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Heart Disease and Heart Failure Drugs (β-blockers (Propranolol) (Toxicity,…

- - - - Increased calcium sequestered by sarcoplasmic reticulum for later release. Effect occurs in both normal and failing heart
    - - Cardiac: progressively more severe dysrhythmia including AV junctional rhythm, premature ventricular depolarization, bigeminal rhythm, AV block, AF, VF
        Gastrointestinal effects: anorexia, nausea, vomiting (effects mediated directly and also by CNS)
        CNS: headache, fatigue, confusion, blurred vision, aberrations of colour perception
        Gynaecomastia (due to steroid structure): rare
      - Treatment of digitalis toxicity
        
        Reduce dose or discontinue cardiac glycoside therapy if side effects visual changes or gastrointestinal disturbances
        Correction of potassium or magnesium deficiency
        Insertion of temporary cardiac pacemaker
        Combined with use of digoxin Fab fragments (digibind)
        Antiarrythmic drugs if used when automaticity is depressed may lead to cardiac arrest
        Cardioversion only if VF (as digitalis induced arrythmias are made worse by cardioversion)