Supply:0.25MG/TAB(LANOXINR)
Use:Congestive heart failure, atrial fibrillation, atrial flutter, paroxysmal atrial tachycardia, cardiogenic shock.
Contraindication:Ventricular fibrillation, digitalis intoxication.
Adverse effect:GI disturbance, anorexia (the earliest symptom of digoxin overdose), cardiac arrhythmia, and conduction defect.
Usual dosage:Adults : Oral : rapid digitalization: 0.75-1.5mg, maintenance dose: 0.125-0.25mg; IV: rapid digitalization: 0.75mg initially, 0.25mg Q2-4H, maximum dose: 1.0-1.5mg. Infants and Child: 10-20mg/kg/day by mouth or by injection.
Patient information:Do not discontinue medication medication without checking with physician; notify physician if loss of appetite or visual changes occur
Mechanism:
Congestive heart failure : Inhibition of the sodium/potassium ATPase pump which acts to increase the intracellular sodium-calcium exchange to increase intracellular calcium leading to increased contractility
Supraventricular arrhythmias: Direct suppression of A-V node conduction to increase effective refractory period and decrease condu ction velocity-positive inotropic effect, enhanced vagal tone, and decreased ventricular rate to fast atrial arrhythmias. Atrial fibrillation may decrease sensitivity and increase tolerance to higher serum digoxin concentrations.
Adrenergic Agents
DOBUTAMINE C
Supply:12.5MG/ML,20ML(UTAMINER)
Use:Used to increase cardiac output in the short-term treatment of patients with cardiac decompensation caused by depressed contractility from organic heart disease or cardiac surgical procedures.
Contraindication:Patients with idiopathic hypertropic subaortic stenosis
Adverse effect:Ectopic heartbeats, increased heart rate, angina, chest pain, palpitation, and elevations in blood pressure.
Usual dosage:The rate of infusion needed to increase cardiac output is 2.5-10mg/kg/min. On rare occasions infusion rates up to 40mg/kg/min have been required to obtain the desired effect.
DOPAMINE C
Supply:200MG/5ML(INTROPINR)
Use:Shock, cardiac disorders
Contraindication: Pheochromocytoma, uncorrected tachycardias, or ventricular fibrillation, Parkinson's disease
Adverse effect:Nausea, vomiting, ectropic beats, palpitation tachycardia, angina pain, dyspnea, headache, excessive vasoconstriction, hypertension.
Usual dosage:IV drip 5-10mg/kg/min as needed, do not add to alkali solution.
Special precautions:During anaesth with cyclopropane, halothane &other halogenated anaesth
Antiarrhythmic Drugs
AMIODARONE D
Supply:200MG/TAB(CORDARONER)
Use:Amiodarone is effective for the treatment of life-threatening recurrent ventricular fibrillation and tachycardia that has been unresponsive to adequate dose of other antiarrhythmic agents. It is also effective in refractory supraventricular arrhythmias.
Contraindication:Bradycardia, impairment of A-V conduction, heart failure, patient with iodine sensitivity, disorders of the thyroid gland, exposure to sunlight.
Adverse effect:Benign yellowish-brown corneal microdepositis, photosensitivity, severe bradycardia, conduction disturbances, severe hypotension, hypo- or hyperthyroidism, peripheral neuropathy, extrapyramidal effects, nausea, vomiting, metallic taste, nightmares, vertigo, headache, sleeplessness and fatigue. The most common adverse effects requiring discontinuance of oral amiodarone are pulmonary infiltrates or fibrosis, paroxysmal ventricular tachycardia, congestive heart failure, and elevations of serum hepatic enzyme concentrations.
Usual dosage:Initial dose: 800-1600mg PO daily for 1-3 weeks. After adeqate control: 600-800mg daily for one month then 400mg daily. IV loading dose: 150mg at rate of 15mg/min over 10 min, then 360mg at rate of 1mg/min (over 6 hrs). IV maintenance dose: 540mg at rate of 0.5mg/min (over 18 hrs), after first 24 hrs the maintenance infusion rate of 0.5mg/min (720mg over 24 hrs) should be continued.
Patient information:Take with food; use sunscreen or stay out of sun to prevent burns; skin discoloration is reversible; photophobia may make sunglasses necessary; do discontinue abruptly; regular blood work for thyroid function tests and ophthalmologic exams are necessary; notify physician if persistent if persistent dry cough or shortness of breath occurs
Mechanism: Class III antiarrhythmic agent which inhibits adrenergic stimulation, prolongs the action potential and refractory period in myocardial tissue; decreases A-V conduction and sinus node function
MEXILETINE C
Supply:100MG/CAP(MEXITILR)
Use:Prevention and treatment of ventricular arrhythmia.
Contraindication:Sinus node dysfunction; conduction defect; bradycardia, hypotension; cardiac, renal or hepatic failure.
Adverse effect:Nausea, vomiting, indigestion, unpleasant taste, hiccups, lightheadedness, drowsiness, confusion, dizziness, diplopia, blurred vision, nystagmus, dysarthria, ataxia, tremor, paraesthesia, convulsions, sinus bradycardia, hypotension, atrial fibrillation, palpitations.
Usual dosage:PO initial: 400-600mg, followed by 200-250mg TID-QID, starting 2 hrs after the loading dose. maintenance: 600-800 mg/day in divided dose.
*Note:
1. Absorption may be delayed by concurrent use of anticholinergics or opiates.
2. Absorption may be enhanced by concurrent use of metoclopramide.
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