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16 Cards in this Set
- Front
- Back
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Procainamide
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Class IA - moderate Na channel block, K block, prolonged APD, dissociates with intermediate kinetics, can induce torsade de pointes
specific: ganglion-blocking --> reduces vasc R --> hypotension 2nd or 3rd choice for sustained vent arrhythmias assoc w/ MI irreversible lupus-like syndrome |
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Quinidine
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Class IA - moderate Na channel block, K block, prolonged APD, dissociates with intermediate kinetics, can induce torsade de pointes
blocks alpha-adren --> vasodilation --> hypotns, reflex tachy blocks muscarinic --> tachycardia ppt digoxin toxicity, thrombocytopenia |
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Disopyramide
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Class IA - moderate Na channel block, K block, prolonged APD, dissociates with intermediate kinetics, can induce torsade de pointes
highest intensity of anti-muscarinic activity not 1st line b/c negative inotropic actions may --> CHF even w/o prev hx adverse effects - urinary retention (CI in males w/ BPH), dry mouth, blurred vision, constipation, worsening of glaucoma |
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lidocaine
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class IB - mild Na channel block, shorten APD, dissociate fast
orally ineffective b/c high 1st pass met suppresses electrical activity of depolarized arrhythmogenic tissues - most effective in arrhythmias assoc w/ depolarization - ischemia or digoxin tox agent of choice for termiantion of vent tachycardia and to prevent vent fib after cardioversion least cardiotoxic most adverse effects are neurologic seizures |
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mexiletine
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class IB - mild Na channel block, shorten APD, dissociate fast
effective orally, resistanc to 1st pass tx vent arrhythmias off label - relief of chronic pain neuro side effects |
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flecainide
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class IC - marked Na channel block, minimal effect on APD, dissociate slow, increase mortality from cardiac arrest or arrhythmic sudden death in pts w/ recent MI
tx supraventricular arrhythmias |
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propafenon
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class IC - marked Na channel block, minimal effect on APD, dissociate slow, increase mortality from cardiac arrest or arrhythmic sudden death in pts w/ recent MI
structurally similar to propranolol, weak beta-blocking activity metallic taste may exacerbate arrhythmias --> constipation |
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moricizine
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class IC - marked Na channel block, minimal effect on APD, dissociate slow, increase mortality from cardiac arrest or arrhythmic sudden death in pts w/ recent MI
used for vent arrhythmias but withdrawn |
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propranolol acebutolol, esmolol
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class II - beta blockers
diminished cardiac work --> reduced myocardial O2 demand prevents recurrent infarction and sudden death in pts w/ acute MI tx supraventricular and ventr arrhythmias casued by symp stimulatino, prevents vent fib esmolol - tx acute arrhythmias during surgery negative inotrope - may induce/worsen HF |
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sotalol
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class III, K+ channel blocker, prolongs APD and refractory period
100% bioavailable nonselective beta-blocker, racemic mix of d and l - l has beta-adrenergic activity tx v-arrhyths maintians sinus rhythm in a-fib tx supravent and vent arrhythmias in peds may --> torsade de pointes |
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amiodarone
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class III, K+ channel blocker, prolongs APD and refractory period
tissue levels even after a year substrate for CYP3A4 - cimetidine increases levels b/c blocks CYP, rifampicin induces CYP so levels drop, inhibits other cytocrhomes to elevate levels of digoxin, warfarin blacks Na and K channels and alpha and beta adrenergic receptors adn Ca channels --> bradycardia low incidence of torsade de pointes tx lifethreatening or recurring vent arrhyths, supravent arrhyths, adjuvant tx to decrease uncomfortable discharges of implanted cardioverter-defibs side effets: bradycardia in pts w/ SA/AV node disease fatal pulmonary fibrosis abn liver fxn, hepatitis, photodermatitis - grayish blue skin discoloration corneal microdeposites --> blindness, neuro probs, thyroid dysfxn |
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dofetilide, ibutilide
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class III, K+ channel blocker, prolongs APD and refractory period
ibutilide = IV dofetilide = oral restore normal sinus rhythm in A-fib or flutter side effects: prolonged QT and torsade de pointes |
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verapamil, diltiazim
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type IV - Ca channel blockers
dont use nifedipine b/c --> reflex tachycardia depresses SA and AV nodes directly tx supravent and vent arrhythmias |
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adensoine
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miscellaneous antiarrhythmics
2 types of receptors: A1 in myocardium --> neg inotropic, chronotropic, and dromotropic A2 in endothelium/vasc --> coronary vasodilation enhances K conductance --> slowed conduction converts paroxysmal supravent tachy --> sinus rhythm |
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magnesium
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prevents torsades de pointes, tx digoxin induced arrhythmias
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potassium
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tx hypokalemia that --> ectopic pacemaker activity, esp during digoxin tx
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