Pharm Iv

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classification used for anti-arrhythmics

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Vaughan-Williams Classification

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Quinidine (Quinidex, Quinoglute)

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IA

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Procainamide (Procanbid)

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IA

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Disopyramide (Norpace)

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IA

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Lidocaine

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IB
depress 0, shorten 3

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Flecainide (Tambocor)

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IC
markedly slows 0

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Propanolol (Inderal)
Sotalol (Betapace)
Esmolol (Brivibloc)

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Class II
Beta-blockers
inhibit sympathetic

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Amiodarone

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Class III
prolong action potentials, prolong 3 w/out altering 0

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prolong action potentials, prolong 3 w/out altering 0

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Class III

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markedly slows 0

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IC

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depress 0, shorten 3

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IB

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Dofetilide (Tikosyn)

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Class III
K channel blockers
prolong action potentials, prolong 3 w/out altering 0

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Ibutilide (Corvert)

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Class III
K channel blockers
prolong action potentials, prolong 3 w/out altering 0

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diltiazem
verabamil

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class IV
Ca channel blockers

slow 4 repolarization, esp effective SA and AV

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slow 4 repolarization, esp effective SA and AV

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class IV
Ca channel blockers

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cardioversion of SVT
"proarrhythmic effect"
BB, CCB, or digoxin given prior

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Quinidine

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torsades de pointes

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quinindine
ibutilide (corvert)

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mild alpha adrenergic blocking action
-vasodilation and decreased BP
-negative inotrope
-atropine-like effect

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quinidine
IA

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SE: GI, diarrhea, N/V in 1/3 to 1/2 of pts

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quinidine

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what are the Cinchonism characteristics?

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quinidine

GI upset
tinnitus
visual disturbances
dizziness and H/A

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CI: myasthenia gravis, digoxin toxicity, caution in HF due to negative inotropic effect

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quinidine
IA

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quinidine alternative
IV form for vent arrhythmias
less cinchonism than quinidine

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procainamide
IA

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aggrevate and cause SLE
1/3 develop reversible lupus symptoms

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procainamide
IA

long-term therapy avoided due to this and frequent dosing

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some bone marrow depression

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procainamide
IA

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3rd choice in CCUs after amiodarone and lidocaine for sustained vent arrhythmias associated with acute MI

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procainamide
IA

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effects similar to quinidine

only FDA approved for vent arrythmias

may precipitate HF due to negative inotropic effect

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disopyramide (Norpace)
IA

CI: cardiogenic shock
2nd and 3rd degree blocks

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CI: cardiogenic shock
2nd and 3rd degree blocks

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disopyramide (Norpace)
IA

effects similar to quinidine

only FDA approved for vent arrythmias

may precipitate HF due to negative inotropic effect

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extensive 1st pass metabolism
only used IV

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lidocaine
IB

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blocks activated and inactivated Na channels w/rapid kinetics

greater effect on long action potentials like purkinje and ventricles

used in cardioverting arrythmias associated w/MI

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lidocaine
IB

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AE: neorologic
-parathesia
-tremor
-nausea
-lightheadedness / lethargy
-slurred speech
-convulsions

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lidocaine
IB

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mild and dose dependent seizures

main COD

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lidocaine
IB

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orally effective
questionable safety
CAST study

use restricted to life-threatening symptomatic vent arrhythmias

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flecainide (Tambocor)
IC

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this beta blocker has class III properties

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Sotalol (Betapace)

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#1 use: post-MI

maintenance of NSR w/symptomatic Afib or Aflutter

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Sotalol (Betapace)

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#1 use: post-MI

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beta blockers
class II

Propanolol (Inderal)
Sotalol (Betapace)
Esmolol (Brervibloc)

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beta blocker that is a short-acting IV med that is used for SVT in surgery or emergency

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Esmolol (Brevibloc)

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oral and IV to tx serious vent arrthymias
particularly recurrent Vfib and hemodynamically unstable Vtach

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amiodarone
class III

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these two are 1st choice in ACLS for Vfib, Vtach, SVT

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amiodarone (class III)
lidocaine (IB)

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extensive 1st pass metabolism
1/2 life of 50 days
accumulates in tissues: heart, lungs, liver, cornea, skin

slow onset, slow stabilization, slow effect

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amiodarone
class III

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SE: N/V
pulm fibrosis
increased LFTs
blue-grey skin deposits
vision impairment (halos in periphery)
hypothyroid and hyperthyroid

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amiodarone
class III

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brand new oral agent
maintenance of NSR in Afib or Aflutter

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Dofetilide (Tikosyn)
class III

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strictly IV for acute conversion of Aflutter and Afib to NSR

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Ibutilide (Corvet)
class III

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AE: excessive QT prolongation and torsades de pointes and must have continuous EKG for 4 hours or until QT intervals return to baseline

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Ibutilide (Corvert)
class III

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esp effective in SA and AV nodes

SVT and vent rate control in Afib and Aflutter

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CCB
class IV


verapamil
diltiazem

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AE/CI:
only rarely associated w/abnormalities in electrolytes, glucose, lipid metabolism
combine cautiously w/BB
-can depress sinus node automaticity and vent contratility
-never combine in pts w/AV blocks
-may precipitate HF

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CCB
class IV


verapamil

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SE:
H/A
dizzy
facial flushing
edema
constipation

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CCB
class IV


verapamil (constipation)

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nucleoside that occurs naturally in body
1/2 life <10 seconds

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adenosine

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drug of choice for prompt conversion of PSVT to NSR

high efficacy and very short duration of action

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adenosine

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used as adjunct to quinidine for initial tx of SVT

slows AV node conduction

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digoxin