Anti-Arrhythmic Drugs

Na channel blocker

moderate block, lower phase0 upstroke rate, prolong AP

used for SVT, AF, VT

SE: long QT

class IA Na blocker

diarrhea, vagolytic, low platelet, torsades, DDI

class IA Na blocker

lupus-like syndrome, agranulocytosis, slow/fast metabolism, torsades

class IA Na blocker

anti-cholinergic (dry mouth, urine retention), negative inotrope

used for hypertrophic cardiomyopathy w/ AF

mild Na blocker w/ rapid kinetics for activated Na channels (>ventricles), reduces AP

used for VT

careful w/ renal dysfcn

class IB Na blocker

neurologic/CNS-confusion/ dizziness/ seizures, sinus slowing

class IB Na blocker

neurologic/CNS-confusion/ dizziness/ seizures, GI

marked Na blocker, most potent, slow kinetics for active channels, widens QRS

class IC Na blocker

paresthesias, diplopia, chest pain, proarrhythmatic

class IC Na blocker

paresthesias, diplopia, chest pain, proarrhythmatic

Beta-blockers

slow sinus rate, prolong AV node conduction and refractoriness, inhibit automaticity, block effect of catecholamines

used for SVT, VT, control V rate in AF, mortality benefit in MI and CHF

K channel blocker

prolong refractoriness, reduce reentry and automaticity

used for AF, VT

SE: long QT, torsades due to long AP duration, exacerbated by hypo K/Mg

class III

reverse-use dependence

renal dysfcn

class III

renal dysfcn

class III

features of all 4 Vaughan Williams classes, most effective drug for AF and VT/VF

class III

class III

Ca channel blocker, block Ltype (phase 4&0)

prolong AVnode conduction and refract, SA slowing, reduce automaticity

used for AF/AFlutter, tx of SVT

SE: bradycardia, CHF, fatigue, dizziness, constipation, hypoTN, gingival hyperplasia, edema

class IV

class IV

increases vagal tone via CNS binding to Na pumps in neuronal plasma membranes

decreases AV nodal conduction, increase AV nodal refractoriness

used for AF w/ rapid response in CHF pt

SE: narrow therapy window, AVblock, n/v, arrhythmia, visual distrub

binds A1 R, decreases AVnode conduction (If, Ca) and slows SA

SVT

half life <10sec

SE: SA slowing, AV block, shortens refract>AF, flushing, headache, chest pain, bronchospasm

blocks action of ACh at parasym sites

used for sinus bradycardia or AV block

SE: tachy, urinary retention, glaucoma, blurred/dilated pupils, constipation, anhidrosis, delirium

Class II, IV

Class IA, IC, II, III, IV, digoxin

consider anticoagulation

Class IA, IC, II, III, IV, adenosine

Class II, IV

Class I, II, III

atropine