Anti-Aritmice

Question 1

Terapia aritmiilor

Answer 1

1. Compresia sino-carotidiana
2. Trat Medicamentos
3. Overdriving
4. Dispozitive implantabile (pace-maker/defib)
5. Ablatie prin radiofrecventa
6. Chirurgie antiaritmica

Question 2

Clasa 1a: Chinidina

Answer 2

Doza: 600-1600mg/zi in 4 prize
Indic: ESA, TA, FiA, Sd Brugada, Repol precoce
CI: BAV 2,3, BNS, Sd Q-T lg, IC
Efec adverse: Digestive/AHAI/Trombopen
Inotrop -, blocuri, ef proaritmice

Question 3

Clasa 1a: Procainamida

Answer 3

1,5-4g/zi in 2-4prize
Ind: TA,FiA,ESV,TV !!WPW!!
CI:~Chinidina
EfA: Sd Lupus-like, Agranulocitoza

Question 4

Clasa 1a: Disopiramida

Answer 4

400-800mg/zi in 3 prize (act rapid)
Ind: Aritmii atriale in CMH
CI:~ Chinidina
EfA: Inotrop -, proaritmic

Question 5

clasa 1b: Xilina

Answer 5

Bolus i.v 1mg/kgc apoi piV 2-4mg/min
Ind: Aritmii Ventric din BCI
EfA: Neurologice–> Depresie,convulsii,fasciculatii

Question 6

clasa 1b: Mexiletin

Answer 6

600-900mg/zi in 3 prize
Ind: Aritmii ventriculare
EfA: ~Xilina + bradicardie, hTA

Question 7

1c(Pe cord N): Propafenona

Answer 7

450-900mg/zi in 3 prize
Ind: FiA, TPSV, Aritmii V/cord N
EfA: Proaritmice, introp -, BAV, bloc subnodal, neuro

Question 8

1c(Pe cord N): Flecainida

Answer 8

200-400mg/zi in 2 prize
Ind: FiA,TPSV, v/cord N, CPVT
Efa: Proaritmice, introp -, neurologice

Question 9

clasa 2 (BB): Propranolol

Answer 9

1mg i.v in 1min evt repetat de 2 ori la 2 min
40-240mg/zi in 3-4prize
Indic:
Control ritm FiA, Fl A, TS
Profilaxia TPSV, ESV, TV, Post IM
CI: BAV 2,3, BNS, Soc card/IC decomp, Br spasm, hTA
EfA: Bronhospasm, Agrav IC, astenie, depresie

Question 10

clasa 2 (BB): Esmolol (ACUT)

Answer 10

500microg/kgc bolus i.v in 1min, apoi PEV 50-300microg/kgc/min
Ind: Control ritm in ACUT
EfA: hTA, IVS ac, BAV2,3
CI: hTA, agrav IC, Brspasm, bradicard

Question 11

clasa 2(BB): Metoprolol

Answer 11

IV 5 mg cu 1mg/min evtl repetat la fel PO max 200mg/zi, 2 prize tartrat (300succinat)
~Propranolol cr (esmolol acut)

Question 12

clasa 3: Amiodarona

Answer 12

Incarcare 400-600/zi 2-4 sapt, apoi 100- 200mg/zi Bolus i.v 150 mg in 10 min apoi 1mg/min 6h, apoi 0,5 mg/min 18 h
Ind: Aritmii SV si V, inclusiv postIM
CI:BAV 2,3, BNS, LQTS, Disfunctie hepatica Interact cu warfarina(< 50%) si digoxin (<50%)

EfA:IV hta braducardie flebita prel QT rar torsada crestere INR PO Cardiace: bradicardie, blocuri, rar ef. proaritmice (torsada,TV) hta
Extracardiace: disfunctie tiroidiana, pulmonare fibroza
depozite corneene, hepatita tox. neuropatii, fotosensibilizare

Question 13

clasa 3: Sotalol

Answer 13

Initial 40-80X2/zi intretinere :pana la 160x2/zi
Ind: Aritmii SV si V, inclusiv postIM, cu FE normala
~BB

Question 14

Clasa 4: Verapamil

Answer 14

5-10 mg i.v, se poate repeta la 15 min 120-480 mg/zi peros, in 2- 3 prize fct de prezentare
Ind: TPSV Controlul ritm in FiA, Fl A
Ci: BAV 2,3 BNS, IC, Tahicardia cu complexe largi WPW
EfA: Cardiace: bradicardie, blocuri,AV rar asistola, agravare IC, EPA la CMH hipotensiune

Question 15

Clasa 4: Diltiazem

Answer 15

0,25 mg/kg i.v in 2min, apoi PEV 5-10 (15) mg/h
90-360 mg/zi, in 2-3 prize fct de prezentare
Ind: TPSV, Controlul ritm in FiA, Fl A
CI/efa: ~Verapamil

Question 16

FiA conversia farmaco

Answer 16

Flecainida (p.o 200-300mg)
Propafenona (p.o 450-600mg)
Vernakalant 3mg/kg —>IC
Amiodarona 5mg/kg—>IC secera,SAo severa,SCA recenta