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Pharmacology

Pharmacology. Antiarrhythmic Drugs. Antiarrhythmic Drugs. Types of Arrhythmias Supraventricular Ventricular. Antiarrhythmic Drugs. Supraventricular Atrial tachycardia Atrial flutter Premature atrial contraction Junctional ectopic beat. Antiarrhythmic Drugs. Ventricular

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Pharmacology

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  1. Pharmacology Antiarrhythmic Drugs

  2. Antiarrhythmic Drugs Types of Arrhythmias • Supraventricular • Ventricular

  3. Antiarrhythmic Drugs Supraventricular • Atrial tachycardia • Atrial flutter • Premature atrial contraction • Junctional ectopic beat

  4. Antiarrhythmic Drugs Ventricular • Ventricular ectopic beat • Ventricular tachycardia • Ventricular fibrillation

  5. Antiarrhythmic Drugs • Class 1 – drugs with local anesthetic properties. • Class 2 – Beta blockers. • Class 3 – drugs that interfere with efflux of potassium ions. • Class 4 – Calcium antagonists.

  6. Antiarrhythmic Drugs Class 1 • Quinidine • Procainamide • Disopyramide • Lidocaine • Phenytoin

  7. Antiarrhythmic Drugs Quinidine • Indications: SVT • Pharmacologic Effects – depression of the conducting system, which reduces cardiac excitability and slows conduction of electric impulses through the heart. • At higher doses it depresses the myocardium and reduces force of contraction.

  8. Antiarrhythmic Drugs Quinidine • Pharmacokinetics – Absorbed by GIT. Metabolized by the liver. Excreted by the kidneys.

  9. Antiarrhythmic Drugs Adverse Effect Noncardiac • Nausea • Vomiting • Diarrhea

  10. Antiarrhythmic Drugs Adverse Effect Noncardiac Cinchonism • Tinnitus • Dizziness • Salivation • Headache • Hallucination

  11. Antiarrhythmic Drugs Adverse Effect Noncardiac Smooth Muscle depression • Arterial dilatation • Hypotension Skeletal Muscle depression • Muscle weakness • Respiratory arrest

  12. Antiarrhythmic Drugs Adverse Effect Cardiac Toxicity EKG changes • Prolonged PR and QT intervals • PAC • PVC • Cardiac arrest

  13. Antiarrhythmic Drugs Contraindication • Patient with hyperkalemia – increase quinidine toxicity. • Patient with AV block - worsens the conduction block

  14. Antiarrhythmic Drugs Drug Interaction • Digitalis – quinidine increase digitalis plasma concentration. • Beta blockers – inhibits metabolism of these drugs.

  15. Antiarrhythmic Drugs Class 2 Drugs • Propanolol • Esmolol

  16. Antiarrhythmic Drugs Propranolol • Beta blocker • Indications – Supraventricular and ventricular arrhythmias • Pharmacologic Effect: Decrease HR Slows conduction Increase refractory period • ROA – oral or IV

  17. Antiarrhythmic Drugs Propranolol • Adverse effect 1. Hypotension 2. Bradycardia 3. CCF • Others 1. Skin rashes 2. Mental confusion 3. Visual disturbances

  18. Antiarrhythmic Drugs Class 3 Drugs • Bretylium • Amidarone • Sotalol

  19. Antiarrhythmic Drugs Bretylium • Adrenergic neuronal blocker – decreases the release of NE from noradrenergic nerve endings. • Prolongs refractory period of the ventricle.

  20. Antiarrhythmic Drugs Bretylium • Indications – Ventricular arrhythmias. • ROA – oral, IM or IV. • Adverse Effect – Nausea, diarrhea and hypotension.

  21. Antiarrhythmic Drugs Class 4 Antiarrhythmic Drugs • Verapamil • Ditiazem

  22. Antiarrhythmic Drugs Verapamil • Site of action is on the pacemaker cells • Decreases SA node activity • Decreases AV node conduction

  23. Antiarrhythmic Drugs Verapamil • Indications – SV and AV nodal arrhythmias. • Also produces vasodilatation. • Adverse effects – headaches, dizziness and GI disturbances

  24. Antiarrhythmic Drugs Verapamil • Vasodilatory effect – hypotension • Serious Complication – Cardiac depression leading to CCF, varying degrees of heart block.

  25. Antiarrhythmic Drugs Verapamil Contraindication - patients with SA or AV node disturbances and patient with CCF.

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