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Cardiovascular Drugs during Pregnancy
Published in “Bert” Bertis Britt Little, Drugs and Pregnancy, 2022
Quinidine is used to treat ventricular arrhythmia and supraventricular tachycardia. The drug was successfully used for intrauterine treatment of fetal tachycardia (Spinnato et al., 1984). It was used to treat fetal hydrops (resulting from reciprocating tachycardia) that did not convert with maternal digoxin (Guntheroth et al., 1985). There have been no controlled studies in human pregnancies. Among fewer than 20 pregnancies exposed to quinidine exposure during the first trimester, the frequency of congenital anomalies was not increased above the expected rate (Rosa, personal communication, cited in Briggs et al., 2021). Only two infants exposed to quinidine during the first trimester were included in the Swedish Birth Defects Registry (Kallen, 2019).
Pulmonary Disease of Parasitic Cause
Published in Lourdes R. Laraya-Cuasay, Walter T. Hughes, Interstitial Lung Diseases in Children, 2019
Malaria is caused by the protozoan parasites of the genus Plasmodium. Endemic in tropical and subtropical parts of the world, malaria is uncommonly transmitted in the U.S., except as it follows blood transfusion and after i.v. use of drugs among addicts through their curious needle-sharing habits. The exact pathogenesis of malarial lung disease remains ill defined, but patients may have pleural effusion, pneumonitis, or acute pulmonary edema. Roentgenograms demonstrate either only an effusion or alveolar or interstitial infiltrates. As the fever pattern is not periodic, the spleen not enlarged, and pulmonary findings predominate, diagnosis is based on a strong index of suspicion and the finding of early ring forms of the parasite in thin and thick peripheral blood smears that should be repeated every 4 hr until diagnosis is made. Occasionally, microscopic examination of the bloody sputum may demonstrate the parasite. Eosinophilia is absent. Quinidine is recommended for treatment.
Cardiovascular Toxicology
Published in Frank A. Barile, Barile’s Clinical Toxicology, 2019
Class IA drugs have a low toxic-to-therapeutic ratio, and their use is associated with serious adverse effects during long-term therapy and life-threatening sequelae following acute overdoses. The most severe manifestation of intoxication is CV compromise, including sinus tachycardia, cardiac arrhythmia with ventricular tachycardia (torsades de pointes), and fatal ventricular fibrillation. Depressed myocardial contractility frequently manifests as vasodilation and hypotension. CNS toxicity presents as lethargy, confusion, coma, respiratory depression, and seizure. Quinidine intoxication causes cinchonism, a symptom complex that includes headache, tinnitus, vertigo, and blurred vision.* Diarrhea is the most common adverse effect during quinidine therapy. Severe immunological reactions of the lupus type have also occurred. Disopyramide also has strong anticholinergic activity, which can precipitate glaucoma, constipation, dry mouth, and urinary retention.
Brugada syndrome
Published in Acta Cardiologica, 2021
Haarika Korlipara, Giridhar Korlipara, Srinivas Pentyala
The main pharmacology therapies for patients with BrS are quinidine and isoprenaline infusion, both of which have been successful in termination of electrical storms. Electrical storm is defined as three or more sustained episodes of VT/VF or appropriate shocks from an ICD within 24 h [67]. Quinidine, a class IA antiarrhythmic drug, is an 10,68]. Low-doses of quinidine were shown in studies to effectively prevent spontaneous VT/VF recurrence for a long-term period in patients with BrS, and may be useful as an adjunct to ICD therapy and sometimes even a safe alternative to the implantation of an ICD when the device is contraindicated or in young patients with limited symptoms [39,69–71]. The most common side-effects of quinidine that prevent it from being an accepted alternative to ICD implantation is diarrhoea and the risk of arrhythmias, especially torsades de pointes [1]. The recent expert consensus suggests quinidine to be used in high-risk BrS patients who have an indication for an ICD but end up not receiving one due to contraindication or preference, and this is a class IIa recommendation [72]. Quinidine is also recommended to be used in ICD-patients with recurrent shocks and electrical storms as well as in asymptomatic patients with a spontaneous Type I ECG [1,72]. Alternatively, isoproterenol is an intravenous beta-agonist that has been proven to be effective in managing electrical storms [73].
AVP-786 as a promising treatment option for Alzheimer’s Disease including agitation
Published in Expert Opinion on Pharmacotherapy, 2021
Rita Khoury, Charlotte Marx, Sidney Mirgati, Divya Velury, Binu Chakkamparambil, George T. Grossberg
Dextromethorphan has been widely used as a cough suppressant for more than 50 years. It is generally well tolerated and has a wide therapeutic window, making it safe for over-the-counter use among children and adults. Adverse drug reactions are infrequent and usually not severe. The predominant symptoms are usually dose-related and include neurological, cardiovascular, and gastrointestinal disturbances [98]. DM acts as a serotonin reuptake inhibitor; thus, its use is contraindicated in patients taking monoamine oxidase inhibitors or selective serotonin reuptake inhibitors due to concerns regarding serotonin syndrome. At high doses (1.5–15 mg/kg), DM has some abuse potential for its dissociative and hallucinatory effects. At doses over 15 mg/kg it can cause full-blown psychological dissociation similar to the effects of high-dose ketamine [99]. Quinidine is one of the most common drugs to cause a prolongation of QT interval, which can progress to torsades de pointes in 1% to 3% of patients. Quinidine crosses the BBB and can be associated with dizziness, headaches, disturbed sleep, and ataxia. It is also associated with gastrointestinal upset and visual disturbances [60].
Precision medicine in cardiac electrophysiology: where we are and where we need to go
Published in Expert Review of Precision Medicine and Drug Development, 2020
Ashish Correa, Syed Waqas Haider, Wilbert S. Aronow
Unlike in LQTS, genetic analysis has not played a major role either in the risk stratification or in the management of patients with BS [46]. Treatment essentially involves the placement of an ICD. ICDs are used for the secondary prevention of SCD, wherein they are placed in symptomatic patients with spontaneous type 1 Brugada EKG patterns and a history of resuscitated cardiac arrest, sustained VT, syncope attributable to malignant ventricular arrhythmias, seizures, or nocturnal agonal breathing [59,60,100]. ICDs may be used for primary prevention of SCD in asymptomatic patients with spontaneous type 1 Brugada EKG pattern if VF can be induced during electrophysiology studies (EPS) [59]. More recently, ablation and quinidine have been used in the treatment of BS, in particular for the intensification of therapy in patients receiving ICD shocks or in patients who qualify for an ICD but either decline it or have a contraindication to it [95]. Quinidine is believed to act by blocking the Ito current in the RV myocardium [55]. The Ito current is responsible for the dispersion of repolarization in the RV that results in the anterior precordial ST-segment elevation that characterizes the type 1 Brugada EKG and predisposes the patients to VT/VF. By blocking this transient outward repolarizing current, quinidine reduces electrical heterogeneity in the RV and reduces the risk of VT/VF. Some small studies have demonstrated the beneficial effects of quinidine in BS [101,102].