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Summary Pharmacy Pharmacology Anti Arrythmics (Key points) Medical School
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Pharmacy Pharmacology Anti Arrythmics (Key points) Medical School
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Pharmacy Pharmacology Antihypertensive Drugs (Comprehensive:Key points) .pdf
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ANTI ARRHYTHMICSStates of Na+ channels: Ventricular myocyte:
1. Open – during upstroke (P0) Na blockers have inc. affinity a) slow down or reduce slope of or ↓upstroke (P0) – this is the main “Na+ channel blockade”
2. Inactivated – during plateau (P2) function
3. Resting/Closed – as the membrane repolarizes (P3) IA - moderate
IB – weak IC > IA > IB
Na & Ca blockers – alter threshold potential (TP) aka the CFL IC – strong
K blockers (class III function) – prolongation of repolarization (P3) → prolong (APD) action potential
duration → prolonged ERP b) some prolongs repolarization (P3) ---- additional potassium channel blockade ↑ APD →
increases ERP
Sodium channel blockade (Class I) IA - increase
SA node: ↓ automaticity by ↑TP (hard to create an action potential) & ↓slope of P4 or slow IB - shortens
P4 (slow spontaneous depolarization) IC – no effect
Class I: SODIUM Channel Blockers
Class IA (“PaQ, Die”) MODERATE Na+ blockade + ↑ ERP Anti-cholinergic/anti-muscarinic/Atropin-like effects : D > Q > P
DRUG CARDIAC EXTRACARDIAC EFFECTS CARDIAC EXTRACARDIAC TOXICITY KINETICS USES
EFFECTS TOXICITY
Procainamide SA nodal effect: Ganglion blocking Excessive slowing of Lupus-like syndrome (25 Different routes: Atrial and ventricular
Slows P4 depolarization properties conduction – 30 %) IV, IM, PO arrhythmias
→ ↓ abnormal ↓ peripheral Precipitation of new (arthralgia, pleuritis, (good absorption)
automaticity vascular resistance* arrhythmias such as pericadtitis, parenchymal NAPA metabolite - Class
↑ threshold for Orthostatic torsades de pointes lung dse., ↑ ANA) III activity (reason for
excitation in atrium and Hypotension (esp.IV) (TDP) Nausea & Diarrhea TDP) Sustained ventricular
ventricles – direct Syncope 10% Liver metabolism and arrhythmias with acute
depressant action WEAK ANTICHOLINERGIC Hepatitis renal excretion MI (second choice)
Ventricular myocyte effects EFFECTS Fever
mentioned above: Constipation Rash Half-life is 3-4 h (frequent
↓ PO Dry mouth Agranulocytosis dosage)
↑P3 → ↑APD → ↑ERP Tachycardia (Cardiac) Dose reduction in renal
Urinary retention failure and heart failure
Blurred vision
Quinidine Similar to procainamide Excessive slowed Diarrhea, nausea, Rapid absorption after Occasional:
More cardiac anti- conduction vomiting oral intake Atrial flutter/fib
muscarinic effects than TDP Hepatitis Binds to albumin and (supraventricular)
procainamide Excessive QT interval Fever glycoprotein
prolongation Cinchonism (less free active)
Dizziness
DizTinHea Hepatic metabolism
Tinnitus
(Destiny)
Headache Half-life: 6-8 hrs
Thrombocytopenia Slow release formulations
Angioneurotic edema
Disopyramide Similar to procainamide Similar to quinidine: ATROPINE-LIKE Oral Ventricular arrhythmias
& quinidine Excessive slowed EFFECTS Reduced dose in renal
least appropriate/ most Greater cardiac anti- conduction Constipation failure
dangerous class I drug muscarinic effect than TDP Dry mouth
quinidine (drug that Excessive QT interval Tachycardia (Cardiac)
slows AV conduction is prolongation Urinary retention
given with it) Precipitation of heart Blurred vision
failure Glaucoma worsening
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