Adverse dermatologic effects of cardiovascular drug therapy: part I

Cardiovascular disease is common, affecting an increasing number of persons as the population ages. To combat this growing health problem, physicians use a multitude of medications in the treatment of their patients. Although pharmacologic therapy greatly enhances quality of life for a majority of patients, there is always the potential for an unfavorable reaction. For example, cardiovascular drugs can induce a vast array of adverse dermatologic responses. This article reviews the various cutaneous reaction patterns that can occur as a result of treatment with Class I and II antiarrhythmic agents.     

Adverse dermatologic effects of cardiovascular drug therapy: part II

Cardiovascular disease is common, affecting an increasing number of persons as the population ages. To combat this growing health problem, physicians use a multitude of medications in the treatment of their patients. Although pharmacologic therapy greatly enhances quality of life for a majority of patients, there is always the potential for an unfavorable reaction. For example, cardiovascular drugs can induce a vast array of adverse dermatologic responses. This article reviews the various cutaneous reaction patterns that can occur as a result of treatment with class III, IV, and other antiarrhythmic agents, ACE inhibitors, Angiotensin II receptor blockers, and diuretics.     

Neuropsychiatric effects of cardiovascular drug therapy

Various cardiovascular drugs have been shown to have neuropsychiatric effects that can be harmful or therapeutically beneficial to patients. As an example, both sedation and mental depression have been described in patients receiving centrally acting antihypertensive drugs and beta-adrenergic blockers, related to their antiadrenergic actions. In contrast, because of these antiadrenergic actions, agents like clonidine have been used to treat opiate, alcohol, and nicotine withdrawal, while beta blockers have been used to treat symptoms of performance anxiety, migraine, and psychocardiac disorders. Some antiarrhythmic drugs have been associated with delirium, and digitalis toxicity has been shown to cause hallucinations, mania, euphoria, and depression. The calcium-channel blocker verapamil has been used as an adjunctive treatment in patients with bipolar disorders. Since neuropsychiatric symptoms are seen in patients with cardiovascular disease, clinicians should be aware of the possible relationship between these symptoms and concurrent cardiovascular drug therapy.     

Adverse effects of antihypertensive drug therapy on glucose intolerance

Several antihypertensive drugs have an adverse effect on glucose tolerance that may partially or completely negate the beneficial effects of reducing blood pressure as it relates to the incidence of coronary heart disease and its complications. Diuretics (particularly high doses) and beta-blockers without intrinsic sympathomimetic activity have the greatest adverse effect on glucose intolerance. Central alpha-agonists, angiotensin-converting enzyme inhibitors, calcium channel blockers, and alpha-blockers do not adversely affect glucose and are preferred in diabetic hypertensive patients, selected hypertensive patients at risk for developing glucose intolerance, and probably most other patients with mild essential hypertension as initial and/or monotherapy compared with diuretics and beta-blockers.     

Adverse drug effects

Adverse drug effects afflict the elderly with greater frequency than the young. Several factors are responsible, among them the age-related alterations in pharmacokinetics and pharmacodynamics. Most importantly, it is the number of drugs taken on a daily basis that is cited as being the cause. When one extends the concept of adverse drug reactions to the concept of adverse drug events, then errors made by the patient, caregiver, and/or health care provider appear to be responsible to a large degree.     

Adverse cardiovascular effects of anticholinesterase medications

Anticholinesterase medications (anti-ChEs) play a significant role in the diagnosis and treatment of myasthenia gravis (MG). The primary effect on the heart produced by a surfeit of ACh is bradyarrhythmias with consequent fall in cardiac output and hypotension; yet, adverse cardiac reactions to these agents have been reported relatively infrequently. The authors describe 12 patients with MG from a pool of more than 1,000 who suffered hypotensive episodes related to use of anti-ChEs. The 12 patients (seven male, five female) had a mean age of 62.6 years; of these, eight adverse reactions occurred after edrophonium, two after neostigmine, and two after pyridostigmine. Seven patients had a recent increase in anti-ChEs and none had a decrease in dosage. Nine patients suffered either from severe sinus bradycardia, (20 beats/min), junctional bradycardia, or complete AV dissociation. Two patients had paradoxic sinus tachycardia and all had syncopal or near-syncopal episodes. Evidence for cholinergic stimulation of other organs was generally lacking. No recurrence appeared with reduction of the dose of anti-ChEs or discontinuation of the drug. The authors believe that these agents should be given with caution to patients with inflammatory, infiltrative, or degenerative disease of the conduction systems, patients being treated with digitalis, calcium-channel antagonists or beta blockers, patients with myocardial ischemia, and elderly patients. Appropriate resuscitative equipment should be readily available.     

Adverse effects of antiretroviral therapy

Antiretroviral toxicity is an increasingly important issue in the management of HIV-infected patients. With the sustained major declines in opportunistic complications, HIV infection is a more chronic disease, and so more drugs are being used in more patients for longer periods. This review focuses on the pathogenesis, clinical features, and management of the principal toxicities of the 15 licensed antiretroviral drugs, including mitochondrial toxicity, hypersensitivity, and lipodystrophy, as well as more drug-specific adverse effects and special clinical settings.     

Adverse effects of antihypertensive therapy

Little information is available on drug effects encountered by elderly persons needing long-term treatment of their hypertension. Information on thiazides and beta-blockers suggests that these drugs have a fairly good safety profile. Individualizing drug choices and employing close laboratory and clinical follow-up should reduce the occurrence of side effects.     

Adverse effects of corticosteroids on the cardiovascular system

OBJECTIVE: To review the potential adverse effects of glucocorticoid therapy on the cardiovascular system and to provide insight into the mechanisms of these effects. DATA SOURCES: Case reports and studies demonstrating adverse effects of glucocorticoid therapy on the cardiovascular system were examined from a MEDLINE search. Animal data and in vitro studies were identified to provide insight on the mechanisms of these effects. DATA SYNTHESIS: Undesirable effects identified were dyslipidemia, hypertension and left ventricular free wall rupture after myocardial infarction. Elevations of total plasma cholesterol, triglycerides, low density lipoprotein cholesterol and high density lipoprotein cholesterol are often reported. The elevation of various lipid subfractions is likely mediated by increased plasma insulin levels, impaired lipid catabolism and increased lipid production in the liver. Hypertension was shown to be more prevalent in patients treated with high doses of glucocorticoid. The mechanisms are complex, but final pathways include increased systemic vascular resistance, increased extracellular volume and increased cardiac contractility. Glucocorticoids were demonstrated to increase the incidence of left ventricular free wall rupture by delaying myocardial scar formation in the postmyocardial infarction period. CONCLUSIONS: The major adverse effects of glucocorticoids on the cardiovascular system include dyslipidemia and hypertension. These effects may predispose treated patients to coronary artery disease if high doses and prolonged courses are used. Accordingly, corticosteroids should be employed judiciously in patients with other risk factors for cardiovascular disease, and attention should be paid to risk modification. Low dose and alternate day therapy may reduce the incidence of complications in corticosteroid therapy. The mechanisms of these adverse effects are complex and have not yet been fully explained.     

Renal considerations in cardiovascular drug therapy

The increasing number of patients with both cardiac and renal disease makes it important for the clinician to bear in mind the effect of both renal failure and peritoneal or hemodialysis on the handling of drugs. Guidelines are available for specific medications; however, they must be used in the light of the patient's individual response and metabolism.     

Recent developments in cardiovascular drug therapy: treatment of atrial arrhythmias with new class III drugs and beyond

Despite recent advances in non-pharmacologic approaches antiarrhythmic drugs still play a dominant role in the treatment of cardiac arrhythmias. Large randomized controlled clinical trials have pointed out the importance of a proper benefit to risk evaluation in various patient subsets. This led to a continuous decline in the use of sodium channel blockers due to their possible proarrhythmic effects particularly in patients with reduced left ventricular function and ischemic heart disease. On the contrary, beta-blockers and more complex class III compounds such as sotalol and amiodarone have been prescribed increasingly. However, side effects commonly observed boosted the development of agents with simpler ion channel-blockade and less adverse reactions. In this review newer so-called "pure" class III agents will be discussed. Their common mechanism of action is an antifibrillatory effect both on the atrial and ventricular level. Clinically, they are used in the chemical cardioversion and the prevention of atrial fibrillation or atrial flutter as well as for the maintenance of sinus rhythm after its successful restoration. This report contains a detailed analysis of the pharmacokinetics, results of clinical studies and implications regarding the use in daily practice for three distinct compounds: ibutilide, dofetilide and azimilide. As efficacy is still limited their current and future role in hybrid therapies combining drug therapy with alternative treatment modalities (catheter ablation, pacemakers and implantable cardioverter defibrillators) is discussed. In addition, an outlook for a future drug design implementing changes in electrically remodeled atrial tissue will be given.     

The effects of lipid-lowering drug therapy on cardiovascular responsiveness in type 2 diabetic patients

Type 2 diabetes is associated with a high prevalence of dyslipidaemia and a high incidence of cardiovascular disease. Lipid lowering therapy with HMG Co-A reductase inhibitors (statins) reduce the risk of cardiovascular events in type 2 diabetic and non-diabetic patients, effects which are believed to be partly due to improvements in vascular function. The aetiology of abnormal vascular function in type 2 diabetics is likely to be multifactorial and the pattern of vascular dysfunction in type 2 diabetes may differ from that which occurs in non-diabetic patients with dyslipidaemia. Abnormalities in endothelium derived hyperpolarising factor (EDHF) mediated vasodilation in resistance vessels may be more prominent in both type 1 and type 2 diabetes than in non-diabetic patients with endothelial dysfunction. The effects of lipid lowering therapy on vascular responsiveness may differ in type 2 diabetic patients from those found in non-diabetic patients. Statin therapy does not appear to improve responses to endothelial dependent vasodilators in type 2 diabetics, but may alter the ratio between nitric oxide (NO) and EDHF mediated responses. Fibrate therapy improves flow mediated dilation of brachial arteries in type 2 diabetic patients, but only appears to improve endothelium dependant vasodilator responses in resistance vessels when given in conjunction with co-enzyme Q.     

Adverse drug effects in relation to renal function

The relationship between acute drug toxicity, diagnosed in the clinical setting, and renal function is estimated for 67 commonly used drugs. Fewer than expected numbers of drugs showed higher rates of toxicity in the presence of an elevated blood urea nitrogen level on admission. For those whose toxicity did correlate positively with an elevated blood urea nitrogen level, detailed study of the relationship, taking into account other important variables, is indicated.     

Adverse effects of outpatient parenteral antibiotic therapy.

PURPOSE: Although home parenteral antimicrobial therapy has become common, few studies have carefully examined its adverse effects. SUBJECTS AND METHODS: We retrospectively reviewed the medical records of 269 patients who received 291 courses of home parenteral antimicrobial therapy through a hospital-based home infusion program during a 2-year period. Patients with human immunodeficiency virus (HIV) infection were not included. RESULTS: The majority (59%) of patients were treated for bone and joint infections. Patients had a mean age of 47 years. The mean duration of antibiotic therapy was 40 days. Of monitored courses, leukopenia occurred in 16%, neutropenia in 7%, thrombocytopenia in 4%, and eosinophilia in 12%, usually after a month of therapy; these adverse effects were most frequently associated with the use of beta-lactam antibiotics. Nephrotoxicity occurred in 8% of monitored courses at a mean of 27 days and was most commonly associated with amphotericin B. Diarrhea occurred in 7% and rash in 4% of patients, and both were most commonly seen with beta-lactam antibiotics. Of those patients with permanent indwelling catheters, 11% of those with central catheters and 9% of those with peripherally inserted central catheters (PICCs) developed line complications. Overall, 8% of patients required rehospitalization. CONCLUSION: Home infusion antibiotic therapy exposes patients to the complications associated with inpatient antibiotic therapy and needs to be monitored closely to prevent serious complications and rehospitalizations.     

艾滋病抗病毒治疗药物不良反应104例观察

目的了解艾滋病（AIDS）抗病毒治疗药物不良反应的发生情况。方法对2005年08月-2007年12月在云南省红河州第一人民医院接受抗病毒治疗的104例AIDS患者服用国家免费AIDS抗病毒药物后所发生的不良反应进行回顾性分析。结果消化道症状、肝损伤、药疹为最常见的AIDS抗病毒药物不良反应,不良反应与抗病毒治疗方案的选择相关,多数不良反应发生于治疗后的第1个月内。抗病毒治疗后大多数患者CD4^＋T细胞计数都有所上升。结论AIDS抗病毒治疗中会发生多种药物不良反应,临床上应对此充分认识并加以重视。