Cardiovascular Pharmacology Publisher



Dabbagh A ; Rajaei S ; Tajbakhsh A ; Talebi Z
Source: Postoperative Critical Care for Adult Cardiac Surgical Patients Published:2026

Abstract

The word “Drug” originated from the French word “drogue,” which also came from “droge-vote,” which comes from Middle Dutch and means “dry barrels” (Harper D, “Drug”. Online etymology dictionary). This concept refers to preserving pharmaceutical plants in barrels. As Claude Bernard quoted in 1865, “Everything is poisonous, nothing is poisonous, and it is all a matter of dose” (Bernard C, An introduction to the study of experimental study, 1865). Therefore, in this chapter, we are reviewing some clinical pharmacological titles, including Vasoactive agents and inotropes (pure vasopressors, inoconstrictors, inodilators, pure vasodilators), including the following items: Vasoactive agents can be classified into pure vasopressors, vasoconstrictors, inodilators, and pure vasodilators. Phenylephrine and vasopressin primarily increase systemic vascular resistance (SVR). Norepinephrine and epinephrine improve both SVR and cardiac contractility. Milrinone and dobutamine enhance contractility while reducing afterload. Drug selection should be tailored to the patient’s hemodynamic status and real-time monitoring data. Antihypertensive agents, anti-arrhythmic agents. Anesthetic drugs and clinical guidelines for anesthesiologists, including maintaining adequate perfusion pressure using individualized vasoactive agent strategies, utilizing multimodal monitoring (TEE, arterial lines) to guide therapy, and considering patient-specific factors like baseline cardiovascular function, surgical complexity, and comorbidities when choosing medications. Also, stress ulcer prevention and treatment, anticoagulation and thrombolysis medicines, principles of antibiotics, and surgical site infection management are among other parts of the chapter. Drug interactions in cardiovascular pharmacology are among the other parts of the chapter, including the role of beta-blockers and drugs like dobutamine and milrinone in combination with diuretics and their role on hypotension due to excessive vasodilation, vasopressors, and inhalational anesthetics, and the interactions between calcium channel blockers and neuromuscular blockade, requiring dose adjustments in anesthetized patients. Opioid-sparing strategies in cardiac anesthesia are among the final parts of the chapter considering multimodal analgesia as the key to reducing opioid use while maintaining effective pain control; regional anesthesia (epidural, paravertebral blocks), which could significantly decrease opioid requirements, and intravenous adjuncts (ketamine, dexmedetomidine, magnesium, lidocaine), which could enhance analgesia and opioid-sparing effects. Finally, enhanced recovery after surgery (ERAS) protocols focus on early mobilization, multimodal pain control, and opioid minimization to improve recovery outcomes. And finally, the role of artificial intelligence (AI) and personalized pharmacology is mentioned throughout the text. AI-driven models and their role in predicting hypotensive episodes and optimizing drug titration based on real-time patient data, machine learning in assisting precision medicine approaches by integrating patient genomics and metabolomics, and other related topics. In this chapter, we emphasize the main clinical considerations and dosage in addition to indications and contraindications. In other words, when will the drug be poisonous, as quoted above? This chapter aims to take a practical, clinical, and logical approach to the pharmaceutical management of patients with heart disease. © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2026.