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Subject: Cardiovascular Drugs (See Digoxin)
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Cardiovascular drugs include the antiarrhythmics, the anticoagulant warfarin, and antihypertensives, as well as the β-adrenergic antagonist propranolol and the drug digoxin.
Normal therapeutic values: see Table 16.15.
To treat arrhythmia, hypertension, blood clotting, and angina.
The majority of these drugs are not routinely monitored as clinical effects do not generally correlate with serum or plasma levels. Notable exceptions are digoxin and procainamide.
Where concentrations are required, specific gas chromatography and HPLC procedures have been developed (e.g., procainamide/N-acetylprocainamide [NAPA], quinidine, mexiletine, diltiazem, verapamil, amiodarone, and metabolite, warfarin). Limits of quantitation vary according to the drug and methodology.
Immunoassay tests (e.g., FPIA) are available for procainamide, quinidine.
In addition, lidocaine, diltiazem, verapamil, and quinidine are qualitatively detectable in urine with a simple alkaline liquid–liquid or solid-phase extraction followed by GC/MS analysis. Limits of detection range from 50 to 250 ng/mL.
Rifampin may decrease verapamil serum concentrations.
With procainamide, separate cells from plasma as soon as possible to prevent loss of drug during storage.
Hemolyzed samples are unacceptable.