Isolated Coronary Artery Anomalies Medication

Updated: Dec 18, 2014
  • Author: Jamshid Shirani, MD; Chief Editor: Eric H Yang, MD  more...
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Medication

Medication Summary

The goals of pharmacotherapy are to reduce morbidity and to prevent complications.

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Cardiovascular agents

Class Summary

Used to improve and preserve hemodynamic status by acting on myocardial contractility, reducing congestion, and decreasing myocardial energy expenditure.

Digoxin (Lanoxin)

Cardiac glycoside with direct inotropic effects in addition to indirect effects on the cardiovascular system. Acts directly on cardiac muscle, increasing myocardial contractility. Its indirect actions result in increased carotid sinus nerve activity and enhanced sympathetic withdrawal for any given increase in mean arterial pressure.

Dobutamine (Dobutrex)

Produces vasodilation and increases inotropic state. At higher dosages may cause increased heart rate, exacerbating myocardial ischemia.

Inamrinone (Inocor)

Formerly amrinone. Bi-pyridine positive inotrope and vasodilator with little chronotropic activity. Different in mode of action from both digitalis glycosides and catecholamines. More likely to cause tachycardia than dobutamine. May exacerbate myocardial ischemia. Adjust dose according to patient response.

Milrinone (Primacor)

Bi-pyridine positive inotrope and vasodilator with little chronotropic activity. Different in mode of action from both digitalis glycosides and catecholamines.

Metoprolol (Lopressor)

Selective beta1-adrenergic receptor blocker that decreases automaticity of contractions.

Atenolol (Tenormin)

Selectively blocks beta1 receptors with little or no effect on beta2 types.

Propranolol (Inderal, Betachron E-R)

Nonselective, beta-adrenergic receptor blocker with membrane-stabilizing activity that decreases automaticity of contractions. Allow time for drug to reach site of action (particularly if circulation is slow). Do not continue doses after desired alteration in rate or rhythm is achieved.

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Diuretics

Class Summary

Loop diuretics decrease plasma volume and edema by causing diuresis. The reduction in plasma volume and stroke volume associated with diuresis decreases cardiac output and, consequently, blood pressure. May improve pulmonary and systemic cardiovascular activity. Should be used cautiously because any drop in intravascular volume may cause a corresponding drop in cardiac output.

Furosemide (Lasix)

Increases excretion of water by interfering with chloride-binding cotransport system, which inhibits sodium and chloride reabsorption in ascending loop of Henle and distal renal tubule. Dose must be individualized to patient. Depending on response, administer at increments of 20-40 mg, no sooner than 6-8 h after the previous dose, until desired diuresis occurs. When treating infants, titrate with 1-mg/kg per dose increments until a satisfactory effect is achieved.

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