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Antiarrhythmics

First AID Antiarrhythmic Drugs

QuestionAnswer
Mnemonic to remember the antiarrhythmics NaB the Long Cab: I=Na blockers, II=Beta blockers, III=Long refractory period and QT interval - K+ block, IV=Ca2+ channel blockers
General information about Class I Antiarrhythmics Local antesthetics. Slow or block conduction (especially in depolarized cells). Decrease the slope of phase 4 depolarization and increase threshold for firing in abnormal pacemaker cells.
Drugs of Class IA Quinidine, Amiodarone, Procainamide, Disopyramide (Queen Amy Proclaims Diso's pyramid)
General Mech of Class IA Slow phase 0. Affect whole heart. Increase AP duration, Increase effective refractory period (ERP), and increase QT interval.
Indications for Class IA Affect both atrial and ventricular arrhythmias, especially reentrant and ectopic supraventricular and ventricular tachycardia.
Causes cinchonism, thrombocytopenia, and torsades des pointes Quinidine
Cinchonism is? Headache, tinnitus and dizziness
What drug reduces the renal elimination of digoxin? Quinidine
N-acetylprocainamide is an active metabolite Procainamide
Can cause a reversible SLE-like syndrome Procainamide
SE common to all Class IA Ventricular arrhythmias, AV block (increased PR), increased QRT/QT intervals
Drugs of Class IB Mexiletine, Lidocaine, Tocainide (Mitra Loves Tom)
General mechanism of Class IB drugs Shorten phase 3, Affect ventricles. Unlike class 1A - these decrease AP duration (and thus ERP). Affect ischemic or depolarized Purkinje and ventricular tissue.
General use of Class IB Acute ventricular arrhythmias (esp post MI) and in digitalis-induced arrhythmias
General side effects of Class IB Local anesthetics - cause CNS stimulation/depression, cardiovascular depression
Drugs of Class IC Flecainide, encainide, propafenone (Follwing Eating Poop)
General actions of Class IC Markedly slow phase 0 (as all class 1 antiarrhythmics do). Affects atria. Has NO effect on AP duration
General use of Class IC Useful in V-tachs that progress to VF and in intractable SVT. Also DOC for WPW.
Toxicity of Class IC Proarrhythmic - especially post-MI (contraindicated). Significantly prolongs refractory period in AV node
Affect both atrial and ventricular arrhythmias especially reentrant and ectopic supraventricular and ventricular tachycardia Class IA antiarrhythmics
Useful in acute ventricular arrhythmias (especially post MI) and in digitalis-induced arrhythmias Class IB antiarrhythmics
Useful in V-tachs that progress to VF and in intractable SVT Class IC antiarrhythmics
AP duration in Class I antiarrhythmics Class IA = Increase AP duration. Class IB = Decrease AP duration, Class IC = don't effect AP duration
Area of heart affected by Class I antiarrhythmics Class IA affect whole heart, Class IB affect ventricles, Class IC affect atria
Class II antiarrhythmics Beta blockers
General actions of Class II Reduces the effects of the sympathetic nervous system. Decreased Phase 4 depolarization, decrease excitability, and increase the EFP of the AV node
Indications for Class II Sympathetic induced tachyarrhythmias, PSVT (b/c Bblockers reduce reentry at the AV node), Atrial flutter and fibrillation (b/c Bblockers slow AV conduction)
Side efx of Beta-blockers Impotence, exacerbate asthma, AV block, may mask signs of hypoglycemia
CI of Beta blockers Asthma, Prinzmetal's angina
How to remember class III antiarrhythmics "A Bodygouar is Strong" (Amiodarone, Bretylium, Ibutilide, Sotalol)
General action of Class III Prolong Phase 3 w/o affecting Phase 0. Increase AP duration, Increase ERP, Increase QT interval. Use these when other antiarrhythmics fail
SE: Torsades des pointes, excessive B-block Sotalol
General SE of Class III All can cause torsades des pointes (b/c inc QT interval)
SE of Amiodarone: Pulmonary fibrosis, hepatotoxicity, Hypo/Hyperthyroidism. Amiodarone inhibits CYP3A4 (so don't use w/warfarin)
Used in prevention of nodal arrhythmias Calcium channel blockers
General mech of Class IV Ca2+ channel blockers. Primarily affect AV nodal cells, decrease conduction velocity. Increase ERP and PR.
General SE of Class IV Flushing, Constipation, Edema. Can also cause heart block, or torsades de pointes.
Drug of choice in diagnosing/abolishing AV nodal arrhythmias (SVT) Adenosine
Depresses ectopic pacemakers, especially in digoxin toxicity K+
Effective in torsades de pointes and digoxin toxicity Mg+
Created by: tommyparisi
 

 



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