Antiarrhythmic Drugs

Department of Therapy

Presented by: Mohamed Fazneen Latheef

Group no:17
6th Year
 INTRODUCTION
Drugs 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 classification
Class 1a Quinidine, Procainamide,
Disopyramide
Lidocaine, Mexiletine,
Class 1b Tocainide

Class 1c Flecainide,Propafanone

Beta adrenergic blocking

agents
Class 2

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 Vaughan Williams classification
Class 3 Amiadarone, Sotalol,
Bretylium,
Ibutilide,Dofetilide

Verapamil, Diltiazem
Class 4

Adenosine, Digoxin
Others

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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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 Quinidine
Class 1a
Daily dose 250-500mg orally
Protein binding 75%
Half life 6hours
Plasma therapeutic 2-5microgram/ml
Indication AF
PSVT
VT
VPB
WPW

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 Side effects of Quinidine
• Nausea
• Diarrhoea
• Blood Dyscrasia
• Rash
• Fever
• Cinchonism
• Syncope

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 Disopyramide
Class 1a
Daily dose 100-250mg thrice oral
Protein binding 40-90%
Half life 5hours
Plasma therapeutic 3-6microgram/ml
Indication AF
PSVT
VT
VPB
WPW

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 Disopyramide SE
• Hypotension
• Anticholinergic effects
• Dry mouth
• Urinary hesitancy
• Blurred vision
• Heart failure

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 Lidocaine
Class 1b
Daily dose 1-4mg/min
Protein binding 50-80%
Half life 1.5-2hours
Plasma therapeutic 2-6microgram/ml
Indication VT/VF
MI
VPB

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 Lidocaine SE
• Confusion
• Convulsion

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 Mexiletine
Class 1b
Daily dose 400-800mg orally
Protein binding 70%
Half life 15hours
Plasma therapeutic 0.5-2microgram/ml
Indication VT
MI

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 Mexiletine SE
• Confusion
• Tremor
• Bradycardia
• Hypotension

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 Flecainide
Class 1c
Daily dose 100mg twice orally
Protein binding 50%
Half life 18hours
Plasma therapeutic 0.2-0.8microgram/ml
Indication VT
PSVT
WPW

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 Flecainide SE
• Dizziness
• Visual disturbance
• Arrhythmogenesis

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 Propafenone
Class 1c
Daily dose 150mg thrice
Protein binding 85%
Half life 6hours
Plasma therapeutic 0.2-1.5microgram/ml
Indication VT/VF
PSVT
WPW

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 Propafenone SE
• Light headedness
• Unusual taste
• Headache
• Constipation
• Arrhythmogenesis

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 Amiodarone
Class 3
Daily dose 200mg twice orally
Protein binding 98%
Half life 50days plus
Plasma therapeutic 0.2-5micrograms/ml
Indication VT/VF
WPW
PSVT
AF

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 Amiodarone SE
• Corneal deposits
• Photosensitivity
• Skin pigmentation
• Thyroid disturbance
• Pulmonary alveolitis
• Nightmares
• Liver disease
• Neurological

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 Sotalol
Class 2/3
Daily dose 80-160mg thrice orally
Protein binding <10%
Half life 24hours
Plasma therapeutic 0.3-1.5micrograms/ml
Indication VT
WPW
PSVT

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 Sotalol SE
• Ventricular arrhythmias
• Bradycardia
• Heart failure
• Bronchospasm
• Hypotension

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 Verapamil
Class 4
Daily dose 0.1mg/kg IV
Protein binding 90%
Half life 6hours
Plasma therapeutic 0.1-0.3micrograms/ml
Indication PSVT

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 Verapamil SE
• Nausea
• Vomiting
• Constipation
• Flushing
• Headache
• Bradycardia
• Fluid retention
• Hypotension

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 Diltiazem
Class 4
Daily dose 60-120mg thrice orally
Protein binding 80%
Half life 2-8hours
Plasma therapeutic 0.02-0.16microgm/ml
Indication PSVT

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 Diltiazem SE
• Nausea
• Vomiting
• Constipation
• Flushing
• Headache
• Bradycardia
• Fluid retention
• Hypotension

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 Digoxin
Class N/A
Daily dose 0.25mg once orally
Protein binding 25%
Half life 36hours
Plasma therapeutic 1.3-2.6millimol/L
Indication AF/AFL
PSVT

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 Digoxin SE
• Nausea
• Anorexia
• Vomiting
• Visual disturbances
• Bradycardia
• Gynaecomastia

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