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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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2.5.1 Vasodilator antihypertensive drugs
First Line
Second Line
Specialist
Hospital Only
These preparations are used here, but are listed elsewhere in the formulary:
- Sildenafil, see section 7.4.5 Drugs for erectile dysfunction
Hydralazine
- Tablets 25mg, 50mg (£8.80 = 50mg four times a day)
- Injection 20mg (dry powder)
Indications
- Heart failure (with long-acting nitrate) when an ACE inhibitor is contra-indicated or not tolerated
- Resistant Hypertension as added on vasodilator by specialists, especially in Heart failure and hypertension
Dose
- Heart failure (initiated in hospital), 25mg 3–4 times daily, increased every 2 days if necessary; usual maintenance dose 50–75mg 4 times daily
- Hypertension, 25mg 3–4 times daily, increased every 2 days if necessary; usual maintenance dose 50–75mg 4 times daily
Bosentan
- Tablets 62.5mg, 125mg
Indication
- Treatment of digital ulceration (DU) in systemic sclerosis in adults
Notes
- NHS England (NHSE) will commission sildenafil and bosentan for patients requiring treatment of digital ulceration in systemic sclerosis in adults, in accordance with the criteria outlined in the NHSE Commissioning Policy
- Patients requiring treatment with bosentan will be referred by their usual consultant rheumatologist for an opinion from a specialised rheumatology centre
Sodium nitroprusside
- 50mg in 2ml vials (unlicensed preparation)
