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Vaughan-Williams Classification (Class I
Na+ channel blockers (local…
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Anti-Arrhythmic Agents
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Class III
Amiodarone
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SE
Eye – corneal microdeposits
Thyroid – hyper / hypo
Lung – pulmonary fibrosis
GI/Liver – ↑ LFTs
– N/V
Neuro – peripheral neuropathy
Skin – photosensitivity
– blue-grey discoloration
– phlebitis (give centrally)
CI
Thyroid disease
Sinus bradycardia
↑ QTc → TdPInteractions
β-B and CCB → ↑ risk of HB↑s levels of
- digoxin (halve dig dose)
- warfarin
- phenytoin
↑ risk of V arrhythmias with :
- Class III/Ia antiarrhythmics
- TCAs, antipsychotics
- Erythromycin
Accumulates in body:
- V. long t½ (10-100 days)
- Extensively tissue bound = requires loading dose
Monitor:
- TFTs, LFTs (base + 6-moly)
- K+ (baseline)
- CXR (baseline)
Avoid sunlight
Digoxin
Cardiac glycoside
Use AF / flutter
SVT
(HF)
SE
Toxicity
- Any arrhythmia
- e.g. SVT c¯ AV block
- Nausea
- Xanthopsia
- Confusion
- ↑ K+
Chronic
- Gynaecomastia
“Reverse tick” ECG
- not a sign of toxicity
CI
Complete heart block
VF/VT
HOCM
SVTs 2O to WPW
Dig fx/toxicity ↑d by:
- CCB (esp. verapamil)
- Amiodarone (halve dig dose)
- Diuretics (loop/thiazide due
to ↓K+)
↓ digoxin intestinal absorption:
- Antacids
- Cholestyramine
Caution
- Renal excretion so caution
in impairment
- e.g. in the elderly
Monitor
- U+Es
- Drug levels (6h post-dose)
Load then maintenance
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