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Pharmacology

Antiarrhythmics

QuestionAnswer
Class I antiarrhythmics are sodium channel blockers, may increase heart rate
Class 1A (quinidine, norpace) reduce rate of firing of ectopic foci, increase the effective refractory period, reduce the speed of conduction
Class 1B (mexiletine) block both activated and inactivated sodium channels
Class 1C (propafenone [Rythmol],flecainide [Tambocor]) primarily block the sodium fast channel during phase 0 of the action potential, reserved for pts with severe ventricular arrhythmias when other drugs have not worked
Class II: beta blockers mask s/s of hypoglycemia except diaphoresis
Class III: (sotalol, amiodarone) prolong the effective refractory period by some mechanism other than sodium channel blockade, often by blocking K channels which result in decreased rate of ventricular ectopic beats
Class IV: CCB's
only short acting antiarrhythmic procainamide
Things to consider about amiodarone inhibits the enzyme that converts T4 to T3 and iodine is a major component of this drug; about 5% of pts with inderlying predisposition to thyroid disease may develop thyrotoxicosis of hypothyroidism (also propranolol)
amiodarone pulmonary fibrosis occurs in 5-15% of pts and use in pulmonary disease is questioned
amiodarone extrapyramidal side effects, hepatitis, epididymitis, corneal and skin deposits, peripheral neuropathy, and photosensitivity
grapefruit juice inhibits the ? CYP 3A4 system
clinical use Atrial arrhythmias, ventricular arrhythmias
amiodarone has effect in all classes; has been shown to reduce mortality in cardiac arrest survivors from 50 to 20% at 2years post cardiac arrest
K levels should be kept above ? in pts with rhythm disturbances 4 mEq/L K concentration in the ECF is the jamor determinant of resting membrane potential and membrane stability
Created by: heatherbrown2020
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