Medical Pharmacology Chapter 43:  Adult Cardiac Procedures

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Chronic Drug Therapy, Previous Surgical, Diagnostic Procedures

 Issues concerning continuing drug treatment up until the time of surgery

Drug Category

Advantages

 Disadvantages

Calcium Channel Antagonists

  • Antiarrhythmic properties

  • Antihypertensive properties

  • Useful in management of coronary vasospastic disorder

  • Attenuated response to inotropic agents and vasopressor drugs

  • May promote atrioventricular (AV) conduction bloc; note that calcium is the primary inward current (depolarizing current) carrying ion at the AV node

  • Peripheral vasodilatation after cardiopulmonary bypass

-adrenoceptor blocking drugs

  • Reduced tachycardia

  • Antiarrhythmic properties

  • Antihypertensive effects

  • May promote bronchospasm

  • Attenuated inotropic response to intraoperative -adrenergic receptor agonists

Antihypertensive agents

  • Antihypertensive effects

  • Peripheral vasodilation following cardiopulmonary bypass

Diuretics

  • Probably none

  • Hypokalemia

  • Hypovolemia

Digitalis glycosides  (digitoxin (Crystodigin); digitoxin (Crystodigin))

  • Inotropic effect

  • Reduces ventricular responses to rapid atrial rates (vagal-mediated AV nodal effect)

  • Arrhythmias (proarrhythmic effect)

  • Conduction abnormalities, other toxicities

  • Worsens risks associated with hypokalemia

Antiarrhythmic agents

  • Arrhythmia suppression

  • May cause toxicity with changes in electrolyte  and pH levels

Insulin

  • Reduced hyperglycemia/ketoacidosis  risk

  • Hypoglycemia {easily managed)

 

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