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My new hot project
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DeREAnnyjency

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Re: My new hot project
« Reply #1 on: October 18, 2020, 06:03:33 AM »

amiodarone is contraindicated for patients with which condition 
ENTER

 
п»ї Magnet? If an ICD patient is not in VT but their ICD is delivering shocks, place a magnet on the ICD to put it into VVI mode (pacing preserved, shocking disabled).
As per ACLS guidelines, If any tachydysrhythmia presents as unstable, the treatment of choice is synchronized electrical cardioversion.
For wide and irregular tachycardia consider other diagnoses (especially when standard treatments are not effective at restoring normal sinus rhythm) such as:
While procainamide is currently considered to be the first line medication for stable sustained VT, there remain three important indications for amiodarone in the setting of VT:
Lens opacities can occur in the anterior cortex of the lens. These are due to pigment deposition and are small and yellowish-white in color. They do not reverse with discontinuation of amiodarone but rarely cause any visual disturbance.
Optic neuropathy is a very rare but serious side effect of long-term amiodarone use. It tends to progress slowly with resulting vision loss. Patients taking amiodarone should have yearly check-ups with an ophthalmologist to monitor for development of optic neuropathy as discontinuing the drug stabilizes the patient’s vision.
Title: Ocular Adverse Effects of Systemic Medications: Amiodarone Author: Emily Ross, 4 th Year Medical Student, Indiana University School of Medicine Location: Med Student Outline > II. Anatomical Approach to Eye Disease > Ocular Adverse Effects of Systemic Medications > 3. Amiodarone.
Open source ophthalmology education for students, residents, fellows, healthcare workers, and clinicians. Produced by the Moran Eye Center in partnership with the Eccles Library.
The Centre for Adverse Reactions Monitoring (CARM) has received 51 reports of eye-related adverse reactions to amiodarone up to April 2011. These include 3 reports of optic neuropathy, 19 reports of corneal deposits and 12 reports of abnormal vision.
Prescriber Update 32(2): 16 June 2011.
Patients treated with amiodarone may also be predisposed to anterior ischaemic optic neuropathy due to their underlying cardiovascular risk factors. The differentiation of this cause of visual loss from a drug induced optic neuropathy can be difficult but both diseases can result in severe visual loss.
All patients experiencing new or worsening visual symptoms whilst taking amiodarone should be referred for ophthalmological assessment. Amiodarone should be stopped if optic neuropathy is confirmed due to the potential for progression to permanent visual loss. 1.
Drs. Horn and Hansten are both professors of pharmacy at the University of Washington School of Pharmacy. For an electronic version of this article, including references if any, visit www.hanstenandhorn.com.
Summary.
Bosentan is a substrate of cytochrome P450 (CYP) 3A4 and CYP2C9. It is also known to be an inducer of CYP3A4 and CYP2C9 and may induce other isoenzymes as well. Thus, it would be expected to induce its own metabolism with chronic dosing, and steady-state plasma concentrations have been noted to be reduced to 50% to 60% of single-dose levels.
When evidence is lacking for a specific interaction, an analysis of the underlying mechanism is warranted. Inhibitor Plus Inducer: Therein Lies the Question.
While the below table is clearly not an exhaustive list of every medication known to inhibit CYP3A4, these are the most common medications used in clinical practice that are known to interact with other medications that are substrates of CYP3A4. It is also important to note that not all medications within a particular drug class have the same effect. For example, within the macrolide antibiotics, all of them are known inhibitors of CYP3A4 with the exception of azithromycin. For the calcium channel blockers, it is only the non-dihydropyridine calcium channel blockers that are known inhibitors of CYP3A4, but not amlodipine or nifedipine. Lastly, within the non-nucleoside reverse transcriptase inhibitors (NNRTI) used in the management of HIV, only delavirdine is an inhibitor of CYP3A4 whereas the other NNRTIs in the class are considered to be inducers of CYP3A4.7-9 This is important as it reveals that the pharmacokinetic profiles do not always completely follow a class effect. Therefore, anytime the medications listed in the provided table are initiated in a patient already on stable does of other medications, the chances of a clinically relevant drug interaction is likely and should be taken into consideration upon initiation. The medications known to be CYP3A4 inhibitors are summarized in the below table based on their class of medications and classifications.1,2,5,6.
Summary :
References:
Of the CYP enzymes, CYP3A4 is not only the most prevalent CYP enzyme in the liver, but is used by more than 50% of medications on the market for their metabolism and elimination from the body. Weak inhibitors of CYP3A4 include: cimetidine. Moderate inhibitors of CYP3A4 include: amiodarone, erythromycin, fluconazole, miconazole, diltiazem, verapamil, delavirdine, amprenavir, fosamprenavir, conivaptan. Strong inhibitors of CYP3A4 include: Clarithromycin, telithromycin, nefazodone, itraconazole, ketoconazole, atazanavir, darunavir, indinavir, lopinavir, nelfinavir, ritonavir, saquinavir, tipranavir. It is important to note that not all drugs within a class of medications are known to be inhibitors of CYP3A4. Editor-in-Chief: Anthony J. Busti, MD, PharmD, FNLA, FAHA Reviewers: Jon D. Herrington, PharmD, BCPS, BCOP Last Reviewed: October 2015.
INR recommand №s et dur №es de traitement.
Quand il y a eu arr єt des AVK, suite  ° une h №morragie grave, lorsque le saignement est contrС„l №, et si l'indication des AVK est maintenue, un traitement par h №parine non fractionn №e ou HBPM  ° dose curative est recommand №, en parall ёle de la reprise des AVK. Il est recommand № que la r №introduction de l'anticoagulation orale se d №roule en milieu hospitalier, sous surveillance clinique et biologique.
Recommandations INR et dur №e de traitement:
Ne pas utiliser de dose de charge.
Les évènements indésirables (Tableau 1) sont classés par fréquence, en commençant par les plus fréquents selon la convention suivante : très fréquent (> 1/10) ; fréquent (> 1/100, 1/1000, 1/10000,
L'hydrochlorothiazide, un sulfamide, a Г©tГ© associГ© Г  une rГ©action idiosyncrasique conduisant Г  une myopie transitoire aiguГ« et Г  un glaucome aigu Г  angle fermГ©. Les symptГґmes comprennent l'apparition brutale d'une diminution de l'acuitГ© visuelle ou une douleur oculaire, et surviennent typiquement dans les quelques heures Г  semaines aprГЁs l'initiation du traitement. En l'absence de traitement le glaucome Г  angle fermГ© peut entraГ®ner une perte de vision permanente. Le traitement initial consiste Г  interrompre l'hydrochlorothiazide le plus rapidement possible. Des antГ©cГ©dents allergiques aux sulfamides ou Г  la pГ©nicilline sont des facteurs de risque dans le dГ©veloppement d'un glaucome aigu Г  angle fermГ©.
Glaucome aigu Г  angle fermГ©.
La posologie initiale est de 50 Г  100 mg/jour, Г©ventuellement 200 mg/jour. La plus petite dose efficace doit ГЄtre identifiГ©e par titration et doit ГЄtre administrГ©e seulement sur des pГ©riodes limitГ©es.

 
 
 
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