Antiarrhythmic Drugs

Class Subclass Drugs Efect on repolarization Other

I: Na Channel blockers
I A Qunidine
Procainamide
Disopyramide
Prolonged
Slows phase 0
depolarizaion
I ! "idocaine
#e$ileine
Phenyoin
Acceleraed
Shorens phase %
repolarizaion
I C &lecainide
Propa'enone
"ile e(ec #arkedly slows phase 0
depolarizaion
II: !ea blockers )Ca* Propanalol
Aenolol
+smolol
Soalol
III: Inhibiors o'
repolarizaion ),*
Amiodarone
Soalol
Ibuilide
Do'eilide
I-: Calcium channel
blockers
-erapamil
Diliazem
DRUG PK EC!A"#S USES AD$ERSE %O&#C#%#ES O%!ER
'a(min)elim
*
E++EC%S
Quinidine
)Class IA*
p.o. sul'ae or
gluconae
i.m.
gluconae
hepaic me
/. block Na channels in
aci0aed sae
-ma$ in phase 0
a. depression o'
auomaiciy1
conducion1 e$ciabiliy2
reco0ery 'rom block is
slower and less
complee in depol han
'ully pol issue
prolonged re'racory
period esp in depol
issue
3. block , channels
prolonged AP
a. prolonged AP1 +4P1
and ma$ reenry
're5uency
%. animuscarinergic
e(ec a low doses
parado$ical in A-
conducion
6. blocker a high conc
+C7 e(ecs:
/. prolong Q4S due o
delayed conducin in
bundle o' 8is and
purkin9e :ners
3. prolong Q; and
alered ; wa0e due o
delayed repol
%. -ariable prolongaion
o' P4 due o e(ecs on
A- conducion and
re'racoryness
Supra0enricular arryhmias
a. Paro$ysmal
supra0enricular
achycardia )<P<
syndrome*
b. Con0er arial =uer>:b
o sinus rhyhm )3
nd
line $*
c. do no use w>ou prior
use o' dig
7I: N>->Diarrhea
CNS: Cinchonism
8>A
Dizziness
;innius
/. depression o'
myocardial
conraciliy
3. parado$ical
increase in sinus
rae and A-
conducion b>o
animuscarinergi
c acions
remo0al o'
proeci0e parial
A- block 0en
achy
%. ;orsades des
poines ?
polymorphic
0en achy )sel'
limiing*
6. Slowing o'
conducion o a
o$ic degree
+$racardiac
e(ecs:
@animalarial )3
nd

line*
@hypoensi0e b>o
blocker aci0iy
DRUG PK
'a(min)elim*
EC!A"#S USES AD$ERSE E++EC%S %O&#C#%#ES O%!ER
Procainamide
)Class I A*
p.o. />3 ? %hrs
hepaic elim
aceylae o N@
aceylprocaina
mide )NAPA*
/. block Na
channels in
aci0aed sae
3. block , channels
)esp NAPA*
%.
Animuscarinergic
bu less han
5uinidine
6. sympaholyic
aci0iy
DAC a'er lidocaine 'or
$ o' susained
0enricular arrhyhmias
ass w>acue #I
p.o. ? use susained
release preparaion
e0ery B hrs 'or
prolonged herapy
i.0. ? in'usion1 +C7@
monioring1 conrol
plasma le0els o' boh
procainamide and NAPA
Dose reducion: renal
'ailure1 sympomaic
C8&
Cardiac: same as
5uinidine
7I: same as 5uinidine
bu less 're5uen
CNS: menal con'usion
and psychosis1 less
're5uen han
w>lidocaine
8ypersensii0iy: more
o'en han w>5uinidine C
'e0er1 arhriis1 skin
rashes1 lupus
eryhemaosus like
syndrome re0ersible
8ypoension
Animuscarinic:
aggra0aes glaucoma1
urinary reenion
Disopyramide
)Class I A*
p.o. 'or $ o'
0enricular
arryhmias
DA 3
nd
C b>o
pronounced
animuscarinic e(ecs
Produces )@* inoropic
e(e greaer han weak
e(ec e$ered by
5unidine and
procainamide and also
causes peripheral
0asoconsricion
#ore pronounced )@*
inoropy
#ay induce cardiac
'ailure w>o pre@e$ising
myocardial dys'uncion
Aropine C like sysemic
A+1 including CNS
e(ecs
No recepor blocker
aci0iy
C"ASS I !
DRUG PK
'a(min)elim
*
EC!A"#S USES AD$ERSE E++EC%S %O&#C#%#ES O%!ER
"idocaine
AN"D i0
!inds o /@
acid@
glycoproine
;/>3 ? 3 hrs
8epaic
meabolism
)dealkylaed
and
eliminaed by
li0er so
dosage
ad9used o
ps w>li0er
dys'uncion
/. block aci0aed
and inaci0aed Na
channels
pronounced e(ecs
in issues w>long
plaeaus
)purkin9e>0en*
pronounced e(ecs
in depol issue
DAC in emergency $ o'
0en arrhyhmias )0@ach1
0@:b a'er cardio0ersion*
Suppression o' arrhyhmia
ass w> depol )pos #I1 dig
o$iciy*
NA; 'or prolonged
prophylacic use pos #I
Cardiac: e$acerbaion o'
arrhyhmias2 SA sandsill
in ps w>#I
CNS: Nausea1 remor1
pareshesias1
;o$ic: con0ulsions1 coma
In: agens ha iner'ere
w>hepaic per'usion or
hepaic microsomal
meabolism
#e$ileine
and
;ocainide
p.o
;/>3 ? E@3F
hrs
Same as lidocaine #e$ileine: chronic $ o'
0en arryhmias ass
w>pre0ious #I
;ocainide: 0enricular
achyarryhmias
;ocainide: pulmonary o$
pulm :brosis
A+ 're5uen e0en a
herapeuic doses
Neurologic: nausea1 remor1
blurred 0ision1 lehargy
Allergic: rash1 'e0er1
agranulocyosis
Phenyoin
p.o.
i.0.
/>3 0ariable
G/Hhrs
hepaic
microsomal
me
Same as lidocaine1
slighly
sympaholyic a
CNS
;$ 0enricular
arrhyhmias1 esp dig
relaed arryhmias
Neurologic: sedaion1
nysagmus1 0erigo1 loss o'
menal accuiy
7ingi0al hyperplasia
C"ASS I C
DRUG PK
'a(min)elim
*
EC!A"#S USES AD$ERSE E++EC%S %O&#C#%#ES O%!ER
&lecainide1
Propa'enone
Anly p.o. 'or
arial
arrhyhmias
in oherwise
uncompromis
ed hears
/>3? /B@30
hrs
Slow dissociaion 'rom
Na channel during
reco0ery
Supresses phase 0
upsroke in pukin9e and
myocardial :bers
marked slowing o'
conducion in all cardiac
issue w>minor e(ec o'
duraion o' AP and
re'racoriness
Auomaiciy reduced by
incr in hreshold
poenial raher han
dec in slope o' phase 6
depol
Arial arryhmias only
Increased moraliy
more han 3I in pos #I
ps $ed 'or premaure
0en conracions
8as )@* inoropic e(ec
and can aggra0ae
congesi0e hear 'ailure
C"ASS II
DRUG PK
'a(min)elim*
EC!A"#S USES AD$ERSE E++EC%S %O&#C#%#ES O%!ER
Propanalol
) blocker*
Cardio0ascular:
@depresses SA node f
sinus brady
@depresses auomaiciy
in purkin9e :bers
@prolongs +4P o' A- node
@supresses ecopic 0en
depols
@)@* inoropy
@di0erse )in*direc
hemodynamic e(ecs
@ risk o' sudden deah in
pos #I ps
@conrol supra0en achy
@e$ercise or sress
precipiaed 0en
arrhyhmias
@ischemic hear
disease>angina pecoris
Cardio0ascular:
@hypoension
@aggra0ae C8&
@aysolia
+$racardiac:
@ashha
@diabees
@peripheral arerial
occlusi0e disease
Acebuolol )/ seleci0e blocker*
+smolol ;/>3 ? F mins )/ seleci0e blocker*
C"ASS III
DRUG PK
'a(min)elim
*
EC!A"#S USES AD$ERSE E++EC%S %O&#C#%#ES O%!ER
Amiodarone ;/>3 ? /@6mos
#eabolie:
desehylamio
darone
"oading dose
'or 3 weeks
o reach
seady sae
/. !lock
inaci0aed Na
channels mos
pronounced e(ecs
in issues w>long
plaeaus )purkin9e1
0en*
3. !lock ,
channels
prolonged AP
%. <eak Ca
channel blocker
6. Non@compeii0e
!@blocker
@discoloraion o' skin
)urns 0iole*
amiodarone deposis
cause lung :brosis1
corneal deposis1
phoodermaiis
Neurologic:
pareshesias1 remor1
aa$ia1 headache
;hyroid dys'uncion
7I and "i0er o$iciy
Ineracions: dig1
heophyline1
war'arine1 5uinidine
Soalol p.o.>i.0.
/>3 ? /3 h
renal
e$creion o'
unchanged
drug
/. lock , channels
prolonged AP
3. Nonseleci0e
bea blocker
;$>prophyla$is o' se0ere
0enricular
achyarrhyhmias1 arial
arrhyhmias
/.same as hose o'
bea blockers
3. proarrhyhmic1
including orsades des
poines
C"ASS I-
DRUG PK
'a(min)elim
*
EC!A"#S USES AD$ERSE E++EC%S %O&#C#%#ES O%!ER
-erapamil1
Diliazem
!locks "@ye Ca
channels in
aci0aed and
inaci0aed sae
#os pronounced
e(e on A-
conducion
/. in re@enran
supra0enricular
achycardia
3. reducion o' 0enricular
rae in arial :b and
=uer
%. in ischemic hear
disease>angina pecoris
6. in hyperension
#ISC+""AN+AJS
DRUG PK
'a(min)elim
*
EC!A"#S USES AD$ERSE E++EC%S %O&#C#%#ES O%!ER
Adenosine i.0. in'usion
/>3?/0s
degraded by
adenosine
deaminase o
pharmacologi
cally inaci0e
inosine
+nhances ,
conducance and
inhibis cA#P
mediaed Ca in=u$

hyperpolarizaion1
especially in A-
node
&lushing
!ronchoconsricion
A- block
Arial :b
#agnesium &uncional Ca
anagonis
@$ o' orsades des
poines
@digialis induced
arrhyhmias
@prophyla$is o' arrhyhmia
in acue #I
Digo$in Jsed o slow down A-
conducions
Aropine Jsed in bradyarrhyhmias
o decrease 0agal one