Interações medicamentosas em cardiologia: Fármacos antiárritmicos / Drugs interactions in cardiology: Antiarrhythmics drugs

As arritmias cardíacas são geradas por diferentes mecanismoseletrofisiológicos que atuam isoladamente ou interagem entresi para a formação e condução do impulso anormal. Com baseno conhecimento da eletrofisiologia celular e dos mecanismosgeradores de arritmias, diversos fármacos antiarrítmicos foramdesenvolvidos com objetivo de propiciar terapias cada vez maiseficazes e seguras. A necessidade de se agrupar os antiarrítmicos deacordo com seu mecanismo de ação e efeitos no impulsocardíaco, resultou na classificação de Vaughan- Williams que,apesar de amplamente difundida, não contempla algumasmedicações classicamente utilizadas como antiarrítmicos, taiscomo a adenosina e os digitálicos. Os antiarrítmicos são, emgeral, metabolizados pelo fígado por meio dos citocromos.Fármacos que interagem no mesmo sítio de ação em que sãometabolizados podem resultar em potencialização ou inibiçãodos efeitos antiarrítmicos. A redução ou o aumento do nívelsérico do antiarrítmico causado pelo fármaco utilizado concomitantemente,em decorrência da alteração na velocidade demetabolização, da redução na absorção ou somatório de efeitos,pode aumentar o potencial para efeitos colaterais deletérios eefeitos pró-arrítmicos e resultar em efeitos tóxicos potencialmentegraves. O objetivo deste capítulo é revisar os diversosmecanismos de interação medicamentosa que podem ocorrerenvolvendo as classes de antiarrítmicos...

Cardiac arrhythrnias are generated by different electrophysiologicalmechanisms that act alone or interact for the formation andconduction of the abnormal impulse. Based on the knowledge ofcellular electrophysiology and arrhythmia mechanisms, severalantiarrhythrnics were developed in order to provide therapiesincreasingly effective and safe. The need of grouping the antiarrhythmicagents according to their mechanism of action andeffects on cardiac impulse have led to the development of theVaughan- Williams c1assification. Although widespread used,this c1assification does not include some drugs c1assically usedas antiarrhythmics such as adenosine and digitalis.Antiarrhythmic agents are generaUy metabolized by the livervia the cytochrome. Drugs that interact at the same site of actionthat are metabolized may result in potentiation or inhibition ofantiarrhythmic effects. The reduction or increase in serum levelscaused by antiarrhythmic drug used concomitantly, due to thechange in the metabolism, reduction in absorption or summationeffects may increase the potential for deleterious side effects andproarrhythmic effects and result in potentiaUy serious toxic effects.The purpose of this chapter is to review the variousmechanisms of drug interactions that may occur involving theantiarrhythmic drugs...

Influence of adenosine, dipyridamole, adenosine antagonists and antiepileptic drugs on EEG after discharge following cortical stimulation.

The effects of adenosine (100 nM, icv), dipyridamole (DPM, 5 mg/kg, i.p.), adenosine A1 receptor antagonist 8-cyclopentyl-theophylline (8-CPT, 10 mg/kg, i.p.), and aminophylline (AMP) and caffeine (CAF) (at equivalent doses of 35 mg/kg, i.p.), were examined in rats. Anti-epileptic drugs (AEDs) were also administered i.p., viz, carbamazepine (CBZ, 10 mg/kg); phenobarbitone (PB, 10 mg/kg); phenytoin (PHT, 20 mg/kg); valproic acid (VPA, 300 mg/kg); and diazepam (DZP, 10 mg/kg), to study their effects on EEG after discharge (AD) and postictal depression (PID) induced by cortical stimulation. The AD parameters: (1) duration of EEG-AD (sec) and (2) number of spikes was noted both during pre and post drug treatment sessions. Adenosine and DPM had no special effects on AD parameters but showed significant prolongation of PID. All the adenosine antagonists, 8-CPT, AMP and CAF produced significant prolongation of AD duration, increase in number of spikes and reduced the duration of PID to a significant extent. Interestingly, some of the AEDs, viz. CBZ, VPA and DZP showed abolition of all the EEG-AD parameters whereas PB and PHT failed to show any significant effect. The results confirm previous findings on involvement of adenosine in postictal events.

Involvement of adenosine in postictal events in rats given electroshock.

The effect of a selective adenosine antagonist, 8-cyclopentyl 1,3-dimethylxanthine (8-CPT) was used to examine involvement of adenosine in ictal and postictal events in rats subjected to maximal electroshock (MES). MES induces the ictal event of hindlimb tonic extension (HLTE) followed by postictal depression (PID). 8-CPT 10 mg/kg, ip produced maximal significant reduction of PID without affecting HLTE, further confirming involvement of adenosine in PID. Carbamazepine and sodium valproate were studied independently and were coadministered with 8-CPT to determine if their anticonvulsant activity was modulated by adenosine and if they altered PID. 8-CPT did not antagonize the seizure protection afforded by CBZ or SV. CBZ significantly reduced postictal events whereas SV had no significant effect. These observations further confirm a role for adenosine in postictal phenomena.