This document summarizes the use of vasoconstrictors like adrenaline in local anaesthetics. It discusses the advantages of adding a vasoconstrictor, common concentrations used in dentistry, dosage guidelines, and important drug interactions. It provides dosage recommendations for various medically compromised patients and contraindications for conditions like cardiovascular disease, hypertension, asthma, and pheochromocytoma. The document emphasizes using the minimum necessary dose of adrenaline, especially for medically complex patients, to avoid adverse reactions.
Nitrates work by relaxing smooth muscle in blood vessels via the production of nitric oxide. This leads to vasodilation and reduced preload and afterload, lowering oxygen demand on the heart. Common side effects include headaches and hypotension. Tolerance develops with chronic use and can be prevented through intermittent dosing schedules and adjunctive treatments that replenish nitric oxide stores. Nitrates are available in various oral, topical, and intravenous formulations for use in angina and heart failure.
This document provides summaries of common emergency medications used to treat critical patients. It lists indications, dosages, and considerations for oxygen, epinephrine, atropine, adenosine, amiodarone, dopamine, lidocaine, diltiazem, procainamide, nitroglycerine, magnesium sulfate, and calcium chloride. The document aims to describe the actions and importance of these frequently prescribed critical medications.
Patients with cardiac arrhythmias require special precautions during dental treatment to prevent life-threatening complications. Stress, vasoconstrictors, and local anesthetics can precipitate arrhythmias in susceptible patients. Dentists should identify risk factors, minimize stress, limit vasoconstrictors, and consult physicians as needed to safely treat patients with arrhythmias.
This document provides information on several vasoconstricting drugs and their uses:
- Vasoconstrictors like epinephrine, norepinephrine, vasopressin, and phenylephrine are used to treat low blood pressure, with epinephrine and vasopressin being first-line treatments for pulseless cardiac arrest.
- Drugs used in cardiac arrest situations include epinephrine, vasopressin, amiodarone, lidocaine, and atropine according to ACLS guidelines. Epinephrine and vasopressin increase blood pressure while amiodarone treats shock-resistant arrhythmias.
- Dopamine, administered via IV drip, is used
1. The document discusses how stress and anxiety can trigger a "fight or flight" response leading to increased blood pressure and heart rate in patients prior to dental surgery.
2. It provides guidelines for evaluating hypertensive patients before dental treatment, including assessing cardiovascular risk factors, functional capacity, and blood pressure levels to determine safety.
3. For hypertensive patients requiring emergency dental treatment, it recommends precautions like using local anesthetics without vasoconstrictors or employing hypotensive anesthesia to control blood pressure and minimize risks of complications like heart attack or stroke.
This document provides information on medications used in advanced cardiac life support (ACLS). It discusses the indications, dosages, routes of administration, and effects of various drugs including epinephrine, vasopressin, amiodarone, lidocaine, atropine, adenosine, and magnesium. A table is also included that lists adult and pediatric doses for common ACLS medications as well as their indications, recommended frequencies, and effects. The document is intended to review best practices for pharmacologic interventions during cardiac arrest and other cardiac emergencies.
This document discusses the calculation of local anesthetic (LA) dose for patients. It notes that patients have varying body sizes so maximum recommended LA dose must be calculated to avoid overdose. The key elements needed for calculation are: maximum dose (mg/kg), drug concentration (%), and patient weight (kg). These are used to determine the maximum recommended volume. The document provides examples of maximum dose for different drugs and concentrations. It also discusses potential complications of overdose like central nervous system and cardiovascular toxicity. Management of overdose involves stabilization, airway control, anticonvulsants, and lipid emulsion therapy.
This document discusses the calculation of local anesthetic (LA) dose for patients. It notes that patients have varying body sizes so maximum recommended LA dose must be calculated to avoid overdose. The key elements needed for calculation are: 1) maximum dose (mg/kg), 2) drug concentration (%), and 3) patient weight (kg). These are used to determine the maximum recommended volume. The document also discusses complications of overdose and their management.
Nitrates work by relaxing smooth muscle in blood vessels via the production of nitric oxide. This leads to vasodilation and reduced preload and afterload, lowering oxygen demand on the heart. Common side effects include headaches and hypotension. Tolerance develops with chronic use and can be prevented through intermittent dosing schedules and adjunctive treatments that replenish nitric oxide stores. Nitrates are available in various oral, topical, and intravenous formulations for use in angina and heart failure.
This document provides summaries of common emergency medications used to treat critical patients. It lists indications, dosages, and considerations for oxygen, epinephrine, atropine, adenosine, amiodarone, dopamine, lidocaine, diltiazem, procainamide, nitroglycerine, magnesium sulfate, and calcium chloride. The document aims to describe the actions and importance of these frequently prescribed critical medications.
Patients with cardiac arrhythmias require special precautions during dental treatment to prevent life-threatening complications. Stress, vasoconstrictors, and local anesthetics can precipitate arrhythmias in susceptible patients. Dentists should identify risk factors, minimize stress, limit vasoconstrictors, and consult physicians as needed to safely treat patients with arrhythmias.
This document provides information on several vasoconstricting drugs and their uses:
- Vasoconstrictors like epinephrine, norepinephrine, vasopressin, and phenylephrine are used to treat low blood pressure, with epinephrine and vasopressin being first-line treatments for pulseless cardiac arrest.
- Drugs used in cardiac arrest situations include epinephrine, vasopressin, amiodarone, lidocaine, and atropine according to ACLS guidelines. Epinephrine and vasopressin increase blood pressure while amiodarone treats shock-resistant arrhythmias.
- Dopamine, administered via IV drip, is used
1. The document discusses how stress and anxiety can trigger a "fight or flight" response leading to increased blood pressure and heart rate in patients prior to dental surgery.
2. It provides guidelines for evaluating hypertensive patients before dental treatment, including assessing cardiovascular risk factors, functional capacity, and blood pressure levels to determine safety.
3. For hypertensive patients requiring emergency dental treatment, it recommends precautions like using local anesthetics without vasoconstrictors or employing hypotensive anesthesia to control blood pressure and minimize risks of complications like heart attack or stroke.
This document provides information on medications used in advanced cardiac life support (ACLS). It discusses the indications, dosages, routes of administration, and effects of various drugs including epinephrine, vasopressin, amiodarone, lidocaine, atropine, adenosine, and magnesium. A table is also included that lists adult and pediatric doses for common ACLS medications as well as their indications, recommended frequencies, and effects. The document is intended to review best practices for pharmacologic interventions during cardiac arrest and other cardiac emergencies.
This document discusses the calculation of local anesthetic (LA) dose for patients. It notes that patients have varying body sizes so maximum recommended LA dose must be calculated to avoid overdose. The key elements needed for calculation are: maximum dose (mg/kg), drug concentration (%), and patient weight (kg). These are used to determine the maximum recommended volume. The document provides examples of maximum dose for different drugs and concentrations. It also discusses potential complications of overdose like central nervous system and cardiovascular toxicity. Management of overdose involves stabilization, airway control, anticonvulsants, and lipid emulsion therapy.
This document discusses the calculation of local anesthetic (LA) dose for patients. It notes that patients have varying body sizes so maximum recommended LA dose must be calculated to avoid overdose. The key elements needed for calculation are: 1) maximum dose (mg/kg), 2) drug concentration (%), and 3) patient weight (kg). These are used to determine the maximum recommended volume. The document also discusses complications of overdose and their management.
Dr. Valluri Ramu is a professor in the Department of Anaesthesiology, CCM & Pain Medicine at KAMSARC in Hyderabad, India. His fields of interest include renal transplant anesthesiology and critical care medicine. The document discusses antithrombotic prophylaxis and regional anesthesia. It defines thromboprophylaxis and describes various anticoagulant and antiplatelet drugs. It also discusses the risks of thromboembolism and bleeding when administering these drugs during regional anesthesia techniques.
- Platelets play an important role in blood clotting by clumping together to form blood clots, which stop bleeding from cuts or wounds. However, blood clots inside arteries can block blood flow and damage tissues.
- Antiplatelet drugs like aspirin work by preventing platelets from clumping together. Aspirin is commonly used after CABG surgery and procedures like angioplasty to prevent new blood clots from forming and reduce the risk of future heart attacks.
- While aspirin is generally safe, concerns remain about how soon after surgery it can safely be given to balance preventing clots versus risks of bleeding complications. Studies found low dose aspirin given within 48 hours of CABG was not
Management of patients with cardiovascular diseases in periodonticsShubhra Bardhar
This document provides guidelines for managing patients with cardiovascular disease undergoing periodontal treatment. It discusses identifying various cardiovascular conditions like hypertension, ischemic heart disease, congestive heart failure, infective endocarditis, and cerebrovascular accidents. For each condition, it outlines steps to take such as consulting the patient's physician, using local anesthetics with low epinephrine concentration, scheduling short and stress-free appointments, and being prepared to treat anginal episodes or arrhythmias that may occur during treatment. The goal is to perform periodontal therapy safely for patients with cardiovascular complications through proper medical evaluation and stress reduction strategies.
Management of medically compromised patients in oral surgery.pptxAmeerasalahudheen1
The document discusses medical conditions that may impact dental treatment and provides guidelines for managing patients with certain conditions. It covers classifications of patient health status, cardiovascular diseases like hypertension, respiratory diseases like asthma, liver diseases like cirrhosis, and provides considerations and precautions for treating patients with each condition. Management may include consultation, stress reduction protocols, modified local anesthetic techniques and medications. The goal is to safely provide dental care for medically compromised patients.
Periodontal treatment of medically compromised patients.pptAshokKp4
1. Periodontal treatment of medically compromised patients requires recognition of underlying medical conditions and formulation of an appropriate treatment plan.
2. Key considerations for patients with cardiovascular diseases like hypertension, ischemic heart diseases, and congestive heart failure include consultation with their physician, use of local anesthetics carefully, keeping procedures short, and monitoring vital signs closely.
3. Management of diabetic patients includes checking blood glucose levels before, during, and after treatment to monitor for hypoglycemia, and consulting their physician about antibiotic premedication for surgical procedures.
Endodontic Considerations In Hypertensive and Bleeding Disorder PatientsSarosh Hussain
Dr. Syed Sarosh Hussain provides guidelines for dental procedures in patients with cardiovascular disease or those taking anticoagulant/antiplatelet medications. For non-surgical procedures, lidocaine with 1:100,000 epinephrine is preferred. For surgical procedures, local anesthetic with vasoconstrictor can be used but the dose should be limited. Certain patients are at very high risk for complications from local anesthetic with vasoconstrictor. It is important to consult with the patient's physician and check coagulation factors/INR prior to any dental procedures depending on the specific health conditions and medications of the patient.
Dental Management of CardioVascular Diseases (CVD)Mohammed Alawad
1. Dental management of patients with cardiovascular diseases requires understanding their medical history and conditions, as well as coordinating care with their physician.
2. For hypertensive patients, dentists should measure blood pressure at every visit and postpone treatment during hypertensive crises.
3. Patients on anticoagulant therapy or at risk of infective endocarditis require special precautions like pre-treatment with antimicrobials and avoidance of invasive procedures whenever possible. Close collaboration with physicians is important.
This document summarizes the pharmacotherapy of hypertension. It begins by defining blood pressure and classifications of hypertension. It then discusses the goals of antihypertensive therapy and classifications of commonly used drug classes including: diuretics, adrenoceptor antagonists, renin-angiotensin system agents, calcium channel blockers, and other centrally acting drugs. Specific examples are provided within each drug class along with their mechanisms of action and uses for treating hypertension.
This document discusses the pharmacotherapy of hypertension. It defines hypertension and classifies blood pressure readings. The main types of drugs used to treat hypertension work by decreasing cardiac output and/or total peripheral resistance. These include diuretics, sympathoplegic agents like methyldopa and beta blockers, vasodilators, ACE inhibitors, and calcium channel blockers. The document provides details on the mechanisms and uses of these drug classes and recommends treatment approaches based on hypertension severity.
- The patient presented with symptoms of an acute myocardial infarction (MI) and should be placed in an environment with continuous ECG monitoring and defibrillation capabilities to identify any ST-elevation and provide immediate reperfusion therapy if needed.
- Initial emergency treatments include oxygen, aspirin, nitroglycerin, and morphine for pain relief.
- Reperfusion therapies like thrombolysis with drugs like streptokinase or percutaneous coronary intervention can be used to restore blood flow in the blocked artery and limit heart muscle damage from ongoing ischemia.
This document discusses different types of drugs used to treat angina pectoris, including nitrates, beta-blockers, calcium channel blockers, and ranolazine. Nitrates work by dilating blood vessels to reduce oxygen demand on the heart. Beta-blockers lower heart rate and contractility. Calcium channel blockers inhibit calcium influx to protect heart tissue. Ranolazine inhibits sodium channels to improve the balance of oxygen supply and demand in the heart. These drugs are commonly used alone or in combination to manage stable angina by reducing factors that can trigger chest pain.
A 28-year-old female presented with palpitations, presyncope and an abnormal ECG strip. The ECG shows a narrow complex tachycardia. Adenosine can be used both diagnostically and therapeutically to help determine if the arrhythmia is dependent on the atrioventricular node by attempting to terminate or cause transient heart block. If the arrhythmia terminates or heart block occurs, it suggests the arrhythmia involves the AV node and is likely a supraventricular tachycardia. If adenosine has no effect, it makes ventricular tachycardia more likely.
Pharmacotherapy of congestive heart faliure Rahulvaish13
This PPT covers the pathophysiology, treatment protocol and details of individual drugs used and those drugs failed in clinical trials; taken from standard text books and articles as reference. This will be extremely useful for undergraduates ( MBBS, BDS,) and postgraduates (MD,MDS ,Phd).
This document discusses antianginal agents used to treat angina pectoris including nitrates, beta blockers, and calcium channel blockers. Nitrates work by causing vasodilation of coronary arteries to increase blood flow. Beta blockers decrease heart rate and contractility to lower oxygen demand. Calcium channel blockers cause peripheral vasodilation and reduce contractility. Nursing implications include monitoring for side effects like hypotension and ensuring proper administration of different drug formulations.
This document discusses antianginal agents used to treat angina pectoris including nitrates, beta blockers, and calcium channel blockers. Nitrates work by causing vasodilation of blood vessels including coronary arteries to increase blood flow and oxygen to the heart. Beta blockers decrease heart rate and contractility to lower oxygen demand. Calcium channel blockers cause peripheral vasodilation and reduce contractility to decrease oxygen demand. The document provides details on common medications in each class and nursing considerations for administration and patient education.
Anti thrombotic therapy in difficult clinical conditionsDrArpan Chouhan
This document discusses anti-thrombotic therapy in difficult clinical conditions. It summarizes various antiplatelet and anticoagulant drugs, difficult situations for their use including high ischemic or bleeding risk, and strategies for balancing thrombotic and hemorrhagic risks. Certain drugs like prasugrel and ticagrelor are preferred for high ischemic burden due to more potent platelet inhibition, while dose adjustments and shorter durations are recommended for high bleeding risk. Careful management is needed in situations like surgery, renal dysfunction, and pregnancy to minimize risks.
The document discusses the classification and mechanisms of action of various antihypertensive agents. It describes how drugs like diuretics, sympathoplegic agents, vasodilators, angiotensin blockers, calcium channel blockers, and ACE inhibitors work to lower blood pressure by different mechanisms throughout the body. It also covers hypertensive emergencies and the intravenous drugs used to rapidly reduce blood pressure in such situations.
A Practical Approach to Ionotropes and vasopressors Aneesh Bhandary
Vasopressors are a powerful class of drugs that induce vasoconstriction and Inotropes increase cardiac contractility. Choice of an agent should be based upon the suspected underlying etiology of shock.
This presentation deals with the practical issues and controversies surrounding the use of these agents
inotropic drugs and vassopressors drugs.pptxAhmed638947
this presentation is toalking about the Sympathomimetic drugs which are agents which in general mimic responses due to stimulation of sympathetic nerves.
These agents are able to directly activate adrenergic receptors or to indirectly activate them by increasing norepinephrine and epinephrine (mediators of the sympathoadrenal system) levels.
These drugs are used clinically to treat glaucoma, anaphylactic shock, chronic obstructive pulmonary disease, hypotension, hypertension, heart failure, nasal congestion, premature labor, attention-deficit/hyperactivity disorder, narcolepsy, and acute or chronic asthma. The α or β adrenergic antagonists block or attenuate the effect of sympathomimetics on α or β receptors. Alpha blockers are used clinically to treat hypertension and benign prostatic hyperplasia. Beta blockers are used clinically to treat ischemic heart disease, essential hypertension, cardiac arrhythmias, congestive heart failure, glaucoma, hyperthyroidism, surgical removal of pheochromocytoma, nonparkinsonian tremor, migraine headache (prophylaxis), and a wide variety of anxiety situations.
This document discusses various anatomical landmarks that appear on dental radiographs. It describes the differences between cortical and cancellous bone, with cortical bone appearing radiopaque and cancellous bone appearing predominantly radiolucent. It then examines specific anatomical structures seen on dental images, such as the maxillary sinus, maxillary tuberosity, nasal cavity, lateral fossa, incisive foramen, mental foramen, mandibular canal, and others. For each structure, it provides a brief definition and description of its radiographic appearance.
1. The document outlines the contents and procedures for a nitrous oxide/oxygen sedation class, including group and individual simulations.
2. It provides study guides for the class, including questions about nitrous oxide pathways of action, interactions with medications, dosing calculations, signs of sedation, and safety protocols.
3. The individual simulation section details the steps of setting up equipment, taking vitals, titrating nitrous oxide doses, monitoring the patient, and ensuring full recovery before the patient is discharged.
Dr. Valluri Ramu is a professor in the Department of Anaesthesiology, CCM & Pain Medicine at KAMSARC in Hyderabad, India. His fields of interest include renal transplant anesthesiology and critical care medicine. The document discusses antithrombotic prophylaxis and regional anesthesia. It defines thromboprophylaxis and describes various anticoagulant and antiplatelet drugs. It also discusses the risks of thromboembolism and bleeding when administering these drugs during regional anesthesia techniques.
- Platelets play an important role in blood clotting by clumping together to form blood clots, which stop bleeding from cuts or wounds. However, blood clots inside arteries can block blood flow and damage tissues.
- Antiplatelet drugs like aspirin work by preventing platelets from clumping together. Aspirin is commonly used after CABG surgery and procedures like angioplasty to prevent new blood clots from forming and reduce the risk of future heart attacks.
- While aspirin is generally safe, concerns remain about how soon after surgery it can safely be given to balance preventing clots versus risks of bleeding complications. Studies found low dose aspirin given within 48 hours of CABG was not
Management of patients with cardiovascular diseases in periodonticsShubhra Bardhar
This document provides guidelines for managing patients with cardiovascular disease undergoing periodontal treatment. It discusses identifying various cardiovascular conditions like hypertension, ischemic heart disease, congestive heart failure, infective endocarditis, and cerebrovascular accidents. For each condition, it outlines steps to take such as consulting the patient's physician, using local anesthetics with low epinephrine concentration, scheduling short and stress-free appointments, and being prepared to treat anginal episodes or arrhythmias that may occur during treatment. The goal is to perform periodontal therapy safely for patients with cardiovascular complications through proper medical evaluation and stress reduction strategies.
Management of medically compromised patients in oral surgery.pptxAmeerasalahudheen1
The document discusses medical conditions that may impact dental treatment and provides guidelines for managing patients with certain conditions. It covers classifications of patient health status, cardiovascular diseases like hypertension, respiratory diseases like asthma, liver diseases like cirrhosis, and provides considerations and precautions for treating patients with each condition. Management may include consultation, stress reduction protocols, modified local anesthetic techniques and medications. The goal is to safely provide dental care for medically compromised patients.
Periodontal treatment of medically compromised patients.pptAshokKp4
1. Periodontal treatment of medically compromised patients requires recognition of underlying medical conditions and formulation of an appropriate treatment plan.
2. Key considerations for patients with cardiovascular diseases like hypertension, ischemic heart diseases, and congestive heart failure include consultation with their physician, use of local anesthetics carefully, keeping procedures short, and monitoring vital signs closely.
3. Management of diabetic patients includes checking blood glucose levels before, during, and after treatment to monitor for hypoglycemia, and consulting their physician about antibiotic premedication for surgical procedures.
Endodontic Considerations In Hypertensive and Bleeding Disorder PatientsSarosh Hussain
Dr. Syed Sarosh Hussain provides guidelines for dental procedures in patients with cardiovascular disease or those taking anticoagulant/antiplatelet medications. For non-surgical procedures, lidocaine with 1:100,000 epinephrine is preferred. For surgical procedures, local anesthetic with vasoconstrictor can be used but the dose should be limited. Certain patients are at very high risk for complications from local anesthetic with vasoconstrictor. It is important to consult with the patient's physician and check coagulation factors/INR prior to any dental procedures depending on the specific health conditions and medications of the patient.
Dental Management of CardioVascular Diseases (CVD)Mohammed Alawad
1. Dental management of patients with cardiovascular diseases requires understanding their medical history and conditions, as well as coordinating care with their physician.
2. For hypertensive patients, dentists should measure blood pressure at every visit and postpone treatment during hypertensive crises.
3. Patients on anticoagulant therapy or at risk of infective endocarditis require special precautions like pre-treatment with antimicrobials and avoidance of invasive procedures whenever possible. Close collaboration with physicians is important.
This document summarizes the pharmacotherapy of hypertension. It begins by defining blood pressure and classifications of hypertension. It then discusses the goals of antihypertensive therapy and classifications of commonly used drug classes including: diuretics, adrenoceptor antagonists, renin-angiotensin system agents, calcium channel blockers, and other centrally acting drugs. Specific examples are provided within each drug class along with their mechanisms of action and uses for treating hypertension.
This document discusses the pharmacotherapy of hypertension. It defines hypertension and classifies blood pressure readings. The main types of drugs used to treat hypertension work by decreasing cardiac output and/or total peripheral resistance. These include diuretics, sympathoplegic agents like methyldopa and beta blockers, vasodilators, ACE inhibitors, and calcium channel blockers. The document provides details on the mechanisms and uses of these drug classes and recommends treatment approaches based on hypertension severity.
- The patient presented with symptoms of an acute myocardial infarction (MI) and should be placed in an environment with continuous ECG monitoring and defibrillation capabilities to identify any ST-elevation and provide immediate reperfusion therapy if needed.
- Initial emergency treatments include oxygen, aspirin, nitroglycerin, and morphine for pain relief.
- Reperfusion therapies like thrombolysis with drugs like streptokinase or percutaneous coronary intervention can be used to restore blood flow in the blocked artery and limit heart muscle damage from ongoing ischemia.
This document discusses different types of drugs used to treat angina pectoris, including nitrates, beta-blockers, calcium channel blockers, and ranolazine. Nitrates work by dilating blood vessels to reduce oxygen demand on the heart. Beta-blockers lower heart rate and contractility. Calcium channel blockers inhibit calcium influx to protect heart tissue. Ranolazine inhibits sodium channels to improve the balance of oxygen supply and demand in the heart. These drugs are commonly used alone or in combination to manage stable angina by reducing factors that can trigger chest pain.
A 28-year-old female presented with palpitations, presyncope and an abnormal ECG strip. The ECG shows a narrow complex tachycardia. Adenosine can be used both diagnostically and therapeutically to help determine if the arrhythmia is dependent on the atrioventricular node by attempting to terminate or cause transient heart block. If the arrhythmia terminates or heart block occurs, it suggests the arrhythmia involves the AV node and is likely a supraventricular tachycardia. If adenosine has no effect, it makes ventricular tachycardia more likely.
Pharmacotherapy of congestive heart faliure Rahulvaish13
This PPT covers the pathophysiology, treatment protocol and details of individual drugs used and those drugs failed in clinical trials; taken from standard text books and articles as reference. This will be extremely useful for undergraduates ( MBBS, BDS,) and postgraduates (MD,MDS ,Phd).
This document discusses antianginal agents used to treat angina pectoris including nitrates, beta blockers, and calcium channel blockers. Nitrates work by causing vasodilation of coronary arteries to increase blood flow. Beta blockers decrease heart rate and contractility to lower oxygen demand. Calcium channel blockers cause peripheral vasodilation and reduce contractility. Nursing implications include monitoring for side effects like hypotension and ensuring proper administration of different drug formulations.
This document discusses antianginal agents used to treat angina pectoris including nitrates, beta blockers, and calcium channel blockers. Nitrates work by causing vasodilation of blood vessels including coronary arteries to increase blood flow and oxygen to the heart. Beta blockers decrease heart rate and contractility to lower oxygen demand. Calcium channel blockers cause peripheral vasodilation and reduce contractility to decrease oxygen demand. The document provides details on common medications in each class and nursing considerations for administration and patient education.
Anti thrombotic therapy in difficult clinical conditionsDrArpan Chouhan
This document discusses anti-thrombotic therapy in difficult clinical conditions. It summarizes various antiplatelet and anticoagulant drugs, difficult situations for their use including high ischemic or bleeding risk, and strategies for balancing thrombotic and hemorrhagic risks. Certain drugs like prasugrel and ticagrelor are preferred for high ischemic burden due to more potent platelet inhibition, while dose adjustments and shorter durations are recommended for high bleeding risk. Careful management is needed in situations like surgery, renal dysfunction, and pregnancy to minimize risks.
The document discusses the classification and mechanisms of action of various antihypertensive agents. It describes how drugs like diuretics, sympathoplegic agents, vasodilators, angiotensin blockers, calcium channel blockers, and ACE inhibitors work to lower blood pressure by different mechanisms throughout the body. It also covers hypertensive emergencies and the intravenous drugs used to rapidly reduce blood pressure in such situations.
A Practical Approach to Ionotropes and vasopressors Aneesh Bhandary
Vasopressors are a powerful class of drugs that induce vasoconstriction and Inotropes increase cardiac contractility. Choice of an agent should be based upon the suspected underlying etiology of shock.
This presentation deals with the practical issues and controversies surrounding the use of these agents
inotropic drugs and vassopressors drugs.pptxAhmed638947
this presentation is toalking about the Sympathomimetic drugs which are agents which in general mimic responses due to stimulation of sympathetic nerves.
These agents are able to directly activate adrenergic receptors or to indirectly activate them by increasing norepinephrine and epinephrine (mediators of the sympathoadrenal system) levels.
These drugs are used clinically to treat glaucoma, anaphylactic shock, chronic obstructive pulmonary disease, hypotension, hypertension, heart failure, nasal congestion, premature labor, attention-deficit/hyperactivity disorder, narcolepsy, and acute or chronic asthma. The α or β adrenergic antagonists block or attenuate the effect of sympathomimetics on α or β receptors. Alpha blockers are used clinically to treat hypertension and benign prostatic hyperplasia. Beta blockers are used clinically to treat ischemic heart disease, essential hypertension, cardiac arrhythmias, congestive heart failure, glaucoma, hyperthyroidism, surgical removal of pheochromocytoma, nonparkinsonian tremor, migraine headache (prophylaxis), and a wide variety of anxiety situations.
Similar to Contraindications to epinephrine.docx (20)
This document discusses various anatomical landmarks that appear on dental radiographs. It describes the differences between cortical and cancellous bone, with cortical bone appearing radiopaque and cancellous bone appearing predominantly radiolucent. It then examines specific anatomical structures seen on dental images, such as the maxillary sinus, maxillary tuberosity, nasal cavity, lateral fossa, incisive foramen, mental foramen, mandibular canal, and others. For each structure, it provides a brief definition and description of its radiographic appearance.
1. The document outlines the contents and procedures for a nitrous oxide/oxygen sedation class, including group and individual simulations.
2. It provides study guides for the class, including questions about nitrous oxide pathways of action, interactions with medications, dosing calculations, signs of sedation, and safety protocols.
3. The individual simulation section details the steps of setting up equipment, taking vitals, titrating nitrous oxide doses, monitoring the patient, and ensuring full recovery before the patient is discharged.
Sulfites are molecules containing one sulfur atom surrounded by oxygen atoms. They occur naturally in some fermented foods like wine, and are commonly added as preservatives to foods. Sulfites are also present in many oral medications, topical creams, cosmetic products, and some Chinese herbs. Sulfites cause allergies in approximately 1% of the population through hypersensitivity reactions like hives or anaphylaxis. Products containing over 10 ppm of sulfite require labeling in the US. Sulfites and sulfonamides have different chemical structures and no evidence of cross-allergy.
Non-selective beta blockers like propranolol block both beta-1 and beta-2 receptors. In patients taking these blockers, epinephrine will primarily work through alpha-1 receptors, causing unopposed vasoconstriction and increased blood pressure. This can lead to profound decreases in heart rate due to vagal stimulation. In emergencies where epinephrine is normally used, like anaphylaxis, higher doses may be needed for patients on beta blockers, but one must be careful of paradoxical bradycardia. Glucagon is another option but evidence for its use is limited to animal studies and it often causes nausea.
The patient provided informed consent for nitrous oxide-oxygen sedation. They understood the risks, benefits, and procedure. All questions were answered and the patient requested nitrous oxide to minimize anxiety during their care. Pre-sedation vitals were taken and nitrous oxide and oxygen levels were monitored throughout the procedure. Post-sedation vitals and signs of recovery were also recorded. The patient was discharged with instructions in a stable condition.
This document discusses the risks and complications of using nitrous oxide for sedation. It notes that nitrous oxide can cause vitamin B12 deficiency by irreversibly inhibiting the methionine synthetase enzyme. This can lead to megaloblastic anemia and neurological issues like subacute combined degeneration of the spinal cord. The document cautions against using nitrous oxide in patients with preexisting vitamin B12 deficiency or neurological conditions. Medical consultations should be considered for patients with potential contraindications due to risks like increased pressure in air spaces, gastrointestinal obstruction, or psychiatric issues. Vital signs should be monitored during and after sedation to ensure patient safety.
This document provides information on nitrous oxide and oxygen sedation. It discusses the different levels of sedation including minimal sedation using less than 50% nitrous oxide and moderate sedation using over 50% nitrous oxide. It emphasizes the importance of careful titration to achieve the intended level of minimal sedation and outlines recommendations for patient monitoring, recovery, and record keeping when using nitrous oxide sedation.
This document describes various anatomical landmarks that appear on dental radiographs. It discusses the differences between cortical and cancellous bone, which appear radiopaque and radiolucent respectively. It also examines maxillary sinus, tuberosity, nasal cavity, lateral fossa, septum, floor of nasal fossa, incisive foramen, alveolar canal, submandibular fossa, mylohyoid ridge, mental foramen, mandibular canal, mental fossa, and mandibular foramen among other structures. The document provides details on the appearance and locations of these landmarks to aid in radiographic interpretation.
This document discusses various nerve blocks used in dental local anesthesia including the superior alveolar, infraorbital, greater palatine, and incisive nerve blocks. It describes the areas anesthetized, techniques, complications and precautions for each block. Precise needle placement is emphasized to effectively anesthetize the intended areas while avoiding risks such as hematoma formation.
This document discusses various aspects of local anesthetics used in dentistry. It covers individual variability in response to local anesthetics, how tissue factors and injection techniques influence onset and duration. It provides details on maximum recommended doses and safe usage of specific local anesthetics like lidocaine, articaine, mepivacaine and bupivacaine. Risk groups that require lower doses are mentioned. Guidelines for calculating maximum recommended doses when combining local anesthetics are also summarized.
This document discusses local anesthetics and vasoconstrictors used in dental procedures. It describes how epinephrine acts as a vasoconstrictor to decrease blood flow and slow absorption of local anesthetics, prolonging their duration and depth. It provides details on the classification, mechanisms of action, effects on cardiovascular and other systems, maximum recommended doses, contraindications, and alternatives to epinephrine for patients with certain medical conditions.
This document summarizes the pharmacokinetics of local anesthetics. It discusses how local anesthetics are absorbed, distributed, metabolized and eliminated by the body. It also describes the mechanisms of action of local anesthetics on the central nervous system, cardiovascular system and other body tissues. Potential side effects from overdose or interactions with other drugs are also outlined.
This document discusses the interaction of nitrous oxide with the body during minimal sedation. It notes that nitrous oxide improves patient perfusion while decreasing anxiety and has minimal effects on the cardiovascular and respiratory systems when used properly. However, it can depress reflexes and there are various medical conditions that require consultation or make nitrous oxide contraindicated due to risks such as hypoxia, gas expansion, or interference with vitamin B12 absorption. These include chronic respiratory diseases, cystic fibrosis, recent eye surgery, pregnancy in the first trimester, and various infections.
This document describes the anatomy and physiology of respiration and the effects of nitrous oxide. It discusses how air moves through the nasal cavity, pharynx, larynx, trachea, bronchi and into the lungs and alveoli where gas exchange occurs. It explains that nitrous oxide rapidly diffuses into the bloodstream due to its low solubility, which can temporarily reduce oxygen saturation levels. The document outlines the levels of sedation and safety precautions for nitrous oxide administration.
This chapter discusses nitrous oxide and oxygen sedation. It covers the pharmacokinetics of nitrous oxide including its absorption, distribution, and excretion. Nitrous oxide is colorless, odorless gas that is relatively insoluble in blood and achieves peak clinical effects within 3-5 minutes of administration. When used for sedation, a minimum of 30% oxygen must be delivered concurrently to prevent hypoxia. The chapter also discusses the manufacturing and distribution of nitrous oxide, its biochemical effects, and safety aspects of its use.
The document discusses nitrous oxide and oxygen sedation, including how nitrous oxide works in the body to reduce pain and anxiety by acting on opioid receptors or increasing endogenous opiates, with effects being reversed by oxygen. It also addresses levels of sedation from anxiolysis to general anesthesia, factors that influence pain response, and techniques for pain and anxiety management during dental procedures.
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
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Contraindications to epinephrine.docx
1. South African Dental Journal
On-line version ISSN 0375-1562
Print version ISSN 0011-8516
S. Afr. dent. j. vol.72 n.4 Johannesburg May. 2017
COMMUNICATION
Local anaesthetics in dentistry - Part 3: Vasoconstrictors in
local anaesthetics
DS Moodley
PhD, MSc, PDD Aesthet. BDS, FICD. Department of Restorative Dentistry, Faculty of
Dentistry, University of the Western Cape, Cape Town, South Africa. Private Bag X1,
Tygerberg, 7505. Tel: 021 9373090 E-mail: dmoodley@uwc.ac.za
INTRODUCTION
Vasoconstrictors like adrenaline in local anaesthetics are associated with more drug
interactions than any other drug in Dentistry1
with an incidence of adverse reactions ranging
from 2.5%-11%.2
Therefore, understanding the physiological and pharmacological effects,
interactions with other drugs, and dosages are important in day to day dental practice.
Local anaesthetics are vasodilators, hence the addition of a vasoconstrictor like adrenaline
provides the following advantages: improves the anaesthetic onset and duration, reduces
bleeding, and decreases the systemic absorption rate of local anaesthetics by reducing the
plasma concentration.2,3
However, adrenaline is unstable and therefore an antioxidant is
added to prevent it oxidizing. Sodium bisulphite is the preservative most commonly added
to local anaesthetics. Of course, patients allergic to sulphites will now react to a local
anaesthetic containing sodium bisulphites.
2. DOSAGE
Calculating the dose of vasoconstrictor is different from ascertaining the local anaesthetic
dosage in that vasoconstrictors are expressed as a dilution ratio and are not weight-
dependent. In local anaesthetics, the adrenaline in dilution ratios of 1:80000 (Xylotox E80A,
Adcock Ingram; Xylestesin, 3M), 1:100 000 (Ubistesin forte, 3M; Septocaine, Septodont)
and 1:200000 (Ubistesin 3M; Septocaine, Septodont) are generally the most commonly
used concentrations in dentistry. Adrenaline concentrations are generally expressed
as 1:1000 which is 1mg/ml. Therefore, a local anaesthetic with 1:100000
adrenaline concentration will translate to 0.01mg/ml resulting in a 1.8ml local
anaesthetic cartridge containing 0.018mg adrenaline. A 1:200000 will therefore
contain a concentration of 0.005mg/ml translating to approximately 0.01mg per cartridge of
local anaesthetic. The maximum dose of adrenaline in healthy patients is 0.2mg per
appointment (approximately 10 cartridges of 1:100000 local anaesthetic). However, in
medically compromised patients, such as those having cardiac risk, the recommended
maximum dosage of adrenaline is 0.04 mg i.e. two cartridges of 1:1000000 local
anaesthetic. The American Heart Association and the American Dental Association have
stated "the typical concentrations of vasoconstrictors contained in local anaesthetics are not
contraindicated in cardiovascular disease so long as preliminary aspiration is practiced, the
agent is injected slowly, and the smallest effective dose is administered".4
Adrenaline
1:100,000 caused more sympathomimetic side effects than did 1:200,000 adrenaline
concentration5
thus it is logical to use this lower concentration of adrenaline when possible.
In several European and Asian countries, adrenaline concentrations of 1:300000 and
1:400000 are now available in dental cartridges.6
Furthermore, using a lower concentration
of adrenaline like 1:200000 does not seem to compromise the anaesthetic efficacy of the
local anaesthetic.7-9
In fact, 1:200000 solutions should be the preferred choice of adrenaline
concentration in the absence of significant differences in performance with the 1:100000
solution.10
For patients undergoing periodontal surgery, 4% articaine with either adrenaline
1:100000 or 1:200000 concentration provides excellent surgical pain control. However, the
4% articaine 1:100000 adrenaline concentration has the additional advantage of providing
better visualization of the surgical field because there is less bleeding.11
ADRENALINE AND DRUG INTERACTION
Another problem associated with adrenaline is that it can interact with some of the drugs
that the patient may be taking. In this instance the most commonly affected drugs are the
non-selective beta blockers, some antidepressants and "street drugs" (Table 1).
NON-SELECTIVE BETA BLOCKERS
Non-selective beta blockers like propranolol (Inderal) and nadolol (Corgard) are used as
anti-hypertensive drugs or to control migraines. Vasoconstrictors administered to patients
on non-selective beta blockers can result in uncompensated peripheral vasoconstriction as a
result of unopposed stimulation of alpha 1 receptors, leading to increase in blood pressure,
bradycardia and headaches.4,12,13
3. Cases have been recorded in both the dental and medical literature where the magnitude of
the blood pressure increased was alarming and potentially life threatening.13
Therefore, in
patients on non-selective beta blockers requiring simple restorative procedures, complete
avoidance of adrenaline seems rational. For more complex procedures for which
haemostasis or a more prolonged duration of local anaesthesia is required, the initial
vasoconstrictor dose should be kept to an absolute minimum such as one-half of a dental
cartridge with 1:100000 or preferably 1:200000 and injected carefully to avoid intravascular
administration. The vital signs of the patient should be monitored before further
administration. If there is no change in cardiovascular status, additional cartridges can be
injected individually at five-minute intervals. Adrenaline containing retraction cord must be
avoided in a patient taking a non- selective β-antagonist.
TRICYCLIC ANTIDEPRESSANTS
Tricyclic antidepressants like imipramine and amitriptyline inhibit the uptake of adrenaline at
the neuronal level, resulting in increased concentrations of the catecholamines at the
sympathetic neuronal junction.14
A maximum dose of 0.04 mg, (equivalent to two cartridges
of 1;100000 local anaesthetic) of exogenous adrenaline is proposed for patients on tricyclic
antidepressants.15
Using a lower concentration of 1:100000or less, eg. 1:200000, is
preferable and in a dosage which is no more than one-third the normal maximum which
would be given, should preclude any problem that could arise from a tricyclic drug
interaction.1
The interactions of vasoconstrictors with general anaesthetics like halothane, thiopental and
barbiturates can increase the dysrhythmic effects of dental vasoconstrictors. The clinician
needs to inform the anaesthetist before administering a local anaesthetic with
vasoconstrictor, and to restrict the dose to the limit recommended for the vasoconstrictor
according to general anaesthetic procedures: halothane (2.2µgkg for halothane, 3.5µg/kg
for enflurane and 5.5µg/kg for isoflurane).1,15
A reported death under halothane anaesthesia
caused by adrenaline in gingival retraction cord reinforces the need to adhere to
recommended doses of adrenaline under general anaesthesia.
"STREET DRUGS"
Methamphetamines and cocaine have sympathomimetic effects and can interact with
adrenaline in local anaesthetics. Vasoconstrictors in combination with cocaine or
methamphetamines increase the risk of hypertensive crises, stroke and myocardial
infarction.4
Elective dental treatment should be postponed for at least 24 hours after the last
cocaine use to allow elimination of the drug.3
ADRENALINE AND THE MEDICALLY COMPLEX PATIENT
Adrenaline is both a hormone and a neurotransmitter belonging to sympathomimetic drugs
that can mimic sympathetic nervous system mediators.6
It provides direct stimulation of the
4. adrenergic receptors. Clinicians need to be aware of its effect on the sympathetic nervous
system especially in medically compromised patients as certain modifications must be made
(Table 1). A joint statement of the American Dental Association and American Heart
Foundation on vasoconstrictors provides the following advice: "Vasoconstrictors should be
used with extreme care to avoid intravascular injection. The minimum possible amount of
vasoconstrictor should be used".6
CARDIOVASCULAR DISEASES
In the presence of ischaemic heart disease, elective dental treatment is contraindicated in
the following situations: patients with unstable angina, recent myocardial infarction (less
than six months), recent coronary artery bypass surgery (less than three months).16
If emergency dental treatment is necessary, medical consultation is required and adrenaline
dosages should be limited to one to two cartridges of 1:100000 solution (0.018 to 0.036 mg
of adrenaline).16,17
Similarly, in patients with stable angina, vasoconstrictors should be
limited to one to two cartridges.16
Vasoconstrictors are contraindicated in patients with
severe arrhythmias.10
Digoxin, prescribed to increase the heart's contractile force, has a
narrow therapeutic index and may precipitate a cardiac arrhythmia when used concurrently
with vasoconstrictors.16,17
STROKE
Use of adrenaline should be deferred for patients who have suffered a cerebrovascular
accident, or stroke within the last six months. After that time, doses of adrenaline should be
limited to less than 0.036 mg, equivalent to two cartridges of local anaesthetic with
1:100000 adrenaline concentration.16,17
HYPERTHYROIDISM
The use of adrenaline in local anaesthetics should be avoided, or at least minimized to one
to two cartridges, in the untreated or poorly controlled hyperthyroid patient.18
Although the
theoretical risk of thyroxine - adrenaline potentiation is serious, no clinical case has been
reported.10
CORTICOSTEROID-DEPENDENT ASTHMA
Administration of local anaesthetic with vasoconstrictors in cortico-dependent asthma
patients may result in a higher risk of sulphite allergy. An anaesthetic without
vasoconstrictor, and thus without bisulphite, is indicated.4,10,17
5. PHEOCHROMOCYTOMA
A tumour of the adrenaline medulla, characterized by the presence of catecholamine-
producing tissue, constitutes an absolute contraindication to the administration of
vasoconstrictors.10
BONE IRRADIATION
It is desirable to avoid the use vasoconstrictors with a local anaesthetic when a patient is
receiving irradiation of bone.10
CONCLUSION
A thorough understanding of the pharmacologic interactions between adrenaline and
vasoconstrictors is important to avoid untoward reactions in patients.
A lower concentration like 1:200000 provides similar vasoconstriction and may be preferred
especially for medically compromised patient.
6. Glycemic effect of administration of epinephrine-containing local
anaesthesia in patients undergoing dental extraction, a comparison
between healthy and diabetic patients.
Tily FE1
, Thomas S.
Author information
Abstract
OBJECTIVES:
To compare the effect of administration of epinephrine (in the dental local anesthetic solution) on
blood glucose concentration in healthy and diabetic dental patients after extraction. To determine
if there is any correlation between blood glucose level changes and the number of carpules
injected, number of teeth extracted and the gender of the patient.
MATERIALS AND METHOD:
An open study of 60 patients (30 healthy and 30 diabetics) visiting the Oral Surgery clinic of
Ajman University of Science and Technology. A drop of blood was taken from the tip of the
patient's finger and placed on a glucometer strip to determine the pre-operative blood glucose
level. Dental local anaesthesia (1.8 ml carpule each) containing 1:80,000 epinephrine was
injected either through infiltration or block. Extraction was carried out atraumatically and 10
minutes post-extraction the glucose measurement was taken.
RESULTS:
The difference in the blood glucose levels pre- and post operatively were not significantly
different (p > 0.05) when a comparison was made between the healthy and diabetic groups.
Comparison of glucose changes in diabetics who had taken their hypoglycaemic medication and
those who had not, showed a significant difference (p < 0.05). Statistical analysis showed no
correlation between the blood glucose level changes and the number of carpules used, number of
teeth extracted and gender.
CONCLUSION:
Dental local anaesthetic solution containing epinephrine is safe to use in all healthy and diabetic
patients (irrespective of their gender), excepting those diabetics who have not taken their pre-
operative hypoglycaemic medication. There is no relation between the post-extraction glucose
changes and the number of carpules used, number of teeth extracted or gender.
7. Contraindications to epinephrine
Epinephrine is contraindicated in patients with known hypersensitivity to sympathomimetic amines, in
patients with angle closure glaucoma, and patients in shock (nonanaphylactic).
What drugs interact with epinephrine?
Some products that may interact with this drug are: anti-arrhythmic drugs (e.g., amiodarone,
quinidine), beta-blockers (e.g., propranolol), digoxin, entacapone, ergot alkaloids (e.g.,
ergotamine), MAO inhibitors (isocarboxazid, linezolid, methylene blue, moclobemide,
phenelzine, procarbazine, rasagiline, safinamide, ...
www.rxlist.com
8. Entacapone is an inhibitor of catechol-O-methyltransferase (COMT). It is used in combination
with levodopa and carbidopa (Sinemet) to treat the end-of-dose 'wearing-off' symptoms of
Parkinson's disease.Feb 15, 2018
Entacapone: MedlinePlus Drug Information
https://medlineplus.gov/druginfo/meds/a601236.html
Nonselective agents
Nonselective beta blockers display both β1 and β2 antagonism.[59]
Propranolol[59]
Bucindolol (has additional α1-blocking activity)[60]
Carteolol[61]
Carvedilol (has additional α1-blocking activity)[59]
Labetalol (has additional α1-blocking activity)[59]
Nadolol[59]
Oxprenolol (has intrinsic sympathomimetic activity)[62]
Penbutolol (has intrinsic sympathomimetic activity)[59]
Pindolol (has intrinsic sympathomimetic activity)[59]
Sotalol (not considered a "typical beta blocker")[59]
Timolol[59]
β1-selective agents
β1-selective beta blockers are also known as cardioselective beta blockers.[59]
Acebutolol (has intrinsic sympathomimetic activity, ISA)[59]
Atenolol[59]
Betaxolol[59]
9. Bisoprolol[59]
Celiprolol (has intrinsic sympathomimetic activity)[63]
Metoprolol[59]
Nebivolol[59]
Esmolol[64]
β2-selective agents
Butaxamine[65]
ICI-118,551[66]
β3-selective agents
SR 59230A[67]
β1 selective antagonist and β3 agonist agents
Nebivolol [59]
The five main classes in the Vaughan Williams classification of antiarrhythmic agents are:
Class I agents interfere with the sodium (Na+
) channel.
Class II agents are anti-sympathetic nervous system agents. Most agents in this class are
beta blockers.
Class III agents affect potassium (K+
) efflux.
Class IV agents affect calcium channels and the AV node.
Class V agents work by other or unknown mechanisms.
With regard to management of atrial fibrillation, classes I and III are used in rhythm control as
medical cardioversion agents, while classes II and IV are used as rate-control agents.
Class
Known
as
Examples Mechanism Medical uses [3]
Ia
Fast-
channel
blockers
Quinidine
Ajmaline
Procainamide
Disopyramide
(Na+
) channel block
(intermediate
association/dissociation)
and K+ channel blocking
effect; affects QRS
complex
Ventricular
arrhythmias
Prevention of
paroxysmal recurrent
atrial fibrillation
(triggered by vagal
overactivity)
10. class 1a prolong the action
potential and has
intermediate effect on the 0
phase of depolarization
Procainamide in
Wolff-Parkinson-
White syndrome
Increases QT interval
Ib
Lidocaine
Phenytoin
Mexiletine
Tocainide
Na+
channel block (fast
association/dissociation);
can prolong QRS complex
in overdose
class 1b shorten the action
potential of myocardial cell
and has weak effect on
intiation of phase 0 of
depolarization
Treatment and
prevention during and
immediately after
myocardial infarction,
though this practice is
now discouraged
given the increased
risk of asystole
Ventricular
tachycardia
Ic
Encainide
Flecainide
Propafenone
Moricizine
Na+
channel block (slow
association/dissociation)
has no effect on action
potential and has the
strongest effect on
initiation phase 0 the
depolarization
Prevents paroxysmal
atrial fibrillation
Treats recurrent
tachyarrhythmias of
abnormal conduction
system
Contraindicated
immediately after
myocardial infarction
II
Beta-
blockers
Carvedilol
Propranolol
Esmolol
Timolol
Metoprolol
Atenolol
Bisoprolol
Nebivolol
Beta blocking
Propranolol also shows
some class I action
Decrease myocardial
infarction mortality
Prevent recurrence of
tachyarrhythmias
Propranolol has
sodium channel-
blocking effects
III
Amiodarone
Sotalol
Ibutilide
Dofetilide
Dronedarone
E-4031
Vernakalant
K+
channel blocker
Sotalol is also a beta
blocker[4]
Amiodarone has
Class III mostly, but also I,
II, & IV activity[5]
In Wolff-Parkinson-
White syndrome
(Sotalol:) ventricular
tachycardias and
atrial fibrillation
(Ibutilide:) atrial
flutter and atrial
fibrillation
(Amiodarone):
prevention of
11. paroxysmal atrial
fibrillation,[6]
and
haemodynamically
stable ventricular
tachycardia[7]
IV
Calcium
Channel
Blockers
Verapamil
Diltiazem Ca2+
channel blocker
Prevent recurrence of
paroxysmal
supraventricular
tachycardia
Reduce ventricular
rate in patients with
atrial fibrillation
V
Adenosine
Digoxin
Magnesium
Sulfate
Work by other or unknown
mechanisms (direct nodal
inhibition)
Used in supraventricular
arrhythmias, especially in
heart failure with atrial
fibrillation, contraindicated
in ventricular arrhythmias.
Or in the case of magnesium
sulfate, used in torsades de
pointes.