Mod Iv Pharm- Antiarrythmics

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CVP

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filling pressure of the right atria

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PCWP

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filling pressure of the left heart

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3 Antiarrhythmic Agent theraputic goals

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maintain electricial impulses at SA node
supress irregular firing outside the pathway

control ventricular rate and cardiac output

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main MOA for Anti arrhythmics

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alter conduction thru atria and ventricles by affection depolorization and the level of cell excitablity and alter conduction by depressing conduction

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def
asystole

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no cardiac electrical activity, hence no contractions of the myocardium and no cardiac output or blood flow

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Antiarrhytmics
Class I: Na Channel Blockers
MOA

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MOA: decreases excitability of myocardium. lowers the inward Na flow in heart cells to depress their automaticity. And to increase their resting potential.

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Na Channel Blockers are indicated for (4)

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Fibrillation,Flutter
Premature Ventricular contractions and Ventricular Tachycardia

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Quinidine (quinaglute)

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Class I Na channel blocker
AntiARRHYTHMIC

usused for atrial fib and flutter PAT’ (premature atrial tach), PVC’s and V-tach

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Lidocaine (Xylocaine)
phenytoin
mexileten (Mexitil)
tocainide (tonocard)

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Class I Na channel blocker
AntiARRHYTHMIC

used to control PVC’s or tachycardia

doses sb adj in pt with CHF and liver dx

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Procainamide (Pronestyl)

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Class I Na channel blocker
AntiARRHYTHMIC

used to treat ventricular ectopics(missed beats), V-tach, & Atrial arrhythmias

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Norpace

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AntiARRHYTHMIC
parasympatholytic

negative inotropic effect
& increases vascular resistance.
USED supra ventricular tach, V-tach,PAT’s, atrial flutter and fib (used for everything)

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Moricizine (Ethmozine)
Flecainide (Tambocor)
propafenone (rythmol)

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Class I Na channel blocker
AntiARRHYTHMIC

act alittle like class II
slows conduction velocity more than the oger agents.

can cause slow contractility

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Class II Drugs: Beta Blocker
MOA

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used to control hypertension.
extends AV conduction reducing HR & contractile force.

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propanolol (inderal)
esmolo (brevibloc)
Metaprolol (Lopressor)

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Class II Drugs: Beta Blocker

treat supraventricular tach

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Class III Drugs: K Channel Blocker MOA

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prolonging the duration of repolarization, (the Refractory Period)

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Class III Drugs: K Channel Blocker indications

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Indicated in V-fib, or V-tach.

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Aminodarone (cordarone)

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Class III Drugs: K Channel Blocker antiarrhytmic

inhibits Alpha and beta
reduces contractile velocity, increases the refactory period.

used for v fib,v tach, & atrial fib

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bretylium (bretylol)

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Class III Drugs: K Channel Blocker antiarrhytmic

prevent and treat ventricular fibrillation.

Also inhibits norepinephrine release, causing a sympathetic blockade

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sotalol (betaspace)

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Class III Drugs: K Channel Blocker antiarrhytmic

slows HR,decreases AV conductions,increases refractory period

Treat A fib

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Antiarrhytmic
Class IV Drugs: Ca Channel Blocker MOA

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prevents influx of Calcium in pacemaker cells & in myocardial cells.lowers the automaticity of atrial tissue and pacemaker cells and by slows conduction velocity through the AV node.

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Verapamil (Calan)

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Antiarrhytmic
Class IV Drugs: Ca Channel Blocker

used for supraventricular tachycardia also used for hypertension and angina

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Digoxin MOA:

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inhibits Na/K exchange in the heart which leads to increased Na Ca in the cell which leads to increased heart contraction.

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Calcium Chloride

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Other Anti-Arrhythmics

provides calcium necessary for cardiac contractility. Used to reverse electromechanical dissociation & increase cardiac output.

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Adenosine

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Other Anti-Arrhythmics

slows AV conduction, The treatment for Paroxysmal supra V-tach.

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Digoxin as an Antiarrhythmic

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Other Anti-Arrhythmics

Digitalis works by inhibiting Na/K exchange which increases intracellular calcium. The increased intracellular Ca gives a positive inotropic effect. It also has a vagal effect on the parasympathetic nervous system, used: to slow the ventricular rate during atrial fib. The dependence on the vagal effect means it is not effective when a pt has a high sympathetic nervous system drive, which is the case with acutely ill persons, and also during exercise.

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what is proarrhythmia???

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arrhythmia caused by drugs

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t or f
arrhythmias can be caused by antiarrhythmic drug toxicity

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true