Folic acid def. Erythropoetin like products: EPO> Other:Alloprinol, -methyldopa
Post-transplantation
Neoplasm:Thymus carcinoma, B-LL
Hypersensitivity Direct toxic to erythroid cell line Immune induction Immune cpx.of drug/metabolite(eg.EPO Hapten (eg.diphenylhydantoin) *may be Folic def. to induce aplastic crisis
management
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