Antiarrhythmic therapy

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Author:
pilismok
ID:
181316
Filename:
Antiarrhythmic therapy
Updated:
2012-11-02 13:10:12
Tags:
Friedman
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Description:
Pharm.
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  1. Antiarrhythmic therapy: Automaticity
    • All cardiac cells have potential to be a pacemaker. Arrhythmia caused by impulses that are NOT initiated by SA node. This impulses are slower, than SA node.
    • Ectopic Foci = abnormal point in the heart.
    • EF caused by ischemia, acidosis, supressant drugs.
  2. Antiarrhythmic therapy: Refractory period + mechanism of action
    • RP= responsiveness of the membrane during recovery from previous activity.
    • Antiarrhythmic drugs:
    • 1) decrease automaticity
    • 2) Increase refractory period
  3. Antiarrhythmic drugs. QUINIDINE
    • comes in different salts:
    • Quinidine Sulfate - 83%
    • Quinidine Glacanate - 62%

    • Pharmacology:
    • - decrease automaticity and increase refractory period.
    • - Never administer IV: dilate vessels -> hypotension -> shock.
    • Injectable vial for IM use only.
    • - Increase conduction through AV node -> potential for V-fib.
    • We use cardiac glycosides as adjunct therapy in order to prevent V-fib (they slow down AV node conduction).
    • - Arrhythmogenic
    • - Toxicity (Cinchonism);
    •      tinnitus, headache, nausea/ vomitting, vertigo

    • USAGE
    • - Atrial tachycardia
    • - A-fib (Use digoxin as adjunct therapy)
  4. Antiarrhytmic drugs. Procainamide
    • 1) Decrease Automaticity and increase RP
    • 2) Slow AV conduction (No need in Digoxin)

    • Adverse RXN:
    • - Lupus-like syndrome (Dose Related, Reversible)
    • - Arrhythmogenic

    • Use:
    • - Atrial tachycardia
    • - Atrial fibrilation
    • - Ventricular Arrhythmia (IV use when Lidocain fails or contraindicated)
  5. Antiarrhythmic drugs. Disopyramide
    • - decrease automaticity and increase refractory period
    • - No effect on AV conduction (no need in Digoxin)
    • - Strong anticholinergic (dry mouth, constipation, GI upset)

    • Contraindication:
    • Heart failure, b/c they increase CO

    • USE:
    • - Atrial tachycardia
    • - Atrial fibrilation
  6. Antiarrhythmic drugs. Lidocaine
    • - local anasthetic
    • - antiarrhythmic (IV use only)
    • - high therapeutic index (safe)

    • Adverse RXN:
    •  CNS toxicity: tinnitus, respiratory depression, seizure

    • Dosing:
    • 1) Loading dose
    • 2) IV infusion

    • USE:
    • Ventricular arrhythmias
    • Digoxin toxicity arrhythmias
  7. Mexelitine, Tocainide, Flecainide
    • - oral agents for ventricular arrhythmias
    • - pharmacology similar to Lidocaine:
    •    

    •     Lidocaine:
    •               - local anasthetic
    •                - antiarrhythmic (IV use only)
    •               - high therapeutic index (safe)

                  Adverse RXN: CNS toxicity: tinnitus, respiratory depression, seizure
  8. Antiarrhythmic. Propranolol
    • B-blocker
    • IV use as an antiarrhythmic

    • Use:
    •    Atrial tachicardia
    •    V tachcardia
  9. Antiarrhythmic. Amiodarone
    45 day half life

    use: Ventricular Arrhythmia (IV use)

    • Adverse reactions:
    • cataract
    • pulmonary fibrosis
    • hypothyroid
  10. Antiarrhythmic. Verapamil
    • Ca++ blocker
    • IV push for antiarrhythmic properties
    • second dose can be prepared in 5 min (90% effective)

    • Use:
    • Atrial tachycardia
  11. Antiarrhythmic. Atropine
    • Anticholinergic
    • IV push for antiarrhythmic use

    • Use:
    •  Sinus bradicardia (slow heart rate)

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