Cardiac Anti Arrhythmics Flashcards by Denisse Tiangco

Group I AA

Sodium channel blockers

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Group II

Beta blockers

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Group 3

Potassium channel blockers

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Group 4

Calcium channel blockers

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Group 5 AA

Miscellaneous groups

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Group I AA Drugs act on

Phase 0

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Group 1A AA MOA

Prolong the AP duration by blocking INa and slowing conduction velocity in atria, purkinje and ventricular cells

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Group 1A AA (4)

Procainamide
Quinidine
Disopyramide
Amiodarone

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Prolongs AP duration

Intermediate dissociation

Group1A

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Blocks Na ch leading to slow upstroke AP

Non specific blockade of K ch (Phase4)

Procainamide

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Procainamide SE (4)

SLE-like symptoms
Arthralgia
Arthritis
Torsade

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Blocks Na ch but more toxic

Quinidine

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Quinidine SE (5)

Cinchonism
Tinnitus
Cardiac depression
GI upset
Torsade

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Na ch blocker with more antimuscarinic effect

Disopyramide

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Disopyramide SE (2)

Heart failure

Atropine-like (mad as hatter etc)

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Class1A drugs can (2)

Inc serum digoxin levels

Hyperkalemia

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Class1A toxicity tx

Na lactate

Vasopressor

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Used for all types of arrhythmias

Procainamide

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Class1B drugs (3)

Lidocaine
Mexiletine
Phenytoin

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Shortens AP duration

Rapid dissociation

Group1B

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selectively affects ischemic or depolarized Purkinje and ventricular tissue and have little effect on atrial tissue

Group1B

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Blocks inactivated and activated Na ch especially Purkinje and ventricular cells

In depolarized cells, inc inactivation and slower unbinding leading to depression of conduction

Lidocaine

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Shortest AP fast dissociation Group1B

Lidocaine

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Used for acute ischemic ventricular arrhythmias after MI, digitalis induced arrhythmias

Lidocaine

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Lidocaine SE (2)

Neurologic - covulsion | Hyootension

Group1B least cardiotox

Lidocaine

For chronic arrhythmias, neuropathic pain ventricular arrhythmias

Mixelitine

Digitalis induced arrhythmias, seizure

Phenytoin

Group1B toxicity (5)

``` Convulsion Cardiovascular depression Allergy Arrhythmia Hyperkalemia ```

Group1B ECG change

No significant change

Group1C drugs (3)

Flecainide Propafenone Movicizine

Minimal effect on AP | Slowly dissociating

Group1C

Powerful depressants of sodium current Markedly slow conduction velocity in atrial and ventricular cells

Group1 C

For refractory ventricular tachycardias Intractable supraventricular arrhythmia

Group1C

Na and K ch blocker with slow unblocking For PVCs Svtacs No QT AP prolongation

Flecainide

Weak beta blocker, Na and K ch blocker for SVTAC

Propafenone

Propafenone SE (2)

Metallic taste | Constipation

Group1C SE (4)

Proarrhythmic Local anesthetic like CNS tox Hyperkalemia Inc QRS duration

GroupII

Propranolol Esmolol Sotalol

cardiac beta adrenoreceptor blockade | reduces cAMP leading to dec in sodium and calcium currents and supression of abnormal pace makers

Beta blocker

Used for atrial arrhythmias

Beta blocker

Postmyocardial infarction prophylaxis against sudden death ventricular fibrillation Thyrotoxicosis

Beta blocker

Beta blocker toxicity (5)

``` Bronchospasm Cardiac depression AV block Hypotension prolongs PR interval ```

beta blocker with direct membrane effect Na ch blockade prolonging AP Slows SA automaticity, AV node velocity

Propranolol

Intraoperative and acute antiarrhythmics

Esmolol

Non selective beta blocker that prolongs AP

Sotalol

Group III blocks

Phase 3

GroupIII (5)

``` Dofetilide Ibutilide Sotalol Amiodarone Dronedarone ```

Blocks K ch leading to AP prolongation inc effective refractory period dec ability of heart to respond to rapid tachycardia

Group III

Prolongs AP and QT interval by blocking K ch, Ca Ch and is also beta blocker Also blocks inactivated Na ch But low torsade de pointes risk

Amiodarone

Multichannel blocking, also beta blocker but removed iodine atoms Must be taken with food to inc absorption 3-4x

Dronedarone

10-15 reduction in bp | Dec mortality in atrial fibrillation

Dronedarone

Class II and III drug causing prolonged AP and drug of choice for pediatric arrhythmia

Sotalol

K ch blocker prolongs AP and effective refractory period

Dofetilide

Sinus rhythm restoration in afib

Ibutilide

Treatment and prophylaxis of atrial fibrillation

Dofetilide, ibutilide

Ventricular arrhythmia and atrial fibrillation

Sotalol

Refractory arrhythmia | broad spectrum

Amiodarone

Amiodarone SE (7)

``` Hypo/hyperthyroidism Pulmonary toxicity pulmo fibrosis Hepatotoxicity Deposit in skin, cornea Bradycardia, AV block Optic neuritis Torsade (rare!) ```

Has half life and duration of 1-10 weeks

Amiodarone

Group IV AA block

Phase 2 Ca L type

GroupIV (3)

Verapamil Diltiazem Amiodarone

Blocks activated inactivated L type Ca channels prolonged SA, AV conduction and refractory period Allows peripheral vasodilation Avoid ventricular tachy

Verapamil

Reduces inward calcium current during AP and during Phase 4 leading to Conduction velocity slowing in AV node Prolonged refractoriness Dec pacemaker activity

Calcium L type Ch blocker Group 4

For AV nodal arrhythmia prohylaxis

Verapamil

For rate control in atrial fibrillation Avoid in ventricular fib

Diltiazem

Verapamil SE (2)

Lassitude | Edema

Diltiazem SE (2)

Hypotension | Bradyarrhythmia

Class IV SE (5)

``` Excessive cardiac depression Dec AV conduction Hypotension Constipation Inc PR interval ```

Activates inward rectifier K channel, blocks Ca ch leading to complete AV blockade

Adenosine

Extremely short duration of action (15s)

Adenosine

DOC for AV nodal arrhythmia

Adenosine

Adenosine SE (4)

Flushing Chest tightness Hypotension Bronchoconstriction

Depresses ectopic pacemaker by Inc K permeability K current Serum level measured and normalized

potassium

Inc incidence of arrhythmia (digitalis induced)

Hypokalemia

Depresses conduction and can cause reentry arrhythmia

Hyperkalemia

Potassium SE

reentrant arrhythmia

Interacts with NaK atpase, K Ca ch | Similar depressant effect as potassium on digitalis-induced arrhythmia

Magnesium

Drug for torsade and digitalis-induced arrhythmia

Magnesium

Magnesium SE

muscle weakness

New agents for angina with anti arrhythmic activity | Effective for Sinus arrhythmia only since acts on SA node

Ranolazine | Ivabradine

Hyperpolarization activated cyclic nucleotide-gated channel blocker

Ivabradine

Beta blockers that slow progression of CHF Dec mortality Attenuates effects of catecholamine Upregulated beta receptor Dec HR and remodelling But not given in acute hf if with systolic dysfxn

Carvedilol Metoprolol succinate Bisoprolol Labetalol