Which of the following glycoprotein IIb/IIIa inhibitors has the shortest halflife but the longest duration of therapy?
c. Abciximab. Abciximab has a serum half-life of 10 to 30 minutes; however, because of its high binding affinity to the glycoprotein IIb/IIIa receptor, it maintains its activity for many hours after discontinuation of therapy, and abciximab can be detected in the serum for longer than 2 weeks. The short-acting inhibitors have half-lives of approximately 2 hours, depending on renal function; however, because of their competitive inhibiting nature, once the infusion is discontinued, their effects wane relatively quickly.
Dronedarone use is contraindicated in which patient population?
c. NYHA class IV heart failure. The Antiarrhythmic Trial with Dronedarone in Moderate-to-Severe Congestive Heart Failure Evaluating Morbidity Decrease (ANDROMEDA) was a mortality trial comparing dronedarone to placebo in patients with moderate to severe heart failure for rhythm control. The trial was prematurely terminated as a significantly higher mortality rate was seen in the dronedarone arm versus placebo (8.1% vs. 3.8%). The risk of death was highest in patients with severely depressed left ventricular systolic function. The package insert for dronedarone states the drug is contraindicted in patients with NYHA Class IV heart failure or symptomatic heart failure with recent decompensation requiring hospitalization because it doubles the risk of death.
Y.K is a 65-year-old male with symptomatic paroxysmal atrial fibrillation and heart failure recently admitted to the hospital for decompensation. The decision has been made to restore sinus rhythm and utilize antiarrhythmic therapy for rhythm control. Which of the following antiarrythmic agents is most appropraite to use in this patient for rhythm control?
a. Dofetalide. Structural heart failure limits the use of antiarrythmic therapies for rhythm control in atrial fibrillation due to mortality concerns. Dofetalide has not shown to increase mortality in patients with atrial fibrillation who also have heart failure unlike dronedarone, flecanide, and quinidine. The agent of choice in this situation; however, would likely be amiodarone unless the patient has other contraindications for amiodarone therapy.
Which of the following agents is effective for converting AFib to sinus rhythm and for maintaining sinus rhythm after it is restored?
b. Amiodarone. Although amiodarone does not carry an FDA indication for the treatment of AFib, it can convert to and maintain normal sinus rhythm. The other agents listed are only used for rate control when used for AFib.
M. G., a 50-year-old man, collapsed at home after shoveling his sidewalk. His son initiated cardiopulmonary resuscitation immediately, and an emergency medical service was called. When the squad arrived, it was determined that M. G. was in ventricular fibrillation (VF), and he was cardioverted with 200, 300, and 360 J. Epinephrine was given, and M. G. was shocked again. M. G. was still in VF. It was decided to initiate antiarrhythmic therapy. Choose the most appropriate agent from the list below.
b. Amiodarone. The most recent advanced cardiac life support guidelines recommend that amiodarone be the first-line agent in patients with pulseless VT/VF. This recommendation is based on the Amiodarone for Resuscitation after Out-of-Hospital Cardiac Arrest due to Ventricular Fibrillation (ARREST) trial, which showed that amiodarone increased the likelihood of admission to the hospital after an out-of-hospital arrest. This is further supported by the recently presented Amiodarone versus Lidocaine in PreHospital Refractory Ventricular Fibrillation Evaluation (ALIVE) trial. Lidocaine is now considered Class Indeterminate based on the lack of controlled trials supporting its use in pulseless VT/VF. Procainamide administration is prolonged and not suitable for rapid administration. Bretylium is no longer available secondary to lack of raw materials.
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