Flecainide Lori Stromness Erik Hansen Case Study J

Flecainide Lori Stromness Erik Hansen

Case Study J. S. is a 36 year old female who was transported by ambulance to the emergency department for palpitations, shortness of breath, and dizziness. The patient states that she has a history of SVT and has been treated in the emergency department 4 -5 times a year for the last 15 years but has noticed increased symptoms lately. She states that she can usually get relieve from the symptoms by bearing down but that hasn’t been as effective lately. She states that ETOH is a trigger and she admits to drinking more than she should have last night for her birthday. The patient states that they can usually give her a medication that fixes it but has said they have had to “shock” her in the past, at times more than once. She also states she has had multiple ablations which have not seemed to help. The patient is concerned about the increased frequency of her symptoms and is wanting to try a preventative medication. She’s concerned about it happening and not being able to be stopped.

Physical Exam Vitals: BP: 110/67, HR: 184 , RR: 32, O 2: 94, Temp: 97. 9, Weight: 174, Height: 5’ 7”, Pain: 2/10 12 Lead EKG: Reveals narrow complex tachycardia with a rate of 184 General: Patient appears anxious and uncomfortable. The patient is crying, slurring her speech and smells of ETOH. Neck: no nodules or thyromegaly palpated. Heart: Rapid heart rate, no murmurs. Lungs: Tachypnea, , clear lung sounds bilaterally, no wheezing or crackles auscultated. Other systems: WNL Patient was successfully converted with 6 mg Adenosine. Follow up 12 lead EKG revealed sinus rhythm at 94 BPM.

Significant Pharmacokinetics Absorption: ● Almost complete absorption orally, but in infants can be decreased when given with milk. Excretion: ● 30% by the kidneys ● oral dose 3% is excreted in feces

Interactions to be aware of. . . Side effects: ● Arrhythmias ● Negative chronotropic effect in existing heart disease Adverse drug reactions: ● Pregnancy class C ● New or worsening arrhythmia ● Study Result Significant Findings: dizziness, visual changes, dyspnea, headache, nausea, fatigue, palpitations & chest pain Drug-drug interactions: ● Amiodarone may enhance the QT prolongation ● CYP 2 D 6 inhibitor ● May enhance QT prolongation with other QT prolonging agents ● Propranolol, other B-Blockers? ● Inducers: phenytoin, phenobarbital & carbamazepine

Why the drug was used in your scenario? Sustained ventricular tachycardia: ● In our patient, her SVT was becoming more frequent and sustained. The patient expressed concern for her safety when she couldn’t convert herself with a vagal maneuver and the frequencies. Considering her episodes increasing in frequency as her provider of care in the hospital, we felt she was justified in being concerned. Having SVT is an indication to use flecainide.

Reference: 3 M. (1998). Tambocor [pdf document]. Retrieved from: https: //utah. instructure. com/courses/452422/files/68165260/download? verifier=y. GJBIHGTEu. Cr 20 z. Mk. R 7 p. G m. Ab 7 QFPz. My. OMv 0 V 18 S 4&wrap=1 Antiarrhythmic Drug Actions. (n. d. ) Antiarrhythmic Drug Actions [pdf document]. Retrieved from: https: //utah. instructure. com/courses/452422/files/68165271/download? verifier=r 3 toh 3 wj. P 1 l. F 24 v. XSbid 6 W 445 Ey 7 g. Cu. L 4 FQ 5 f. I 12&wrap=1 s