INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com

www.indiandentalacademy.com
Dysrhythmia


Any deviation from the normal rhythm of the heart

Antidysrhythmics


Drugs used for the treatment and pre...


Inside the cardiac cell, there exists a net
negative charge relative to the outside of
the cell.

www.indiandentalacade...







This difference in the electronegative charge.
Results from an uneven distribution of ions
(sodium, potassium, ...
www.indiandentalacademy.com


A change in the distribution of ions causes
cardiac cells to become excited.



The movement of ions across the cardia...
Four Phases


The SA node and the Purkinje cells each have separate
action potentials.

www.indiandentalacademy.com
www.indiandentalacademy.com


System commonly used to classify
antidysrhythmic drugs

www.indiandentalacademy.com


Class 1









Class Ia
Class Ib
Class Ic

Class II
Class III
Class IV
Other

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Class I




Membrane-stabilizing agents
Fast sodium channel blockers
Divided into Ia, Ib, and Ic agents, according
to e...
Class I
moricizine




General Class I agent
Has characteristics of all three subclasses
Used for symptomatic ventricul...
Class Ia
quinidine, procainamide, disopyramide





Block sodium channels
Delay repolarization
Increase the APD
Used f...
Class Ib
tocainide, mexiletine, phenytoin, lidocaine





Block sodium channels
Accelerate repolarization
Decrease the...
Class Ic
encainide, flecainide, propafenone





Block sodium channels (more pronounced effect)
Little effect on APD o...
Class II
Beta blockers: atenolol, esmolol, petaprolol,
propranolol





Reduce or block sympathetic nervous system
stim...
Class III
amiodarone, bretylium, sotalol, ibutilide







Increase APD
Prolong repolarization in phase 3
Used for dy...
Class IV
verapamil, diltiazem




Calcium channel blockers
Depress phase 4 depolarization
Used for paroxysmal supravent...
Other Antidysrhythmics
digoxin, adenosine


Have properties of several classes and are not placed
into one particular cla...
Digoxin


Cardiac glycoside



Inhibits the sodium-potassium ATPase pump



Positive inotrope—improves the strength of ...
adenosine (Adenocard)








Slows conduction through the AV node
Used to convert paroxysmal supraventricular
tachy...
ALL antidysrhythmics can cause
dysrhythmias!!


Hypersensitivity reactions







Nausea
Vomiting
Diarrhea
Dizzines...





Obtain a thorough drug and medical history.
Measure baseline BP, P, I & O, and
cardiac rhythm.
Measure serum potas...





Assess for conditions that may be
contraindications for use of specific agents.
Assess for potential drug interact...





During therapy, monitor cardiac rhythm, heart
rate, BP, general well-being, skin color,
temperature, heart and bre...






Instruct patients to take medications as
scheduled and not to skip doses or double up
for missed doses.
Patients ...




For class I agents, monitor ECG for QT
intervals prolonged more than 50%.
IV infusions should be administered with
a...


Patients taking propranolol, digoxin, and other
agents should be taught how to take their own
radial pulse for 1 full m...


Monitor for therapeutic response:
Decreased BP in hypertensive patients
 Decreased edema
 Regular pulse rate or
 Pul...
Leader in continuing dental education
www.indiandentalacademy.com

www.indiandentalacademy.com
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Anti dysrhythmics /certified fixed orthodontic courses by Indian dental academy

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Welcome to Indian Dental Academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.


Indian dental academy has a unique training program & curriculum that provides students with exceptional clinical skills and enabling them to return to their office with high level confidence and start treating patients

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Anti dysrhythmics /certified fixed orthodontic courses by Indian dental academy

  1. 1. INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
  2. 2. Dysrhythmia  Any deviation from the normal rhythm of the heart Antidysrhythmics  Drugs used for the treatment and prevention of disturbances in cardiac rhythm www.indiandentalacademy.com
  3. 3.  Inside the cardiac cell, there exists a net negative charge relative to the outside of the cell. www.indiandentalacademy.com
  4. 4.     This difference in the electronegative charge. Results from an uneven distribution of ions (sodium, potassium, calcium) across the cell membrane. An energy-requiring pump is needed to maintain this uneven distribution of ions. Sodium-potassium ATPase pump www.indiandentalacademy.com
  5. 5. www.indiandentalacademy.com
  6. 6.  A change in the distribution of ions causes cardiac cells to become excited.  The movement of ions across the cardiac cell’s membrane results in the propagation of an electrical impulse.  This electrical impulse leads to contraction of the myocardial muscle. www.indiandentalacademy.com
  7. 7. Four Phases  The SA node and the Purkinje cells each have separate action potentials. www.indiandentalacademy.com
  8. 8. www.indiandentalacademy.com
  9. 9.  System commonly used to classify antidysrhythmic drugs www.indiandentalacademy.com
  10. 10.  Class 1        Class Ia Class Ib Class Ic Class II Class III Class IV Other www.indiandentalacademy.com
  11. 11. Class I    Membrane-stabilizing agents Fast sodium channel blockers Divided into Ia, Ib, and Ic agents, according to effects www.indiandentalacademy.com
  12. 12. Class I moricizine    General Class I agent Has characteristics of all three subclasses Used for symptomatic ventricular and life-threatening dysrhythmias www.indiandentalacademy.com
  13. 13. Class Ia quinidine, procainamide, disopyramide     Block sodium channels Delay repolarization Increase the APD Used for atrial fibrillation, premature atrial contractions, premature ventricular contractions, ventricular tachycardia, Wolff-Parkinson-White syndrome www.indiandentalacademy.com
  14. 14. Class Ib tocainide, mexiletine, phenytoin, lidocaine     Block sodium channels Accelerate repolarization Decrease the APD Used for ventricular dysrhythmias only (premature ventricular contractions, ventricular tachycardia, ventricular fibrillation) www.indiandentalacademy.com
  15. 15. Class Ic encainide, flecainide, propafenone     Block sodium channels (more pronounced effect) Little effect on APD or repolarization Used for severe ventricular dysrhythmias May be used in atrial fibrillation/flutter www.indiandentalacademy.com
  16. 16. Class II Beta blockers: atenolol, esmolol, petaprolol, propranolol    Reduce or block sympathetic nervous system stimulation, thus reducing transmission of impulses in the heart’s conduction system Depress phase 4 depolarization General myocardial depressants for both supraventricular and ventricular dysrhythmias www.indiandentalacademy.com
  17. 17. Class III amiodarone, bretylium, sotalol, ibutilide      Increase APD Prolong repolarization in phase 3 Used for dysrhythmias that are difficult to treat Life-threatening ventricular tachycardia or fibrillation, atrial fibrillation or flutter—resistant to other drugs Sustained ventricular tachycardia www.indiandentalacademy.com
  18. 18. Class IV verapamil, diltiazem    Calcium channel blockers Depress phase 4 depolarization Used for paroxysmal supraventricular tachycardia; rate control for atrial fibrillation and flutter www.indiandentalacademy.com
  19. 19. Other Antidysrhythmics digoxin, adenosine  Have properties of several classes and are not placed into one particular class www.indiandentalacademy.com
  20. 20. Digoxin  Cardiac glycoside  Inhibits the sodium-potassium ATPase pump  Positive inotrope—improves the strength of cardiac contraction  Allows more calcium to be available for contraction  Used for CHF and atrial dysrhythmias  Monitor potassium levels, drug levels, and for toxicity www.indiandentalacademy.com
  21. 21. adenosine (Adenocard)       Slows conduction through the AV node Used to convert paroxysmal supraventricular tachycardia to sinus rhythm Very short half-life Only administered as fast IV push May cause asystole for a few seconds Other side effects minimal www.indiandentalacademy.com
  22. 22. ALL antidysrhythmics can cause dysrhythmias!!  Hypersensitivity reactions       Nausea Vomiting Diarrhea Dizziness Blurred vision Headache www.indiandentalacademy.com
  23. 23.    Obtain a thorough drug and medical history. Measure baseline BP, P, I & O, and cardiac rhythm. Measure serum potassium levels before initiating therapy. www.indiandentalacademy.com
  24. 24.    Assess for conditions that may be contraindications for use of specific agents. Assess for potential drug interactions. Instruct patients regarding dosing schedules and side effects to report to physician. www.indiandentalacademy.com
  25. 25.    During therapy, monitor cardiac rhythm, heart rate, BP, general well-being, skin color, temperature, heart and breath sounds. Assess plasma drug levels as indicated. Monitor for toxic effects. www.indiandentalacademy.com
  26. 26.    Instruct patients to take medications as scheduled and not to skip doses or double up for missed doses. Patients who miss a dose should contact their physician for instructions if a dose is missed. Instruct patients not to crush or chew any oral sustained-release preparations. www.indiandentalacademy.com
  27. 27.   For class I agents, monitor ECG for QT intervals prolonged more than 50%. IV infusions should be administered with an IV pump. www.indiandentalacademy.com
  28. 28.  Patients taking propranolol, digoxin, and other agents should be taught how to take their own radial pulse for 1 full minute, and to notify their physician if the pulse is less than 60 beats/minute before taking the next dose of medication. www.indiandentalacademy.com
  29. 29.  Monitor for therapeutic response: Decreased BP in hypertensive patients  Decreased edema  Regular pulse rate or  Pulse rate without major irregularities, or  Improved regularity of rhythm  www.indiandentalacademy.com
  30. 30. Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com

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