Antiarrhythmic agent resident survival guide: Difference between revisions
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{{Family tree | | | | | B01 | | B02 | | B03 | | B04 | | B05 | | B06 | |B01='''[[Class IA]]''' |B02='''[[Class IB]]''' |B03='''[[Class IC]]''' |B04='''[[Class II]]'''|B05='''[[Class III]]''' |B06='''[[Class IV]]''' |B07= }} | {{Family tree | | | | | B01 | | B02 | | B03 | | B04 | | B05 | | B06 | |B01='''[[Class IA]]''' |B02='''[[Class IB]]''' |B03='''[[Class IC]]''' |B04='''[[Class II]]'''|B05='''[[Class III]]''' |B06='''[[Class IV]]''' |B07= }} | ||
{{Family tree | | | | | |!| | | |!| | | |!| | | |!| | | |!| | | |!| | |}} | {{Family tree | | | | | |!| | | |!| | | |!| | | |!| | | |!| | | |!| | |}} | ||
{{Family tree | C01 | | C02 | | C03 | | C04 | | C05 | | C06 | | C07 | |C01= '''Mechanism''' |C02= *Mainly | {{Family tree | C01 | | C02 | | C03 | | C04 | | C05 | | C06 | | C07 | |C01= '''Mechanism''' |C02= *Mainly sodium channel blockade <br> *some potassium channel blockade|C03= *Mainly predominant '''β1''' agonist (↑ cardiac contractility) <br> * some α1 agonist(Vasoconstrictive)|C04= *'''V<sub></sub>1''' receptor of GIT vasculatures <br> *Antidiuretic effects |C05= *'''Pure α1''' agonist(Vasoconstrictive) <br> *No β1 |C06= *Predominant '''β1''' agonist (↑contractility) <br> *β2 arterial smooth muscle (Hypotensive) |C07= }} | ||
{{Family tree | | | | | |!| | | |!| | | |!| | | |!| | | |!| | | |!| | |}} | {{Family tree | | | | | |!| | | |!| | | |!| | | |!| | | |!| | | |!| | |}} | ||
{{Family tree | D01 | | D02 | | D03 | | D04 | | D05 | | D06 | | D07 | |D01= '''Agents''' |D02= *'''1st''' line in : <br> *'''Septic shock''' <br> *'''Cardiogenic shock''' <br>*Undifferentiated shock |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= *'''1st''' line in : <br> *'''Septic shock''' <br> *'''Cardiogenic shock''' <br>*Undifferentiated shock |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= }} | ||
Revision as of 17:00, 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 | *Mainly sodium channel blockade *some potassium channel blockade | *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 | *1st line in : *Septic shock *Cardiogenic shock *Undifferentiated shock | 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 | 1-30 mcg/min 0.01-0.3mcg/kg/min | 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.