Antiarrhythmic agent resident survival guide: Difference between revisions
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{{Family tree | D01 | | D02 | | D03 | | D04 | | D05 | | D06 | | D07 | |D01= '''Agents''' |D02= [[Quinidine]], [[procainamide]], [[disopyramide]] |D03= 2nd line septic shock |D04= 2nd line septic shock |D05= '''1st''' line '''Neurogenic shock''' <BR> 3rd-4th line septic shock |D06= *1st line '''cardiogenic shock''' <BR>* low output septic shock |D07= }} | {{Family tree | D01 | | D02 | | D03 | | D04 | | D05 | | D06 | | D07 | |D01= '''Agents''' |D02= [[Quinidine]], [[procainamide]], [[disopyramide]] |D03= 2nd line septic shock |D04= 2nd line septic shock |D05= '''1st''' line '''Neurogenic shock''' <BR> 3rd-4th line septic shock |D06= *1st line '''cardiogenic shock''' <BR>* low output septic shock |D07= }} | ||
{{Family tree | | | | | |!| | | |!| | | |!| | | |!| | | |!| | | |!| | |}} | {{Family tree | | | | | |!| | | |!| | | |!| | | |!| | | |!| | | |!| | |}} | ||
{{Family tree | E01 | | E02 | | E03 | | E04 | | E05 | | E06 | | E07 | |E01= '''Effect''' |E02= | {{Family tree | E01 | | E02 | | E03 | | E04 | | E05 | | E06 | | E07 | |E01= '''Effect''' |E02= Slow conduction, and prolongation of repolarization |E03= 2-20 mcg/min |E04= 0.03 unit/min |E05= 20-300 mcg/kg/min |E06= 2.5-20 mcg/kg/min |E07=}} | ||
{{Family tree | | | | | |!| | | |!| | | |!| | | |!| | | |!| | | |!| | |}} | {{Family tree | | | | | |!| | | |!| | | |!| | | |!| | | |!| | | |!| | |}} | ||
{{Family tree | F01 | | F02 | | F03 | | F04 | | F05 | | F06 | | F07| |F01= '''Indications''' |F02= Tachyarrhythmia {less β1 effect} <br>( less than Dopamine ) |F03= Arrhythmia (more β1) |F04= *Coronary spasm<br>*Splanchnic vasoconstriction|F05= Reflex bradycardia <br>(only α1) |F06= Hypotension (β2) |F07=}} | {{Family tree | F01 | | F02 | | F03 | | F04 | | F05 | | F06 | | F07| |F01= '''Indications''' |F02= Tachyarrhythmia {less β1 effect} <br>( less than Dopamine ) |F03= Arrhythmia (more β1) |F04= *Coronary spasm<br>*Splanchnic vasoconstriction|F05= Reflex bradycardia <br>(only α1) |F06= Hypotension (β2) |F07=}} | ||
Revision as of 17:06, 12 December 2013
Template:Antiarrhythmic agent Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:
Definition
Causes
Life Threatening Causes
Common Causes
Prognosis
Vaughan-Williams classification of antiarrhythmic agents
| Vaughan-Williams classification of antiarrhythmic agents | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Class IA | Class IB | Class IC | Class II | Class III | Class IV | ||||||||||||||||||||||||||||||||||||||||||||||||||||
| Mechanism | Predominantly sodium channel blocker with some potassium channel blocking activity | *Mainly predominant β1 agonist (↑ cardiac contractility) * some α1 agonist(Vasoconstrictive) | *V1 receptor of GIT vasculatures *Antidiuretic effects | *Pure α1 agonist(Vasoconstrictive) *No β1 | *Predominant β1 agonist (↑contractility) *β2 arterial smooth muscle (Hypotensive) | ||||||||||||||||||||||||||||||||||||||||||||||||||||
| Agents | Quinidine, procainamide, disopyramide | 2nd line septic shock | 2nd line septic shock | 1st line Neurogenic shock 3rd-4th line septic shock | *1st line cardiogenic shock * low output septic shock | ||||||||||||||||||||||||||||||||||||||||||||||||||||
| Effect | Slow conduction, and prolongation of repolarization | 2-20 mcg/min | 0.03 unit/min | 20-300 mcg/kg/min | 2.5-20 mcg/kg/min | ||||||||||||||||||||||||||||||||||||||||||||||||||||
| Indications | Tachyarrhythmia {less β1 effect} ( less than Dopamine ) | Arrhythmia (more β1) | *Coronary spasm *Splanchnic vasoconstriction | Reflex bradycardia (only α1) | Hypotension (β2) | ||||||||||||||||||||||||||||||||||||||||||||||||||||
| Complications | Arrhythmia | *Not in cardiogenic shock *Arrhythmia *Ischemia induced cardiotoxicity | *Ischemic heart *Gut ischemia | *Bradycardia *Heart block | *Hypotension (add α1 agonist) | ||||||||||||||||||||||||||||||||||||||||||||||||||||
Do's
- Assess the cause of shock
- Always volume fluid resuscitation first
- Norepinephrine in undifferentiated shock.
- Titrate dobutamine according to clinical response slowly ( 2-20 ug/kg/min ) to avoid tachycardia (10% increase from the baseline). The benefit that dobutamine has as minimal effect on myocardial oxygen demand is lost if it is not well titrated.
Don'ts
- Do not start with low dose Dopamine dose to perfuse the kidney.