Podcasts about Diltiazem

Podcast summary of articles from the December 2024 edition of the Journal of Emergency Medicine from the American Academy of Emergency Medicine.  Topics include pulmonary embolism in COVID19 patients, intracranial bleeding, diltiazem in patients with heart failure, vital sign abnormalities, naloxone from the ED, and an interesting case report.  Guest speaker is Dr. Kinda Sweidan.

Contributor: Taylor Lynch MD Supraventricular tachycardias (SVTs) arise above the bundle of His The term SVT includes AV nodal reentrant tachycardia (AVNRT), atrioventricular reentrant tachycardia (AVRT), atrial tachycardia, atrial fibrillation, atrial flutter, and multifocal atrial tachycardia  AVNRT is the most common form of SVT Paroxysmal Spontaneous or provoked by exertion, coffee, alcohol, or thyroid disease More common in women (3:1 women:men ratio) HR 160-240 Narrow complex with a normal QRS Unstable patients receive synchronized cardioversion at 0.5-1 J/kg Valsalva maneuver is attempted before pharmaceutical interventions Increases vagal tone at the AV node to slow conduction and prolongs its refractory period to normalize the conduction Traditionally, patients are asked to bear down, but this only works in 17% of patients REVERT trial assessed a modified valsalva that worked in 43% of patients Adenosine Slows conduction at the AV node by activating potassium channels and inhibiting calcium influx Extremely uncomfortable for most patients Not commonly used anymore Nondihydropyridine calcium-channel blockers are preferred A 2009 RCT investigated low-infusion CCBs compared with adenosine bolus The study found a conversion rate of 98% in the CCB group vs. adenosine group at 86.5% The main adverse effect of CCB is hypotension, which a slow infusion rate can mitigate Diltiazem dose is 0.25 mg/kg/2min and repeat at 0.35 mg/kg/15 minutes or slow infusion at 2.5 mg/min up to a conversion or 50 mg total References 1. Appelboam A, Reuben A, Mann C, et al. Postural modification to the standard Valsalva manoeuvre for emergency treatment of supraventricular tachycardias (REVERT): A randomised controlled trial. Lancet. 2015;386(10005):1747-1753. doi:10.1016/S0140-6736(15)61485-4 Belz MK, Stambler BS, Wood MA, Pherson C, Ellenbogen KA. Effects of enhanced parasympathetic tone on atrioventricular nodal conduction during atrioventricular nodal reentrant tachycardia. Am J Cardiol. 1997;80(7):878-882. doi:10.1016/s0002-9149(97)00539-0 Lim SH, Anantharaman V, Teo WS, Chan YH. Slow infusion of calcium channel blockers compared with intravenous adenosine in the emergency treatment of supraventricular tachycardia. Resuscitation. 2009;80(5):523-528. doi:10.1016/j.resuscitation.2009.01.017 Page RL, Joglar JA, Caldwell MA, et al. 2015 ACC/AHA/HRS Guideline for the Management of Adult Patients With Supraventricular Tachycardia: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society [published correction appears in Circulation. 2016 Sep 13;134(11):e234-5. doi: 10.1161/CIR.0000000000000448]. Circulation. 2016;133(14):e506-e574. doi:10.1161/CIR.0000000000000311 Summarized & Edited by Jorge Chalit, OMS3 Donate: https://emergencymedicalminute.org/donate/  

Welcome to the latest episode of Cardiology Digest, where we chart a course through groundbreaking studies that are shaping cardiology practice!   STUDY #1: First, we discuss the nuanced world of drug interactions involving diltiazem and direct-acting oral anticoagulants like apixaban and rivaroxaban. Tune in as we scrutinize the study's limitations and practical implications for your patients with atrial fibrillation.  Ray, WA, Chung, CP, Stein, CM, et al. 2024. Serious bleeding in patients with atrial fibrillation using diltiazem with apixaban or rivaroxaban. JAMA. 18: 1565–1575. (https://jamanetwork.com/journals/jama/article-abstract/2817546) STUDY #2: Next, we turn our attention to a case-control study examining the bleeding risks associated with the combination of selective serotonin reuptake inhibitors and anticoagulants in patients with atrial fibrillation. Are the bleeding risks substantial enough to rethink this combination therapy, or are there scenarios where the benefits outweigh the dangers? We'll leave no stone unturned. Rahman, AA, Platt, RW, Beradid, S, et al. 2024. Concomitant use of selective serotonin reuptake inhibitors with oral anticoagulants and risk of major bleeding. JAMA. 3: e243208. (https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2816687) STUDY #3: Finally, we explore a fascinating meta analysis that looked at renal denervation and its long-term efficacy in controlling blood pressure. See how renal denervation stacks up against traditional antihypertensive medications and what you need to consider when thinking about incorporating it into your treatment arsenal. Sesa-Ashton, G, Nolde, JM, Muente, I, et al. 2024. Long-term blood pressure reductions following catheter-based renal denervation: A systematic review and meta-analysis. Hypertension. 6: e63–e70. (https://www.ahajournals.org/doi/10.1161/HYPERTENSIONAHA.123.22314) Join us to explore the potential impacts of these studies, the ongoing debates they spark within the cardiology community, and to see how these findings could influence your clinical decisions. Learn more with these courses: Atrial Fibrillation Essentials (1 CME):  Pacemaker Essentials (5 CME) Pacemaker Essentials Workshop (1 CME) Get a Basic or Pro account, or, get a Trial account. Show notes: Visit us at  https://www.medmastery.com/podcasts/cardiology-podcast.

Editor's Summary by Christopher W. Seymour, MD, MSc, Associate Editor of JAMA, the Journal of the American Medical Association, for the May 14, 2024, issue.

ACC Part 2: The TACT2 trial of chelation, inter-atrial shunts for HF, and triglyceride lowering; plus diltiazem and Factor Xa anticoagulants are the topics John Mandrola, MD, covers this week. This podcast is intended for healthcare professionals only. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I. TACT 2 Chelation Therapy Provides No Benefit Post-MI https://www.medscape.com/viewarticle/chelation-therapy-provides-no-benefit-post-mi-2024a10006l5 Chelation Therapy and CV Risk: Why TACT2 Showed No Benefit https://www.medscape.com/viewarticle/chelation-therapy-and-cv-risk-why-tact2-showed-no-benefit-2024a1000761?src= JAMA TACT 1 paper https://jamanetwork.com/journals/jama/fullarticle/1672238 Diabetes Subgroup paper https://pubmed.ncbi.nlm.nih.gov/24254885/ A New Look at P-values https://evidence.nejm.org/doi/abs/10.1056/EVIDoa2300003 PARAGON HF https://www.nejm.org/doi/full/10.1056/NEJMoa1908655 II. Interatrial Shunts for HF No Net HF Benefit for Interarterial Shunt Device https://www.medscape.com/viewarticle/no-net-hf-benefit-interarterial-shunt-device-2024a10006kk REDUCE LAP HF II https://doi.org/10.1016/S0140-6736(22)00016-2 III. Triglyceride Lowering Early Olezarsen Results Show 50% Reduction in Triglycerides https://www.medscape.com/viewarticle/early-olezarsen-results-show-50-reduction-triglycerides-2024a10006oz Is It Time to Stop Treating High Triglycerides? https://www.medscape.com/viewarticle/990126 NEJM https://www.nejm.org/doi/full/10.1056/NEJMoa2402309 Substantial Triglyceride Reduction With Plozasiran https://www.medscape.com/viewarticle/substantial-triglyceride-reduction-plozasiran-2024a10006wf?icd=login_success_email_match_norm JAMA Cardiology https://jamanetwork.com/journals/jamacardiology/article-abstract/2817469 IV. Diltiazem and Factor Xa inhibitors JAMA Vanderbilt University Paper https://jamanetwork.com/journals/jama/fullarticle/2817546 You may also like: The Bob Harrington Show with the Stephen and Suzanne Weiss Dean of Weill Cornell Medicine, Robert A. Harrington, MD. https://www.medscape.com/author/bob-harrington Questions or feedback, please contact news@medscape.net

Understanding Diltiazem is an important part of your cardiac skillset. It's indications range from blood pressure management, long term stable angina, to it's mainstay in the hospital setting: acute rate control of arrhythmias with rapid ventricular rates. This episode will cover Diltiazem's mechanism of action, its multiple indications for both acute and routine use, as well as important nursing considerations.Mentioned in the episode:ICU Advantage: Diltiazem (Cardizem) - CC MedsStrong Medicine by Dr. Eric Strong: Antiarrhytmics (Lesson 7 - How to Choose the Right Med and Classic Pitfalls)Check out Nicole Kupchik's exam reviews and practice questions at nicolekupchikconsulting.com. Use the promo code UPMYGAME20 to get 20% off all products.Do you need help with your resume, interviewing, or need career coaching? Check out Sarah at New Thing Nurse:Get 15% off of her resume and cover letter templates using the promo code UPMYGAMENursing students and new grad career services Experienced RN career servicesNP career servicesUp My Nursing Game is partnering with VCU Health Continuing Education to offer FREE continuing education credits for registered nurses. Click here to obtain nursing credit.See the show notes at upmynursinggame.com.

Host Jeff Matcha, along with EMS Division Director Dan Pojar, System Medical Director Dr. Weston, and Assistant Medical Directors Dr. Grawey and Dr. Engel, discuss system updates and the nuances of A Fib with RVR and Diltiazem administration.

Visit: https://nursing.com/140meds to request your free copy of "140 Must Know Meds" Generic Name Diltiazem Trade Name Cardizem Indication Hypertension, angina, SVT, AFib, aflutter Action Inhibits calcium transport resulting in inhibition of excitation and contraction, leads to depression of AV and SA node leading to decreased HR, leads to vasodi- latation and decreased blood pressure. Therapeutic Class Antianginals, antiarrhythmics, antihypertensive Pharmacologic Class Ca Channel Blocker (Benzothiazepine) Nursing Considerations • Contraindicated in 2nd and 3rd AV block • May cause arrhythmias, CHF, bradycardia, peripheral edema, gingival hyperplasia • Increases digoxin levels • Don't drink grapefruit juice • Assess for signs of CHF • Monitor EKG continuously • Tell patient to change positions slowly • Monitor serum potassium • Instruct pt on how to take blood pressure

The management of atrial fibrillation with rapid ventricular response is often complicated by the presence of heart failure with reduced ejection fraction. The presence of HFrEF limits pharmacologic options for rate control. This podcast will cover a retrospective study looking at the use of metoprolol vs diltiazem in patients with A fib with RVR and concomitant heart failure

In this month's episode, Assistant Editor and Amy Ho, MD, MPH, FACEP, chats with Ken Milne, MD, about his clinical column. Then, Dr. Ho speaks with Ron Stewart, MD, about his experiences within the emergency department as a patient. Registration is open for ACEP's Leadership & Advocacy Conference. ACEP Nowcast listeners can save $100 on registration with promo code POWERUP. Read more on ACEPNow.com Revisit ACEP Nowcast podcast episodes.  Catch up on all of ACEP Now in past issues.

The following question refers to Section 6.1 of the 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure. The question is asked by Keck School of Medicine USC medical student & CardioNerds Intern Hirsh Elhence, answered first by Mount Sinai Hospital cardiology fellow and CardioNerds FIT Trialist Dr. Jason Feinman, and then by expert faculty Dr. Mark Drazner. Dr. Drazner is an advanced heart failure and transplant cardiologist, Professor of Medicine, and Clinical Chief of Cardiology at UT Southwestern. He is the President of the Heart Failure Society of America. The Decipher the Guidelines: 2022 AHA / ACC / HFSA Guideline for The Management of Heart Failure series was developed by the CardioNerds and created in collaboration with the American Heart Association and the Heart Failure Society of America. It was created by 30 trainees spanning college through advanced fellowship under the leadership of CardioNerds Cofounders Dr. Amit Goyal and Dr. Dan Ambinder, with mentorship from Dr. Anu Lala, Dr. Robert Mentz, and Dr. Nancy Sweitzer. We thank Dr. Judy Bezanson and Dr. Elliott Antman for tremendous guidance. Enjoy this Circulation 2022 Paths to Discovery article to learn about the CardioNerds story, mission, and values. Question #2 A 67-year-old man with a past medical history of type 2 diabetes mellitus, hypertension, and active tobacco smoking presents to the emergency room with substernal chest pain for the past 5 hours. An electrocardiogram reveals ST segment elevations in the anterior precordial leads and he is transferred emergently to the catheterization laboratory. Coronary angiography reveals 100% occlusion of the proximal left anterior descending artery, and he is successfully treated with a drug eluting stent resulting in TIMI 3 coronary flow. Following his procedure, a transthoracic echocardiogram is performed which reveals a left ventricular ejection fraction of 35% with a hypokinetic anterior wall. Which of the following medications would be the best choice to prevent the incidence of heart failure and reduce mortality? A Lisinopril B Diltiazem C Carvedilol D Sacubitril-valsartan E Both A and C Answer #2 The correct answer is E – both lisinopril and carvedilol are appropriate to reduce the incidence of heart failure and mortality. Evidence-based beta-blockers and ACE inhibitors both have Class 1 recommendations in patients with a recent myocardial infarction and left ventricular ejection fraction ≤ 40% to reduce the incidence of heart failure and to reduce mortality. Multiple randomized controlled trials have investigated both medications in the post myocardial infarction setting and demonstrated improved ventricular remodeling as well as benefits for mortality and development of incident heart failure. At this time, there is not sufficient evidence to recommend ARNi over ACEi for patients with reduced LVEF following acute MI. The PARADISE-MI trial randomized a total of 5,661 patients with myocardial infarction complicated by a reduced LVEF, pulmonary congestion, or both to receive either sacubitril-valsartan (97-103mg twice daily) or ramipril (5mg twice daily). After a median follow up time of 22 months, there was no statistically significant difference in the primary outcome of cardiovascular death or incident heart failure. At this time, ARNi have not been included in the guidelines for this specific population. Diltiazem is a non-dihydropyridine calcium channel blocker, a family of drugs with negative inotropic effects and which may be harmful in patients with depressed LVEF (Class 3: Harm, LOE C-LD). Main Takeaway:  For patients with recent myocardial infarction and reduced left ventricular function both beta blockers and ACEi have Class 1 recommendations to reduce the incidence of heart failure and decrease mortality. Guideline Location: Section 6.1

This is one of my drug name pronunciation episodes.  Today, we're talking about tianeptine.   How do these pronunciation episodes work?   I break drug names down into syllables.   I explain which syllable has the emphasis.   I reveal the source of the information.  I put the written pronunciation in the show notes so that you see it and use it right away.   If you're new to my pronunciation episodes, welcome!  The purpose is to provide the intended pronunciations of drug names from reliable sources so that you feel more confident saying them and less frustrated learning them.  I hope this episode helps you! Why did I pick tianeptine for this episode? To talk about the pronunciation  To improve awareness about it   Highlights from this episode Written pronunciation = Tye uh NEP teen Tianeptine has 4 syllables. Tye - like you tie your shoes Uh - schwa “A” sound  Nep - like the planet Neptune Teen - like a teenager

In this episode, we “deep dive” into diltiazem, describing its most important drug facts, pharmacology and medicinal chemistry, pharmaceutics, AB compatibility, and important medication safety issues. Key Concepts Diltiazem is a non-dihydropyridine calcium channel blocker (CCB). This type of CCB reduces both heart rate and blood pressure whereas dihydropyridine CCBs only reduce blood pressure. Diltiazem has numerous dosage forms (IV, immediate release tablets, and extended-release products). Extended-release products are always dosed once or twice daily. Historically there were a significant number of extended-release capsules with a variety of brand names and AB-compatibility. Today, only a few branded products still exist in the US market (Cardizem CD, Cartia XT, Cardizem LA, Tiazac, Taztia XT). The FDA Orange Book describes “AB” compatibility, which outlines whether one formulation is therapeutically equivalent to another formulation. Depending on state law, pharmacists can use AB compatibility codes to automatically substitute formulations without notifying the prescriber. The numerous dosage forms of diltiazem is a medication safety issue. Remember that immediate release diltiazem is always dosed TID/QID (3-4 times per day) whereas extended-release formulations are always dosed once daily. A twice-daily extended-release product was previously on the market but has since been discontinued.

Download the cheat: https://bit.ly/50-meds  View the lesson: https://bit.ly/DiltiazemCardizemNursingConsiderations    Generic Name Diltiazem Trade Name Cardizem Indication Hypertension, angina, SVT, AFib, aflutter Action Inhibits calcium transport resulting in inhibition of excitation and contraction, leads to depression of AV and SA node leading to decreased HR, leads to vasodi- latation and decreased blood pressure. Therapeutic Class Antianginals, antiarrhythmics, antihypertensive Pharmacologic Class Ca Channel Blocker (Benzothiazepine) Nursing Considerations • Contraindicated in 2nd and 3rd AV block • May cause arrhythmias, CHF, bradycardia, peripheral edema, gingival hyperplasia • Increases digoxin levels • Don't drink grapefruit juice • Assess for signs of CHF • Monitor EKG continuously • Tell patient to change positions slowly • Monitor serum potassium • Instruct pt on how to take blood pressure

Trade – Cardizem Class – Calcium channel Blocker ( class IV antiarrhythmic) MOA – Blocks Calcium from moving into the heart muscle cell, which prolongs the conduction of electrical impulses through the AV node Indication – Rapid atrial fibrillation Contraindications – Hypotension, Heart block, heart failure Side effects – Flushing, headache, bradycardia, hypotension, heart block, myocardial depression, severe AV block, at high doses cardiac arrest Dosing Adult: 0.25mg/kg IV/IO 2nd dose of 0.35mg/kg IV/IOPediatric: Not recommended 

Contributor: Aaron Lessen, MD Educational Pearls: Atrial fibrillation is an irregular heart rhythm that sometimes requires rate control in setting of rapid ventricular response (RVR) Calcium channel blocker and beta blockers are the most frequently used medications to block the AV node and slow down the heart rate in atrial fibrillation with RVR If a patient is on one of these agents at home, the IV form should be used first Recent systematic review and meta-analysis found 3 trials addressing which medication to use to control heart rate in atrial fibrillation with RVR with a total of 150 patients Found diltiazem, a CCB, was 4x more likely to reduce heart rate than metoprolol 50% of patients had a normal heart rate at 21 minutes with diltiazem versus 22% in those who received metoprolol Both agents had a similar decrease in blood pressure after administration References Jafri SH, Xu J, Warsi I, Cerecedo-Lopez CD. Diltiazem versus metoprolol for the management of atrial fibrillation: A systematic review and meta-analysis. Am J Emerg Med. 2021 Oct;48:323-327. doi: 10.1016/j.ajem.2021.06.053. Epub 2021 Jun 30. PMID: 34274577. Summarized by John Spartz, MS4 | Edited by Erik Verzemnieks, MD   The Emergency Medical Minute is excited to announce that we are now offering AMA PRA Category 1 credits™ via online course modules. To access these and for more information, visit our website at https://emergencymedicalminute.org/cme-courses/ and create an account.  Donate to EMM today!

Want to hear key medical literature facts to help become that awesome doctor, whilst also being able to tell if people like beer by their facial expressions?Your ears are in the right place.Dr LJ Smith, Dr Camille Hirons, Dr Jonathan Hudson and Dr Barnaby Hirons scour and digest the latest and greatest medical literature out there... and some other fun stuff too: Why pulse oximeters miss deadly hypoxia in people of colour. How paracetamol and sodium can kill. Are sweeteners a safe alternative to sugar? Empagliflozin in acute heart failure - EPULSE trial. Should we be banning tanning salons? Metoprolol vs Diltiazem in AF with RVR? How much exercise to save lives? Drug induced liver injury causes.Facial expressions drinking beer!Tell us what you think! Twitter @JournalSpotting, journalspotting@gmail.com, www.journalspotting.com.Rate us on apple podcasts or spotify.Share us everywhere.Want a free JS mug for your doctors' mess? Just get in touch.

It's the JournalFeed Podcast for the week of February 28 - March 4, 2022. We cover molnupiravir for COVID, bacterial meningitis, diltiazem vs metoprolol for a-fib with RVR, PLUS RCT on balanced fluids, and pad placement for a-fib cardioversion.

It's our last episode in 2021! This episode we have Dr. Libo Wang and Dr. Jon Harrison on to talk about their new paper in the Annals of Internal Medicine about ultrasound JVP for estimating CVP, validated with right heart catheterization. We also ask them their thoughts on a new meta-analysis looking at metoprolol vs diltiazem for atrial fibrillation with RVR. We also look at a new large retrospective study of apixaban vs rivaroxaban for stroke prevention, a study looking at reducing sleep interruptions in the hospital, and two new outpatient therapies for COVID-19 infection. Happy New Year! Ultrasound JVP for estimating CVPIV Diltiazem vs Metoprolol for A fib with RVRMajor Ischemic and Hemorrhagic Events in Apixaban vs Rivaroxaban for AFReducing Sleep Interruptions in Hospitalized Patients Early Remdesivir for Outpatient COVID-19Molnupiravir for Outpatient COVID-19Music from Uppbeat (free for Creators!):https://uppbeat.io/t/soundroll/dopeLicense code: NP8HLP5WKGKXFW2R

The 11 Worst Medications Causing Atrial Fibrillation Could one of your medications actually be causing your AFib? Over the years I've seen a number of patients either significantly decrease their AFib episodes or even put their AFib into remission for a few years just by getting off an AFib causing medication. For those who needed a particular medication, catheter ablation was very helpful in eliminating the AFib so that they could continue to take their necessary medication. Below are my 11 worst medications causing atrial fibrillation. 1. Diuretics With the exception of spironolactone (Aldactone) and triamterene, diuretics can be problematic for atrial fibrillation patients. The reason is that most diuretics are well-known to cause mineral depletion in the body. Depletion of those key minerals, especially potassium and magnesium, is often enough to trigger atrial fibrillation. 2. NSAIDs Non-steroid anti-inflammatory drugs, or NSAIDs, can also induce AFib. NSAIDs are relatively common drugs like ibuprofen and naproxen that are often used to fight pain. NSAIDs are particularly troublesome for AFib patients because they also increase the risk of heart and kidney failure. For those who are also on a blood thinner, NSAIDs increase the risk of an emergency room visit for a life-threatening gastrointestinal bleed. 3. Proton Pump Inhibitors Proton pump inhibitors, which suppress stomach acid, can also atrial fibrillation by blocking magnesium absorption or possibly by changing a person's gut microbiome. These drugs include omeprazole, lansoprazole and pantoprazole, which are often sold under the brand names Prilosec, Prevacid, and Nexium, respectively. 4. Steroids Steroids, like prednisone and Solu-medrol, can cause atrial fibrillation, too, by raising blood glucose levels to very high levels and increasing blood pressure through fluid retention and weight gain. Over my career, I've even seen many cases of steroid injections triggering AFib. 5. Any Stimulant Cardiac stimulant medications, like albuterol inhalers or theophylline for asthma, have long been associated with AFib. Even over-the-counter decongestants such as pseudoephedrine, which is sold as Sudafed, or medications for attention deficit hyperactivity disorder can trigger an AFib attack. The bottom line is that anything that revs up the cardiovascular system has a risk of causing AFib. 6. Digoxin, Diltiazem, Verapamil, and Beta-Blockers Perhaps a bit counterintuitively, some if the classic drugs used to treat abnormal heart rhythms such as digoxin, calcium-channel blockers such as verapamil and diltiazem, and beta-blockers have all been associated with an increased risk of AFib. While the exact mechanisms whereby these drugs may increase the AFib risk aren't entirely clear, plenty of cases have been documented in the medical literature. We've even seen beta-blockers, which are often used to treat AFib, linked to AFib episodes due to associated weight gain, particularly with women. 7. Fish Oil As many readers know, there is prescription-strength fish oil, like Lovaza, as well as the over-the-counter fish oil. Prescription-strength fish oil is used to treat high triglycerides whereas the over-the-counter version is used to treat a myriad of complaints. Regardless of which form it is, fish oil has now been implicated as a potential cause of AFib. If fish oil has been particularly helpful for you, try keeping the dose under 1 gram per day to minimize the risk of AFib. Or, alternatively, you can do what I've done and go back to eating wild-caught fish high in omega 3s instead of taking a supplement. Interestingly, since stopping fish oil for myself, I've noticed a lot fewer palpitations. 8. Antiarrhythmics like Amiodarone, Flecainide, and Propafenone Another surprise to many readers is that the antiarrhythmic drugs, the ones that are supposed to prevent AFib, have been linked to AFib. For example, amiodarone is well-known to cause hyperthyroidism which ca...

Diseño y forma de elaboración de una prescripción de diltiazem en gel para el tratamiento de la fisura anal.Si quieres conocer las características y forma de elaboración de los geles base más empleados en formulación magistral, visita mi curso sobre geles bases más frecuentes haciendo click en este enlace: https://cosmeticadoctoralia.com/curso-elaboracion-de-geles/Narración, realización y sintonía de este podcast: Dr. AlíaCopyright: Dr. Enrique Alía

Dr. Ian Stiell'in izniyle aslına sadık kalarak Türkçe'ye çevrilerek yayınlanmıştır.​1​ Bu Yazıda: A. Değerlendirme ve risk sınıflandırmasıB. Hız ve ritim kontrolüC. İnmenin ÖnlenmesiD. Taburculuk ve TakipKısaltmalar 2021 CAEP Akut Atriyal Fibrilasyon/Flutter En İyi Uygulamalar Kontrol Listesi A. Değerlendirme ve risk sınıflandırması Hızlı ventriküler yanıtlı AF/AFL, primer bir aritmi mi yoksa başka tıbbi nedenlere sekonder mi?Tıbbi nedenlere sekonder kalp hızı hızlanması (genellikle önceden var olan/kalıcı AF'si olan hastalarda), örneğin sepsis, kanama, PTE, KY, AKS, vb.:Altta yatan nedenleri agresif bir şekilde araştırın ve tedavi edinKardiyoversiyon zararlı olabilirAgresif hız kontrolünden kaçınınPrimer aritmi, örneğin ani başlangıçlı AF/AFL İPUCU: Tıbbi bir sebebe sekonder kalp hızı hızlanması düşündüren durumlar: Ani başlangıçlı değil, çarpıntı yokBilinen kalıcı AF hastası, OAK kullanıyor, eski EKG'sinde AF varAcil serviste KV özgeçmişi yokKalp hızı < 150 vuru/dkAteş, dispne, ağrı Hasta anstabil mi?Akut primer AF/AFL'ye bağlı instabilite, hızlı ventriküler yanıtlı preeksitasyon (WPW) ile AF'nin beraber olduğu durum dışında yaygın değildir:Hipotansiyon: SKB  2 mm)Pulmoner ödem: belirgin dispne, raller ve hipoksiAnstabil hastayı tedavi edin:Başlangıç  48 saat ise önce hız kontrolünü deneyin Bu primer AF/AFL hastasında KV yapmak güvenli mi?Güvenli ise, genellikle ritim kontrolü hız kontrolüne tercih edilir: Yaşam kalitesi, daha kısa kalış süresi, daha az hastane kaynağıAşağıdaki durumlarda KV yapmak güvenlidir:Hasta en az 3 hafta süreyle yeterince antikoagüle edilmiş ise, VEYAHasta 3 haftadan uzun süredir yeterince antikoagüle edilmemiş, inme veya GİA öyküsü yok, kalp kapak hastalığı yok VE:Başlangıç 

#572 - Como eu uso Diltiazem? by Cardiopapers

Hoy revisamos lo bueno, como el efecto que tiene en el manejo de la hipertensión arterial y las arritmias cardiacas, lo malo como son los eventos adversos desde bradicardia hasta infarto y lo feo como es la complejidad del uso de estos fármacos tan importantes para el sistema cardiovascular.Veremos las indicaciones, las dosis, los eventos adversos y las contraindicaciones de este grupo de medicamentos.Visita nuestra tienda en línea para comprar nuestros libros y material educativo:https://bit.ly/3i6eAnGCheca el video aquí: https://youtu.be/tg9buLdCK_ASi necesitas una consulta aquí nos puedes encontrar:http://bit.ly/3aUSt12Unete al equipo de Mecenas en YouTube desde 1 dolar al mes: http://bit.ly/2O1AtsXSupport the show (https://www.paypal.com/donate?hosted_button_id=2ENWQ7V289PBE)

Autor: Domingo Casamián, Lic. Vet., CertSAM DVC DECVIM-CA MRCVS. Profesor y Jefe del Servicio de Cardiología, Respiratorio y Cardiología. Intervencionista, Hospital Veterinario UCV, Universidad Católica de Valencia FCCA: signos clínicos, frecuencia cardiaca variable; Tratamiento: oxígeno y evitar estrés. Cómo administrar el oxígeno. Cómo minimizar el estrés. Drenar efusión pleural. Furosemida. Antitrombótico, clopidogrel. Pimobendán. Espironolactona. Betabloqueantes. Diltiazem. Venodilatadores en monitorización continua. Monitorización. Efectos secundarios hemodinámicos. Alimentación, hidratación. Arritmias.

Pautas ACVIM: estadios B1, B2. Fase Preclínica: Atenolol? IECA benaceprilo? Diltiazem? Pimobendan?. Clopidogrel: cuándo empezar? Monitorización respiratoria. Pronóstico. Revisiones ecocardiográficas. Autor: Domingo Casamián Sorrosal, Lic. Vet. DVM CertSAM DVC DECVIM-CA MRCVS. Profesor y Jefe del Servicio de Cardiología, Respiratorio y Cardiología. Intervencionista, Hospital Veterinario UCV, Universidad Católica de Valencia

It’s the JournalFeed Podcast for the week of Feb 1-5, 2021. We cover the accuracy of history, exam, labs, and POCUS for diagnosing giant cell arteritis; diltiazem vs. metoprolol for atrial fibrillation with rapid ventricular response; and IV ketorolac dosing for renal colic.

Let’s talk through diltiazem, a common calcium channel blocker (CCB) using the Straight A Nursing acronym DRRUGS. You’ll see this medication used to treat hypertension, angina and tachycardic arrhythmias such as atrial fibrillation. Want to go beyond the 5-Rights of Medication Administration and BULLETPROOF your medication administration? Grab your free guide https://straightanursing.ck.page/fc69f2501b Love PodQuizzes? Get announcements on our latest project here: www.straightanursingstudent.com/announcements Looking for a way to conquer your nursing school schedule? Check out the planners we design specifically for nursing students here: www.etsy.com/shop/straightanursing Starting nursing school soon? Grab my FREE guide, the 11 Habits of Successful Nursing Students https://straightanursing.ck.page/8bb93602c7 Read the show notes here: https://www.straightanursingstudent.com/diltiazem/

(DİLTİZEM-L) intravenöz (İ.V.) kullanım içindir. %5 dekstroz ve Serum Fizyolojik çözeltileri içinde infüzyon şeklinde de uygulanabilir. Enjeksiyonluk su veya uygun diğer çözücüler ile kullanıma hazır hale getirildikten sonra bolus veya sürekli infüzyon olarak damar içine uygulanır​1​. Direkt İntravenöz Tekli Enjeksiyonlar (Bolus) Diltiazem hidroklorür enjeksiyonunun başlangıç dozu, 2 dakika boyunca uygulanan bir bolus olarak 0.25 mg/kg gerçek vücut ağırlığı olmalıdır (20 mg, ortalama hasta için makul bir dozdur). Sürekli İntravenöz İnfüzyon Diltiazem hidroklorürün önerilen başlangıç infüzyon hızı 10 mg/saattir. Bazı hastalar 5 mg/saat'lik bir başlangıç hızına yanıtı sürdürebilir. Kalp atış hızında daha fazla azalma gerekirse, infüzyon hızı 5 mg/saatlik artışlarla 15 mg / saate kadar artırılabilir. İnfüzyon 24 saate kadar muhafaza edilebilir. Diltiazem, doza bağlı, doğrusal olmayan farmakokinetik gösterir. 24 saatten uzun infüzyon süresi ve 15 mg/saatten daha yüksek infüzyon hızları çalışılmamıştır. Bu nedenle, 24 saati aşan infüzyon süresi ve 15 mg/saati aşan infüzyon hızları önerilmez​2–4​. IV: Sürekli EKG ve kan basıncı izleme ile 2 dakikaya kadar verilen bolus dozları ile uygulanabilir. Sürekli infüzyon, infüzyon pompası aracılığıyla yapılmalıdır. Gerektiğinde 5 mg/saatlik artışlarla infüzyon hızı artırılabilir (maksimum: 15 mg/saat). Bolusa yanıtın maksimuma ulaşması birkaç dakika sürebilir. İnfüzyon kesildikten sonra yanıt birkaç saat devam edebilir​5​. Kaynaklar 1. DİLTİZEM-L 25 mg liyofilize enjeksiyonluk toz. DİLTİZEM-L 25 mg liyofilize enjeksiyonluk toz. Published September 3, 2020. Accessed September 3, 2020. https://titck.gov.tr/storage/Archive/2020/kubKtAttachments/TTCKONAYLIKTDLTZEMENJ_b683718a-6d33-4c52-9da1-5c90cbb24631.pdf 2. CARDIZEM ® -DILTIAZEM. CARDIZEM ® -DILTIAZEM. Published September 3, 2020. Accessed September 3, 2020. https://globalrph.com/dilution/cardizem-diltiazem/ 3. Gaharr BL, Nazareno AR. Gahart’s 2021 Intravenous Medications: A Handbook for Nurses and Health Professionals. Elsevier Health Sciences. 37th ed. Elsevier; 2020. 4. Micromedex Drug Information. Micromedex Drug Information. Published September 3, 2020. Accessed September 3, 2020. www.micromedexsolutions.com 5. Uptodate Drug Information. Uptodate Drug Information. Published September 3, 2020. Accessed September 3, 2020. https://www.uptodate.com/contents/diltiazem-drug-information?search=diltiazem&source=panel_search_result&selectedTitle=1~148&usage_type=panel&kp_tab=drug_general&display_rank=1

(DİLTİZEM-L) intravenöz (İ.V.) kullanım içindir. %5 dekstroz ve Serum Fizyolojik çözeltileri içinde infüzyon şeklinde de uygulanabilir. Enjeksiyonluk su veya uygun diğer çözücüler ile kullanıma hazır hale getirildikten sonra bolus veya sürekli infüzyon olarak damar içine uygulanır​1​. Direkt İntravenöz Tekli Enjeksiyonlar (Bolus) Diltiazem hidroklorür enjeksiyonunun başlangıç dozu, 2 dakika boyunca uygulanan bir bolus olarak 0.25 mg/kg gerçek vücut ağırlığı olmalıdır (20 mg, ortalama hasta için makul bir dozdur). Sürekli İntravenöz İnfüzyon Diltiazem hidroklorürün önerilen başlangıç infüzyon hızı 10 mg/saattir. Bazı hastalar 5 mg/saat'lik bir başlangıç hızına yanıtı sürdürebilir. Kalp atış hızında daha fazla azalma gerekirse, infüzyon hızı 5 mg/saatlik artışlarla 15 mg / saate kadar artırılabilir. İnfüzyon 24 saate kadar muhafaza edilebilir. Diltiazem, doza bağlı, doğrusal olmayan farmakokinetik gösterir. 24 saatten uzun infüzyon süresi ve 15 mg/saatten daha yüksek infüzyon hızları çalışılmamıştır. Bu nedenle, 24 saati aşan infüzyon süresi ve 15 mg/saati aşan infüzyon hızları önerilmez​2–4​. IV: Sürekli EKG ve kan basıncı izleme ile 2 dakikaya kadar verilen bolus dozları ile uygulanabilir. Sürekli infüzyon, infüzyon pompası aracılığıyla yapılmalıdır. Gerektiğinde 5 mg/saatlik artışlarla infüzyon hızı artırılabilir (maksimum: 15 mg/saat). Bolusa yanıtın maksimuma ulaşması birkaç dakika sürebilir. İnfüzyon kesildikten sonra yanıt birkaç saat devam edebilir​5​. Kaynaklar 1. DİLTİZEM-L 25 mg liyofilize enjeksiyonluk toz. DİLTİZEM-L 25 mg liyofilize enjeksiyonluk toz. Published September 3, 2020. Accessed September 3, 2020. https://titck.gov.tr/storage/Archive/2020/kubKtAttachments/TTCKONAYLIKTDLTZEMENJ_b683718a-6d33-4c52-9da1-5c90cbb24631.pdf 2. CARDIZEM ® -DILTIAZEM. CARDIZEM ® -DILTIAZEM. Published September 3, 2020. Accessed September 3, 2020. https://globalrph.com/dilution/cardizem-diltiazem/ 3. Gaharr BL, Nazareno AR. Gahart’s 2021 Intravenous Medications: A Handbook for Nurses and Health Professionals. Elsevier Health Sciences. 37th ed. Elsevier; 2020. 4. Micromedex Drug Information. Micromedex Drug Information. Published September 3, 2020. Accessed September 3, 2020. www.micromedexsolutions.com 5. Uptodate Drug Information. Uptodate Drug Information. Published September 3, 2020. Accessed September 3, 2020. https://www.uptodate.com/contents/diltiazem-drug-information?search=diltiazem&source=panel_search_result&selectedTitle=1~148&usage_type=panel&kp_tab=drug_general&display_rank=1

Diltiazem is a non-dihydropyridine calcium channel blocker that can be used in atrial fibrillation as well as hypertension. One big downside to diltiazem is that it does have a few drug interactions via CYP3A4. Aripiprazole, apixaban, and certain statins are all examples of medication that can have concentrations increased by adding diltiazem to a patient's regimen. Diltiazem works a little differently from dihydropyridine calcium channel blockers (like amlodipine) as it works on the heart AND the vessels.

In addition to the three main classes of anti-hypertensives we already discussed, ACE Inhibitors like Lisinopril and Captopril, Beta Blockers like Metoprolol and Propranolol, and Calcium Channel Blockers like Nicardipine and Diltiazem, there are a number of other classes of… The post Cardiac Labs and Meds for Nurses appeared first on NURSING.com.

A Fib is the most common arrhythmia that is encountered in the ED. Knowing how to manage it when it is causing problems is important! Join the EM GuideWire Team as they discuss a-fib with RVR management with esteemed Cardiologist (and friend of us in the ED), Dr. Laszlo Littmann.

Podcast summary of articles from the October 2016 edition of Journal of Emergency Medicine from the American Academy of Emergency Medicine.  Topics include Pyuria in Renal Stones, Sickle Cell Anemia, CMAC as Direct Laryngoscopy, Wernicke Korsakoff Syndrome, Ultrasound for Diastolic Heart Failure, Diltiazem dosing, and Board Review on Atrial Fibrillation.  Guest speakers are Dr. John Sakles and Dr. Adam Haushalter.

This week we discuss an age-old debate: Calcium Channel Blockers or Beta Blockers for rate control in atrial fibrillation. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_Episode_64_0_Final_Cut.m4a Download Leave a Comment Tags: Atrial Fibrillation, Beta Blocker, Calcium Channel Blocker, Cardiology, Rate Control Show Notes CoreEM: Recent Onset Atrial Fibrillation ALiEM: Atrial Fibrillation Rate Control in the ED: Calcium Channel Blockers or Beta Blockers? ALiEM: Beta Blockers vs Calcium Channel Blockers for Atrial Fibrillation Rate Control: Thinking Beyond the ED Fromm C, et al. Diltiazem vs. Metoprolol in the Management of Atrial Fibrillation or Flutter with Rapid Ventricular Rate in the Emergency Department. J Emerg Med. 2015 Apr 22. PMID 25913166

This week we discuss an age-old debate: Calcium Channel Blockers or Beta Blockers for rate control in atrial fibrillation. https://media.blubrry.com/coreem/content.blubrry.com/coreem/Podcast_Episode_64_0_Final_Cut.m4a Download Leave a Comment Tags: Atrial Fibrillation, Beta Blocker, Calcium Channel Blocker, Cardiology, Rate Control Show Notes CoreEM: Recent Onset Atrial Fibrillation ALiEM: Atrial Fibrillation Rate Control in the ED: Calcium Channel Blockers or Beta Blockers? ALiEM: Beta Blockers vs Calcium Channel Blockers for Atrial Fibrillation Rate Control: Thinking Beyond the ED Fromm C, et al. Diltiazem vs. Metoprolol in the Management of Atrial Fibrillation or Flutter with Rapid Ventricular Rate in the Emergency Department. J Emerg Med. 2015 Apr 22. PMID 25913166

This week we discuss the management of hyperkalemia + a journal update on beta blockers vs Ca channel blockers in AF https://media.blubrry.com/coreem/content.blubrry.com/coreem/Core_EM_Podcast_7_Final.m4a Download Leave a Comment Tags: Atrial Fibrillation, Hyperkalemia Show Notes Core EM: Hyperkalemia REBEL EM: Is Kayexalate Useful in the Treatment of Hyperkalemia in the Emergency Department? Core EM: Diltiazem vs. Metoprolol for Rate Control in Atrial Fibrillation Read More

This week we discuss the management of hyperkalemia + a journal update on beta blockers vs Ca channel blockers in AF https://media.blubrry.com/coreem/content.blubrry.com/coreem/Core_EM_Podcast_7_Final.m4a Download Leave a Comment Tags: Atrial Fibrillation, Hyperkalemia Show Notes Core EM: Hyperkalemia REBEL EM: Is Kayexalate Useful in the Treatment of Hyperkalemia in the Emergency Department? Core EM: Diltiazem vs. Metoprolol for Rate Control in Atrial Fibrillation Read More

This week we discuss the management of hyperkalemia + a journal update on beta blockers vs Ca channel blockers in AF https://media.blubrry.com/coreem/content.blubrry.com/coreem/Core_EM_Podcast_7_Final.m4a Download Leave a Comment Tags: Atrial Fibrillation, Hyperkalemia Show Notes Core EM: Hyperkalemia REBEL EM: Is Kayexalate Useful in the Treatment of Hyperkalemia in the Emergency Department? Core EM: Diltiazem vs. Metoprolol for Rate Control in Atrial Fibrillation Read More

Diltiazem efficacy and safety comparing weight based and non-weight based intravenous dosing to treat atrial fibrillation

Jon Lund talks about the presentation, aetiology and treatment of anal fissure, explaining the aetiology with the help of diagrams in this video podcast. Get in touch though School of Surgery at podomatic.com and request topics you'd like to have available as podcasts

Die vorliegende Arbeit befasste sich mit der Charakterisierung der Photoinstabilität von Arzneistoffen und verschiedenen Darreichungsformen sowie der Photo-stabilisierung von Infusionslösungen mit transparenten Kunststofffolien. Die Qualifizierung des eingesetzten Belichtungsgerätes wurde anhand von Radio- und Spektroradiometeruntersuchungen sowie speziellen Testlösungen durchgeführt. Für das hochphotoinstabile Chinolonderivat SB-265805-S wurde eine Charakterisierung der Photoinstabilität als Feststoff und in Lösung unter Berücksichtigung kinetischer Aspekte und der Wellenlängenabhängigkeit der Photolyse durchgeführt. Zudem wurde der Einfluss von parenteral einsetzbaren Hilfsstoffen auf die Photostabilität von SB-265805-S Lösungen im Hinblick auf eine geeignete Formulierung untersucht. Die bisher unbekannte Lichtempfindlichkeit von Wirkstoffen in Lyophilisaten wurde anhand des Gyrasehemmers untersucht. Dabei wurden auch Einflüsse von unterschiedlichen Hilfsstoffen und ihren Eigenschaften berücksichtigt. Zur Photostabilisierung von Infusionslösungen wurden transparente Polymerfilme in Form von unterschiedlichen sekundären Packmitteln hergestellt und die photo-protektiven Eigenschaften anhand verschiedener Infusionslösungen ermittelt. Unter Berücksichtigung der Befunde wurden Anforderungen an UV-Schutzfilme abgeleitet. Fragen der Photoinstabilität von Arzneistoffen wurden bei den bisher wenig untersuchten Gruppen der Vasodilatatoren und Antiarrhythmika bearbeitet. Neben der Zersetzungsgeschwindigkeit und der Ermittlung des photodestruktiven Wellenlängenbereiches waren auch Hilfsstoffeinflüsse und entstehende Photolyse-produkte von Interesse. Dabei kamen chromatographische und spektroskopische Verfahren zur Untersuchung der Abbauprodukte zum Einsatz. Besonders photostabilitätsgefährdete Handelspräparate, wie parenterale und topische Lösungen, wurden einbezogen, um auch die praktische Auswirkung der Photoinstabilität zu erfassen. Im wesentlichen ergaben sich folgende Befunde: 1. Für die Durchführung von reproduzierbaren Photostabilitätsprüfungen spielt die Qualifizierung des Belichtungsgerätes eine entscheidende Rolle. Die Untersuchung des zur Verfügung stehenden Gerätes zeigt, das eine Kombination aus Radiometer, zur Ermittlung der Gesamtbestrahlungsdosis, Spektroradiometer, zur Untersuchung von spektralen Veränderungen und Testlösungen, zur Untersuchung der praktischen Relevanz von gemessenen Abweichungen, sowie Mapping der Probenebene, geeignet ist. 2. Eine Verkürzung der Belichtungszeit durch Erhöhung der Bestrahlungsstärke zum Erreichen der in der ICH-Richtlinie geforderten Bestrahlungsdosis ist bei Lösungen aufgrund direkter Proportionalität von Bestrahlungsdosis und Grad der Zersetzung anwendbar. 3. Die bei höheren Bestrahlungsstärken im Suntest CPS + ermittelten Photolyse-geschwindigkeiten sind nur eingeschränkt mit unter natürlichen Bedingungen (Raumlicht) ermittelten vergleichbar. Mit zunehmender Entfernung zum Fenster sinkt die Lichtintensität und damit die Photolysegeschwindigkeit stark ab. 4. Der Wirkstoff SB-265805-S stellt ein hochlichtempfindliches Chinolonderivat dar. Als Ursache der vergleichsweise außerordentlichen Photoinstabilität wurde die Oximetherstruktur des Substituenten in Position 7 des Chinolin-carbonsäureringes in Betracht gezogen. Die Photozersetzung des Gyrasehemmers wird durch Licht mit Wellenlängen bis 385 nm hervorgerufen. Mit steigender Wirkstoffkonzentration sinkt die Photolysegeschwindigkeit in Wirkstofflösungen.5. Bei der Formulierung von photoinstabilen Wirkstofflösungen muss mit Einflüssen von eingesetzten Hilfsstoffen wie Puffersubstanzen und Lösungs-vermittler gerechnet werden. Bei basischen oder sauren beziehungsweise zwitterionischen Substanzen wie dem Chinolon SB-265805-S spielt der pH-Wert der Lösung eine besonders große Rolle. Antioxidantien führen auch bei Photooxidationen nicht immer zu einer Photostabilisierung. Bei komplexen Abbauwegen kann ihr Effekt nivelliert werden. 6. Lyophilisate zeigen als hochporöse feste Darreichungsformen eine deutlich erhöhte Lichtempfindlichkeit im Vergleich zum Feststoff. Ein hoher Rest-wassergehalt ist für wasserlösliche Wirkstoffe wie SB-265805-S zu vermeiden, da dieser die Photostabilität des Lyophilisates herabsetzt. 7. Bei der Auswahl des Gerüstbildners ist bei lichtempfindlichen Wirkstoffen mit Beeinflussung der Photostabilität zu rechnen. Das Chinolon zeigte sich in Saccharose- und Lactosekuchen deutlich stabiler als in Mannitol enthaltenden Lyophilisaten. Ein Einfluss der Kuchenstruktur, amorph oder kristallin, wurde diskutiert. 8. Die Eindringtiefe von Licht erwies sich in Lyophilisatkuchen deutlich höher als in Tabletten. Wie anhand von Chinolonlyophilisaten gezeigt werden konnte, besteht ein Zusammenhang von Art und Konzentration des Gerüstbildners und der Eindringtiefe von Licht, und damit dem Ausmaß der zersetzten Wirkstoffmenge. 9. Farblos-transparente Polyethylenfolien sind als Sekundärpackmittel zur Photostabilisierung von UV-sensiblen Infusionslösungen einsetzbar. Das Aufschrumpfen der Folien hat keinen nachteiligen Einfluss auf die Transmission und den stabilisierenden Effekt. 10. Mit 1 % UV-Absorber und 100 µm Folienstärke wird eine zur Photo-stabilisierung ausreichende Transmissionsreduktion im Wellenlängenbereich bis 380 nm erreicht. Eine Mischung (1:1) der eingesetzten Absorber führt dabei zu einer kontinuierlich niedrigen Transmission in diesem Bereich. Diese Filme zeigten daher auch den besten stabilisierenden Effekt und breite Einsetzbarkeit. Mit Tauchfilmen überzogene Flaschen sind ebenfalls als Lichtschutz-verpackungen einsetzbar. 11. Intransparenz von Kunststofffolien ist keine Garantie für ausreichenden Lichtschutz. Pigmentdichte und Folienstärke sind für eine optimale Photoprotektion entscheidend. 12. Quartäre HPLC-Pumpen erwiesen sich zur Auftrennung besonders komplexer Gemische als vorteilhaft. Zur Untersuchung und Detektion der Photo-zersetzungsprodukte sind On-line-Verfahren wie Diodenarray- und Massen-kopplung besonders geeignet. 13. Alpha1-Rezeptorantagonisten lassen sich strukturell in zwei Gruppen einteilen, die sich auch deutlich in ihrer Photoinstabilität unterscheiden. Die einen 2-Aminochinazolinring enthaltenden Wirkstoffe Prazosinhydrochlorid, Terazosin-hydrochlorid, Bunazosinhydrochlorid und Doxazosinmesilat zeigten eine, in obiger Reihenfolge abnehmende, jedoch deutlich höhere Lichtempfindlichkeit als das 6-Aminouracilderivat Urapidilhydrochlorid. Für die erstgenannte Gruppe konnten zahlreiche Photolyseprodukte nachgewiesen werden. Eine erhöhte Photoinstabilität der Furancarbonsäure- beziehungsweise Tetrahydro-furancarbonsäurestruktur des Substituenten in Position 2 wurde diskutiert. 14. Die Photozersetzung der Alpha1-Rezeptorantagonisten verläuft stark lösungs-mittelabhängig. Neben Unterschieden in der Zersetzungsgeschwindigkeit konnte das Auftreten abweichender Zersetzungsprodukte nachgewiesen werden. Die Wirkstoffe werden durch Licht mit Wellenlängen bis etwa 355 nm zersetzt. In festen Darreichungsformen können Alpha1-Blocker als photostabil angesehen werden. 15. In der Gruppe der Vasodilatatoren sind Dipyridamol und Budralazin besonders photoinstabil. Die Feststoffe sind deutlich photostabiler als die Wirkstoff-lösungen. Beide Wirkstoffe zeigen Lichtempfindlichkeit bis zu einer Wellenlänge von etwa 445 nm. Dipyridamol zersetzt sich in wässrig-saurer Lösung um den Faktor 6 schneller als in ethanolischer Lösung und zusätzliche Zersetzungsprodukte konnten nachgewiesen werden. Eine mehrfache Oxidation unter Lichteinfluss wurde diskutiert. Lichtschutz für die Infusionslösung während der Applikation ist zu fordern. Budralazin zeigt eine auffällige Zersetzungskinetik. Für das einzige Photo-zersetzungsprodukt wurde das Cis-Isomer vorgeschlagen. Minoxidil ist in Wasser-Ethanol-Propylenglykol-Mischungen zur topischen Anwendung photostabiler als in rein wässrigen Lösungen. Der Feststoff zeigt keine Photozersetzung. Trapidil-, Diltiazem-, und Verapamilhydrochlorid sind trotz der Lichtschutz-forderungen in den Arzneibüchern oder Gebrauchsanweisungen auch in Lösung als weitgehend photostabil einzustufen. 16. Antiarrhythmika sind strukturell sowie bezüglich ihrer Lichtempfindlichkeit eine sehr heterogene Gruppe. Unter den gleichen Bedingungen liegt für Amiodaronhydrochlorid die t90% bei 30 Sekunden, für Chinidinhydrogensulfat bei 140 Minuten und für Arotinolol-, Mexiletin- und Soltalolhydrochlorid bei etwa 300 Minuten. Amiodaronhydrochlorid bildet in Wasser und Ethanol zahlreiche Abbauprodukte. Die bei Belichtung generell auftretende gelbbraune Verfärbung weist auf durch Photodeiodierung entstehendes Iod hin. Der Feststoff, Tabletten, Injektions- und Infusionslösungen zersetzen sich durch Lichteinwirkung und sind schutzbedürftig. Deutliche organoleptische Veränderungen treten auch bei der Feststoff-belichtung von Arotinololhydrochlorid und Chinidinhydrogensulfat auf. 17. Die Bewertung der Lichtschutzbedürftigkeit von Wirkstoffen ist in offiziellen Pharmacopoen zum Teil widersprüchlich. Hier ist daher eine Überprüfung und Vereinheitlichung der Lichtschutzangaben zu fordern. Aufgrund der beträchtlichen Unterschiede der Lichtempfindlichkeit von Wikstoffen in Lösung und als Fesstoff ist in diesem Zusammenhang auch eine Präzisierung der Lichtschutzforderung, wie es in der USP für unterschiedliche Darreichungsformen teilweise der Fall ist, wünschenswert.