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This Concept Map, created with IHMC CmapTools, has information related to: Antiarrhythmics, Arrhythmia AFib/AFlutter 1st - control rapid V rate -beta-blockers -Ca++ channel blockers -digoxin (these don't help atrium) 2nd-convert rhythm to sinus -DC Cardioversion -Class III (ibutilide, dofetilide) Long-term suppression: -Class I or III - lots of ADRs -OR can stabilize V + anti-coag If WPW-no digoxin or verapamil ->VTach, Arrhythmia Class III - K+ blockers -MOST COMMONLY USED 1st - control rapid V rate -beta-blockers -Ca++ channel blockers -digoxin (these don't help atrium) 2nd-convert rhythm to sinus -DC Cardioversion -Class III (ibutilide, dofetilide) Long-term suppression: -Class I or III - lots of ADRs -OR can stabilize V + anti-coag If WPW-no digoxin or verapamil ->VTach, Arrhythmia Class II - beta-blockers Acute PSVT, WPW - need AV block - Adenosine - Ca++ blocker - verapamil - beta-blocker - esmolol Long-term - - Ca++ blocker - beta-blocker - digoxin, Arrhythmia Other ADENOSINE A1K+ activation ->(-) chronotropy ->(-) inotropy For PSVT, WPW, SVT, SV Dx -NOT atrial problems Caution: dipyridamole increases concentration T1/2=10s, Arrhythmia Class III - K+ blockers -MOST COMMONLY USED Wide QRS complex -120 BPM -usually MI->block, reentry -decreases CO, can->VFib Tx- if no pulse - DC Cardioversion -if recurrent: -IV Amiodarone or bolus -IV procainimide -ICD if sustained ɮd post-MI -if benign: sustained or PVCs -Amiodarone -Sotalol If TCA overdose: use NaHCO3, Arrhythmia V Tach Wide QRS complex -120 BPM -usually MI->block, reentry -decreases CO, can->VFib Tx- if no pulse - DC Cardioversion -if recurrent: -IV Amiodarone or bolus -IV procainimide -ICD if sustained ɮd post-MI -if benign: sustained or PVCs -Amiodarone -Sotalol If TCA overdose: use NaHCO3, Arrhythmia CLASS IV - Ca++ Blockers Acute PSVT, WPW - need AV block - Adenosine - Ca++ blocker - verapamil - beta-blocker - esmolol Long-term - - Ca++ blocker - beta-blocker - digoxin, Arrhythmia Supraventricular Tach Acute PSVT, WPW - need AV block - Adenosine - Ca++ blocker - verapamil - beta-blocker - esmolol Long-term - - Ca++ blocker - beta-blocker - digoxin, Arrhythmia Class III - K+ blockers -MOST COMMONLY USED Chemical defib - block INACTIVE K+ ->Prolong Phase 3 Repol (QT interval) ->Decrease automaticity Indications-Aflutter, SVT, V Tach WPW-drug of choice BRETYLIUM-not used AMIODARONE-block alpha/beta, Na, Ca too ->decrease vent conduction ->pulm fibrosis, gray skin, eye deposits, increase [flecainide], hypo/hyper-thyroid -inhibitor of CYP 2C9-elevate warfarin, dig ->TORSADES -reverse rate INDEPENDENT -T1/2=60-120d SOTALOL-beta-blocker; RR DEpendent ->TORSADES IBUTILIDE-ONLY for Afib/Aflutter ->TORSADES DOFETILIDE-AFib/AFlutter ->TORSADES AZIMILIDE-lower torsades, Arrhythmia WPW Long-term Tx: Amiodarone Class IA Adenosine, Arrhythmia CLASS IV - Ca++ Blockers 1st - control rapid V rate -beta-blockers -Ca++ channel blockers -digoxin (these don't help atrium) 2nd-convert rhythm to sinus -DC Cardioversion -Class III (ibutilide, dofetilide) Long-term suppression: -Class I or III - lots of ADRs -OR can stabilize V + anti-coag If WPW-no digoxin or verapamil ->VTach, Arrhythmia Class III - K+ blockers -MOST COMMONLY USED Most common cause of sudden cardiac death 300-400/min depols -irregular -due to disorganized reentry Tx: electrical defib -if VF persists after 3 shocks ->IV epinephrine + amiodarone + continued defib attempts -maybe try lidocaine if all else fails Long-term, if VT or VF 24-48 hrs post-MI - ICD + beta-blocker, Arrhythmia Class I - Na+ Blockers Class IA - block activated channels -slowed PHASE 0 -some anti-mucarinic -can ->TORSADES, cinchonism -Block K+ too -slow PHASE 3 REPOL Indications: WPW, SV or VT (preload w/ DIGITALIS) QUINIDINE->diarrhea common PROCAINAMIDE->met to NAPA (III) ->SLE DISOPYRAMIDE-greatest (-) inotropy (don't use in MG)-very anti-musc -for vent arrhythmias, Arrhythmia V Fib Most common cause of sudden cardiac death 300-400/min depols -irregular -due to disorganized reentry Tx: electrical defib -if VF persists after 3 shocks ->IV epinephrine + amiodarone + continued defib attempts -maybe try lidocaine if all else fails Long-term, if VT or VF 24-48 hrs post-MI - ICD + beta-blocker, Arrhythmia Class I - Na+ Blockers 1st - control rapid V rate -beta-blockers -Ca++ channel blockers -digoxin (these don't help atrium) 2nd-convert rhythm to sinus -DC Cardioversion -Class III (ibutilide, dofetilide) Long-term suppression: -Class I or III - lots of ADRs -OR can stabilize V + anti-coag If WPW-no digoxin or verapamil ->VTach, Arrhythmia Class I - Na+ Blockers Class IB - block inactive channels -in ISCHEMIC, DIGOXIN TOXICITY ->shorten PHASE 3 repol Indications - Vent arrhythmias LIDOCAINE MEXILETINE TOCAINIDE->agranulocytosis, Arrhythmia CLASS IV - Ca++ Blockers Block interior Ca++ channels ->decrease inward Ca current -dec AV conduction ->inc AV refractory period -decreased PHASE 4 K, Na block, alpha block -(-) inotropy Indications: acute SVT -reduce V rate in AFib/Flutter -NOT WPW, VTach (can accel) VERAPAMIL-increase [digoxin] DILTIAZEM, Arrhythmia Class II - beta-blockers 1st - control rapid V rate -beta-blockers -Ca++ channel blockers -digoxin (these don't help atrium) 2nd-convert rhythm to sinus -DC Cardioversion -Class III (ibutilide, dofetilide) Long-term suppression: -Class I or III - lots of ADRs -OR can stabilize V + anti-coag If WPW-no digoxin or verapamil ->VTach, Arrhythmia Class II - beta-blockers Block beta receptors - vagal dominates ->suppress PHASE 4 depol -decrease automaticity ->decrease inotropy, chronotropy ->decrease CO ->decrease AV conduction-prolong PR Indications: catechol-gen'd tachy -SV tachs, PSVT, Aflutter/Afib -post-MI (REDUCE SUDDEN DEATH) -NOT WPW or CHF pts PROPRANOLOL METOPROLOL, ACEBUTOLOL-beta1 CARVEDILOL-decrease free rad dmg ESMOLOL-cardiac surgery also block alpha-reduce infarction: LABETALOL DILEVALOL, Arrhythmia Other DIGITALIS -Na/K ATPase blocker -increase intracell [Ca++] ->increase refractory period ->increase PR interval (slow AV conduction) ->increase vagal activity ->decrease SA firing Indications: CHF, Aflutter/Afib (not as much bradycardia as beta-blockers) -NO WPW ADRs-ABNL automaticity (due to high [Ca++] -afterdepolarization) -Mg++ treats toxicity