Classification  <ul><li>Class 1 </li></ul><ul><li>Class 2 </li></ul><ul><li>Class 3 </li></ul><ul><li>Class 4 </li></ul>
Class 1 <ul><li>1a </li></ul><ul><li>1b </li></ul><ul><li>1c </li></ul>
Class 1A <ul><li>Quinidine </li></ul><ul><li>Procainamide </li></ul><ul><li>Dysopyramide </li></ul>
Action of 1A <ul><li>Open state Na channel blockers </li></ul><ul><li>Moderate delay on channel recovery-1-10 sec </li></u...
Use of 1A <ul><li>Ectopics </li></ul><ul><li>Re-entry-UDB  BDB </li></ul>
 
Effects <ul><li>Moderate phase o depression </li></ul><ul><li>Prolonged APD </li></ul><ul><li>Prolongs ERD </li></ul><ul><...
Quinidine  <ul><li>Na channel blockade </li></ul><ul><li>Antivagal action –inc atrial ERP---reduce disparity among atrial ...
Quinidine on ECG <ul><li>Inc PR </li></ul><ul><li>Inc QT </li></ul><ul><li>Changes in the shape of T wave </li></ul>
MOA of quinidine <ul><li>Na channel block in open state---reduce automaticity…. </li></ul><ul><li>Reduce phase o depoleris...
Use of quinidine <ul><li>VT </li></ul><ul><li>SVT </li></ul>
ADR <ul><li>TDP </li></ul><ul><li>Cardiac arrest </li></ul><ul><li>VF </li></ul>
interactions <ul><li>Inc digoxin toxicity </li></ul><ul><li>Hypotn </li></ul><ul><li>Risk of TDP is increasd by hypokalemi...
Procainamide <ul><li>Orally active </li></ul><ul><li>Cardiac electro physiology is almost identical to quinidine </li></ul>
Difference form quinidine <ul><li>Less effect in suppressing ectopic automaticity </li></ul><ul><li>Less marked depression...
PK <ul><li>Oral BA- 75% </li></ul><ul><li>Met by liver ---N acetyl Procainamide---NAPA--- no Na blocker </li></ul><ul><li>...
Major side effect of Procainamide <ul><li>SLE in 1/5 th  of pateints </li></ul><ul><li>Presence of Anti Nuclear Antibodies...
Dysopyramide <ul><li>Quinidine like </li></ul><ul><li>Prominent cardiac depressent </li></ul><ul><li>Anticholinergic </li>...
Class 1B <ul><li>Drugs block Na channel </li></ul><ul><li>More in inactivated stage </li></ul><ul><li>Do not delay recover...
 
Lignocaine-Lidocaine <ul><li>Supress automaticity in ectopic foci </li></ul><ul><li>Antogonize----phase 4 depolerisation a...
<ul><li>Red—APD---PF,Ventricles </li></ul><ul><li>No effect on APD and ERP of atrial fibres </li></ul><ul><li>Atrial re-en...
MOA of lignocaine <ul><li>Block inactivated Na channels </li></ul><ul><li>Relatively selective for partially depolarised c...
Pk  <ul><li>Orally inactive ---high first pas met </li></ul><ul><li>i.v. bolus </li></ul><ul><li>50-100 mg bolus followed ...
ADR—of lignocaine <ul><li>Neurological effects—drowsines,nausea,blurre vision </li></ul><ul><li>No pro arrythmic effect </...
Use of lignocaine <ul><li>Only in VA </li></ul><ul><li>A following acute MI </li></ul><ul><li>Cardiac surgery </li></ul><u...
1c <ul><li>Most potent Na channel blockers </li></ul><ul><li>More action on open </li></ul><ul><li>Longest recovery time <...
 
Class 2 <ul><li>Beta blockers </li></ul>
 
 
 
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Anti arrythmics

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  • 1a
  • 1b
  • 1c
  • Class 2
  • Class 3
  • Anti arrythmics

    1. 5. Classification <ul><li>Class 1 </li></ul><ul><li>Class 2 </li></ul><ul><li>Class 3 </li></ul><ul><li>Class 4 </li></ul>
    2. 6. Class 1 <ul><li>1a </li></ul><ul><li>1b </li></ul><ul><li>1c </li></ul>
    3. 7. Class 1A <ul><li>Quinidine </li></ul><ul><li>Procainamide </li></ul><ul><li>Dysopyramide </li></ul>
    4. 8. Action of 1A <ul><li>Open state Na channel blockers </li></ul><ul><li>Moderate delay on channel recovery-1-10 sec </li></ul><ul><li>Suppress A-V conduction </li></ul><ul><li>Prolong refractoriness </li></ul><ul><li>Na channel blocking greater at high frequency </li></ul><ul><li>Alpha blocker </li></ul>
    5. 9. Use of 1A <ul><li>Ectopics </li></ul><ul><li>Re-entry-UDB  BDB </li></ul>
    6. 11. Effects <ul><li>Moderate phase o depression </li></ul><ul><li>Prolonged APD </li></ul><ul><li>Prolongs ERD </li></ul><ul><li>Suppress A-V conduction </li></ul>
    7. 12. Quinidine <ul><li>Na channel blockade </li></ul><ul><li>Antivagal action –inc atrial ERP---reduce disparity among atrial ERP </li></ul><ul><li>Inc AV nodal ERP---but here this effect is countered by anti vagal action </li></ul><ul><li>Depress myocardial contractility---may cause CHF </li></ul>
    8. 13. Quinidine on ECG <ul><li>Inc PR </li></ul><ul><li>Inc QT </li></ul><ul><li>Changes in the shape of T wave </li></ul>
    9. 14. MOA of quinidine <ul><li>Na channel block in open state---reduce automaticity…. </li></ul><ul><li>Reduce phase o depolerisation </li></ul><ul><li>Prolongs APD---K channel block </li></ul><ul><li>Inc ERP – due to moderate effect on recovery on Na and K channels </li></ul><ul><li>High conc—inhibit Ca channel </li></ul>
    10. 15. Use of quinidine <ul><li>VT </li></ul><ul><li>SVT </li></ul>
    11. 16. ADR <ul><li>TDP </li></ul><ul><li>Cardiac arrest </li></ul><ul><li>VF </li></ul>
    12. 17. interactions <ul><li>Inc digoxin toxicity </li></ul><ul><li>Hypotn </li></ul><ul><li>Risk of TDP is increasd by hypokalemia by diuretics </li></ul><ul><li>Synergestic cardiac depression with beta blockers, CCB,K salts </li></ul>
    13. 18. Procainamide <ul><li>Orally active </li></ul><ul><li>Cardiac electro physiology is almost identical to quinidine </li></ul>
    14. 19. Difference form quinidine <ul><li>Less effect in suppressing ectopic automaticity </li></ul><ul><li>Less marked depression of contractility and AV conduction </li></ul><ul><li>Anti vagal action is minimal </li></ul><ul><li>Not an alpha blocker </li></ul>
    15. 20. PK <ul><li>Oral BA- 75% </li></ul><ul><li>Met by liver ---N acetyl Procainamide---NAPA--- no Na blocker </li></ul><ul><li>NAPA---K blocker </li></ul><ul><li>Dose 0.5-1 g </li></ul><ul><li>ADR-cardiotoxic,TDP </li></ul>
    16. 21. Major side effect of Procainamide <ul><li>SLE in 1/5 th of pateints </li></ul><ul><li>Presence of Anti Nuclear Antibodies </li></ul><ul><li>Use –Monomorphic VT,WPW---i.v. </li></ul>
    17. 22. Dysopyramide <ul><li>Quinidine like </li></ul><ul><li>Prominent cardiac depressent </li></ul><ul><li>Anticholinergic </li></ul><ul><li>No alpha block </li></ul><ul><li>C/I- sick sinus,CHF,Prostatic hypertrophy </li></ul>
    18. 23. Class 1B <ul><li>Drugs block Na channel </li></ul><ul><li>More in inactivated stage </li></ul><ul><li>Do not delay recovery </li></ul><ul><li>No AV conduction depression </li></ul><ul><li>Shortens APD,ERP,QT </li></ul><ul><li>Eg.---Lidocaine </li></ul>
    19. 25. Lignocaine-Lidocaine <ul><li>Supress automaticity in ectopic foci </li></ul><ul><li>Antogonize----phase 4 depolerisation and after depolerization---in PF </li></ul><ul><li>SA node automaticity is not depressed </li></ul><ul><li>Phase 0 dep and cond vel of AV bundl and ventricles---not decreased </li></ul>
    20. 26. <ul><li>Red—APD---PF,Ventricles </li></ul><ul><li>No effect on APD and ERP of atrial fibres </li></ul><ul><li>Atrial re-entry is not affected </li></ul><ul><li>Suppress ventricular re-entry </li></ul>
    21. 27. MOA of lignocaine <ul><li>Block inactivated Na channels </li></ul><ul><li>Relatively selective for partially depolarised cells and with longer APD </li></ul><ul><li>Nl ventricular conducting fibres- not affected </li></ul><ul><li>Not effective in atrial arrythmias </li></ul><ul><li>Minimal effect on ECG </li></ul><ul><li>No depression of contractility/BP </li></ul>
    22. 28. Pk <ul><li>Orally inactive ---high first pas met </li></ul><ul><li>i.v. bolus </li></ul><ul><li>50-100 mg bolus followed by 20-40 mg every 20 min </li></ul>
    23. 29. ADR—of lignocaine <ul><li>Neurological effects—drowsines,nausea,blurre vision </li></ul><ul><li>No pro arrythmic effect </li></ul><ul><li>Least cardio toxic </li></ul>
    24. 30. Use of lignocaine <ul><li>Only in VA </li></ul><ul><li>A following acute MI </li></ul><ul><li>Cardiac surgery </li></ul><ul><li>Used in digitalis toxicity as does not worsen A-V block </li></ul>
    25. 31. 1c <ul><li>Most potent Na channel blockers </li></ul><ul><li>More action on open </li></ul><ul><li>Longest recovery time </li></ul><ul><li>Markedly delay conduction </li></ul><ul><li>Prolong P-R </li></ul><ul><li>Broaden QRS complex </li></ul><ul><li>APD not affected </li></ul>
    26. 33. Class 2 <ul><li>Beta blockers </li></ul>

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