Warning arrhythmia

The answer is b. (Hardmanr p 444.) This patient ate tyramine-rich foods while taking an MAOI and went into hypertensive crisis. Tyramine causes release of stored catecholamines from presynaptic terminals, which can cause hypertension, headache, tachycardia, cardiac arrhythmias, nausea, and stroke. In patients who do not take MAOls, tyramine is inactivated in the gut by MAO, and patients taking MAOls must be warned about the dangers of eating tyramine-rich foods. 

Bepridil has Class I antiarrhythmic properties and, like other such drugs, can induce new arrhythmias, including ventricular tachycardia/ventricular fibrillation (VTA/F). In addition, because of its ability to prolong the QT interval, bepridil can cause torsades de pointes type VT. Because of these properties, reserve bepridil for patients in whom other antianginal agents do not offer a satisfactory effect (see Warnings). P.285... 

Serious side effects such as ventricular arrhythmias, convulsions, or even death may appear as the first sign of toxicity without any previous warning. Less serious signs of toxicity (eg, nausea, restlessness) may occur frequently when initiating therapy, but are usually transient when such signs are persistent during maintenance therapy, they are often associated with serum concentrations greater than 20 mcg/mL. Serious toxicity is not reliably preceded by less severe side effects. 

WARNING Long-acting p2-agonists may t risk of asthma-related death Uses COPD maint Action LA p2-agonist, relaxes airway smooth muscles Dose 15 meg neb bid, 30 meg/d max Caution [C, ] w/ CV Dz, X Contra Not for acute asthma component hyp sensitivity peds w/ phenothiazines Disp Meg neb SE Chest/back pain, D, sinusitis, leg cramps, dyspnea, rash, flu-synd, t BP, arrhythmias, heart block J-K EMS Monitor ECG for arrhythmias, heart block, and hypokalemia (flattened T waves) t risk of acute asthma attack, treat w/ shortacting p-agonist OD May cause CP, palpitations, muscle tremors and cramps, and syncope symptomatic and supportive... 

Dofetilide (Tikosyn) [Antiarrhythmic] warning To minimize the risk of induced arrhythmia, hospitalize for minimum of 3 d to provide calculations... 

Imipramine (Tofranil) [Antidepressant/TCA] WARNING Close observation for suicidal thinking or unusual changes in behavior Uses Depres-sion, enuresis, panic attack, chronic pain Action TCA t CNS synaptic serotonin or norepinephrine Dose Adults. Hospitalized Initial 100 mg/24 h PO in doses T over several wk 300 mg/d max Output Maint 50-150 mg PO hs, 300 mg/24 h max Peds. Antidepressant 1.5-5 mg/kg/24 h daUy-qid Enuresis >6 y 10-25 mg PO qhs T by 10-25 mg at 1-2-wk int vals (max 50 mg for 6-12 y, 75 mg for >12 y) Rx for 2-3 mo, then tap Caution [D, /-] Contra Use w/ MAOIs, NAG, acute recovery from MI, PRG, CHF, angina, CVD, arrhythmias Disp Tabs, caps SE CV Sxs, dizziness, xerostomia, discolored urine Interactions t Effects W/ amiodarone, anticholinergics, BBs, cimetidine, diltiazem, Li, OCPs, quinidine, phenothiazines, ritonavir, verapamil, EtOH, evening primrose oil t effects OF CNS depressants, hypoglycemics, warfarin T risk of serotonin synd W/MAOIs 4-... 

Sotalol (Betapace) [Antiarrhythmic, Antihypertensive/Beta Blocker] WARNING Monitor pts for 1st 3 d of Rx to 4- risks of arrhythmia Uses Ventricular arrhythmias, AF Action p-Adrenergic blocking agent Dose Adults. 80 mg PO bid may be T to 240-320 mg/d Peds. Neonates 9 mg/m tid... 

WARNING Exacerbation of ischemic heart Dz w/ abrupt D/C Uses HTN MI Action p-Adrenergic receptor blocker, pj, P2 Dose HTN 10-20 mg bid, up to 60 mg/d MI 10 mg bid Caution [C (1st tri D if 2nd or 3rd tri), +] Contra CHF, cardiogenic shock, bradycardia, heart block, COPD, asthma Disp Tabs SE Sexual dysfxn, arrhythmia, dizziness, fatigue, CHF Interactions t Effects W/ antihyper-tensives, ciprofloxacin, fentanyl, nitrates, quinidine, res pine t bradycardia and... 

On the basis of two large randomized trials aimed at suppressing premature ventricular complexes after MI, so-called warning arrhythmias, it was discovered that many common antiarrhythmic medications actually increase the risk of mortality [20, 21]. Amiodarone also has been shown to have no definitive effect on mortality in patients after an MI, including in the recent SCD-HeFT trial [22-24]. In fact, of all antiarrhythmic medications, only beta blockers have been clearly shown to prevent SCD after MI [25], particularly among those with depressed LV function [11]. 

Theophylline should be used only where methods to measure theophylline blood levels are available because it has a narrow therapeutic window, and its therapeutic and toxic effects are related to its blood level. Improvement in pulmonary function is correlated with plasma concentrations in the range of 5-20 mg/L. Anorexia, nausea, vomiting, abdominal discomfort, headache, and anxiety occur at concentrations of 15 mg/L in some patients and become common at concentrations greater than 20 mg/L. Higher levels (more than 40 mg/L) may cause seizures or arrhythmias these may not be preceded by gastrointestinal or neurologic warning symptoms. 

Among the newest atypical antipsychotics, prolongation of the QT or QTC interval has received much attention. Because this was believed to indicate an increased risk of dangerous arrhythmias, sertindole has been delayed and ziprasidone and quetiapine are accompanied by warnings. There is, however, no evidence that this has actually translated into increased incidence of arrhythmias. 

Procainamide (Pronestyl, Pronestyl SR, Procanbid) [Antiarrhythmic] WARNING Only use in life-treating arrhythmias hematologic tox can be severe Uses Supraventricular/ventricular arrhythmias Action Class 1A antiarrhythmic (Table VI-7) Dose Adults. Recurrent VF/pulseless VT 20 mg/min slow IV inf to a max of 17 mg/kg or until QRS T by 50% or dysrhythmia resolves Maint inf 4 mg/min (mix 1 gm in 250 mL NS to make 4 mg/mL use 60 gtt set—60 gtt/min = 4 mg) Peds. Loading dose 15-50 mg/kg IV/IO Caution [C, +] Contra Complete heart block, 2nd- or 3rd-degree heart block w/o pacemaker, torsades de pointes, SLE Disp Tabs caps 250, 500 mg SR tabs 500, 750, 1000 mg inj 100, 500 mg/mL SE 1 BP, lupus-like synd, GI upset, taste perversion, arrhythmias, tach, heart block, angioneurotic edema, blood dyscrasias Interactions T Effects W/ acetazolamide, amiodarone, cimetidine, ranitidine, trimethoprim T effects OF anticholinergics, antihypertensives i effects W/ procaine, EtOH EMS Monitor BP and ECG use caution to prevent rapid... 

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