By Helmut Lydtin M. D., Peter Trenkwalder M. D. (auth.)
This quantity severely and objectively analyses the literature as much as 1989 and provides a advisor to the sensible use of all calcium antagonists that have been completely investigated thus far. It starts with a concise evaluate of physiological rules as a foundation for a dialogue of the final and particular pharmacodynamics and pharmacokinetics of calcium antagonists. detailed emphasis is given to their healing use in perform, specific dosage schedules are supplied, interactions with different drugs defined, and healing possible choices thought of.
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Additional resources for Calcium Antagonists: A Critical Review
Ventricular tachycardias, ventricular fibrillation) have so far been observed only with intravenous administration (Petri et al. 1982 observed no change in AV conduction with oral administration), in long-term oral therapy with verapamil in the presence of WPW syndrome, electrophysiological testing must nevertheless be undertaken. Paroxysmal supraventricular reentry tachycardias with retrograde conduction via the accessory pathway can be positively influenced by verapamil through inhibition of AV conduction (Spurrell et al.
With substances of the veraparnil group and (to a lesser extent) with diltiazem, direct negative inotropic action on the cardiac muscle predominates owing to the reduced peripheral vasodilating effects and less powerful autonomic counter-regulation. When prescribing these drugs, it is not always possible to predict precisely whether myocardial contractility will remain unchanged or decrease. Overall, contractility seems to be decreased more rapidly with verapamil than with diltiazem (Millard et al.
In certain situations of verapamil therapy, a more pronounced negative inotropic effect must be expected, possibly leading to congestive heart failure (Singh et al. g. 10 mg verapamil as an intravenous bolus); in severe hypotension; and where there is a radiologically and/or echocardiographically enlarged heart. In patients with coronary heart disease and an ischaemic myocardium, verapamil (Hecht et al. 1981), gallopamil (Sesto et al. 1983) and diltiazem (Dash et al. 1985) are reported to reduce regional disturbances of ventricular wall motion and improve the ejection fraction in these areas.
Calcium Antagonists: A Critical Review by Helmut Lydtin M. D., Peter Trenkwalder M. D. (auth.)