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Class Class IA

Prototype Quinidine

Effects on the Heart Blocks sodium channels Slows impulse conduction Delays repolarization Blocks vagal input to the heart

Class IB


Slows conduction in the atria, ventricles, His Reduces automaticity in the ventricles, His Accelerates repolarization Block Na+ channels Delay repolarization Decreasing atrial conduction velocity Exacerbate existing dysrhytmias

Class IC


Class II

Propanol Decreased automaticity of the SA node (non-selective Beta) Decreased AV conduction velocity Decreased myocardial contractility

Class III


Reduced automaticity in the SA node .Reduced contractility .Reduced conduction velocity .QRS widening .Prolongation of the PR and QT intervals .Also promotes coronary and peripheral vasodilation Reduce SA nodal automaticity Delay AV nodal conduction Reduce myocardial contractility

Class IV

Verapamil Diltiazem



Decreases automaticity in the SA node ▪Slows conduction through the AV node ▪Prolongation of PR interval

Effects on the ECG Therapeutic Uses Widens the QRS complex Long-term suppression of Prolongs the QT interval Atrial fibrillation Atrial flutter SVT Sustained vent. Tachy

Adverse Effects *Diarrhea and GI upset Cardiotoxicity Cinnhosism Arterial Embolism

No significant effectsShort term vent. Dysrhythm entricles, His

Generally well tolerate Some possible CNS

Same as heart effects Sympathetic stimulation dysrhythmias Heart block ▪Exercise-induced tachydysrhythmias .Heart failure ▪Supraventricular tachydysrhythmias .AV block ▪Suppression of excessive discharge .Sinus arrest ▪Slowing of ventricular rate .Hypotension Persistent sinus tachycardia .Bronchospasm Recurrent ventricular tachycardia Same as heart effects Recurrent ventricular fibrillation Unstable ventricular tachycardia Pulmonary toxicity Cardiotoxicity Pregnancy Corneal microdeposits Breast feeding

T intervals peripheral vasodilation Same as heart effects Terminate SVT Atrial flutter Atrial fibrillation Slow ventricular rate

Bradycardia .Hypotension .AV block .Heart failure .Peripheral edema .Constipation Increase digoxin Do not use w/ beta blk Sinus bradycardia .Dyspnea .Hypotension .Facial flushing .Chest discomfort Adminster as close to heart; short 1/2 life

Same as heart e AV node

Termination of paroxysmal SVT Inhibit cAMP calcium influx

and GI upset

well tolerate ible CNS



w/ beta blk

as close to rt 1/2 life