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| {| class="wikitable" | | {{#ask: [[Is DrugClass::Benzodiazepine]] | ?SeizureDose=Dose | ?BrandName=Trade Name}} |
| | align="center" style="background:#f0f0f0;"|'''Medication''' | | |
| | align="center" style="background:#f0f0f0;"|'''Dose'''
| | [[Scarlet_fever_1.2.jpg|thumb|"Slapped cheeks" and "white mustache" (circumoral pallor) typical of scarlet fever.]] |
| | align="center" style="background:#f0f0f0;"|'''Comments''' | | |
| | align="center" style="background:#f0f0f0;"|'''Contraindications''' | | We heard you. '''Our native WikEM app is back!''' Download from your app store now ([http://apps.apple.com/us/app/wikem/id576405449 iOS] and [https://play.google.com/store/apps/details?id=wikem.chris Android]). |
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| | '''[[Calcium-Channel Blockers]]'''||||||
| | [http://mediawiki.org MediaWiki] |
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| | [[Diltiazem]]||
| | [http://apps.apple.com App] |
| *Bolus 0.25 mg/kg (average adult dose 20mg) over 2 min
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| *If, after 15min 1st dose is tolerated but inadequate re-bolus 0.35 mg/kg
| | [https://apps.apple.com App] |
| *If patient responds start infusion at 5-15mg/hr or give PO dilt 30mg QID
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| | [http://apps.apple.com/us/app/wikem/id576405449 iOS] |
| *Preferred in patients with chronic lung such as [[Asthma]] and [[COPD]]<ref>Short PM, Lipworth SI, Elder DH, Schembri S, Lipworth BJ. Effect of beta blockers in treatment of chronic obstructive pulmonary disease: a retrospective cohort study. BMJ. 2011 May 10;342:d2549</ref>
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| | [https://apps.apple.com/us/app/wikem/id576405449 https://play.google.com/store/apps/details?id=wikem.chris iOS] |
| *Decompensated heart failure
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| *Preexcitation (especially in pediatrics)
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| *Significant hypotension
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| | '''[[Beta-Blockers''']]||||||
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| | [[Metoprolol]]||
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| *Bolus 2.5-5mg IVP over 2min q5min up to 3 doses
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| *If patient responds orally load with 25-50mg
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| *Particularly useful when A-fib a/w exercise, after acute MI, or w/ thyrotoxicosis
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| *Also long-term beta blocker improves patient survival whereas non-dihydropyridine calcium channel blockers may even worsen outcomes. Important to consider if a patient will most likely be started on a beta blocker upon discharge then strongly consider using the agent for acute conversion if they do not have any relative contraindications.<ref>Effect of metoprolol CR/XL in chronic heart failure: Metoprolol CR/XL Randomised Intervention Trial in Congestive Heart Failure (MERIT-HF). Lancet. 1999 Jun 12;353(9169):2001-7Effect of verapamil on mortality and major events after acute myocardial infarction (the Danish Verapamil Infarction Trial II–DAVIT II). Am J Cardiol. 1990 Oct 1;66(10):779-85</ref>
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| *COPD
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| *Asthma
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| *Decompensated heart failure
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| *Hypotension
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| | [[Esmolol]]||
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| *Bolus 0.5 mg/kg over one minute, followed by 50 µg/kg/min
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| *If, after 4min response is inadequate, re-bolus followed by infusion of 100 µg/kg/min
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| *If, after 4min response is still inadequate, try final bolus followed by infusion of 150 µg/kg/min
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| *If necessary, infusion can be increased to maximum of 200 µg/kg/min after another four minutes
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| *Use if unsure whether patient will tolerate a beta blocker since the duration of action is only 10 minutes
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| | '''Other'''||||||
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| | [[Digoxin]]||||||
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| *0.25 mg IV q2hr up to 1.5 mg, then 0.125-0.25 mg PO or IV QD
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| *Adjust dose in presence of renal failure, amiodarone, etc
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| *Consider as initial therapy for pts with LV dysfunction who:
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| **Do not achieve rate control targets on beta blockers alone
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| **Cannot tolerate addition of or increased doses of beta blocker due to decompensated CHF
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| **Would have digoxin added anyway to improve CHF symptoms independent of A-fib
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| *Consider as initial therapy in pts with severe hypotension
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| *Consider as 2nd agent in pts in whom IV BB or IV CCB has failed to control their rate
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| *May take up to 6-8 hours to work
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| | [[Amiodarone]]||
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| *Load 3-7 mg/kg IV over 30 min; then 1200 mg over 24hr via continuous infusion or in divided oral doses<ref>Khan IA et al. Amiodarone for pharmacological cardioversion of recent-onset atrial fibrillation. Int J Cardiol. 2003 Jun;89(2-3):239-48.</ref>
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| *Consider for patients with decompensated heart failure or those with accessory pathways
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| *2nd-line agent for chronic rate control when BBs and CCBs, alone, combined, or when used with digoxin, are ineffective
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| |}
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