Antiarrhythmics Flashcards
(23 cards)
Nexterone, Pacerone
Class III antiarrhythmic
Amiodarone
Nexterone, Pacerone:
Boxed Warnings
Pulmonary toxicity -> baseline CXR & PFTs
Hepatotoxicity -> baseline LFTs
For life-threatening arrhythmias only; proarrhythmic, must be hospitalized for IV loading dose
Nexterone, Pacerone:
Contraindications
Iodine hypersensitivity
Nexterone, Pacerone:
Warnings
Hyper & Hypothyroidism (hypo more common) - amiodarone partially inhibits peripheral conversion of T4 to T3
visual impairment
photosensitivity (slate blue skin)
peripheral neuropathy
SJS/TENS
Nexterone, Pacerone:
ADE
hypotension
bradycardia
corneal microdeposits
photosensitivity (sun protection required)
Nexterone, Pacerone:
Monitoring
ECG, BP, HR, electrolytes
LFTs Q6 months
Thyroid function Q3-6 months
CXR annually
regular eye exams
Nexterone, Pacerone:
Notes
- infusions > 2h require non-PVC container (PVC tubing is fine)
- choice antiarrhythmic in HF
- decrease infusion rate or DC as needed with hypotension or bradycardia
- IV admin: use 0.22 micron filter; central line preferred
- incompatible with heparin (flush with saline)
- many Y-site additive incompatibilities
- t1/2 40-60 days
Nexterone, Pacerone:
this drug is an ______ of CYP ___, ___, ___, & ___
inducer of CYP 2C9, 2D6, 3A4, & P-gp
Nexterone, Pacerone:
Dose adjustments to other CV meds when starting this agent
decrease digoxin by 50%
decrease warfarin by 30-50%
do not exceed:
- 20 mg/day simvastatin
- 40 mg/day rosuvastatin
Nexterone, Pacerone:
DDI with NDHP CCBs, digoxin, BB, & clonidine
additive effect
bradycardia
Sofosbuvir can ______ the _______ effect of amiodarone. Do not use together.
Sofosbuvir can enhance the bradycardic effect of amiodarone
Digitek, Lanoxin
Na-K-ATPase blocker
Digoxin
decreases HR by increasing force of contraction (positive inotrope)
Digitek, Lanoxin:
Contraindication
Ventricular fibrillation
Digitek, Lanoxin:
Warnings
vesicant
Digitek, Lanoxin:
ADE
dizziness
mental disturbances
N/V/D
Digitek, Lanoxin:
Monitoring
take levels 12-24hr after first dose
therapeutic range: 0.8-2 ng/mL for AF
Digitek, Lanoxin:
Toxicity
Symptoms: N/V, loss of appetite, blurred/double vision, altered color perception, bradycardia, life-threatening arrhythmias
Hypokalemia & hypomagnesemia inc risk of toxicity
Hypothyroidism can inc digoxin levels
Antidote: DigiFab
Digitek, Lanoxin:
Dosing & adjustments
typical dose: 0.125-0.25 mg PO once daily
CrCl < 50 mL/min -> dec dose or frequency, hold in acute renal failure
Decrease dose 20-25% when switching from PO to IV
Digitek, Lanoxin:
DDI
increased digoxin levels with P-gp inhibitors (amiodarone, dronedarone, diltiazem, verapamil)
- w/ amiodarone & dronedarone dec digoxin dose by 50%
additive effects with other drugs that decrease HR (amiodarone, NDHP CCBs, BBs, clonidine, dexmedetomidine (Precedex)
Class 1a drugs + warnings
Disopyramide (Norpace)
- proarrhythmic, anticholinergic effects
Quinidine
- proarrhythmic, hemolysis risk (avoid in G6PD deficiency), DILE, diarrhea & cramping, take with food
Procainamide
- BW for agranulocytosis, long term use -> DILE
Class 1c drugs + warnings
Flecainide
- proarrhythmic (do not use in chronic AF), CI in HF & MI
Propafenone (Rythmol SR)
- proarrhythmic, taste disturbance, CI in HF & MI
Class 3 antiarrhythmics:
agents + warnings
Dronedarone (Multaq)
- BW: inc risk of death, stroke, and HF in pts with decompensated HF or permanent AF
- CI with CYP3A4 inhibitors and QT prolonging drugs
- Warnings: hepatic failure, pulmonary disease
Sotalol (Betapace, Sotylize, Sorine)
- BW: renal dose adjustments to reduce QT prolongation risk
Ibutilide (Corvert)
- correct hypokalemia & hypomagnesemia prior to use
Dofetilide (Tikosyn)
- BW: must be initiated in setting with continuous ECG monitoring, assess CrCl for a minimum of 3 days, proarrhythmic
Adenocard
Adenosine
antiarrhythmic not covered by Vaughan Williams classification
Use: supraventricular re-entrant tachycardias
t1/2 less than 10 sec
