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18 Antiarrhythmics

Chapter 18 Pharmacology of Cardiac Rhythm

QuestionAnswer
Class IA Antiarrhythmics Block of voltage-gated Na+ channels and K+ channels in vent. myocytes (decr. phase 0 upstroke velocity and prolongs repolar.) and SA nodal cells (shifts threshold to more + potentials and decr. slope of phase 4 depolar.) CONTRA: Prolonged QT interval
Quinidine + Vagolytic effect ADV: torsades de pointes, complete AV block, vent. tachycardia, agranulocytosis, thrombocytopenia, hepatotoxicity, acute asthma attack, resp. arrest, angioedema, rare occurrence of systemic lupus *Quinidine-induced digoxin toxicity
Procainamide ADV: Same as quinidine, except fewer anticholinergic effects. Lupus-like syndrome may occur after prolonged use.
Disopyramide Same as quinidine, except more profound anticholinergic effects and fewer GI effects.
Class IB Antiarrhythmics Use-dependent block of voltage-gated Na+ channels in ventricular myocytes (decreases phase 0 upstroke velocity); may also shorten repolarization CONTRA: Stokes-Adams syndrome
Lidocaine √Ventricular arrhythmias in the context of MI ADV: Seizures, asystole, bradycardia, cardiac arrest, new or worsened arrhythmias, respiratory depression, anaphylaxis, status asthmaticus
Mexiletine Oral analogue of lidocaine.
Phenytoin √Seizures ADV: Agranulocytosis, leukopenia, pancytopenia, thrombocytopenia, hepatitis, Stevens-Johnson syndrome, toxic epidermal necrolysis. *Inducer of P450 3A4
Class IC Antiarrhythmics Marked block of voltage-gated Na+ channels in ventricular myocytes (decreases phase 0 upstroke velocity)
Created by: Cepheus_5
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