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