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Anti-Arrhythmia Drug (Anti-Arrhythmics (⭕️Class III: Block outward K…

- - - - MOA: Moderate block of fast inward Na channels ;
        ⛔️ muscarinic effect > quinidine
      - Tox: Pronounced negative inotropic, Anticholinergic effects , HF de novo
    - - MOA: Blocks fast inward Na;, ⛔️alpha-arenergic ®️ Blocks inward K rectifiers
      - TOX: Cinchonism, Torsades de Pointes (QT prolongation)
    - - Tox: Renal Clearance, SLE effects, reversible Lupus-like syndrome
      - MOA: Moderate block of fast inward Na Channels , ไม่มี ⛔️alpha-arenergic ®️ = anti-muscarinic effect(glaucoma, dry mouth, urinary retention)
  - - - TOX: Pulmonary tox/fibrosis > irreverse cause death, thyroid abnormalities, TdP, High half-life (3 เดือน), corneal deposit(มีสิ่งตกตะกอนอยู่ในตา)
        
        โครงสร้าง Ami มี iodine จะไปรบกวน Thyroid
      - Indication: Severe heart disease, any arrhythmia except TdP also block Na channels (effect คล้าย class 1,2 คือ non-compettitive a and B-blocker)
        
        รักษา tachy w/ Woff-Parkinson White syndrome
      - SE : CNS efffect , hypo or hyperthyroid ,cutaneous sense (ผิวไวต่อแสง) , ผิวสีฟ้า-เทา
    - - Tox: TdP, Hepatotox, Increased mortality in CHF
      - Indications: Afib
    - - Indication: Afib, A-flutter
      - Tox: TdP
    - - Tox: TdP
      - Indication: Afib, A-flutter
    - - TdP, CI: in CHF, renal clearance
      - MOA: Non-selective b-blocker (NO ISA or LA)that also acts on Ikr
      - Treatment : ventricular arrhythm , use for **paroxysmal supraventricular arrhythmia and suppress v ectopic beats
  - - - TOX:Bronchostriction (nonselective),cardiac conduction abnormalities , Hypotension, Masks hypoglycemic epidoses, Sexual dysfunction
      - Subclasses
        
        Nonselective (B1 and B2)
        
        Propanolol, Nadolol
        
        Exceptions
        
        Pindolol (crosses CNS barrier), Labetalol/Carvedilol (block a-receptors as well), Nebivolol (B1 block; B3 stimulates)
        
        Selective Examples (B1 only)
        
        Atenolol Acebutolol, Bisprolol, Esmolol, Metoprolol, Nebivolol "A on the NBME"
      - MOA: Block B1 adrenergic receptors on the heart —>
        ⬆️ERP(❤️มีระยะพักเพิ่ม) , ⬇️ Rate atrial depolarization into the ventricles , ทำให้ membrane กระตุ้นยาก
      - Clinical uses : reduce mortality follow MI, prevent recurrence of tachy(patoxysmal atrial fibrillation) = + symp
  - - - TOX: Increased mortality after MI (Cast Trials), Confusion, Visual Changes ,GI upset , CNS...
      - MOA: Potent Ina and Ikr inhibitor
        and K ch
    - - TOX: Increased mortality after MI (Cast Trials), B-blocker effect , metallic tasre , constipation , Arrhytnmia รุนแรง
      - MOA: Potent Ina and Ikr inhibitor...add weak ⛔️beta act.
  - - - MOA: ⛔️ Na+ ch (มีผลมากกับเซลล์ที่ long AP เข่น Purkinje and ventricular calls Mild, Preferentially works on diseased or ischemic cells
      - Tox: CNS problems (seizures, dizziness...)
    - - Pretty much the same as lidocaine
      - Tox: add GI upset
  - - - MOA: Inhibition of the Na/K ATPase; Increased intracellular Ca/increased Ca dependent K channels
      - TOX: Multiple proarrhythmia's, Xanthopsia, NARROW THERAPEUTIC INDEX
    - - Transient AV block
      - MOA: Activates K channels and hyperpolarizes membrane
  - - - Verapamil, Diltiazem
      - Tox: similar to B-blockers, binds to multidrug resistance pumps (Digoxin interaction) CI: CHF