Pharmacology Of Cardiac Rhythm

Front 1

class IA antiarrhythmic used for conversion of Aflutter or Afib adn maintenance of normal sinus rhythm; paroxysmal supraventricular tach; premature atrial/ventricular contractions; paroxysmal AV junctional rhythm or A/V tach

side effects: torsades, complete AV block, Vtach, agranulocytosis, thrombocytopenia, hepatotoxicity, acute asthma attack, respiratory arrest, angioedema, SLE, fatigue, headache, lightheadedness,widening QRS and QT/PR intervals, hypotension, PVC, tachycardia, diarrhea, cinchonism

contraindications: Hx torsades, prolonged QT; concurrent use of drugs that prolong QT; conduction defects

Back 1

Quinidine

Front 2

Class AI antiarrhythmic used for symptomatic PVC, life threatening Vtach, maintanence normal sinus rhythm after conversion Aflutter, malignant hyperthermia

side effects: fewer anticholinergic effects; SLE may occur after prolonged use

contraindications myasthenia graivs, SLE; torsades, prolonged QT

Back 2

Procainamide

Front 3

Class IA aniarrhythmic used for PVC, Vtach, conversion Afib, Aflutter, and paroxysmal Atch to normal sinus rhythm

side effects: more profound anticholinergic effects; fewer GI effects

contraindications: Hx torsades, prolonged QT, conduction defects

Back 3

Disopyramide

Front 4

Class IB antiarrhythmics used for ventricular arrhythmias in context MI, cadiac manipulation, cardiac glycosides; status epilepticus, local anesthetic; pain, burning, itching; post herpetic neuralgia

side effects: seizures, asystole, bradycardia, cardiac arrest, new/worsened arrhythmias, respiratory depression, anaphylaxis, status athmaticus, restlessness, stupor, tremor, hypotension, blurred or double vision, tinnitus

contraindications: stokes-adams syndrome, wolff-parkinson-white syndrome, servere SA/AV/intraventricular block, inflammation or infections in puncture region, septicemia, severe hypertension, spinal defomities, neurologic disorders

Back 4

lidocaine and mexiletine

Front 5

class IB antiarrhythmic used for generalized tonic-clonic seizures related to eclampsia; neuralgia, ventricular arrhythmias unresponsive to lidocaine/procainamide; arrhythmias induced by cardiac glycosides

side effects: agranulocytosis, leukopenia, pancytopenia, thrombocytopenia, hepatitis, stevens-johnson syndrome, toxic epidermal necrolysis, ataxia, confusion, slurred speech, diplopia, nystagmus, gingival hyperplasia, nausea, vomiting, hirsutism

contraindications: hydantoin hypersensitivity, sinus bradycardia, SA node block, 2nd/3rd degree AV block, stokes-adams syndrome

Back 5

phenytoin

Front 6

Class IC antiarrhythmics used for sustained Vtach, paroxysmal supravenricular tachycardia, paroxysmal Afib unresponsive to other measures

side effects: cardiac arrest, HF, new/worsened arrhythmias, sinus node dysfunction, marked decrease in conduction velocity, conduction block, dizziness, headache, syncope, visual disturbances, dyspnea

contraindications: cardiogeic shock, 2nd/3rd degree AV block, right bundle branch block with left hemiblock, proarrhythmic effects in patients with Afib or Aflutter

Back 6

encainide, flecainanide, moricizine, propafenone

Front 7

Class III antiarrhythmics used for conversion of Afib or Aflutter to normal sinus rhythm

side effects: AV block, bradycardia, sustained ventricular tachycardia, torsades de pointes

contraindications: Hx of polymorphic ventricular tachycardia (torsades), pre-existing long QT syndrome

Back 7

ibutilide

Front 8

Class III antiarrhythmic used for conversion of Afib or Aflutter to normal sinus rhythm, maintenance of normal sinus rhythm in patients with symptomatic Afib or Aflutter

side effects: AV block, bradycardia, sustained ventricular tach, torsades

contraindications: Hx polymorphic Vtach, pre-existing QT; creatine clearance less than 20 mL/min

Back 8

dofetilide

Front 9

Class III antiarrhythmic used for life threatening ventricular arrhythmias, maintenance of normal sinus rhythm in patients with symptomatic Afib or Aflutter

side effects: bradycardia, torsades, PVC, Vfib, Vtach, AV block, HF, bronchospasm, dyspnea, chest pain, fatigue

contraindications: severe sinus node dysfunction, sinus bradycardia, 2nd/3rd degree AV block, long QT syndrome, cardiogenic shock, uncontrolled HF, asthma

Back 9

sotalol

Front 10

class III antiarrhythmic used for life threatening ventricular arrhythmias

side effects: arrhythmias, asystole, bradycardia, HF, hypotension, sinus arrest, neutropenia, pancytopenia, hepatic failure, severe pulmonary toxicity (pneumonitis, alveolitis, fibrosis), thyroid dysfunction, fatigue, corneal microdeposits, blue-gray skin pigmentation, photosensitivity

contraindications: patients receiving ritonavir, severe SA disease, 2nd/3rd degree AV block, bradycardia with syncope

Back 10

amiodarone

Front 11

antiarrhythmic used for conversion of paroxysmal supraventical tachycardia to normal sinus rhythm

side effects: facial flushing, bronchocontriction in asthma, chest pressure, diaphoresis, excessive SA/AV node inhibition

contraindications: 2nd/3rd degree AV block; don't use for Afib/Aflutter

Back 11

adenosine

Front 12

antiarrhythmic used for chronic angina pectoris

side effects: prolonged QT interval, syncope, acute renal dysfunction, constipation, dizziness, headache

contraindication: drugs taht prolong the QT interval, prexisting long QT syndrome, concurrent use of moderately potent P450 3A inhibitors, hepatic dysfunctiong

Back 12

ranolazine

Front 13

Class IV antiarrhythmics used for prinzmetal or variant angina or chronic stable angina; hypertension, Afib/flutter, paroxysmal supraventricular tachycardia

side effects: cardiac arrhythmia, AV block, bradyarrhythmia, exacerbation of HF, peripheral edema, syncope, gingival hyperplasia, dizziness

contraindications: sick sinus syndrome/ 2nd or 3rd degree AV block, supraventricular tach associted with bypass, LV failure, hypotension, acute MI; v: patients with Vtach or receiving IV beta blockers

Back 13

diltiazem/ verapamil

Front 14

Class II antiarrhythmic used for hypertension, angina, HF, pheochromocytoma, glaucoma

side effects: bronchospasm, AV block, bradyarrhythmia, sedation, decreased libido, mask symptoms of hypoglycemia, depression, dyspnea, wheezing

contraindications: asthma or COPD, cardiogenic shock, uncompensated cardiac failure, 2nd/3rd degree AV block, severe sinus bradycardia

Back 14

propranolol, nadolol, timolol

Front 15

class II antiarrhythmic used for hypertension and angina

side effects: same as other Class II agents; hepatotoxicity

contraindications: same as other class II agents

Back 15

labetalol, carvedilol

Front 16

Class II antiarrhythmics used for hypertension and angina

side effects: same as other class II agents; no hepatotoxicity

contraindications: same as other class II agents

Back 16

pindolol, acebutolol

Front 17

class II antiarrhythmics used for hypertension , angina, HF, thyroid sotrm

side effects: same as other class II agents; less bronchospasm

contraindications: same as other class II agents

Back 17

esmolol, metoprolol, atenolol, celiprolol