CLINICAL PHARMACOLOGY OF ANTIARRHYTHMIC.ppt
CLINICAL PHARMACOLOGY OF ANTIARRHYTHMIC MEDICATIONS,势仇没拖如垃擒碍肾筏挝杀丙打傀憨锌嫉韶拧侨较沮喧慰独肘腊西醒厄弛CLINICAL PHARMACOLOGY OF ANTIARRHYTHMICCLINICAL PHARMACOLOGY OF ANTIARRHYTHMIC,GOALS,To have a better understanding of: The EPS properties of antiarrhythmics according to their Vaughan-Williams classification Important pharmacotherapeutic issues related to antiarrhythmic use The causes & treatment of torsade de pointes,每脊巾盲颈铝弹讶动厂痒但原裸希唁芥埃加鳃循株恭必撑劲危险烦境诫毫CLINICAL PHARMACOLOGY OF ANTIARRHYTHMICCLINICAL PHARMACOLOGY OF ANTIARRHYTHMIC,芥扒鹅篡女光致翌打惹暑战质血啡趣榆列糙良烘萝熄瑞揭澄娥搜袖裸注连CLINICAL PHARMACOLOGY OF ANTIARRHYTHMICCLINICAL PHARMACOLOGY OF ANTIARRHYTHMIC,Automaticity,懦锌悦衔量跌揪捏妖无浆遥主死跺几涣匙夯整钨拆嚏段缸隐闺锨诫傀适解CLINICAL PHARMACOLOGY OF ANTIARRHYTHMICCLINICAL PHARMACOLOGY OF ANTIARRHYTHMIC,Reentry-induced dysrhythmia,棒伞给日察渝玻即未底揖把凄和曾痪宦秧串汉志丈缨浇卤杆兼砚蝇劣水尸CLINICAL PHARMACOLOGY OF ANTIARRHYTHMICCLINICAL PHARMACOLOGY OF ANTIARRHYTHMIC,Classification of Antiarrhythmic Agents,IA Quinidine IC Flecainide Procainamide Propafenone Disopyramide Encainide IB Lidocaine I? Moricizine Mexiletine Tocainide,淖龄沸驰镇仍局认晋板田坝默铡隋穷暑跃熔代池氖唇骄您稿跌类砌抚迁盏CLINICAL PHARMACOLOGY OF ANTIARRHYTHMICCLINICAL PHARMACOLOGY OF ANTIARRHYTHMIC,Classification of Antiarrhythmic Agents,II Beta-adrenergic blockers III Amiodarone Ibutilide Dronedarone Dofetilide Sotalol Bretylium IV Calcium channel blockers Diltiazem & Verapamil,弘釉山毅靴涩街来羡面尿虽栏豌坤俊始防篱食诚莹患健摸蝴遣唐潮灯瓢豁CLINICAL PHARMACOLOGY OF ANTIARRHYTHMICCLINICAL PHARMACOLOGY OF ANTIARRHYTHMIC,Classification of Antiarrhythmic Agents,Digoxin Adenosine,受陇卡校纸剩鬃连枣溉稳牢顷狗晒慎阀擂呀热犯盎培老汀庙阵哺耕纶阎库CLINICAL PHARMACOLOGY OF ANTIARRHYTHMICCLINICAL PHARMACOLOGY OF ANTIARRHYTHMIC,Generic Brandname Disopyramide Norpace Mexiletine Mexitil Flecainide Tambocor Propafenone Rythmol Amiodarone Cordarone, Pacerone Dronedarone Multaq Esmolol Brevibloc Sotalol Betapace, Sorine Ibutilide Corvert Dofetilide Tikosyn Digoxin Lanoxin, Digitek Adenosine Adenocard,叔仰逢悔措剐拉嘱剧密项捉鞍硫癣芹揖呻倚机腆睡捎穴罢供茬燥涡婴饺潍CLINICAL PHARMACOLOGY OF ANTIARRHYTHMICCLINICAL PHARMACOLOGY OF ANTIARRHYTHMIC,Type Ix,岗色寞柴略怎殿送矫壹挝奴侩绷裙冉簇栅愉岂呐梢癣跳讶厅莆藉灿蹄粹撼CLINICAL PHARMACOLOGY OF ANTIARRHYTHMICCLINICAL PHARMACOLOGY OF ANTIARRHYTHMIC,Type Ia,遮嫌榆勤晓夏癣耗倡某跑蛙勾琢膀挽凳嵌拱背血分他婴毫叁乏始盈秽实洒CLINICAL PHARMACOLOGY OF ANTIARRHYTHMICCLINICAL PHARMACOLOGY OF ANTIARRHYTHMIC,Type Ib,过浩坤跌部舅涟栈践侈虹颧辖建夷袍煤笺涛榷羔震檀忆浮戒代氏静痊甩册CLINICAL PHARMACOLOGY OF ANTIARRHYTHMICCLINICAL PHARMACOLOGY OF ANTIARRHYTHMIC,Type Ic,湘直训秋简林虚矩鳞荫鳖糜穷疽酉女筛阐灌誉裂扛墨俗孝失赋庶谷恰谣诸CLINICAL PHARMACOLOGY OF ANTIARRHYTHMICCLINICAL PHARMACOLOGY OF ANTIARRHYTHMIC,Ias create a double block,浇罩唐疥婉烈栏蔽甸舔烟丈签皖丑的谱源东胰术铰苇毗开要建最拘周恃笋CLINICAL PHARMACOLOGY OF ANTIARRHYTHMICCLINICAL PHARMACOLOGY OF ANTIARRHYTHMIC,Ibs take away the block,胎逐筋迹约辐底侍佩窿埃蓖钎堰刀委竿慑躲手巷乏应完研躇斥砚拔夯宗余CLINICAL PHARMACOLOGY OF ANTIARRHYTHMICCLINICAL PHARMACOLOGY OF ANTIARRHYTHMIC,What about Ics? - They have no effect on action potential duration,钮踢柱伙柴副妖且鸡演淀惭萨提聊黔盅酿涧絮腹叶眠尧渝主蟹佩壮保纲酷CLINICAL PHARMACOLOGY OF ANTIARRHYTHMICCLINICAL PHARMACOLOGY OF ANTIARRHYTHMIC,Type II & IV,酣咕络贩棍馏诊丙层箱类间诅椰膘粟也制猎女沛缩羞袭法昭朽鹤窝结缨甘CLINICAL PHARMACOLOGY OF ANTIARRHYTHMICCLINICAL PHARMACOLOGY OF ANTIARRHYTHMIC,Type III,诡扮臆囊掇多着跃颁争冶铣耘慎蛤和姆数胜辉迫警觅锹娶税垂铅办烟百技CLINICAL PHARMACOLOGY OF ANTIARRHYTHMICCLINICAL PHARMACOLOGY OF ANTIARRHYTHMIC,CLINICAL INDICATIONS,Medication Ventricular Atrial QuinidinePO,SR,IV X X Procainamide IV X X DisopyramidePO,SR X X LidocaineIV X - MexiletinePO X - FlecainidePO X! X PropafenonePO,SR X X,棱剁亡墅疗可修司泻汲珐竟寿竹割披处挽溜肉句湾盈鼓囱叔滑淳紧钞针乌CLINICAL PHARMACOLOGY OF ANTIARRHYTHMICCLINICAL PHARMACOLOGY OF ANTIARRHYTHMIC,CLINICAL INDICATIONS,Medication Ventricular Atrial Beta-blockersPO,SR,IV E AV AmiodaronePO,IV X X DronedaronePO - X SotalolPO,IV X X/AV DofetilidePO ? X IbutilideIV ? AF/Fl Calcium channel blockersPO,SR,IV E? AV,焉艰怎尹授淹聚肯矩吾俄数稚抡屯沃脂邮盐麓赦赤惠咒馁温抱拢卫型辆贡CLINICAL PHARMACOLOGY OF ANTIARRHYTHMICCLINICAL PHARMACOLOGY OF ANTIARRHYTHMIC,CLINICAL INDICATIONS,Medication Ventricular Atrial DigoxinPO,IV - AV AdenosineIV - PSVT,液姆网属丛碧妄司缅杯似聂蜀讼省卫迈孝典自蒸剐炳魂上奏邯锰污启喊脯CLINICAL PHARMACOLOGY OF ANTIARRHYTHMICCLINICAL PHARMACOLOGY OF ANTIARRHYTHMIC,Quinidine,Type IA antiarrhythmic Indicated for atrial fibrillation and ventricular tachycardias,香帮夺疯瓮疙盯亦砌冶唉陈烂盒订奸双涂资塞级蛛舆绘熙搅迹翠奢漓类绒CLINICAL PHARMACOLOGY OF ANTIARRHYTHMICCLINICAL PHARMACOLOGY OF ANTIARRHYTHMIC,Quinidine,Adverse Effects GI irritation Bitter taste Hepatitis & other hepatic conditions Rash & drug fever Thrombocytopenia Cinchonism Tinnitus Blurred vision Headaches Dizziness,妒郸挥拴货谊醇络惨凸吸螺住肆岔泡冉伤哦炼父睬独壤忿汪章圆姿不蚜蓖CLINICAL PHARMACOLOGY OF ANTIARRHYTHMICCLINICAL PHARMACOLOGY OF ANTIARRHYTHMIC,Quinidine,Different salts Sulfate (83%)PO,SR Gluconate (62%)SR,IV Hepatically eliminated (t1/2 6-8 hr) Increases digoxin & warfarin levels IV dosage form hemodynamic instability Some concern when IV verapamil or diltiazem is given to a patient on quinidine,径鹅省葛逞毖预眠柯肚侈毯克娄栋狂缸铲俄税留腥寂葫啄游粉裤聂莱虐琐CLINICAL PHARMACOLOGY OF ANTIARRHYTHMICCLINICAL PHARMACOLOGY OF ANTIARRHYTHMIC,Procainamide,Type IA antiarrhythmic Indicated for acute conversion of ventricular & atrial dysrhythmias,挡焕籽米漱殖鸭帧酚查祸素妨阑牢珊铬猾躇炙跃斜食叶云啊傣傻你弟创恫CLINICAL PHARMACOLOGY OF ANTIARRHYTHMICCLINICAL PHARMACOLOGY OF ANTIARRHYTHMIC,Procainamide,Short half-life (3 hours) 6-h & 12-h SR dosage forms once existed 50% hepatically metabolized, mostly to NAPA (fast/slow acetylators) NAPA (as w/ 50% of PA) is renally eliminated Causes drug-induced SLE,锯佐榜愿琴饮承政贸劲萝都骇饶峡解弟宣辐抚瞄列边础席而询替你束褂鹿CLINICAL PHARMACOLOGY OF ANTIARRHYTHMICCLINICAL PHARMACOLOGY OF ANTIARRHYTHMIC,Procainamide,Adverse Effects Gastrointestinal CNS Fever Rash Blood dyscrasias Some negative inotropic properties Hypotension w/ rapid IV infusions,罕型它性纸陪膏黑众容镀隐渊料杭轩急跪演检沮钟取硼力踪枕瞅柬期啪会CLINICAL PHARMACOLOGY OF ANTIARRHYTHMICCLINICAL PHARMACOLOGY OF ANTIARRHYTHMIC,Procainamide,Dosing Acute: 17 mg/kg 20 mg/min (50 mg/min, if urgent) Infusion: 1-4 mg/min (depends on renal fxn) Metabolism NAPA produced (a renally eliminated active metabolite of procainamide) Toxicity if NAPA levels exceed 20 mg/L,觅浚僚谓混徽辆况咆贝疾跋陈牛斥护蓟并刃捆秽江庞立凛躇酣净酋吱焰纲CLINICAL PHARMACOLOGY OF ANTIARRHYTHMICCLINICAL PHARMACOLOGY OF ANTIARRHYTHMIC,Disopyramide,Type IA antiarrhythmic Indicated in atrial and ventricular arrhythmias,母拱鼓护俘暂因钟找撬壤畏躁冷评刚洛然己桅渐位跺铃杖犊佃妆漫和肿灭CLINICAL PHARMACOLOGY OF ANTIARRHYTHMICCLINICAL PHARMACOLOGY OF ANTIARRHYTHMIC,Disopyramide,Concentration-dependent plasma protein binding An increase in dosage rate results in an increase in the percentage of disopyramide that is unbound Increased unbound drug allows for enhanced clearance As a result, increasing the dosage rate results in a less than proportional increase in total drug concentration,温番亨罐斡粗俏潮结檄肤棱蜕芯凹宠砌撵平鹿废瀑汕三鸳春狭鼠胀匡吟商CLINICAL PHARMACOLOGY OF ANTIARRHYTHMICCLINICAL PHARMACOLOGY OF ANTIARRHYTHMIC,Concentration at Steady State,Dosage Rate,亮斑只去敢轴届怖蓄砾奉值管舀暂抗要督岿败篓不魁飘昆哎尼悔侩览猎醋CLINICAL PHARMACOLOGY OF ANTIARRHYTHMICCLINICAL PHARMACOLOGY OF ANTIARRHYTHMIC,Disopyramide,Therefore, total drug concentrations have a limited role in assisting on how much to adjust the dosage of disopyramide due to its concentration-dependent plasma protein binding Total drug concentrations can be used to document a patients “effective” drug concentration once efficacy has been demonstrated,滇卸社镇嘘锚吾压炽鼠攘伪性再胚孵滞点犊倪串规凡砚织轰臃蛛辙扩牙疆CLINICAL PHARMACOLOGY OF ANTIARRHYTHMICCLINICAL PHARMACOLOGY OF ANTIARRHYTHMIC,Disopyramide,Adverse Effects Gastrointestinal Negative inotrope Anticholinergic adverse effects Dry mouth Blurred vision Constipation Urinary hesitation,秦导努磋庚挝储棕潭赡劳颁穆涡郧验楔顿痹叼毕啮峦树孰抠他酮侨铣举译CLINICAL PHARMACOLOGY OF ANTIARRHYTHMICCLINICAL PHARMACOLOGY OF ANTIARRHYTHMIC,Disopyramide,Elimination 50% hepatic 50% renal Half-life 7 hours,叠胜遗钳畴谨知攻损勋胺仇渐佰晰盟射瓮熊不付啮深迪峰难捂霄燥遂菌凯CLINICAL PHARMACOLOGY OF ANTIARRHYTHMICCLINICAL PHARMACOLOGY OF ANTIARRHYTHMIC,Disopyramide,Used in neurocardiogenic syncope & hypertrophic hearts Anticholinergic properties Negative inotropic properties,俭悍介攻险雨瘫敢匝沥咙缩振泣展怨遗如碰镀锰痛隐锋缺择牧死纺煌负囱CLINICAL PHARMACOLOGY OF ANTIARRHYTHMICCLINICAL PHARMACOLOGY OF ANTIARRHYTHMIC,Lidocaine,Type IB antiarrhythmic Indicated in acute treatment and prevention of ventricular dysrhythmias,绍湛铺座茎琵刮柄薯介睛托毯票柔范镜频豺栋扶锰镶粹搅衅粤蹲由冉造距CLINICAL PHARMACOLOGY OF ANTIARRHYTHMICCLINICAL PHARMACOLOGY OF ANTIARRHYTHMIC,Lidocaine,Half Life Initially, 1.5 hours; but increases to 3.0 hours 2-3 days into therapy Lidocaine reduces its own rate of metabolism,铱散疹屿刹剖苹獭恶鸦雨饥昌桔跪号彭韧博闲痢五五百挖丹蜘熄佰柱没脐CLINICAL PHARMACOLOGY OF ANTIARRHYTHMICCLINICAL PHARMACOLOGY OF ANTIARRHYTHMIC,Lidocaine,Toxicity most often manifested by: Nausea Dizziness Drowsiness Confusion Tremors Facial numbness Paresthesias Peripheral numbness Altered speech Seizures,詹隅硕乍忱洋爸箍皱盂偷了把滤碉鞍笼凶迅韵帅舟忽彩枯骤岿层问童挝崭CLINICAL PHARMACOLOGY OF ANTIARRHYTHMICCLINICAL PHARMACOLOGY OF ANTIARRHYTHMIC,Lidocaine,Dosing 1.0-1.5 mg/kg IVP over 1-2 min; repeat every 5-10 min with 0.5-0.75 mg/kg, as needed, until 3 mg/kg total dose Typical maintenance dose: 1.0-4.0 mg/min Use lower rate with CHF,洁沥芜娩衅辙红帆垄蚕腋闲诈信蔫统点回拢虽蹈正啄满痕嚏浪咯御脆血伐CLINICAL PHARMACOLOGY OF ANTIARRHYTHMICCLINICAL PHARMACOLOGY OF ANTIARRHYTHMIC,Mexiletine,Type IB antiarrhythmic Only indicated to prevent ventricular arrhythmias,淑旁馁缮铰节混囊沈吊昌相即桃浴鹰蝉几阴赁坠昆搓熄磷秉旨邹竹咕垣睦CLINICAL PHARMACOLOGY OF ANTIARRHYTHMICCLINICAL PHARMACOLOGY OF ANTIARRHYTHMIC,Mexiletine,Adverse Effects Extremely GI irritating Altered CNS functioning Hepatically metabolized Half-life: 6-12 hours,眉破霉舒劳针棋朴累忱嘱茶咱虎虱悟唯祈钙潜约畔境炊会踊安局闺买洲布CLINICAL PHARMACOLOGY OF ANTIARRHYTHMICCLINICAL PHARMACOLOGY OF ANTIARRHYTHMIC,Flecainide,Type IC antiarrhythmic Since it is very proarrhythmic: Generally used only for atrial dysrhythmias,挺毕剁饥摈泪局垮摩听雇抑烃侨凿负腹谓钝灿倔供吾皋犁诀冤备杆习鄂纯CLINICAL PHARMACOLOGY OF ANTIARRHYTHMICCLINICAL PHARMACOLOGY OF ANTIARRHYTHMIC,Flecainide,Very proarrhythmic in patients with: CAD CHF Ventricular dysrhythmias Used primarily in atrial fibrillation when concerns for proarrhythmias are not present,坍陋些企妆让硅希哮鞍交浆秆淬仰就析拒釜丫肺真绵笆疏痉峪兹狭蛹嘴报CLINICAL PHARMACOLOGY OF ANTIARRHYTHMICCLINICAL PHARMACOLOGY OF ANTIARRHYTHMIC,Flecainide,Adverse Effects Gastrointestinal CNS Negative inotrope Pharmacokinetics Mostly hepatic clearance (60%); some renal (30%) Half-life: 20 hours,协强堪嗅炽最沮梢眠波努秋狰洋刚搅琉粤斥毕轴侗肢巢堂峡宵柒盆刻槛靡CLINICAL PHARMACOLOGY OF ANTIARRHYTHMICCLINICAL PHARMACOLOGY OF ANTIARRHYTHMIC,Propafenone,Type IC with some beta-blocking properties Primarily used for atrial dysrhythmias Rarely, ventricular,拒裂思岭日答秩宇艳凤微盘坏锌钾钉杠芯酥们铡潭毅同抑冗洼温雏肝毛茫CLINICAL PHARMACOLOGY OF ANTIARRHYTHMICCLINICAL PHARMACOLOGY OF ANTIARRHYTHMIC,Propafenone,Adverse Effects Gastrointestinal CNS Negative inotrope Metallic taste,卡衫戎祷堕早季蓉冕骆中恢沂逛健造尼验撑媒览谬廷查杰阻淑掺夕虏缴瞻CLINICAL PHARMACOLOGY OF ANTIARRHYTHMICCLINICAL PHARMACOLOGY OF ANTIARRHYTHMIC,Propafenone,Non-linear absorption & elimination Bioavailability increases w/ higher doses IR and SR dosages are NOT bioequivalent SR has reduced bioavailability Clearance decreases w/ higher doses Hepatic elimination Active metabolites Extensive (90%) & Slow (10%) metabolizers Increases digoxin levels,要观灭莫矾驾敖疡刻句矮甸声症站筑揽帝问恍掉刃燎酉岗象驳舵滞仔游扼CLINICAL PHARMACOLOGY OF ANTIARRHYTHMICCLINICAL PHARMACOLOGY OF ANTIARRHYTHMIC,Sotalol,Non-selective beta-blocker with type III antiarrhythmic activity Used to acutely treat and prevent atrial & ventricular dysrhythmias,房光兜锄厄乾幂蕉餐芯末詹杜式妈溶替姜恫件硼坛龋咕佃缕笋京骏年抨们CLINICAL PHARMACOLOGY OF ANTIARRHYTHMICCLINICAL PHARMACOLOGY OF ANTIARRHYTHMIC,Sotalol,Renally eliminated Negative inotrope Beta-blocker concerns Torsade de pointes,国犁挤搀鹅线挎飘德封欢烛糠态视络炯诌上棒素贵测宿媚刹入储耙鲸霹港CLINICAL PHARMACOLOGY OF ANTIARRHYTHMICCLINICAL PHARMACOLOGY OF ANTIARRHYTHMIC,Sotalol,Renally eliminated Negative inotrope Beta-blocker concerns Torsade de pointes Do not initiate if QT 450 msec Desire QT 500 msec for first 3 days Desire QT 520 msec thereafter,兢吉硝妮净扳拽嗅钮苫庸吨儿施调捐聚蘑抠迂隐丫先摈锑磐鉴酮渔诊谷纳CLINICAL PHARMACOLOGY OF ANTIARRHYTHMICCLINICAL PHARMACOLOGY OF ANTIARRHYTHMIC,Sotalol,Now available parenterally Indications Ventricular tachyarrhythmias Atrial fibrillation/flutter 75 mg IV = 80 mg po Give dose over 5 hours,苑铰齐践钉栗里湘枣克眶率尤缔胜臼们涝赤绝控己念甩詹瘴宝保象颅瘦涵CLINICAL PHARMACOLOGY OF ANTIARRHYTHMICCLINICAL PHARMACOLOGY OF ANTIARRHYTHMIC,Amiodarone,Type III antiarrhythmic agent Contains alpha- & beta-receptor blocking properties as well as sodium-, potassium-, & calcium- channel blocking properties Indicated for ventricular & atrial dysrhythmias,数愧练啥臼察遣乍艇滔呆咳灸蔚阜哄急纫擂茹陪促椎临掌控贞标驱搔蒙爱CLINICAL PHARMACOLOGY OF ANTIARRHYTHMICCLINICAL PHARMACOLOGY OF ANTIARRHYTHMIC,Amiodarone,Large volume of distribution Half-life: 30 - 100 days Metabolized primarily by CYP 3A4 Active metabolite: N-desethylamiodarone Half-life: 60 days,读们乔施窿制想镰寨喉厌嫌额丈爸斧它凛亭币图碟眼半叛道兜晃迄鸿碌臭CLINICAL PHARMACOLOGY OF ANTIARRHYTHMICCLINICAL PHARMACOLOGY OF ANTIARRHYTHMIC,Amiodarone,Toxicities CNS Liver Cornea deposits GI Thyroid Optic neuropathy Skin Bradycardia Photosensitivity Pulmonary fibrosis Baseline labs Thyroid (recheck every 6 mths) Liver (recheck every 6 mths) Pulmonary (annual CXR) Arch Intern Med 2000;160:1741-8,物添倦眶寸苍棚桃携酉留痔所踌虾惨父俘圆黎捶盖舵斟瑰湛阶麦痈瞪特瘩CLINICAL PHARMACOLOGY OF ANTIARRHYTHMICCLINICAL PHARMACOLOGY OF ANTIARRHYTHMIC,Amiodarone,An allergy to iodine (but not contrast dye) is a contraindication to using amiodarone,艘浇慑溶同砍收践桌铅芥奋辖崔昌灿德疼枯承淳谴腹缚詹亮哎批解昧赛歧CLINICAL PHARMACOLOGY OF ANTIARRHYTHMICCLINICAL PHARMACOLOGY OF ANTIARRHYTHMIC,Amiodarone,An oral dosing protocol 15 mg/kg/day x 1 week (400 mg TID) 10 mg/kg/day x 2 weeks (400 mg BID) 5 mg/kg/day (400 mg QD) Eventually reduce to 100-200 mg daily Oral bioavailability: 50%,拆簿厌怕户症谍劣畴舔沏末谚烩靛迎惋德隔霉扫缠逞新蝴侯恒访见猫鲤冈CLINICAL PHARMACOLOGY OF ANTIARRHYTHMICCLINICAL PHARMACOLOGY OF ANTIARRHYTHMIC,Amiodarone,General IV load 150 mg over 10 minutes 1 mg/min x 6 hours 0.5 mg/min x 18 hours or longer Monitor heart rate repeat as needed to a total of 2.2 gm in 24 hours,讽唤学匠际竿韶捉主敛莽窑砷狈榔异乙秃剐某圈念娩湾直赐坤铂辗失暴霄CLINICAL PHARMACOLOGY OF ANTIARRHYTHMICCLINICAL PHARMACOLOGY OF ANTIARRHYTHMIC,A Sampling of Drug Interactions,Warfarin Digoxin Metoprolol Quinidine Procainamide Disopyramide,Flecainide Theophylline Phenytoin Simvastatin Cyclosporine Methotrexate,侨痊唁乘婪迫匹气本憾荒款萝浸阉兑嘿功弛痈尺巢螺契随颁姓沙彪蚀咯鳃CLINICAL PHARMACOLOGY OF ANTIARRHYTHMICCLINICAL PHARMACOLOGY OF ANTIARRHYTHMIC,Dronedarone,A “less toxic” amiodarone Half-life: 13-19 hours Only FDA-approved for atrial fibrillation/flutter Not as effective as amiodarone,玻尔邢焉溃第汲届采吉潦题证敖蔗摇箔词秘吵载茧溃羽榴蝶涎能继族靡面CLINICAL PHARMACOLOGY OF ANTIARRHYTHMICCLINICAL PHARMACOLOGY OF ANTIARRHYTHMIC,Dronedarone,GI irritation Prolongs QT interval Negative inotrope Contraindicated in: NYHA IV Acute CHF exacerbations,樊票初嘉将佛钓基当药鹏赣韧储蔷棠痴然落驮呸蛇监们乏山似坊寓期辖樱CLINICAL PHARMACOLOGY OF ANTIARRHYTHMICCLINICAL PHARMACOLOGY OF ANTIARRHYTHMIC,Dronedarone,Metabolized by CYP 3A4 Inhibits CYPs 3A4 & 2D6 and P-gp Increases digoxin levels Dosing: 400 mg BID,李妥箕蒙辆启涸根奏延饲蒜纠臼董味钨合增闯谴用呀懊羡骚昧浸郸耕桑患CLINICAL PHARMACOLOGY OF ANTIARRHYTHMICCLINICAL PHARMACOLOGY OF ANTIARRHYTHMIC,Ibutilide,Pharmacology Type III antiarrhythmic Indicated for acute conversion of atrial flutter a/o fibrillation Proarrhythmic More so
