XENOBIOTICS AFFECTING RENAL AND CARDIOVASCULAR FUNCTION

Table of contents :



Anti-systemic arterial hypertension xenobiotics
Side effects : orthostatic systemic arterial hypotension.

Anti-sexual dysfunction xenobiotics : Anti-premature ejaculation (PE) xenobiotics : Antiarrhythmic xenobiotics (vs. cardiac arrhythmias, expecially used to treat PSVT and AF) : Vaughan Williams' classificationref Torsades de pointes (TDP) occurs most often in the setting of slow heart rates, QT prolongation, and hypokalemia or hypomagnesemia and at the time of conversion from atrial fibrillation to sinus rhythm. QT prolongation and torsades de pointes are not dose-related phenomena. QRS prolongation is a dose-related phenomenon also and will occur at toxic concentration. QT and WRS interval should be monitored and dose reductions made for interval prolongations.

Anti-chronic stable angina xenobiotics :
 
drug
usual dose
side effects
contraindications
nitrates sublingual nitroglycerin 0.3-0.6 mg flushing, headache intolerance of side effects
isosorbide dinitrate slow release oral 10-60 mg q8h flushing, headache, tolerance after 24 h as above, worsening ischemia on withdrawal
isosorbide dinitrate slow release oral SR 2.5-10 mgq4-6h
transdermal nitroglycerin patch 0.4-1.2 mg/h for 12-14 h
isosorbide-5-mononitrate oral 20-30 mg bid
isosorbide-5-mononitrate oral slow release 60-240 mg once daily
b-blockers propanolol 20-80 mg qid depression, constipation, impotence, bronchospasm, heart failure, bradycardia asthma, AV conduction block, heart failure
metoprolol 25-200 mg bid
atenolol 50-150 mg once daily
CCB nifedipine slow release preparation 30-90 mg daily hypotension, flushing, edema, worsening angina hypotension, intolerance of side effects
diltiazem slow release 60-120 mg bid constipation, AV conduction block, worsening heart failure AV conduction block, impaired LV function, bradycardia
verapamil slow release 180-240 mg daily constipation, AV conduction block, worsening heart failure AV conduction delay, impaired LV function, bradycardia
amlodipine slow release 5.10 mg daily edema intolerance of side effects

Anti-congestive heart failure (CHF) xenobiotics

Vasoprotectants Chondro-protective, chondro-stimulatory or chondro-nutritive agents are able to inhibit enzymatic breakdown of articular cartilage, stimulate anabolic processes in cartilage, and to enhance the supply of nutritional and energy substrates for the cartilage cells Sclerosing agents or solutions / sclerosants (for sclerotherapy of varices) : the best imaginable sclerosant would have no systemic toxicity. It would be effective only above some threshold concentration, so that its effects could be precisely localized through dilution. It would require a long period of contact to be effective, so that it would be relatively more effective in areas of stasis and relatively safer in the deep veins where there is high flow. It would be non-allergenic. It would be strong enough to sclerose even the largest vessels, yet it would produce no local tissue injury if extravasated. It would not cause staining or scarring. It would not cause telangiectatic matting. It would be perfectly soluble in normal saline. It would be painless upon injection. It would be inexpensive. It would be approved by the United States Food and Drug Administration.
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