Pharm - Anti-Arrhythmic Drugs (Block 1)

Front 1

Procainamide

Back 1

Class I (Na Blocker) Anti-Arrhythmic

Primarily a Na Antagonist, to a lesser degree a K Antagonist

Half Life ~ 3-4 Hours

Metabolized via Acetylation to NAPA, which is a less active Antiarrhythmic which Inhibits K Channels! It has a slightly longer half life!

Uses:
1) Acutely to Suppress Ventricular Tachycardias
2) Cardiovert Atrial Flutter/Fibrillation
3) Suppress PAT in pts with Wolf Parkinson White Syndrome
4) Oral for Long Term Suppression of Ventricular and Supraventricular Arrhythmias

Side Effects:
1) Bradycardia and Blocks
2) Tachycardias (prolonged use)
3) Hypotension and Decreased Contractility
4) HYPERSENSITIVITY - "LUPUS SYNDROME" --> Slow Acetylators are at Greatest Risk

Front 2

Lidocaine

Back 2

Class I (Na Blocker) Anti-Arrhythmic

Very Specific Na Antagonist

Used for Acute Suppression of Ventricular Arrhythmias in pts with Acute Ventricular Injuries (infarction, cardiac surgery)

Rapidly Inactivated by LIVER, thus Metabolism is dependent on Hepatic Blood Flow

Half Life ~60 Mins

Side Effects and Toxicity:
1) Mild and Rapidly Reversible
2) CNS Suppression with Sedation, Hallucinations, and Convulsions
3) CHF --> Decreased Hepatic Blood Flow --> Half Life Increases!

Front 3

Flecainide

Back 3

Class I (Na Blocker) Anti-Arrhythmic

Used for V Tach

Balanced Inhibition of Na and K!

Front 4

dl-Sotalol

Back 4

Class II (B Blocker) and III (K Blocker) Anti-Arrhythmic

Half Life ~ 20 Hours

L-Sotalol = Non-Selective B Blocker. Predominates at Lower Doses!

D-Sotalol = Class III Anti-Arrhythmic (K Blocker)

Uses:
1) Long Term Suppression of VAs in pts at risk for VTach and SCD
2) Useful adjunct with ICD
3) Suppress Atrial Flutter/Fibrillation and PAT in pts at risk for SupraventTachs

Front 5

Metoprolol

Back 5

Class II (B Blocker) Anti-Arrhythmic (Selective B1)

Used in Pts with Compromised Pulmonary Fx (Asthma, COPD, etc.)

Oral used for Long Term Rate Control (Ventricular Response Rate)

Front 6

Propranolol

Back 6

Class II (B Blocker) Anti-Arrhythmic

IV Used to control Ventricular Response Rate in patients with A Flutter/Fibrillation

Front 7

Amiodarone

Back 7

Class III (K Blocker) Anti-Arrhythmic

Can Inhibit K, Na, and B!

Half Life ~ Months

Structure related to Thyroid Hormone!

VERY FEW CARDIAC SIDE EFFECTS!

Particularly effective in suppressing Refractory Ventricular Arrhythmias

Side Effects (Extra-Cardiac, due to Very Low Solubility):
1) Pulmonary Fibrosis
2) Corneal Deposits
3) Bluish Rash (due to Iodinated structure) and a Photodermatitis
4) Hypo OR Hyper Thyroidism

Front 8

Dofetilide

Back 8

Class III (K Blocker) Anti-Arrhythmic

Front 9

Verapamil

Back 9

Class IV (Ca Blocker) Anti-Arrhythmic

IV Used to Control Ventricular Response Rate in pts with Atrial Flutter/Fibrillation

Front 10

Diltiazem

Back 10

Class IV (Ca Blocker) Anti-Arrhythmic

Oral used for Long-Term Rate Control (Ventricular Response Rate)