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Antidysrhythmics
| Class | Effects on heart/ECG | Therapeutic Uses | Adverse Effects | Drug Interactions | Notes |
|---|---|---|---|---|---|
| Class IB Agents: lidocaine (IV)-> very diff from: phenytoin (dig-induced dys, acute&chronic supp.PK:2C9, 2C19 substrate); memexilitene (symptomatic c dyd. PK:1A2,2D6 substrate) | slows conduction in atria, vent, His-Purkinje sys; reduces automaticity in vent and His-Pur sys; accelerates repolarization; minimak ECG changes | therapeutic range 1.5-5 mcg/mL (narrow); used for ventricular dysrhythmias | CNS effects, drowsiness, confusion, neurologic effects, paresthesias, GI disturbances; dysrhythmias | prodysrhythmic drugs and drugs that affect metabolism of Class IB agents | |
| Class II: BB (propranolol-nonselective) Others: acebuterol (cardioselective, for PVCs); esmolol (cardioselective w/ short 1/2life for immediate control of a-flutter and a-fib) | decreased automaticity of SA node, decreased velocity of conduction through AV node (prolonged QT interval), decreased myocardial contractility | dysrhythmias caused by excessive SNS stim. of heart, in pts w/ supravent. tachydysrhy, propranolol: -supression of excessive discharge, slowing of ventricular rate (by decreasing trans of atrial impulses through AV node) | heart block, HF, AV block, sinus arrest, hypotn, bronchospasm (propranolol-nonselective) | ||
| Class III: K Channel Blockers (amioderone, bretylium, dofetilide, sotalol, ibutelide) | |||||
| Class IA Agents: Quinidine, procainamide, disopyramide | blocks Na channels, slows impulse conduction, delays repolarization, blocks vagal input to heart (quinidine-increase SA automaticity and AV conduction, so pretreated w/dig. veramipil or BB->suppress AV cond.);widens QRS complex, prolongs QT interval | quinidine and procainamide:broad spectrum agents against sv. and v.dysrhythmias (frequently used); disopyramide:only indicated for V.dysrhyth and is reserved for pts. who can't tolerate safer meds (others) | GI Effects; hypersensitivity rxns; cardiotoxicity; hypotn;hepatotoxicity (quinidine);+anti-nuclear antibody tier (procainamide-autoimmune); *NB:disopyramide, unlike quinidine, causes a pronounced reduction in contractility, causing severs hypotn 2/2 red. | digoxin (quinidine can 2x dig levels); 3A4 inhibitors, drugs that can prolong QT interval (ranolazine, etc) | |
| Class IC Agents: flecainide, propafenone | Blocks cardiac Na channels->slowing conduction in atria, ventricles, and His Pur sys, delay ventricular repolarization | dysrhythmias, HF, GI effects, bronchospasm (propafenone) | drugs that can cause dysrhythmias | All class IC agents can exacerbate existing dysrhythmias |
Created by:
jellyfishh
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