A Fib W/RVR Medications

Question 1

Meds for A Fib w RVR??

Answer 1

Diltiazem
Metoprolol
Amiodarone
Digoxin
Magnesium (MgSO4)

(MADD MAG)

Question 2

Diltiazem (a-fib w rvr)

Answer 2

0.25mg/kg (20mg max) over 2 min
Then
0.35mg/kg (25mg max) over 5 min
Then
IV drip started at 5mg/hr titrated up to 15mg/hr to maintain rate control

Question 3

Metoprolol (a-fib w rvr)

Answer 3

5mg IV q 5min (15mg max)
“Old folks” - may start with 2.5mg

• consider propranolol or esmolol

Question 4

Amiodarone dose (a-fib w rvr)

Answer 4

150mg IV over 10min
Then
1mg/min x 6hrs
Then
0.5mg/min x 18hrs

Question 5

When to consider skipping bolus of amiodarone (a-fib w rvr)?

Answer 5

Consider skipping bolus if transient HOTN is a concern

Question 6

Digoxin dose (a-fib w rvr)

Answer 6

8-12 mcg/kg
- load 1/2 up front then 1/4 q6-8hrs

Question 7

Magnesium (MgSO4) dose (a-fib w rvr)

Answer 7

2.5g over 20 min
Then
2.5g over 2hrs

Question 8

What is the use of Magnesium (MgSO4) in a-fib w rvr?

Answer 8

• not a mono-therapy -

Helps the other 4 with effectiveness
The other 4: diltizem, metoprolol, Amiodarone, digoxin