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8 views2 pages

Notes

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rrainjja
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Cardiotonic drugs are a class of medications that enhance the force of contraction of the heart

muscle (myocardium), leading to improved cardiac output. These drugs are primarily used to
treat conditions such as heart failure and sometimes certain types of arrhythmias. They act by
increasing the contractility of the heart, often through modulating intracellular calcium levels or
improving cardiac muscle performance.

Categories of Cardiotonic Drugs:


1. Cardiac Glycosides

 Examples: Digoxin, Digitoxin


 Mechanism of Action:
o Inhibit the sodium-potassium ATPase pump in cardiac cells.
o This increases intracellular sodium levels, which indirectly increases calcium
levels through the sodium-calcium exchanger.
o Elevated intracellular calcium enhances myocardial contractility.
 Clinical Uses: Heart failure, atrial fibrillation, and atrial flutter.
 Side Effects: Arrhythmias, nausea, vomiting, visual disturbances ("yellow halos").

2. Sympathomimetic Agents

 Examples: Dobutamine, Dopamine


 Mechanism of Action:
o Stimulate beta-adrenergic receptors, increasing cyclic AMP (cAMP) levels.
o This promotes calcium entry into cardiac cells, enhancing contractility.
 Clinical Uses: Acute heart failure, cardiogenic shock.
 Side Effects: Tachycardia, arrhythmias, hypotension.

3. Phosphodiesterase Inhibitors (PDE-3 Inhibitors)

 Examples: Milrinone, Inamrinone


 Mechanism of Action:
o Inhibit phosphodiesterase enzyme (PDE-3), leading to increased cAMP levels.
o This enhances calcium influx and myocardial contractility, while also causing
vasodilation.
 Clinical Uses: Short-term treatment of severe heart failure unresponsive to other
therapies.
 Side Effects: Hypotension, arrhythmias, thrombocytopenia.
4. Calcium Sensitizers

 Examples: Levosimendan
 Mechanism of Action:
o Enhance the sensitivity of myocardial contractile proteins to calcium.
o Improves contraction without increasing intracellular calcium levels significantly,
reducing the risk of arrhythmias.
 Clinical Uses: Acute decompensated heart failure.
 Side Effects: Hypotension, arrhythmias.

Key Points to Remember:

 Indications: Cardiotonic drugs are most commonly used in heart failure and arrhythmias.
 Risks: Excessive use or improper dosing can lead to arrhythmias, tachycardia, or even
worsening heart conditions.
 Monitoring: Serum electrolyte levels (e.g., potassium), renal function, and signs of
toxicity (especially with digoxin) are crucial during treatment.

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