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Well, since we're going to talk about rhythm.control, let's talk about our drug choices,.and let me just in no particular order talk.about the drugs..So, you have a drug like dofetilide..Dofetilide can markedly prolong the .QT interval in some patients..This is the reason it's mandated .to start in the hospital..There's a lot of literature on all these drugs,.so I've treated hundreds of .people with drugs for afib..I'm going to give you some of my .own personal experiences..Dofetilide has a unique property for me.when I have a patient who has a .slow heart rate when they're in normal rhythm..Most of the other antiarrhythmic drugs kind.of pile on because their ionic effects.also affect the sinus node, .so it gets slower and slower,.and you get an issue of should I need a .pacemaker now to keep the heart rate up..Dofetilide doesn't do it that much, so it's.one of the drugs that I use.to try to get out of that conundrum..It also has a wonderful ability to actually.cardiovert the patient..In our experience, 40 to 50 percent of people.will be spontaneously cardioverted,.and you can avoid a direct shock cardioversion..But, you have to watch for drug-drug interactions..That's a big thing..I like to use that drug when I'm looking to.get cardiovert a patient.when I have a patient with a slow sinus rate..They can't have a thick ventricle, but they.can have coronary disease,.and they can have even heart failure..So, that's a drug that I sort of look at. in that situation..Sotalol is another common drug I use..It's both a beta blocker and an antiarrhythmic..And, at the lower doses, there tend to be.a little more beta blocker effects..So, if you have somebody whose heart rate.is 45 to 50 when they're in normal rhythm,.I'm just telling you, you're not going .to get away with sotalol,.because if you give sotalol, now they're .going to be 35 to 40 beats a minute,.and they're just not going to feel good..Now, maybe you could add a pacemaker, that's.a brady-tachy syndrome,.and now you can advance the dose..The problem is, you use too little .of it, it doesn't work,.and then you say, \"ahh, .the drugs don't work.\".Well, the drug isn't working because you didn't.use the appropriate dose, but I get it..But, if a person has reasonable sinus rates,.and they have a normal heart,.I often will start it as an outpatient .if they're not in atrial fib..I know that some people don't like to do that,.so if you don't, you can start it in the hospital..But, I don't start it as an outpatient at.120 milligrams twice a day..I start low, like 80 milligrams twice a day..I either have them come back for an ECG or.I have them send me in rhythm strips..If they do fine, and they're keeping.a normal rhythm, I stop..If not, I might up the dose..Dronedarone?.It's an interesting drug in my experience..It's safe to use as an outpatient in multiple.situations, not heart failure,.but I've used it in coronary disease..It's an interesting drug because, for me,.it's like a yes or no drug..I do not know why this is so, but in my own.experience, it either has a remarkable ability.to suppress someone's afib, or it does almost.nothing, and you usually figure that out.within the first week or two of using the drug..The patient will call and say, .\"nothing's happening, Dr. P.\".and I say, \"okay, we'll switch .to something else.\".Or, I'll call them, or they'll call me and say, .\"Wow, I don't have any more episodes!\".I'm not exactly sure why that happens, but.at least in my experience,.it's almost like a switch..It either works, or it doesn't work..Then, you have the drugs like .flecainide and propafenone..They're kind of similar in my experience..They're excellent drugs..I use them mostly in patients who have, almost.in fact exclusively in patients who have normal hearts..I also want to make sure those patients have.a beta blocker.or calcium channel blockers,.so they don't go real fast.if they go into atrial fib or flutter..But, they're safe to start as an outpatient,.if you're in normal rhythm..They don't have a lot of drug-drug interactions,.and they're quite successful..And, I sometimes will start flecainide even.at low doses, at 50 milligrams twice a day..It's amazing to see how some people .are so sensitive to the drug.that you can get away with a really low dose..Last of all, you have amiodarone..So, amiodarone is the kingpin of drugs. in the fact of effectiveness;.it's also the kingpin in side effects..So, amiodarone has multiple ways .it can affect atrial fib..It affects a lot of different channels .in the heart. It's extremely effective..It can be started safely as an .outpatient in almost any situation..The downside of amiodarone?.It does have a lot of drug-drug interactions..You have to check what else patients are on .— warfarin, certain statins —.you've got to be aware of that..And, it can have a three to five percent chance.of causing toxicity to the lungs, liver, and thyroid..So, you can see, you have a lot of choices..You've got to know the drugs, you got to know.the patient, you got to know the doses,.but you can usually, with a little time and effort.with each patient,.pick the best one-two-punch for that patient..And, if that's not working, in my experience,.if you fail a couple of drugs,.you might as well go on to ablation, .unless you haven't tried amio..If you fail one or two of the non-amio drugs,.my experience has been.the third one's not going to work, and. either go amiodarone or ablation..But don't forget, ablation could also be used.as an upfront therapy..

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Tikosyn Certification 2015 2019 Form FAQs

Notice answers to questions about Tikosyn Certification 2015 2019 Form . Find out the most welcome topics and more.

Need help? Contact support

How do I fill out a CLAT 2019 application form?

How do I fill out the college preference form of the CLAT 2019? If you are AIR 1 and eligible for admission to all 21 NLUs, which one would you prefer? That is your first choice. Your first choice is not available. Out of the remaining 20, you are eligible for all 20. Which one will you prefer? That is your second choice. Your second choice is not available. Out of the remaining 19, you are eligible for all 19. Which one will you prefer? That is your third choice. Repeat the process till you have ranked all 21 NLUs. All the best.

How do I fill out the NEET 2019 application form?

Though the procedure is same as last earlier only the dates has been changed (tentative) yet to be announced by cbse u can fill form in October for the exam of February and in March for the exam of may if u r not satisfied with ur previous performance. All the best

How can I fill out the BITSAT Application Form 2019?

Hi dear First You have To sign Up Registration On BITSAT official website, and then fill up all of requirement they have to Know after registration successfully you have to fill login detail on the official website to process application form for different course you have to become eligible , for more detail all about you can Click Here

How can I fill out the COMEDK 2019 application form?

Go to homepage of COMEDK go to www. Comedk. org. in. then go register and after getting registered u will get a application number then u can proceed in the application form.

I am 2015 passed out CSE student, I am preparing for GATE2016 from a coaching, due to some reasons I do not have my provisional certificate, am I still eligible to fill application form? How?

You are eligible but you have to get a certificate from head of your institution in a specific format described in GATE 2016 notice (Eligibility | GATE 2016 prove that you are going to complete your B.Tech in 2016.

How long can you take Tikosyn?

Ask the prescribing doctor or your pharmacist, not random strangers. This is why it's a good idea to get all your medications filled at the same pharmacy. The pharmacist can alert you and your doctor(s) if there is a potential drug interaction.

How long can you stay on Tikosyn?

For some individuals, the ketogenic diet is an incredible alternative for weight reduction. It is totally different and permits the individual on the eating routine to eat an eating regimen that comprises of nourishments that you may not anticipate. As is valid for any eating routine, you should possibly start to tail it on the off chance that you can keep up it as a way of life change. Everything necessary is 3 to about a month to see a tremendous change. "In the event that you need to keep the weight off, you will need to eat well. You can't return to your old ways. An eating regimen has an en Continue Reading

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