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Anti Arrhythmic Drugs

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The anti-arrhythmic drugs can modify impulse generation and conduction.

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Anti Arrhythmic Drugs

  1. 1. ANTI-ARRHYTHMICANTI-ARRHYTHMIC DRUGSDRUGS S.SEETARAM SWAMY, M.Pharm., Asst. professor, Dept. of Pharmaceutical Chemistry, Chilkur Balaji College of Pharmacy. E-mail:seetaram.443@gmail.com S.SEETARAM SWAMY, M.Pharm., Asst. professor, Dept. of Pharmaceutical Chemistry, Chilkur Balaji College of Pharmacy. E-mail:seetaram.443@gmail.com 1
  2. 2. Anti-arrhythmic agents are a group of drugs that are used to suppress abnormal rhythms of the heart (cardiac arrhythmias), such as atrial fibrillation, atrial flutter, ventricular tachycardia, and ventricular fibrillation. OR The anti-arrhythmic drugs can modify impulse generation and conduction. Cardiac Arrhythmiasis are abnormalities in the rate, regularity or site of origin of the cardiac impulse or a disturbances in conduction of the impulse such that the normal sequence of activation of atria and ventricles are altered. 2 Mr.S.SEETARAMSWAMY., M.Pharm
  3. 3. A-RHYTHM –IA Definition- Arrhythmia is deviation of heart from normal RHYTHM. RHYTHM 1) HR- 60-100 2) Should origin from SAN 3) Cardiac impulse should propagate through normal conduction pathway with normal velocity. A heartbeat that is too fast is called Tachycardia. A heartbeat that is too slow is called bradycardia. 3 Mr.S.SEETARAMSWAMY., M.Pharm
  4. 4. Heart Mr.S.SEETARAMSWAMY., M.Pharm
  5. 5. Rhythm Disorders Rhythm disorders are treated with medications that normalize the heart rate by affecting the nervous system that controls the heart rate. Medications for: RHYTHM DISORDERS •beta blockers •calcium channel blockers 5 Mr.S.SEETARAMSWAMY., M.Pharm
  6. 6. Conduction System 6 Mr.S.SEETARAMSWAMY., M.Pharm
  7. 7. The heart’s pacemaker causes regular contracting of the myocardium resulting in a regular heartbeat or pulse. Contraction Phases •Polarization (resting) •Depolarization (contracting) •Repolarization (recharging) 7 Mr.S.SEETARAMSWAMY., M.Pharm
  8. 8. CAUSES: 8Mr.S.SEETARAMSWAMY., M.Pharm
  9. 9. A fluttering in your chest. A racing heart beat (tachycardia) A slow heart beat (bradycardia) Chest pain. Shortness of breath. Lightheadedness. Dizziness. Fainting (syncope) SYMPTOMS:SYMPTOMS: 9 Mr.S.SEETARAMSWAMY., M.Pharm
  10. 10. The anti-arrhythmic drugs can be classified according to their predominant effects on the action potential. The Vaughan William’s Classification of AAD is based on their effects on the cardiac action potential (AP). CLASSIFICATIONCLASSIFICATION 10 Mr.S.SEETARAMSWAMY., M.Pharm
  11. 11. Class I:  Anti-arrhythmic drugs act by blocking voltage-sensitive sodium channels via the same mechanism as local anesthetics.  The decreased rate of entry of sodium slows the rate of rise of Phase 0 of the action potential. Quinidine Procainamide 11Mr.S.SEETARAMSWAMY., M.Pharm
  12. 12. O2N COOH O2N COCl + NH2CH2CH2N C2H5 C2H5 O2N C NHCH2CH2N O C2H5 C2H5 H2N C NHCH2CH2N O C2H5 C2H5 P-nitro benzoic acid SOCl2 P-nitro benzoyl chloride Sn/HCl Reduction N-diethyl ethanamine Procainamide Procainamide Synthesis 12 Mr.S.SEETARAMSWAMY., M.Pharm
  13. 13. Class II: β-adrenergic antagonists: These drugs diminish Phase 4 depolarization, thus depressing automaticity, prolonging AV conduction, and decreasing heart rate and contractility. Class II agents are useful in treating tachy- arrhythmias caused by increased sympathetic activity. They are also used for atrial flutter and fibrillation and for AV-nodal reentrant tachycardia. Class II: Beta blockers Propranolol Acebutalol Sotalol Esmolol Timolol Metoprolol  Atenolol Propranolol Therapeutic Use of β-Blockers Hypertension Angina Myocardial infarction Arrhythmias Heart failure 13 Mr.S.SEETARAMSWAMY., M.Pharm
  14. 14. Class III: Potassium (K) channel blockers (Repolarization prolongators) Amiodarone Ibutilide Dofetilide  Bretylium CLASS-III: It mainly acts by blocking K+ channels. It increases the refractory period. It increases the duration without effecting phase 0 and resting membrane potential. Amiodarone 14Mr.S.SEETARAMSWAMY., M.Pharm
  15. 15. Verapamil Class IV: Calcium (Ca+2) channel blockers Verapamil Diltiazem Class IV: Calcium-channel blockers: They decrease the inward current carried by calcium, resulting in a decreased rate of Phase-4 spontaneous depolarization. Therapeutic Use of Calcium-Channel Blockers •Hypertension (systemic & pulmonary) •Angina •Arrhythmias Diltiazem 15 Mr.S.SEETARAMSWAMY., M.Pharm
  16. 16. AdenosineAdenosine inhibits AV conduction. The duration of effect is less than 60 s. •used as an i.v. bolus in SV tachycardiaSV tachycardia with narrow QRS complexwith narrow QRS complex. •ADRs: bradycardia, AV block. Other drugs used in Tachy-arrhythmias Digoxin reduces conduction through the AV node and is useful in the control of atrial flutter and atrial fibrillation. 16 Mr.S.SEETARAMSWAMY., M.Pharm
  17. 17. CLINICAL USES: Sodium channel blockers are also used as local anesthetics and anticonvulsants. Procainamide can be used to treat atrial fibrillation in the setting of Wolff-Parkinson-White syndrome. Supra-ventricular arrhythmias. Nodal and ventricular arrhythmias. Refractory ventricular arrhythmias 17 Mr.S.SEETARAMSWAMY., M.Pharm
  18. 18. 18Mr.S.SEETARAMSWAMY., M.Pharm
  19. 19. PACEMAKER A pacemaker is  a  small  device  that's  placed  in  the  chest  or  abdomen  to  help control abnormal heart rhythms. This device uses low-energy electrical  pulses to prompt the heart to beat at a normal rate.  Pacemakers are used to treat arrhythmias. Arrhythmias are problems with  the rate or rhythm of the heartbeat. 19 Mr.S.SEETARAMSWAMY., M.Pharm
  20. 20. Class II: Beta blockers Propranolol Acebutalol Sotalol Esmolol Timolol Metoprolol  Atenolol Class III: Potassium (K) channel blockers (Repolarization prolongators) Amiodarone Ibutilide Dofetilide  Bretylium Class V: Variable mechanism Adenosine Digoxin Magnesium sulfate Class IV: Calcium (Ca+2) channel blockers Verapamil Diltiazem Class I: Sodium (Na) channel blockers (Membrane depressant drugs) Quinidine Procainamide Disopyramide Lidocaine Phenytoin Mexiletine Flecainide Tocainaide Propafenone Moricizine 20 Mr.S.SEETARAMSWAMY., M.Pharm
  21. 21. 21Mr.S.SEETARAMSWAMY., M.Pharm

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