Department of Therapy Presented by: Mohamed Fazneen Latheef Group no:17 6 th Year Antiarrhythmic Drugs
Aug 17, 2014
Department of Therapy
Presented by: Mohamed Fazneen LatheefGroup no:17
6th Year
Antiarrhythmic Drugs
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INTRODUCTIONDrugs that modify the rhythm and
conduction of the heart are used to prevent cardiac arrhythmias.
All such drugs may aggravate or produce arrhythmias and they may also depress ventricular contractility.
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Vaughan Williams classificationClass 1a
Class 1b
Class 1c
Class 2
Quinidine, Procainamide, Disopyramide
Lidocaine, Mexiletine, Tocainide
Flecainide,Propafanone
Beta adrenergic blocking agents
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Vaughan Williams classificationClass 3
Class 4
Others
Amiadarone, Sotalol, Bretylium, Ibutilide,Dofetilide
Verapamil, Diltiazem
Adenosine, Digoxin
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Class 1 Drugs• These are membrane depressant
drugs.• They reduce the rate of entry of
sodium into the cell• They may slow conduction,delay
recovery or reduce the spontaneous discharge of myocardial cells
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Class 2 Drugs• These anti-sympathetic drugs
prevent the effects of catecholamines on the action potential.
• Most are beta adrenergic antagonists• Cardioselective beta blockers
include,metoprolo,atenalol,acebutalol
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Class 3 Drugs• These prolong the action potential
and do not effect sodium transport through the membrane.
• Two major classes: Amiadarone and Sotalol(Beta blocker)
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Class 4 Drugs• The non-dihydropyridine calcium
antagonists that reduce the plateau phase of the action potential and particularly effective at slowing conduction in the nodal tissue.
• Verapamil n Diltiazem are the most important drugs in this group
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QuinidineClassDaily doseProtein bindingHalf lifePlasma therapeuticIndication
1a250-500mg orally75%6hours2-5microgram/mlAFPSVTVTVPBWPW
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Side effects of Quinidine• Nausea• Diarrhoea• Blood Dyscrasia• Rash• Fever• Cinchonism• Syncope
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DisopyramideClassDaily doseProtein bindingHalf lifePlasma therapeuticIndication
1a100-250mg thrice oral40-90%5hours3-6microgram/mlAFPSVTVTVPBWPW
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Disopyramide SE• Hypotension• Anticholinergic effects• Dry mouth• Urinary hesitancy• Blurred vision• Heart failure
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LidocaineClassDaily doseProtein bindingHalf lifePlasma therapeuticIndication
1b1-4mg/min50-80%1.5-2hours2-6microgram/mlVT/VFMIVPB
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Lidocaine SE• Confusion• Convulsion
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MexiletineClassDaily doseProtein bindingHalf lifePlasma therapeuticIndication
1b400-800mg orally70%15hours0.5-2microgram/mlVTMI
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Mexiletine SE• Confusion• Tremor• Bradycardia• Hypotension
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FlecainideClassDaily doseProtein bindingHalf lifePlasma therapeuticIndication
1c100mg twice orally50%18hours0.2-0.8microgram/mlVTPSVTWPW
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Flecainide SE• Dizziness• Visual disturbance• Arrhythmogenesis
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PropafenoneClassDaily doseProtein bindingHalf lifePlasma therapeuticIndication
1c150mg thrice85%6hours0.2-1.5microgram/mlVT/VFPSVTWPW
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Propafenone SE• Light headedness• Unusual taste• Headache• Constipation• Arrhythmogenesis
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AmiodaroneClassDaily doseProtein bindingHalf lifePlasma therapeuticIndication
3200mg twice orally98%50days plus0.2-5micrograms/mlVT/VFWPWPSVTAF
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Amiodarone SE• Corneal deposits• Photosensitivity• Skin pigmentation• Thyroid disturbance• Pulmonary alveolitis• Nightmares• Liver disease• Neurological
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SotalolClassDaily doseProtein bindingHalf lifePlasma therapeuticIndication
2/380-160mg thrice orally<10%24hours0.3-1.5micrograms/mlVTWPWPSVT
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Sotalol SE• Ventricular arrhythmias• Bradycardia• Heart failure• Bronchospasm• Hypotension
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VerapamilClassDaily doseProtein bindingHalf lifePlasma therapeuticIndication
40.1mg/kg IV90%6hours0.1-0.3micrograms/
mlPSVT
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Verapamil SE• Nausea• Vomiting• Constipation• Flushing• Headache• Bradycardia• Fluid retention• Hypotension
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DiltiazemClassDaily doseProtein bindingHalf lifePlasma therapeuticIndication
460-120mg thrice
orally80%2-8hours0.02-0.16microgm/mlPSVT
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Diltiazem SE• Nausea• Vomiting• Constipation• Flushing• Headache• Bradycardia• Fluid retention• Hypotension
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DigoxinClassDaily doseProtein bindingHalf lifePlasma therapeuticIndication
N/A0.25mg once orally25%36hours1.3-2.6millimol/LAF/AFLPSVT
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Digoxin SE• Nausea• Anorexia• Vomiting• Visual disturbances• Bradycardia• Gynaecomastia