Author Topic: ________ 13 _____ 14.11.2019 1tv 15-11-2019  (Read 203 times)

Emanuel727

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________ 13 _____ 14.11.2019 1tv 15-11-2019
« on: November 14, 2019, 06:50:28 PM »
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KIeteradvob

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Re: «________ 13 _____ 14.11.2019» 1tv 15-11-2019
« Reply #1 on: October 22, 2020, 07:38:33 AM »

amiodarone in dextrose 
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п»ї In this study, we found that documented recurrence within the blanking period was an independent predictor of later recurrence (at 6 months). Other studies have made similar findings. 9, 12, 13.
The power calculation and sample size were based on a 50% reduction of recurrence rate. Hence, a lower reduction of recurrence rate at 6 months might not be detected in this study. This decision was made with the potential side effects of amiodarone in mind.
Subgroup analyses of the primary end-point based on the type of AF (paroxysmal/persistent) and whether patients were treated with PVI only or PVI plus additional ablations might have been interesting. The latter comparison might even more accurately reflect the extent of electroanatomical remodelling of the left atria, thus provide better information on mechanisms and possible treatment success of the ablation than the clinical term paroxysmal/persistent. However, in the present setting, such subgroup analysis would be statistically underpowered and were not performed due to the risk of false-negative findings.
Forest plot displaying AF/AT-related hospitalizations and cardioversions as Poisson rate ratio for the amiodarone group compared with the placebo group.
“One might expect that the reduced hospitalisation and cardioversion rates could also decrease the cost of post-ablation care,” she added.
“Current guidelines for AF ablation do not give specific recommendations with respect to early antiarrhythmic drug therapy after ablation, but our data suggests that short term prophylactic treatment with amiodarone should be considered, particularly for patients with persistent AF.”
“The adverse effects of amiodarone therapy are well known and not unexpected,” said Dr. Darkner. “The similarities in quality of life, despite the higher number of adverse events in the amiodarone group may be due to the reduced AF-related hospitalisations and cardioversions,” she suggested.
The study, presented as a Hot Line at the congress and published simultaneously in the European Heart Journal, also showed that amiodarone’s beneficial impact on early rhythm control reduced hospitalisations among treated patients compared to those on placebo, and resulted in fewer cardioversions – a procedure by which normal heart rhythm is restored with electric shocks. The study included 212 patients undergoing radiofrequency ablation for the treatment of either paroxysmal or persistent AF who were randomised to receive 8 weeks of either amiodarone (n=108) or placebo (n=104) starting immediately after their procedure. The primary end point of the study was AF lasting more than 30 seconds after the “blanking period” - a three-month period in which AF episodes can occur as part of the healing process and are generally not counted in final study results. At six months, the study showed no significant difference in AF recurrence between the treated and placebo groups (39% vs. 48%, p=0.18), however during the blanking period, amiodarone reduced the number of AF recurrences compared to placebo (34% vs. 53%, p=0.006), and more than halved arrhythmia-related hospitalisation (p=0.006) and cardioversion rates (p=0.0004). Looking separately at patients who entered the study with either paroxysmal (n=107) or persistent (n=105) AF, the analysis showed that, amiodarone prolonged the time to first AF recurrence compared to placebo in both subgroups (p=0.045 and p=0.005 respectively) during the blanking period. Hospitalisation and cardioversion rates within the blanking period were only statistically significantly reduced by amiodarone in the subgroup of patients with persistent AF. “Thus, it seems that effect was largely driven by the group of patients with persistent AF,” noted Dr. Darkner. There was no statistically significant difference in the number of serious adverse events between the treated and placebo groups. Even though significantly more patients in the amiodarone group experienced transient adverse effects (sleep disturbances, gastrointestinal symptoms and asymptomatic changes in serum concentrations of thyroid hormones), these patients did not report reduced quality of life compared to those treated with placebo.
This drug may make you dizzy. Alcohol or marijuana (cannabis) can make you more dizzy. Do not drive, use machinery, or do anything that needs alertness until you can do it safely. Limit alcoholic beverages. Talk to your doctor if you are using marijuana (cannabis).
The dosage is based on your medical condition and response to treatment. Your doctor may direct you to start this medication at a higher dose and gradually decrease your dose. Follow your doctor's instructions carefully. Do not stop taking this medication or change the dose without first consulting your doctor.
See also Warning section.
Before having surgery, tell your doctors or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).
The clearance of a 75mg oral dose was 18,960В±15,890L/h and for a 300mg oral dose was 16,980В±10,410L/h. 5.
A single dose of clopidogrel at 1500-2000mg/kg was lethal to mice and rats while 3000mg/kg was lethal to baboons. 9 Symptoms of overdose include vomiting, breathing difficulty, gastrointestinal hemorrhage, and prostration. 9 Clopidogrel is irreversibly bound to platelets for their lifetime, which is approximately 11 days. 9 Overdoses of clopidogrel can be treated with platelet transfusions to restore clotting ability. 9.
A rating for the strength of the evidence supporting each drug interaction.
Clopidogrel is a prodrug of a platelet inhibitor used to reduce the risk of myocardial infarction and stroke. 3,9 Clopidogrel is indicated to reduce the risk of myocardial infarction for patients with non-ST elevated acute coronary syndrome (ACS), patients with ST-elevated myocardial infarction, and in recent MI, stroke, or established peripheral arterial disease, 9.
After the first 24 hours , the maintenance infusion rate of 0.5 mg/min (720 mg/24 hours) should be continued utilizing a concentration of 1 to 6 mg/mL (Cordarone I.V. concentrations greater than 2 mg/mL should be administered via a central venous catheter). In the event of breakthrough episodes of VF or hemodynamically unstable VT, 150-mg supplemental infusions of Cordarone I.V. mixed in 100 mL of D 5 W may be administered. Such infusions should be administered over 10 minutes to minimize the potential for hypotension. The rate of the maintenance infusion may be increased to achieve effective arrhythmia suppression.
Elevations of blood hepatic enzyme valuesalanine aminotransferase (ALT), aspartate aminotransferase (AST), and gamma-glutamyl transferase (GGT)are seen commonly in patients with immediately life-threatening VT/VF. Interpreting elevated AST activity can be difficult because the values may be elevated in patients who have had recent myocardial infarction, congestive heart failure, or multiple electrical defibrillations. Approximately 54% of patients receiving Cordarone I.V. in clinical studies had baseline liver enzyme elevations, and 13% had clinically significant elevations. In 81% of patients with both baseline and on-therapy data available, the liver enzyme elevations either improved during therapy or remained at baseline levels. Baseline abnormalities in hepatic enzymes are not a contraindication to treatment.
Cordarone I.V. loading infusions at much higher concentrations and rates of infusion much faster than recommended have resulted in hepatocellular necrosis and acute renal failure, leading to death (see PRECAUTIONS, Liver Enzyme Elevations ).
50 mg per mL, NDC 0008-0814-01.
Newer IV formulation (Nexterone) does not contain polysorbate 80 or benzyl alcohol.
May follow initial dose with 150 mg IV q3-5min.
300 mg IV or intraosseous push after dose epinephrine if no initial response to defibrillation.
Maintenance: 10-20 mg/kg/day for 7-10 days; follow with 3-20 mg/kg/day.
Cordarone IV (amiodarone hydrochloride) Intravenous.
Antihypertensives: Amiodarone should be used with caution in patients receiving ОІ -receptor blocking agents (e.g., propranolol, a CYP3A4 inhibitor) or calcium channel antagonists (e.g., verapamil, a CYP3A4 substrate, and diltiazem, a CYP3A4 inhibitor) because of the possible potentiation of bradycardia, sinus arrest, and AV block; if necessary, amiodarone can continue to be used after insertion of a pacemaker in patients with severe bradycardia or sinus arrest.
Cyclosporine (CYP3A4 substrate) administered in combination with oral amiodarone has been reported to produce persistently elevated plasma concentrations of cyclosporine resulting in elevated creatinine, despite reduction in dose of cyclosporine.
Other substances, including herbal preparations.

 
 
 
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