Difference between revisions of "Torsades de pointes"

(See Also)
Line 12: Line 12:
  
 
==Treatment==
 
==Treatment==
#Mg (1-2gm over 1-2 minutes; then, 1-2gm/hr gtt)
+
#Magnesium
#Overdrive pacing (hr = 90-120)
+
##1-2gm IV over 1-2 min; then 1-2gm/hr gtt
#Isoproterenol (if no pacing, 2-8 mcg/min)
+
#Overdrive pacing
#lidocaine
+
##Goal HR 90-120
 +
#Isoproterenol
 +
##2-8 mcg/min
  
 
==See Also==
 
==See Also==

Revision as of 22:15, 27 February 2012

Background

Drugs that inhibit P450

  1. erythromycin
  2. biaxin
  3. ketoconozole
  4. itraconozole
  • certain antihistamines like terfandadine or astemizole, inhibit the delayed rectifier potassium channel
  • terfenadine is completely metabolized in liver. Once metabolized, has no cardiac activity
  • unmetabolized terfenadine has quinidine- like activity- gives torsades
  • if P450 enz inhibited by other drug, then will have increase in concentration of unmetabolized terfanadine.

Treatment

  1. Magnesium
    1. 1-2gm IV over 1-2 min; then 1-2gm/hr gtt
  2. Overdrive pacing
    1. Goal HR 90-120
  3. Isoproterenol
    1. 2-8 mcg/min

See Also

Source

10/07 DONALDSON (adapted from Tintinalli, Lampe)