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Chapter 2: Cardiovascular
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Management of atrial fibrillation
Drugs that prolong the QT interval
Anticoagulation prescribing guidance
Management of suspected deep vein thrombosis (DVT) and pulmonary embolism (PE)
Secondary prevention of stroke / TIA in primary care
Management of angina
Chronic heart failure guidance
Management of hypertension
Management of blood lipids
2.1 Positive inotropic drugs
2.2 Diuretics
2.3 Anti-arrhythmic drugs
2.4 Beta-adrenoceptor blocking drugs
2.5 Hypertension and heart failure
2.6 Nitrates, calcium-channel blockers, and other antianginal drugs
2.7 Sympathomimetics
2.8 Anticoagulants and protamine
2.9 Antiplatelet drugs
2.10 Stable angina, acute coronary syndromes, and fibrinolysis
2.11 Antifibrinolytic drugs and haemostatics
2.12 Lipid regulating drugs
2.13 Local sclerosants
2.14 Miscellaneous cardiovascular preparations
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2.1 Positive inotropic drugs
First Line
Second Line
Specialist
Hospital Only
2.1.1 Cardiac glycosides
Digoxin
- Tablets 62.5micrograms, 125micrograms and 250micrograms (£2.49 = 125micrograms daily)
- Oral solution 50micrograms in 1ml (£6.95 = 60ml)
- Injection 250micrograms in 1ml
- Injection 100micrograms in 1ml (unlicensed special)
Indications
- Supraventricular arrhythmias
- Heart failure
Dose
- Maintenance, for atrial fibrillation or flutter
- oral, according to renal function and initial loading dose; usual range 125-250micrograms daily
- Rapid digitalisation, for atrial fibrillation or flutter
- oral, 0.75-1.5mg over 24 hours in divided doses
- Heart failure (for patients in sinus rhythm)
- oral, 62.5-125 micrograms once daily
Notes
- The above doses may need to be reduced if digoxin (or another cardiac glycoside) has been given in the preceding 2 weeks. Digoxin doses in the BNF may differ from those in product literature. For plasma concentration monitoring, blood should be taken at least 6 hours after a dose.
2.1.2 Phosphodiesterase type-3 inhibitors
Enoximone
- Injection 100mg in 20ml
Levosimendan
- 12.5mg in 5ml solution for infusion vials (unlicensed)
Milrinone
- Injection 10mg in 10ml
