1 / 26

Anti-Arrhythmic Agents PRCL 628: Medical Pharmacology Robert J. DiDomenico, PharmD , FCCP Clinical Associate Professor

OBJECTIVES For each of the anti-arrhythmic drugs, students should be able to: Describe the mechanism of action. Compare and contrast the pharmacokinetic and drug interaction profiles within each class. Compare and contrast the clinical effects. List the common and/or serious adverse effects.

makaio
Download Presentation

Anti-Arrhythmic Agents PRCL 628: Medical Pharmacology Robert J. DiDomenico, PharmD , FCCP Clinical Associate Professor

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. OBJECTIVES For each of the anti-arrhythmic drugs, students should be able to: Describe the mechanism of action. Compare and contrast the pharmacokinetic and drug interaction profiles within each class. Compare and contrast the clinical effects. List the common and/or serious adverse effects. Anti-Arrhythmic AgentsPRCL 628: Medical PharmacologyRobert J. DiDomenico, PharmD, FCCP Clinical Associate ProfessorCardiovascular Clinical Pharmacist

  2. Required Reading: Hume JR, Grant AO. Chapter 14. Agents Used in Cardiac Arrhythmias. In: Katzung BG, Masters SB, Trevor AJ, eds. Basic & Clinical Pharmacology. 12th ed. New York: McGraw-Hill; 2012. http://www.accessmedicine.com/content.aspx?aID=55822293. Suggested Reading: Sampson KJ, Kass RS. Chapter 29. Anti-Arrhythmic Drugs. In: Knollmann BC, ed. Goodman & Gilman's The Pharmacological Basis of Therapeutics. 12th ed. New York: McGraw-Hill; 2011. http://www.accessmedicine.com/content.aspx?aID=16668361. Anti-Arrhythmic AgentsPRCL 628: Medical Pharmacology

  3. “Antiarrhythmic drugs are toxins with occasional therapeutic side effects” • Peter Buttrick, MD

  4. Sampson KJ, Kass RS. Chapter 29. Anti-Arrhythmic Drugs. In: Knollmann BC, ed. Goodman & Gilman's The Pharmacological Basis of Therapeutics. 12th ed. New York: McGraw-Hill; 2011. http://www.accessmedicine.com/content.aspx?aID=16668361.

  5. Mechanisms of Arrhythmias

  6. Mechanisms of ArrhythmiasEnhanced Automaticity • Susceptible tissues include SA & AV nodes, His-Purkinje system, & cells that lack spontaneous pacemaker activity (e.g., ischemic ventricular cells) • Stimuli • Beta-adrenergic stimulation • Hypokalemia • Mechanical stretch

  7. Mechanisms of ArrhythmiasTriggered Activity Sampson KJ, Kass RS. Chapter 29. Anti-Arrhythmic Drugs. In: Knollmann BC, ed. Goodman & Gilman's The Pharmacological Basis of Therapeutics. 12th ed. New York: McGraw-Hill; 2011. http://www.accessmedicine.com/content.aspx?aID=16668361.

  8. Mechanisms of ArrhythmiasRe-Entry Sanoski CA, Bauman JL. Chapter 25. The Arrhythmias. In: Wells BG, ed. Pharmacotherapy: A Pathophysiologic Approach. 8th ed. New York: McGraw-Hill; 2011. http://www.accesspharmacy.com/content.aspx?aID=7972803.

  9. Pharmacologic Approaches to Terminating Tachyarrhythmias • Decrease automaticity of ectopic foci • Facilitate conduction (shorten refractory period) in an area of unidirectional block • Depress conduction (prolong refractory period) in either part of the re-entry circuit

  10. http://www.cvpharmacology.com/antiarrhy/sodium-blockers.htm

  11. Pharmacology of Antiarrhythmic Drugs

  12. Pharmacology of Antiarrhythmic Drugs

  13. Pharmacology of Antiarrhythmic Drugs

  14. http://www.cvpharmacology.com/antiarrhy/potassium-blockers.htmhttp://www.cvpharmacology.com/antiarrhy/potassium-blockers.htm

  15. Pharmacology of Antiarrhythmic Drugs

  16. Sanoski CA, Bauman JL. Chapter 25. The Arrhythmias. In: DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM, eds. Pharmacotherapy: A Pathophysiologic Approach. 8th ed. New York: McGraw-Hill; 2011. http://www.accesspharmacy.com/content.aspx?aID=7972803. Accessed August 7, 2013.

  17. ACC/AHA/ESC Guidelines for the Management of Patients with Atrial Fibrillation. J Am CollCardiol2001;38:1266.

  18. CAST Investigators. N Engl J Med 1989;321:406-12.

  19. Risk Factors for Ventricular Proarrhythmia with Antiarrhythmic Drugs

  20. Examples of QTc Prolonging Drugs • Psychotropics • Haloperidol • Risperidone • Ziprasidone • Olanzapine • Quetiapine • Antidepressants • SSRIs • Tricyclic antidepressants • Anti-infectives • Macrolide antibiotics • Quinolone antibiotics • Bactrim • Azoleantifungals • Methadone • Quinine • Promethazine • Tacrolimus http://www.crediblemeds.org/everyone/composite-list-all-qtdrugs/

  21. Bauman JL. Eur Heart J2001;3:K93-K100.

  22. Common Antiarrhythmic Drug Interactions • Avoid/Contraindicated • QTc prolonging drugs • Amiodarone, Dronedarone • Strong CYP3A4 inhibitors • Dofetilide • Verapamil • Cimetidine • Hydrochlorothiazide • Trimethoprim • Propafenone, Flecainide • HIV protease inhibitors • Use caution • Amiodarone, Dronedarone • Warfarin • Statins • Digoxin • Propafenone • Strong CYP2D6 inhibitors • Moderate CYP3A4 inhibitors • Flecainide • Moderate/strong CYP2D6 inhibitors • Itraconazole • Ketoconazole • Prochlorperazine • Megestrol

  23. Antiarrhythmic Drug Selection for Maintaining Normal Sinus Rhythm No/Minimal Structural Heart Disease Hypertension Coronary Artery Disease Heart Failure Substantial LVH ≠ LVH Dronedarone Flecainide Propafenone Sotalol Amiodarone Amiodarone Dofetilide Dofetilide Sotalol Amiodarone Dofetilide Catheter Ablation Amiodarone Dofetilide Catheter Ablation Wann LS, et al. Circulation 2011;123:104-23.

More Related