Agents that can be considered as Amiodarone alternatives for the treatment of atrial fibrillation depend upon the patient’s cardiac history, as individuals with reduced left ventricular systolic function are especially prone to the proarrhythmic effects of certain antiarrhythmic agents. Some commonly used Amiodarone alternatives include ibutilide, dofetilide, and sotalol. Strong consideration should be made for […]
Ibutilide prolongs repolarization by inhibition of the delayed rectifier potassium current (Ikr) and by selective enhancement of the slow inward sodium current. Ibutilide is a newer anti arrhythmic used in particularly for patients suffering from atrial fibrillation not responding to the commonly used medications. Ibutilide is efficacious in the termination of atrial fibrillation (AF) and flutter with both single and repeated intravenous infusions. It
Dofetilide prolongs the action potential and QTC in a concentration-related manner. Dofetilide exerts its effects solely by inhibition of the rapid component of the delayed rectifier potassium current Ikr. Dofetilide has stronger evidence in its favor for acute cardioversion of atrial fibrillation than for maintenance thereafter, according to a meta-analysis. It can be given to
Human albumin is obtained from pooled human plasma; 100 ml of 20% human albumin solution is the osmotic equivalent of about 400 ml of fresh frozen plasma or 800 ml of whole blood. It can be used without regard to patient’s blood group and does not interfere with coagulation. Unlike whole blood or plasma, human
Polyvinylpyrrolidone PPV is a synthetic polymer (average MW 40,000) used as a 3.5% solution. It is used as a volume or plasma expander and is used to increase the intravascular compartment fluid. It interferes with blood grouping and cross-matching and is a histamine releaser. Polyvinylpyrrolidone ppv is slowly excreted by kidney and small amounts by
The fibrates (isobutyric acid derivatives) primarily activate lipoprotein lipase which is a key enzyme in the degradation of VLDL resulting in lowering of circulating TGs. This effect is of the fibrates is exerted through paroxisome proliferator-activated receptor ci (PPARc) that is a gene transcription regulating receptor expressed in liver, fat and muscles. Activation of PPARct enhances
Fenofibrate is another 2nd generation prodrug fibric acid derivative which has greater HDL-CH raising and greater LDL-CH lowering action than other fibrates. Hence Fenofibrate may be more appropriate as an adjunctive drug in subjects with raised LDL-CH levels in addition to raised TG levels. No rise in LDL-CH has been observed in patients with high
Bezafibrate is a second generation fibric acid derivative and is used to lower cholesterol levels. It is an alternative for gemfibrozil in mixed hyperlipidaemias (type III, IV and V). Though it has also been indicated in hypercholesterolaemia (type II), it is inferior to statins and resins. Bezafibrate has not shown propensity to increase LDL-CH in
Minoxidil is a powerful vasodilator, the pattern of action resembling hydralazine, i.e. direct relaxation of arteriolar smooth muscle with little effect on venous capacitance. Marked vasodilatation elicits strong compensatory reflexes: increased renin release and proximal tubular Na’ reabsorption — marked Na and water retention — oedema and CHF may occur; increased sympathetic activity – palpitation,
Nipride medication is a rapidly (within seconds) and consistently acting vasodilator; has brief duration of action (2-5 min)—vascular tone can be titrated with the rate of i.v. infusion. It relaxes both resistance and capacitance vessels which reduces t.p.r. as well as c.o. (by decreasing venous return). Myocardial work is reduced—ischemia is not accentuated, as occurs
