22. Reteta: Fibrilatie atriala permanenta

Question 1

Rp 1 / 2

Answer 1

Rp1/Amiodarona cpr 200 mg
AO nr I (unu)
DS oral 1 cpr/zi, 30 zile
#
Rp2/Acenocumarol cpr 2 mg
AO nr I (unu)
DS oral 1 cpr/zi, in functie de valoarea INR, 30 zile

Question 2

1.Clasificare

Answer 2

1.Clasificare:
Amiodarona- antiaritmic, blocant canale K

Acenocumarol- antitrombotic, anticoagulant oral, antivitamine K

Question 3

2.Forma farmaceutica + doza

Answer 3

Amiodarona cpr 200 mg de 1-2ori/zi (oral); fiole 150mg/3ml (iv)
Acenocumarol cpr 2 mg, 4mg (oral)

Question 4

3.Actiune FD

Answer 4

Amiodarona:
- creste durata PA si a PRE, int PR, QT si largeste complexul QRS;
- VD sistemica si coronariana (actiune antianginoasa)

Acenocumarol:
- impiedica sinteza hepatica a factorilor coagularii: II, VII, IX, X
- inhiba competitiv actiunea vitaminei K epoxid reductaza si vit K chinon reductaza
-actiune persistenta, timp de 7-10zile dupa oprirea tratam;

Question 5

4.Indicatii terapeutice

Answer 5

Amiodarona:
 tratament cronic al aritmiilor ventriculare și supraventriculare
 in urgenta: de electie in tahicardia ventriculara stabila hemodinamic, FiA, tahicardie ventriculara fara puls.
 in TSV rezistenta la tratament

Acenocumarol:
 FiA si bolnavii protezati valvular
 tromboze venoase profunde
 profilaxia trombemboliilor, IMA
 tromboflebite si arteriopatii periferice

Question 6

5.Efecte adverse

Answer 6

Amiodarona:
 fibroza pulmonara ireversibila
 disfunctie tiroidiana
 fotosensibilitate
 depozite pigmentare corneene cu tulburari de vedere
 bradicardie, BAV, torsada varfurilor

Acenocumarol:
 hemoragie -> antidot: FITOMENADIONA (vit K1)
 efecte teratogene in primul trimestru de sarcina;
 alopecie reversibila
 intarzierea formarii calusului
 necroze cutanate si subcutanate

Question 7

6.Contraindicatii

Answer 7

Amiodarona: afectiuni tiroidiene, afectiuni pulmonare

Acenocumarol: sarcina si alaptare, ulcerul activ, traumatism major sau interv chir, IR sau IH grava, hemoragie, endocardita, HTA necontrolata (TAD>110mmHg)