Arrhythmia

Question 1

Amiodarone

Answer 1

Brand: Nexterone, Pacerone
* Warnings: BITCH
* Bradycardia/blue man
* Interstitial lung disease (pulmonary tox)
* Thyroid (hyper/hypo)
* Corneal microdeposits
* Hepatic/hypotension

Peripheral neuropathy, photosensitivity, SJS/TEN

• requires non-PVC container
• Use 0.22 micron filter, central line preferred
• incompatible with heparin, many Y-site additive incompatibilities
• teratogenic, excreted in breast milk

inhibits CYP2C9, 3A4, 2D6, P-gp
Careful w/other drugs that can decrease HR
Do not use w/sofosbuvir (brady)

General dose: 100-200 mg daily for afib (need loading dose)

Question 2

Digoxin

Answer 2

Brand: Digitek, Digox, Lanoxin
Typical dose: 0.125 mg - 0.25 mg daily
Therapeutic range (AFib): 0.8-2 ng/mL (lower for HF)
CrCl< 50: decrease dose or frequency; hold in AKF
IV:PO –> decrease dose by 20-25%

CI: Vfib

Dig level drawn 12-24 hrs after dose (monitoring)

ADE: dizziness, mental disturbances, N/V/D

Toxicity
- Initial: N/V, loss of appetite, brady
- Severe: blurred/double vision, greenish-yellow halos around lights, altered color perception, abd pain, confusion/delirium, arrhythmias

Antidote: Digifab
Low K, Mg and high Ca can increase risk of dig tox; hypothyroid can increase dig levels

Substrate of P-gp

Question 3

Double Quarter Pounder Lettuce Fries Mayo Please!
Dieting During Stress Is Always Very Difficult

Answer 3

Disopyramide
Quinidine
Procainamide