Anti-arrhythmia Pharma PDF

Non-pharmacological techniques for arrhythmia treatment are preferred because: Arrhythmogenic effect of the drugs used in treatment of arrhythmias. Efficacy of these methods. Nonpharmacological techniques include: Ablation technique Implantable cardioverter defibri...

Non-pharmacological techniques for arrhythmia treatment are preferred because: Arrhythmogenic effect of the drugs used in treatment of arrhythmias. Efficacy of these methods. Nonpharmacological techniques include: Ablation technique Implantable cardioverter defibrillator Artificial pacemaker. Vagal stimulation. DC shock Class I Ib Ic Ia {block Na / open K / ↓APD} { block Na { block Na & K & ↑APD} No effect on K No effect on APD } Quinidine { Cinchona bark} Procainamide Disopyramide Lidocaine Mexiletine Phenytoin Flecainide & Propafenone Block α- NO MORE local anesthetic Orally Orally No longer oral Indicated adrenoreceptors→Vas α-blocking effect Anticholinergi Because they c effect half-life → 1.5 hour. Not given May be given :- odi-lation → LESS given I.V bolus are hypotension anticholinergic NO at ICU, given proarrhythmic injection followed by a IV but cause anticholinergic effects α- blocking maintenance infusion. to the patient and cause effects at home. thrombophlebitis cardiac arrest effects→ ↑HR IM but painful Atropine like effect Therapeutic uses: - Therapeutic uses:- Therapeutic uses :- Therapeutic Therapeutic uses:- All atrial arrhythmia Ventricular & uses :- epileptic AF – SVT – Atrial flutter supraventricular In most ventricular seizures. tachycardia. arrhythmia In ventricular Used at high doses. ventricular arrhythmias. {2 / 3 times / day} Oral OR IV. Arrhythmia associated with arrhythmia MI Metabolized by In digitalis induced acetylation in arrhythmias liver. local anesthetic Adverse effects: - Adverse effects: - High Risk of Adverse effects: - Adverse effects: - Cinchonism In slow acetylators torsade de Muscle twitching Gum {headache- blurred vision – → accumulation → pointes Drowsiness -Confusion hyperplasia tinnitus- vomiting- diarrhea}. SLE like symptoms Slurred speech -Seizures Hirsutism Idiosyncrasy {allergy} Teratogenicity Embolism Paradoxical tachycardia Megaloblastic Quinidine syncope anemia→→→ Hypotension {damage folic Torsade de pointes acid} Microsomal Enzyme inducer damage Warfarin, Oral hypoglycemics, Oral contraceptives [so, pregnancy may occur] and damage the vitamins (K, D&A) may cause thrombocytopenia. [So, patient must take vitamins]. Class II { β- blockers } Class III { K channel blocker } Class IV Ca channel blocker Dronedarone Esmolol – propranolol- Amiodarone - Cordarone Dofetilide Verapamil sotalol It is a heavily iodinated { 40%} sotalol ↑ APD Phase 0 → ↓ excitability Block K channel. Structural Pure K blocker Supraventricular Phase 4 → ↓ sloping Blocking Na+ channels analogue of arrhythmia amiodarone Blocking α and β adrenergic receptors without ↓ conductivity Weak Ca++ channel blockers iodine Wolff-Parkinson-White syndrome -ve inotropic. Blocks Half life 7 days. K, Ca, Na & β receptors Reach Steady state after month. Take a month to be eliminated from the body. Supraventricular arrhythmias Supraventricular & particularly in:- ventricular arrhythmias. Thyrotoxicosis& pheochromocytoma adverse effects :- No thyroid & alteration of thyroid function pulmonary (Hypothyroidism) toxicity pulmonary fibrosis cough Corneal microdeposits Photosensitivity pulmonary infiltration myopathy peripheral neuropathy hepatotoxicity sleeplessness A-V block and sinus bradycardia Other antiarrhythmic Adenosine Digoxin Magnesium sulfate Drug of choice in supraventricular in emergency. Drug of choice in supraventricular in Torsade de pointes home {prophylaxis} , not in emergency. Cause bronchospasm so contraindicated in asthmatic patients. Dose : 6-12 mg Supra ventricular arrhythmia In emergency Adenosine Prophylaxis At home Digitalis /Β- blocker /Ca channel blocker /amiodarone. In Ventricular arrhythmia emergency Class Ib → lidocaine DC shock Home Mexiletine /phenytoin Torsade de pointes Magnesium sulfate. Wolf Parkinson white syndrome amiodarone drugs block K channel Sotalol / Dofetilide / dronedarone / Cordarone / class Ib N.B Bradyarrhythmia is treated by atropine OR corticosteroids.