Junctional Rhythm Medication

Updated: Sep 22, 2016
  • Author: Sean C Beinart, MD, FACC, FHRS; Chief Editor: Jeffrey N Rottman, MD  more...
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Medication

Medication Summary

The goals of pharmacotherapy are to reduce morbidity and prevent complications.

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Anticholinergics

Class Summary

Agents used to accelerate heart rate if symptomatic bradycardia is present.

Atropine IV/IM

Used to increase heart rate through vagolytic effects, causing an increase in cardiac output.

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Antidigitalis agents

Class Summary

Used to treat digitalis toxicity.

Digoxin immune Fab (Digibind)

Immunoglobulin fragment with a specific and high affinity for both digoxin and digitoxin molecules. Removes digoxin or digitoxin molecules from tissue binding sites.

Each vial of Digibind contains 40 mg of purified digoxin-specific antibody fragments, which bind approximately 0.6 mg of digoxin or digitoxin. Dose of antibody depends on total body load (TBL) of digoxin; estimates of TBL can be made in 3 ways, as follows:

(1) Estimate quantity of digoxin ingested in acute ingestion and assume 80% bioavailability (amount ingested [mg] X 0.8 = TBL).

(2) Obtain a serum digoxin concentration and, using a pharmacokinetics formula, incorporate the Vd of digoxin and the patient's body weight in kg (TBL = digoxin serum level [ng/mL] X 6 L/kg X body weight in kg).

(3) Use an empiric dose based on average requirements for an acute or chronic overdose in an adult or child.

If the quantity of ingestion cannot be estimated reliably, administer empirically (safest to use the largest calculated estimate); alternatively, be prepared to increase dosing if resolution is incomplete.

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Antiarrhythmic agents, Class 1-B

Class Summary

These agents alter the electrophysiologic mechanisms responsible for arrhythmia.

Phenytoin (Dilantin)

Depresses spontaneous depolarization in ventricular tissues.

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