Anti arrhythmic agents

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Anti arrhythmic agents

  1. 1. Anti-Arrhythmic Agents
  2. 2. Anatomy of a Heartbeat
  3. 3. Normal Electrical Activity
  4. 4. Cardiac Arrhythmias <ul><li>Physiology </li></ul><ul><ul><li>Normal Sinus rhythm </li></ul></ul><ul><ul><li>Abnormal rhythm </li></ul></ul><ul><ul><ul><li>Disturbance of impulse formation </li></ul></ul></ul><ul><ul><ul><li>Disturbance of impulse conduction </li></ul></ul></ul><ul><li>Arrhythmias </li></ul><ul><ul><li>Tachycardia, bradycardia </li></ul></ul><ul><ul><li>Atrial flutter, fibrillation </li></ul></ul><ul><ul><li>PVC, premature ventricular contraction </li></ul></ul>
  5. 5. Therapeutic Agents <ul><li>Rational </li></ul><ul><li>Aim of therapy </li></ul><ul><li>MOA </li></ul><ul><ul><li>Na+ channel block </li></ul></ul><ul><ul><li>SANS block on heart </li></ul></ul><ul><ul><li>Prolong refractory period </li></ul></ul><ul><ul><li>Ca+ block </li></ul></ul>
  6. 6. Class I Class III <ul><li>Quinidine </li></ul><ul><ul><li>Synchronism </li></ul></ul><ul><li>Procainamide </li></ul><ul><li>Amiodarone </li></ul><ul><li>Lidocaine </li></ul><ul><li>Class II </li></ul><ul><ul><li>Beta-blockers </li></ul></ul><ul><ul><ul><li>propranolol </li></ul></ul></ul><ul><li>Bretylium (Bretylol) </li></ul><ul><li>Sotolol (Betapace) </li></ul><ul><li>Class IV </li></ul><ul><ul><li>Ca+ Channel Blockers </li></ul></ul><ul><ul><ul><li>Verapamil (Calan) </li></ul></ul></ul><ul><ul><ul><li>Diltiazem (Cardizem) </li></ul></ul></ul>
  7. 7. Clinical Therapy <ul><li>Evaluation </li></ul><ul><li>Risk versus Benefit </li></ul><ul><li>Non-Drug Therapy </li></ul><ul><li>CASE STUDY </li></ul>
  8. 8. <ul><li>DP is a slender, 45-year-old mother of three children all under the age of 15 years old. She presents to clinic with palpitations, sweating and hyperventilation. EKG reveals she is experiencing PVC’s every 10-12 beats. She is agitated and appears to be worried that her husband will be angry with her for getting sick. </li></ul><ul><li>BP 140/85 P 110 Temp 38.6 Wt 55 kg Ht 5’7” </li></ul><ul><li>Currently on no medications </li></ul>
  9. 9. Points to Ponder <ul><li>Evaluate this patient’s condition and possible etiologies. </li></ul><ul><li>Discuss the risks versus benefits of anti-arrhythmic therapy. Goals of therapy? </li></ul><ul><li>Is DP a candidate for drug treatment of her PVC’s? </li></ul><ul><li>Consider avenues of non-drug therapy. </li></ul>

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