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CVS Pharmacology

Dr. Maleque's CVS Drugs

Class I Antiarrhythmic Drugs Na+ Channel Blockers
Class II Antiarrhythmic Drugs Beta-adrenoreceptor Blockers
Class III Antiarrhyhtmic Drugs Potassium Channel Blockers
Class IV Antiarrhythmic Drugs Calcium Channel Blockers
Class IA Quinidine, Procainamide, Disopyramide, Amiodarone
Quinidine - MOA Slows upstroke AP & conduction; prolongs QRS duration via blockage of Na+ Channels; AP prolongation via K+ Channel blockade
Quinidine - Toxicity QT interval prolongation; torsade de points; slowed conduction
Procainamide - MOA Slows upstroke AP & conduction; prolongs QRS duration via blockage of Na+ Channels; AP prolongation via K+ Channel blockade; not as effective against ectopic pacemakers (quinidine does); effective in depolarized cells
Procainamide - Toxicity Excessive AP & QT interval prolongation; torsades de pointes; syncope; slow conduction; lupus-like syndrome (arthralgia/arthritis); increased antinuclear antibody
Disopyramide - MOA Same as quinidine with more antimuscrainic effects; used for superventricular arrhythmias
Disopyramide - Toxicity Can precipitate de novo heart failure or can cause heart failure in patients with left ventricular hypertrophy; not a first-line drug in the US
Amiodarone - MOA Prolongation of AP (QT interval) via blockage of IKR (Chronic use --> IKS; blocks inactivated sodium channels; low incidence of trosades de pointes
Amiodarone - Toxicity Symptomatic bradycardia and heart block; tissue accumulation; photodermatitis (blue-gray spots/UV exposure); thyroid issues;
Class IB Lidocaine, Mexiletine, Tocainide
Lidocaine - MAO blocks activated & inactivated (ensures greater effect on cells with long APs (Purkinje, ventricular) Na+ Channels; IV/IM routes;
Lidocaine - Toxicity One of the least cardiotoxic; Large doses + preexisting conditions = hypotension due to decreased contractility; neurologic effects: paresthesias, hearing disturbed, etc; all short-lived
Mexiletine - MAO Orally active congener of lidocaine; Tx of ventricular arrhythmias; same actions as lidocaine
Mexilitine - Toxicity Tremor; blurred vision; lethargy (CNS issues
Phenytoin - MAO Usually used for epilepsy; similar to lidocaine and mexiletine;
Phenytoin - Toxicity Gingival hyperplasia
Class IC Flecanide, Propafenone, Encanide
Flecanide - MAO Potent Na+ and K+ Channel blocker; NO QT INTERVAL PROLONGATION!!!; No antimuscarinic effects; used for supraventricular contractions and PVCs; eliminated by the kidney and liver
Flecanide - Toxicity May cause severe exacerbation of arrhythmia when patient has preexisting ventricular arrhythmias; CAST showed 2.5 increased in premature death
Propafenone - MAO Similar effects to the of propanolol; weak beta-blocking activity; Most similar to quinidine, except there's no AP prolongation; metabolized in the liver; used for SVAs
Propafenone - Toxicity
Created by: TreyDoc