Author Topic: ________ `257 ______ _____ ____ 5 _____` _ _______ ________  (Read 33 times)

AudryMehaf

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________ `257 ______ _____ ____ 5 _____` _ _______ ________
« on: April 06, 2020, 07:03:24 AM »
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sUNmesBlago

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Re: ________ `257 ______ _____ ____ 5 _____` _ _______ ________
« Reply #2 on: October 20, 2020, 02:26:13 PM »

amiodarone junctional bradycardia 
ENTER

 
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Haroon Siddique Specialist Registrar in Diabetes and Endocrinology.
Department of Diabetes and Endocrinology, University Hospital of North Staffordshire (NHS) Trust, Stoke-on-Trent, ST4 6QG.
Maria Mushkbar Senior House Officer in Medicine.
The mother was keen to breast feed the baby. In previous reports of amiodarone and breast feeding, amiodarone treatment was for a maternal indication and hence continued post partum. 1, 2 In this case, the amiodarone treatment stopped at delivery. However, because of the long terminal half life of amiodarone (about 50 days 3 ), it could take several months for the level to fall. As one of the adverse effects of amiodarone is thyroid toxicity, the baby’s thyroid function was assessed and found to be normal. A decision was made to allow the mother to breast feed, and the baby was closely monitored.
Breast milk was sent for analysis to determine the amiodarone level on days 5, 11, 18, and 25. It had increased on day 11 (2.1 mg/l) compared with day 5 (0.6 mg/l). This may be due to changes in composition of the milk. We do not know at what time of day the milk was expressed or whether the sample was taken at the beginning or the end of the feed. The fat content of the milk was likely to be greater after 11 days than after 5 days, which may affect the distribution of amiodarone. McKenna et al 4 described changes in amiodarone concentration in breast milk throughout the day. By 25 days, amiodarone was undetectable. Throughout this period the baby remained well and thyroid function was normal.
An infant was born at 33+2 weeks gestation by caesarean section after an in utero diagnosis of fetal ascites and tachycardia. The mother had received treatment during pregnancy with flecainide, amiodarone, and propranolol. The amiodarone was prescribed initially at 200 mg three times a day and was reduced to twice a day after 11 days.
Although we would not recommend that breast feeding is necessarily safe for all babies exposed to amiodarone, this case illustrates that, in some circumstances, with close monitoring, breast feeding can be initiated.
PubMed: 32474442 ( click the link to review the publication )
Drugs across therapeutic indications induce lipid formation in hiPS-CM. Lipid accumulation was detected in cardiac cells using the LipidTox plate-based fluorescent assay on the Thermo Scientific CellInsight High Content platform. A) Ten drugs increased lipid levels in hiPS-CM following 48 h treatment. The lowest drug dose that induced a N1.5-fold increase in lipid formation is shown. B) Representative images (20Г—) from the assay are shown to the right. All drugs had >55% cell viability at 48 h at these tested concentrations. C) Of these 10 drugs, 8 significantly increased lipid accumulation following only 24 h treatment (images not shown). All drugs had >80% cell viability at 24 h at these drug doses. The graphs represent the mean fold-change of the lowest concentration of drug that significantly induced lipid formation >1.5-fold more than vehicle control. *P [1]
PubMed: 30301560 ( click the link to review the publication )
Amiodarone HCl is a sodium/potassium-ATPase inhibitor and an autophagy activator, used to treat various types of cardiac dysrhythmias.
Incomplete Trifascicular Block:
Trifascicular block (TFB) refers to the presence of conducting disease in all three fascicles:
Right bundle branch block Left axis deviation (Left anterior fascicular block) Third degree heart block.
Complete trifascicular block.
AF. In AF, normal contraction of the atria is lost, and a rapid and irregular series of stimuli bombard the AV node. Many impulses stop at the AV node; those passing through it elicit a ventricular response that is generally rapid and irregularly irregular (random). AF may be either chronic or paroxysmal ( Fig. 3.3 ).
Fig. 3-3. Two examples of atrial fibrillation. Note the irregular random nature of the heart rate.
Atrial tachycardia with block. Atrial tachycardia with block has elements that make it resemble both PSVT and atrial flutter. The atrial rate is generally between 130 and 250 beats per minute; 2:1 AV block is common. The exact mechanism of this arrhythmia is not known. By far, the most common etiology is digitalis intoxication. Carotid sinus massage may aid in making the diagnosis (same response as with PSVT) and, in some instances, may terminate the arrhythmia. Digitalis-induced atrial tachycardia generally responds to potassium administration. Digitalis administration should be discontinued. Phenytoin, 250 mg IV over 5 minutes, may also be effective. If the patient is hemodynamically compromised and digitalis intoxication is suspected because of a high serum digoxin level, Fab fragments that specifically bind to digoxin (Digibind) should be administered.
Atrial flutter. Atrial flutter results from rapid atrial contractions at a rate of 280 to 350 beats per minute (usually 300 per minute), with variable AV block (2:1, 3:1, or 4:1) causing a ventricular response of 75 to 150 beats per minute. The diagnosis is made by observing the regular sawtooth pattern of atrial contractions on the ECG (usually leads II and V1) ( Fig. 3.4 ).
Restrictions: Restricted to patients for the prevention of recurrence of AF in patients in whom beta-blockers, class 1c drugs and amiodarone are contraindicated, ineffective or not tolerated and who do not have a diagnosis of heart failure.
The European Medicines Agency’s (EMA) Committee for Medicinal Products for Human Use (CHMP) has recommended restricting the use of dronedarone (Multaq ® ) for maintaining heart rhythm in patients with paroxysmal or persistent atrial fibrillation for the maintenance of sinus rhythm after successful cardioversion. It has also recommended that due to an increased risk of liver, lung and cardiovascular adverse events, dronedarone should only be prescribed after alternative treatment options have been considered. The Committee also recommended a number of other risk minimisation measures to reduce the risk of injuries to liver, lung and cardiovascular system. Patients who are currently taking dronedarone are recommended to have their treatment evaluated by their doctor at their next scheduled appointment.
In accordance with the marketing authorisation and BNF, dronedarone should only be initiated and monitored only under specialist supervision. In cases where GPs continue the prescribing, associated monitoring should continue to be the responsibility of the acute sector.
Prescribing Notes:

 
 
 
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