Antiarrhythmics
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| Class I antiarrhythmics are | sodium channel blockers, may increase heart rate
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| Class 1A (quinidine, norpace) | reduce rate of firing of ectopic foci, increase the effective refractory period, reduce the speed of conduction
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| Class 1B (mexiletine) | block both activated and inactivated sodium channels
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| 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
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| Class II: beta blockers | mask s/s of hypoglycemia except diaphoresis
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| 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
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| Class IV: CCB's |
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| only short acting antiarrhythmic | procainamide
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| 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)
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| amiodarone | pulmonary fibrosis occurs in 5-15% of pts and use in pulmonary disease is questioned
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| amiodarone | extrapyramidal side effects, hepatitis, epididymitis, corneal and skin deposits, peripheral neuropathy, and photosensitivity
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| grapefruit juice inhibits the ? | CYP 3A4 system
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| clinical use | Atrial arrhythmias, ventricular arrhythmias
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| 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
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| 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
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