Arrythmias and Cardiac Failure

32 Drugs classified under this therapeutic system

ACE Inhibitor. Captopril 12.5, 25, 50 mg.
TABS: 90 x 12.5mg, 25mg, 50mg.
Max. dly. dose: 150 mg. Hypertens: Initial: 25-50 mg 2 x dly in div. doses. Incr.
intervals at least 2 wks: 100-150 mg dly in div. doses to reach target BP.
Heart fail.: Init.: 12.5 mg BID or TID.
Titrat. to maint. dose (75-150 mg dly) at intervals of at least 2 wks. depen. on pt. response.
Type 1 diabet. nephropathy: 75-100 mg dly in div doses.
MI, ren. impair., elderly: See lit.
Hypertens., C.H.F., insulin depend. diabet. nephropathy in hypertens./nonhypertens. pts. when serum creatinine level < 2.5 mg/dl. Improve survival follow. MI in clinic. stable pts. with left ventric. dysfunct. manifest. as eject. fract. < or equals 40% and to reduce incidence of overt heart fail. and subseq. hospitalizat. for C.H.F. in these pts.
C/I: Hypersens. Hypersens. to other ACE inhib.
Hist. of angioedema assoc. with previous ACE-inhib. ther., hered. idiopath. angioedema.   2nd, 3rd trim. of preg.
Concom. use with aliskiren contain. product in pts. with diab. mell. or renal impair. (GFR <60ml/min/1.73 m²). See lit.

Purine Nucleoside. Adenosine 3 mg / ml.
Vials. Sol. for IV inject. 6X 2 ml
Adults:
Initial dose: 3 mg g as a rapid IV bolus (over 2 seconds).
Second dose: If the first dose does not result in elimin. of the supraventric. tachycard. within 1 – 2 min., 6 mg should be given also as a rapid IV bolus.
Third dose: If the second dose does not result in elimin. of the supraventric. tachycard. within 1 – 2 minutes. 12 mg should be given also as a rapid IV bolus. See full Prescr. details.
Rapid convers. to normal sinus rhythm of paroxymal supraventric. tachycard. incl. those assoc. with accessory bypass tracts (wolf parkinson-white syndr.).
C/I:  Hypersens./Sick sinus syndr./second- or third-degree Atrio-Ventric. (AV) block (except in patients with a funct. pacemaker)/Chron. obstruct. lung dis. with evid. of bronchospasm (e.g. asthma bronchiale)/ Long QT syndr./Sev. hypotens./Decompen. states of HF.

Purine Nucleoside. Adenosine 6 mg / 2 ml.
VIALS: 6 x 6 mg/2 ml. 1st dose: 3mg given as a rapid IV bolus (over 2 seconds).
2nd dose: If 1st dose does not result in
elimination of the SVT within 1 to 2
min., 6mg should be given also as a
rapid IV bolus, followed by a rapid
saline flush.
3rd dose: If the 2nd dose does not result
in elimination of the SVT within 1 to 2
min. 12mg should be given as a rapid
IV bolus. Higher doses are not recom.
Paroxy. supraventric. tachycard. incl.
Wolf Parkinson-White syndr.
C/I: 2n or 3rd AV block (except in pts.
with funct. artific. pacemaker), sick sinus
syndr. (except in pts. with funct. artific.
pacemaker), asthma. see lit

Class III Antiarrhythmic. Amiodarone HCl 200 mg.
TABS.: 30. Initial tmt.: 3 tabs./d, for 8- 10 days. In some cases, the initial tmt. has involved higher doses (4 to 5 tabs./day), always for short periods and under ECG monitor.
Maint. treatment: Seek the minimum effective dose, which varies depend. on the pt., ranging from 1/2 tab/d (1 tab. every 2 day.) to 2 tabs. every day.
Coronary insufficiency arrhythmias resistant to other treatments.
C/I: Hypersens. Pts. with Sinus bradycard. & sinoatrial heart block without pacemaker. –Sinus node dis. (Sick sinus syndrome) without a pacemaker (risk of sinus arrest).
Severe AV conduct. disord. without a pacemaker. Thyroid dysfunct. Preg.- unless exceptional circumstance. Lact. Comb. with med. products liable to induce torsades de pointes.

Class III Antiarrhythmic. Amiodarone HCl 150 mg / 3 ml.
AMPS: 6, 5 x 150 mg/3 ml. 5 mg/kg
given by IV infusion over a period of
20 min. to 2 hrs. See lit.
Tmt should be init. and monit. only under
hospital or specialist superv. Indic. for
Coronary insuffic., arrhythmias resistant to
other tms, Wolff Parkinson White
Syndrome. Can be used where a rapid
response is required or where oral admin. is
not possible.
C/I: Sinus bradycardia, SA heart block,
thyroid dysfunction, sev. resp. failure,
circulatory collapse, arterial hypoten.;
hypoten., heart failure and
cardiomyopathy C/I when using a bolus
inj. hypersens. to iodine or the drug,
comb. with drugs that may induce torsa.
de. poin.; children up to 3 years old,
pregnancy – except in exceptional
circumst., lactation. See lit.

Antiarrhythmics Class I and III. Vernakalant (as HCl) 20 mg/ml.
VIAL: 1×10, 25 ml. Recom. init. infus. is 3 mg/kg to be infus. over a 10 min. period. pts. weigh. ≥ 113 kg, do not exceed the max. init. dose of 339 mg (84.7 ml of 4 mg/ml sol.). If conver. to sinus rhythm does not occur within 15 min. after the end of the init. infus., a 2nd 10 min. infus. of 2 mg/kg may be admin. Pts. weigh. ≥ 113 kg, do not exceed the max. 2nd infus. of 226 mg (56.5 ml of 4 mg/ml sol.). Cumulative doses of greater than 5 mg/kg should not be admin. within 24 hrs. There are no clin. data on repeat doses after the
init. and 2nd infus. By 24 hrs. there
appears to be insignificant levels of
vernakalant. See lit.
Rapid conver. of recent onset atrial fibril.
to sinus rhythm in adults who are
hemodynamic. stable For non-surgery pts.: atrial fibril. ≤ 7 d. duration. For post-cardiac surgery pts.: atrial fibrill.≤ 3 d. duration.
C/I: Hypersen. Pts. with severe aortic
stenosis, pts. with systolic blood pressure
<100 mm Hg, and pts. with Heart fail. class
NYHA III and NYHA IV. Pts. with prolon. QT
at baseline (uncorrected > 440 msec), or
severe bradycar. sinus node dysfunc. or
2nd degree and 3rd degree heart block in
the absence of a pacemaker. Use of IV
rhythm control anti-arrhythmics (class I
and class III) within 4 hrs. prior to, as well
as in the first 4 hrs. after, drug admin.
Acute coron. synd. (includ. MI) within the
last 30 days.