pharmacology i drugs used to treat arrhythmias. arrhythmias needing treatment: atrial...

Download Pharmacology I Drugs Used to Treat Arrhythmias. Arrhythmias Needing Treatment: Atrial Fibrillation/Flutter (AF) Supraventricular Tachycardia (SVT) Ventricular

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  • Slide 1
  • Pharmacology I Drugs Used to Treat Arrhythmias
  • Slide 2
  • Arrhythmias Needing Treatment: Atrial Fibrillation/Flutter (AF) Supraventricular Tachycardia (SVT) Ventricular Tachycardia (VT)
  • Slide 3
  • Drug Classifications: Ia Used For: Used to treat SVT, AF, VT Mechanism: Blocks Na+ Channels (slows action potential) ECG Effects: QRS and Q-T interval Examples: Quinidine (Quinora), Procainamide (Pronestyl), Disopyramide (Norpace)
  • Slide 4
  • Other Effects: Class Ia Slight increase in resting HR Causes peripheral vasodilation Which decreases TPR Which decreases BP Supresses PVCs Quinidine Toxicity: Prolonged Q-T: Causes polymorphic VT Torsades de Pointe Syncope
  • Slide 5
  • Exercise Capacity: Class Ia Drugs (ACSM Manual) No Change in Exercise Tolerance Exercise ECG: Prolonged Q-T intervals False Positive ST changes Exercise HR/BP unaffected
  • Slide 6
  • Drug Classification: Ib Used For: VT Mechanism: Blocks Na+ channels ECG Effects: Decreased Q-T Interval Examples: Lidocaine (Xylocaine), Tocainide (Tonocard), Phenytoin (Dilantin)
  • Slide 7
  • Other Effects: Class Ib Increases Preload Decreases Contractility (Reduces Ejection Fraction) Lidocaine Toxicity: May reduce CO and BP excessively Nevertheless: Well tolerated by CHF patients NO Significant Exercise Effects
  • Slide 8
  • Drug Classification: II Used For: SVT and AF Mechanism: Blocks Beta receptors for SNS and Adrenal stimulation ECG Effects: Prolong P-R interval and reduce HR Examples - Beta Adrenergic Blockers: Inderal, Lopressor, Corzide
  • Slide 9
  • Other Effects: -Blockers Reduce risk of prolonged Q-T intervals Reduces all types of tachycardias Adverse Effects: May disrupt glucose control and Hypoglycemic symptoms in Diabetics May exacerbate Cardiac failure in CHF Sudden Withdrawal is DANGEROUS
  • Slide 10
  • Exercise Effects: II Very Common Cardiac Drugs Exercise Tolerance: Improved in patients with angina Decreased in non-anginal patients Exercise ECG: HR and ischemic changes Hemodynamics: HR and BP at rest and Exercise
  • Slide 11
  • Drug Classification: III Used For: SVT, VT and AF Mechanisms: Na+/K+ channel blocker and many others ECG Effect: Prolong Q-T Examples: NAPA, Amiodarone
  • Slide 12
  • Other EffectsIII Other Effects: III Slows HR Decreases TPR (BP too) Increases Coronary Artery blood flow Slightly reduces contractility ADVERSE: symptomatic sinus brady, AV blocks, sinus arrest
  • Slide 13
  • Exercise Effects: III Exercise Tolerance: No change Exercise ECG: Decreased HR Hemodynamics: Decreased HR
  • Slide 14
  • And Finally: Class IV
  • Slide 15
  • Drug Classification: IV Used For: SVT and AF Mechanisms: Ca++ Channel Blockers ECG Effects: Decrease HR and Increase PR- Interval Examples: Verapamil (Calan), Diltiazem (Cardizem)
  • Slide 16
  • Other Effects: Class IV Used more for other cardiac effects especially hypertension and ischemia Uncontrolled AF: Reduces Ventricular rate in AF (>100) Adverse Effects: Hypotension, bradycardia and rarely, ventricular asystole
  • Slide 17
  • Exercise Effects: IV Exercise Tolerance: Improved in patients with angina Exercise ECG: Reduced HR and ischemic ST changes Hemodynamics: Reduced blood pressure
  • Slide 18
  • What About Digitalis?
  • Slide 19
  • Cardiac Glycosides: Nightshade plant Used For: SVT and AF Mechanisms: Inhibits Na+/K+- ATPase activity (maintains resting potential) ECG Effects: QRS and Q-T Examples: Lanoxin
  • Slide 20
  • Other Effects: Digitalis Most commonly used to treat CHF Great Risk of Toxicity: Serum levels monitored closely Tachyarrhythmias Anorexia Halo Vision when looking at lights
  • Slide 21
  • Exercise And Digitalis: Exercise Tolerance: Improved in patients with CHF or AF ECG Effects: Scooping ST segment Hemodynamics: Some decrease in patients with AF /CHF

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