Cardiac Pharmacology by R. Douglas Wilkerson (Eds.)

By R. Douglas Wilkerson (Eds.)

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Digitalis The nervous system plays much less of a role in the contractile force effect of digitalis glycosides. Initially, some studies using isolated cardiac atrial and ventricular tissues or the heart-lung preparation did implicate the sympathetic nervous system in the positive inotropic effect of these agents. , 1963; Tanz, 1964; Tanz, 1967; Carpi and Oliverio, 1965). , 1966; Wendtlandt and Varma, 1967), failed to confirm those reports. Analysis of the data obtained from the in vitro studies leads to the conclusion that the positive inotropic effect of digitalis is due to a direct effect on the heart, rather than to an action mediated by catecholamines.

1979). This concept is perhaps best exemplified by drugs used to treat hypertension. Historically, the first drugs to gain prominence for their neurally induced antihypertensive action were the veratrum alkaloids. These agents were shown to reduce arterial pressure (and heart rate) by stimulation of sensory nerve endings within, as well as outside of, the heart. This was followed by the introduction of the ganglionic blocking agents. Later, antihypertensive agents were introduced which were found to exert their primary site of action on the postganglionic sympathetic nerve terminal (reserpine and guanethidine).

ANTIHYPERTENSIVE AGENTS A. Reserpine As mentioned in the introductory section, the nervous system has proved to be an important site of action for drugs used to treat hypertension. The older agents such as the veratrum alkaloids, ganglionic blocking agents, and guan- 36 Richard A. Gillis and John A. Quest ethidine are considered to act primarily on peripheral components of the sympathetic nervous system. This is also probably true of reserpine, although at one time this agent was thought to exert part of its effect by a central action (McCubbin and Page, 1958).

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