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Pharmacological Treatment of Tachyarrhythmias in Acute Myocardial Infarction - a Review

Alexandru Deaconu
Alexandru Deaconu
, 
Silvia Deaconu
Silvia Deaconu
, 
Andrei Radu
Andrei Radu
 y 
Maria Dorobantu
Maria Dorobantu
   | 03 may 2022
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Article Category: Review
Publicado en línea: 03 may 2022
Páginas: 311 - 317
DOI: https://doi.org/10.47803/rjc.2021.31.2.311
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© 2021 Alexandru Deaconu et al., published by Sciendo
This work is licensed under the Creative Commons Attribution 4.0 International License.

j.rjc.2021.31.2.311.tab.001

Dabigatran CrCl>30mL/min-150mg b.d CrCl=30–49mL/min-110mg b.d CrCl=15–30mL/min-75 mg b.d CrCl<15mL/min-Avoid
Apixaban CrCl>15mL/min-5mg b.d Any 2 (>80yrs, <60kg, SCr>1,5mg/dl)-2,5mg b.d CrCl<15mL/min-Avoid
Rivaroxaban CrCl>50mL/min-20mg o.d CrCl=15-50mL/min-15mg o.dzx CrCl<15mL/min-Avoid
Edoxaban CrCl>50mL/min-60mg o.d CrCl=30–49mL/min-30mg o.d CrCl=15–30mL/min 30mg o.d CrCl<15mL/min-Avoid

j.rjc.2021.31.2.311.tab.002

Class Mechanism Drug name Indications Adult Dose Side Effects & Warnings
Ib Net effect: Depress conduction with NO change in or shortened APD (repolarization)MOA: Weakly blocks fastNa+ channels: ↓ membrane responsiveness; may shorten APD & end resting membrane potential (ERP) by ↑ K+ conductance Lidocaine Approved: VF, VT 1–1.5 mg/kg IV/IO x1; 0.5–0.75 mg/kg IV repeat in 3–5 min (max 3 mg/kg)Maintenance: 30–50 ug/kg/min SE: Hypotension; neuro (↓ CNS, dizziness, drowsiness and seizures at high levels). Warnings: prophylactic use in AMI; (Warning: reduce maintenance dose if liver disease or left ventricular dysfunction); Adam-Stokes Syndrome.Pregnancy Risk: B
II Net effect:↓ chronotropy & inotropy by inhibition of β Esmolol & other β-blockers Approved: VT, AFib, AFlutter, Intraoperative HTN Doses vary based on indication. Please see prescribing recommendations. SE: Bradycaerdia, hypotension, exacerbation of heart failure, bronchospasm Warning: Asthma (especially moderate to severe), decompensated HFPregnancy Risk: C
III Net effect: Prolong repolarization (recovery) by effective refractory period and APD.MOA: inhibition of K+ conductance Amiodarone Approved: VT, VFOther Uses: AFib, AFlutter, PSVT Inj: Pulseless VT/VF: 300 mg IV/IO push in 20 cc ; Other VT/VF: 150 mg IV × 10 min, then 360 mg IV × 6h, then 540 mg × 18h Note: Can be used in patients with impaired left ventricular dysfunction and WPW.SE: Hypo & hyperthyroidism (inj&tab contain 37% iodine), pulmonary fibrosis, liver toxicity, blue discoloration of skin, optic neuropathy/neuritis, QT prolongation.Warning: heart block; Pregnancy Risk: D
Net effect: ↓ chronotropy & inotropy; MOA: ↓ SA & AV nodal conduction of Ca+ through a blockade of voltage gated Ca+ channels Diltiazem Approved: AFib, AFlutter 15–20 mg IV × 2 min; Repeat in 15 min at 20–25 mg SE: Bradycardia, HB, worsening of HF, ↓ BPWarnings: WPW, sick sinus syndrome, HBPregnancy Risk: C
Verapamil Approved: Angina, AFib, AFlutter 2.5–5 mg IV over 2 min; then 5–10 mg (if needed) q15–30min (max dose 20mg).
Other Net effect: ↓ chronotropy & ↓ inotropy; MOA: PNS; ↑ gK & ↑ gCa Digoxin Approved: AFib, AflutterHF 0.4–0.6 mg IV over ≥5 min; may repeat 0.1–0.3 mg IV over ≥5 min SE: Arrhythmias, N/VWarnings: Bradycardia, HB, renal failure, hypokalemia.Pregnancy Risk: C
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Inglés
Calendario de la edición:
4 veces al año
Temas de la revista:
Medicine, Clinical Medicine, Internal Medicine, Cardiology, Pediatrics and Juvenile Medicine, Paediatric Cardiology, Surgery, Cardiac Surgery
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