Arrhythmias

Question 1

Amiodarone (Aratac OR Cordarone)

Answer 1

A) Anti-Arrhythmic

B)

1. PREV and TREAT. Serious TACHY-ARRHYTHMIAS (refractory):
   a) Ventricular Tachycardia
   b) AF
   c) SVT

C)
Load: 200 mg TDS (week 1)
Cont. 200 mg BD (week 2)
Maint: 100-400 mg ONCE daily

D)
1. X-RAY (PULMONARY toxicity* develop early or late)
2. TFT (THYROID dysfunction* hypothyroidism - first 2 years)
3. OCULAR effects* (benign corneal microdeposits - visual haloes)
4. CONCENTRATION monitoring (TDM)
5. ECG* (prolong QT interval)
6. Serum ELECTROLYTES (electrolytes disturbances increase risk of arrhythmias)
7. Other DRUG INTERACTIONS
8. HEPATIC** (Hepatotoxicity)
no renal

E)
Labels: 5, 8, 18
#Avoid SUN exposure
#Interacts with GRAPEFRUIT
#You will need REGULAR BLOOD tests, ECGs and Chest X-rays
**DR - (pulmonary toxicity) SOB or a DRY COUGH
**DR - (ocular effects) problems with your VISION
**DR - (hepatotoxicity) WEIGHT LOSS, Muscle WEAKNESS
**DR - (arrhythmias) worsening of HEART symptoms
S/E
*Nausea and Vomiting
*Constipation
*Anorexia
*Taste disturbance (metallic)

Question 2

Digoxin (Sigmaxin)

Answer 2

A) Cardiac Glycoside

B)

1. AF and Atrial Flutter
2. Heart FAILURE (HF)

C)
LOAD: 
62.5 - 500 mcg q4-6hrs
(max 1.5 mg)
MAINT:
62.5 - 500 mcg ONCE daily

D)
1. CONCENTRATION monitoring (serum digoxin toxcitiy)
2. ECG** (prolong PR interval, ST depression or T wave inversion)
3. Heart RATE (bradycardia)
4. Serum ELECTROLYTES** (low K, low Mg, High Ca increase risk of digoxin toxicity
5. THYROID (low = increase dig; high = decrease dig)
6. Other DRUG interactions (P-gp)
7. RENAL function (predominantly renally cleared)
no hepatic

E)
Labels: 5
S/E
*GIT (anorexia, nausea, vomiting, diarrhoea)
*EYES (blurred vision)
*CNS (drowsiness, dizziness, headache)

Question 3

Flecainide (Tambocor)

Answer 3

A) Anti-Arrhythmic

B)

1. SVT
2. Paroxysmal AF or Atrial Flutter
3. Maintenance of SINUS rhythm following cardioversion
4. Serious VENTRICULAR arrhythmias (refractory)

C)
50-200 mg TWICE daily (Max400)

D)

1. ECG (proarrhythmic effect)
2. CONCENTRATION monitoring
3. ELECTROLYTES (low K, high K, low Mg - increase risk of arrhythmias)
4. RENA
5. HEPATIC

E)
Labels: 9, 12
S/E
Dizziness, BLURRED VISION, Sensitivity or light, Headaches and Nausea

Question 4

Sotalol (Sotacor)

Answer 4

A) Non-selective Beta-Blocker

B)

1. ARRHYTHMIAS (Prev. and Tx.)
   a) Atrial
   b) SupraVentricular
   c) Serious Ventricular

C)
40-320 mg TWICE daily
Max 640 mg daily

D)
1. Blood PRESSURE (contraindicated if SysBP <90)
2. ECG (may prolong QT interval)
3. ELECTROLYTES (low K, high K, low Mg - increase risk of arrhythmias)
4. RESPIRATORY (asthma; sotalol induces bronchospasms)
5. RENAL (accumulates in impairment)
no hepatic

E)
Labels: 3b, 4a, 9, 12+, 16
S/E:
*Can cause SOB, Faitgue, Lack of Energy, Dizziness and Headache; these decrease with cont. use