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Pharmacology - cardiac - Anti-Arrhythmics (*Antiarrhythmics = AntiAR…
Pharmacology - cardiac - Anti-Arrhythmics
*Antiarrhythmics = AntiAR
Tyoes of Antiarrhythmics
*Class 1 anti AR
Class 1B = weak Na+ channel blockers
Lidocaine = class1 B antiarrhythmic
1A inhibit Na+ in the active state
--> inhibit all Na+ chnnels
1B like lidocaine are B class so they only inhibit B rated cells = damaged / ischemic cells post MI
Lidocaine = class1 B antiarrhythmic
Notes
:
note that
Clinical Case
Class 1A = moderate Na+ channel blockers
phase 0 / samll bit phase 3 refractory K+
block Na+ channels in the active state
--> longer action potentials
small action on K+ channels
--> makes refractory period longer
Class 1C = strong Na+ channel blockers
class 1 C have the strongest slant of the first Na DEPOL curve
--> think of a very excessive change in the pyramid from Class 1A
-->
more FLAT = very HOT
= CAN I have some very HOT FRIES PLEASE
CAN I have very hot ONE PROPER FRIES PLEASE?
class 1 C
FRIES = flecainamide
PROPER / PLEASE = propafenone
PYRAMID
=
MIDES
effect the first slope of the pyramid
--> both class 1A and !C
Mexican tacos cure arrhythmias...
I'd BUY LIDDLE MEXICAN TACOS all the TINE!!
class 1 BUY
LIDDLE = lidocaine
MEXICAN TACOS all the TINE!! = mexiletine
shifts the potential into a pyramid with a DISCO BALL on top...
this is to distract the people from the famine --> PARTY PYRAMID with a crown on top...
QUEEN PROCLAIMS it the FIRST DISCO PYRAMID
The QUEEN PROCLAIMS it the FIRST DISCO PYRAMID
class 1 A = a pyramid -> more shift to right for both NA+ depol and K+ REPOL
QUEEN = Quinidine
PROCLAIMS = procainamide
DISCO PYRAMID = disopyramide
PYRAMID
=
MIDES
effect the first slope of the pyramid
--> both class 1A and !C
Class 1 Drugs on Na+ Channels = Phase 0 of AP
Class 1c = strong
Class 1A = medium
Class 1c = weak (more to do with K+ increase = phase 3)
*Class 2 = Beta blockers
think more
AV node
and
PACEMAKER
cells
Beta BLockers SLOW AV node = long PR
--> class 2 = beta blockers work on the PR interval
--> mainly SLOW AV node conduction
--> longer PR interval = SA to AV nodes
they work on Gs proteins
--> increase cAMP and Ca++
--> thus decrease the Ca++ in the cell
note 2/4 switch for antiAR
--> class 2 = Beta blockers work on phase 2 plateau
--> class 4 = CC blockers work on phase 2 plateau
Beta Blockers Prolong PR interval = SLOW AV node conduction
MAIN action of beta blockers = longer PR interval = SA to AV nodes
EXCEPTION of beta blockers = sotalol
--> class 3 anti AR
--> amiodarone / sotalol / dufo
"AMELIO drinking SODA like a LITTLE DUFUS"
*Class 3 AntiAR = K+ outflow channel blockers
stop K+ flowing out
--> make cell more + during phase 3
--> longer repolarization and slows the myocytes down
Class 3 AntiAR Drugs
sotalol
dofetalide
*Amiodarone
40% of am
IOD
arone is iodine
--> affects TFTs and thyroid
Side Effects:
-
Thyrdoi Side Effects of AmIODarone
Initiating patient on amiodarone
ALWAYS check TFTs
--> especially TSH looking for subclinical hypothyroidism
high iodine content of amiodarone can increase or decrease the production of T4 and T3
1 more item...
Class 3 Cases
class 3 antiAR case
Clinical Case
Notes
:
note that
class 3 --> think of the 3 male student in the breakfast club IN Detention
"AMELIO drinking SDOA IN DETENTION, dancing DUFFUS"
AMELIO = amiodarone
SODA = sotalol
IN DETENTION = Ibutilide + Defetilide
DUFFUS= Dofetilide
Notes
:
note the crossover of class 3 and class 1 A that both increase the phase 3 time to the right
--> prolong the repolarization
class 3 --> think of the 3 male student in the breakfast club
"AMELIO drinking SDOA like a LITTLE DUFUS"
AMELIO = amiodarone
SODA = sotalol
LITTLE DUFUS = Dofetilide
Adenosine and Mg++
Adenosine
--> good for SVTs
--> VERY fast acting
--> within 15 seconds
*Adenosine
Supra fast acting AV Slower
blocks K+ channels in the AV node of the atrium
used in emergency for supra ventricular VTachy to stop reentry from ventricles and atrium
Contraindicated in Bradycardia
caffeine = adenosine antagonist --> will counteract the Adenosine
MOA for PSVTs
PSVT = paroxysmal Supraventricular tachycardia
adenosine vasodialtes the coronary arteries and also stops conduction through the AV nodde for a short period of time to kick the heart out of reentry circuits and back into sinus rhythm
Supraventricular TAchycardias and Adenosine
Supra V Tach
give SUPRA fast drug = Adenosine
Adenosine works in 15 seconds
Clinical Cases
Clinical Case
Notes
:
note that
Clinical Case
*Class 4 = CCBs
Nondihydropyridines
verapamil and diltiazam
note 2/4 switch for antiAR
--> class 2 = beta blockers work on phase 4
--> class 4 = CC blockers work on phase 2 plateau
class 4 non-dihydro CCBs work on the end of Phase 0 of pacemaker cells
--> slow conduction through SA and AV nodes
Class 4 anti-AR = nondihydro CCBs on PAcemaker cells phase 0
:
verapamil and diltiazem slow the rate of Phase 0 T type calcium channels
slow conduction through SA and AV nodes
PAcemaker Cells automatocity from funny leak channels and T type calcium channels
note there is a transition in phase 4 from funny leak channels to transition type = t type calcium channels
then in phase 0 of pacemaker = L type = long type calcium channels that stay open for long time
= stopped eventually by the outgoing K+ efflux in phase 3
Clinical Cases
Clinical Case
2 more items...
Tetralogy case
4 more items...
Case examples
Side Effects of Non-dyhidros (Verapamil and Diltiazem)
Constipation
= biggest side effect
Non-dyhidros
"non-DIARRHEA = Constipation"
Clinical Cases
Clinical Case
Notes
:
note that
Clinical Case
*DIRTY USMLE
*anti ARs
*2 class ARs
Rule of $s with beta blockers
*3 class ARs
class 4 = CCBs NON- Dihydros
NON diarrhea
V > D at ventricles
--> Diltiazem mix of both
*1 class ARs
class 1 C have the strongest slant of the first Na DEPOL curve
--> think of a very excessive change in the pyramid from Class 1A
-->
more FLAT = very HOT
= CAN I have some very HOT FRIES PLEASE
CAN I have very hot ONE PROPER FRIES PLEASE?
class 1 C
FRIES = flecainamide
PROPER / PLEASE = propafenone
PYRAMID
=
MIDES
effect the first slope of the pyramid
--> both class 1A and !C
Mexican tacos cure arrhythmias...
I'd BUY LIDDLE MEXICAN TACOS all the TINE!!
class 1 BUY
LIDDLE = lidocaine
MEXICAN TACOS all the TINE!! = mexiletine
shifts the potential into a pyramid with a DISCO BALL on top...
this is to distract the people from the famine --> PARTY PYRAMID with a crown on top...
QUEEN PROCLAIMS it the FIRST DISCO PYRAMID
The QUEEN PROCLAIMS it the FIRST DISCO PYRAMID
class 1 A = a pyramid -> more shift to right for both NA+ depol and K+ REPOL
QUEEN = Quinidine
PROCLAIMS = procainamide
DISCO PYRAMID = disopyramide
PYRAMID
=
MIDES
effect the first slope of the pyramid
--> both class 1A and !C
