cardiotonic drugs by sheeba yohannan

1. Cardiotonic drugs

2. Cardiotonic drugs
• Cardiotonic drugs are drugs, which increase cardiac contractile force during
heart failure.
• Cardiotonic are drugs used to increase the efficiency and improve the
contraction of the heart muscle, which leads to improved blood flow to all
tissues of the body.
• Cardiotonic drugs increase the force of the contraction of the muscle
(myocardium) of the heart. This is called a positive inotropic action.
• When the force of contraction of the myocardium is increased, the amount
of blood leaving the left ventricle at the time of each contraction is
increased.
• When the amount of blood leaving the left ventricle increases, cardiac
output (the amount of blood leaving the left ventricle with each
contraction) is also increased.

3. Classification of cardiotonic drugs
1.Cardiac glycosides /CGs/– Strophantine, Digoxin, Corglycon
2.Sympathomimetic drugs
➢ β - adrenomimetics –Prenalterol, Xamoterol
➢Catecholamines and their derivatives – Dopamine, Dobutamine
3. Phosphodiesterase inhibitors
➢Bipyridine derivatives – Amrinone, Milrinone Imidazole derivatives –
Enoximone, Piroximone, Fenoximone
➢ Benzimidazole derivatives - Pimobendane
4. Cardiotonic drugs with other mechanism - Vesnarinone, Forskoline

4. Digitalis
• Biological source:
Digitalis consists of dried leaves of Digitalis purpurea
• Family: Scrophulariaceae
• Chemical constituents:
Digitalis contains 0.2 to 0.45 % of Cardiac glycosides (Cardenolides),
Purpurea glycosides A and B, which are primary glycosides.
Digitalis also contains several other glycosides such as Odoroside H,
Glucogitaloxin, Gitaloximn, Verodoxin and Glucoverodoxin.

5. Chemical tests
•Keller Killiani: Alcoholic extract of drug + equal volume of water + 0.5 ml of
strong lead acetate solution → shake → filter→ filtrate extracted with same
amount of CHCl3 → CHCl3 extract evaporated to dry → remainder dissolved
in 3 ml of glacial acetic acid + few drops of FeCl3 solution + 2ml of conc.
H2SO4→ reddish brown layer → turns to bluish green → indicate the
presence of aglycon ( digitoxose).
•Baljet test: Section of drug containing cardiac glycoside ( thick section of
leaf of digitalis) →dipped into sodium picrate solution → appearance of
yellow to orange colour → indicate the presence of aglycon moiety.
•Legal Test: Alcoholic extract of drug + equal volume of water + 0.5 ml of
strong lead acetate solution → well shake →filter → filtrate extracted with
same volume of CHCl3→CHCl3 extract evaporate → dryness → remainder
dissolve with 2 ml of pyridine and sodium nitropruside + NaOH solution to
make it alkaline → appearance of pink colour → indicates the presence of
aglycon or glycoside moiety.

6. Uses of Digitalis
•Digitalis increases excitability of Cardiac muscles and produces more
powerful contractions.
•It is effective in Congestive cardiac failure to increase cardiac output
and to relieve venous congestion. Hence it is described as a
Cardiotonic.
•The improvement of circulation through kidney results in diuresis and
loss of Oedema.
•The major disadvantage of Digitalis is that it has cumulative effect and
therefore, in prolonged treatment one has to watch the patient
carefully.

7. Arjuna
• Synonyms : Arjun bark, arjun.
• Biological Source:
Arjuna consists of dried stem bark of the plant known as Terminalia
arjuna Rob, belonging to family Combretaceae.

8. Chemical Constituents
• The dry bark from the stem contains about 20 to 24% of tannin,
whereas that of the bark obtained from the lower branches is up to
15 to 18%.
• The tannins present in arjuna bark are of mixed type consisting of
both hydrolysable and condensed tannins.
• The tannins are reported to be present are (+) catechol, (+)
gallocatechol, epicatechol, epigallocatechol, and ellgic acid.
• The flavonoids such as arjunolone, arjunone, and baicalein have been
reported from the stem bark.

9. • The triterpenoid compounds arjune-tin, arjungenin, arjunglucoside I
and II, and terminoic acid have also been reported from the bark.
• The root contains number of triterpenoids such as arjunoside I and II,
terminic acid, oleanolic acid, arjunic acid, arjunolic acid, etc.
• The fruits also contain 7 to 20% of tannins.
• A pentacyclic triterpenic glycoside arjunoglucoside III has been
reported from the fruits along with hentriacontane, myristyl oleate
and arachidic stearate.

10. • Chemical Test
Ethereal extract of arjuna shows pinkish fluorence under ultra-violet
light.
• Uses
1. Arjuna bark is used as a diuretic and astringent.
2. The diuretic properties can be attributed to the triterpenoids present
in fruits.
3. It causes decrease in blood pressure and heart rate.
4. It is used in the treatment of various heart diseases in indigenous
systems of medicines.
5. The bark was extensively used in the past by the local tanneries for
tanning animal hides.
6. It yields a very firm leather of a colour which is similar babool tanned
leather.

11. Thank you