ANTIARRHYTMIC MEDICATIONS

VAUGHAN-WILLIAMS CLASSIFICATION

Key Words: Inotrope = Contractility Chronotrope = Heart Rate Dromotrope = Conduction

CLASS I ANTIARRHYTHMICS – Sodium Channel Blockers

Common Side Effects: tachycardia, dry mouth, urinary retention, blurred vision, constipation, diarrhea,
nausea, headache, and dizziness.

IA – PROCAINAMIDE - Moderate Strength - Slows (A) and (V) rates (negative chronotrope)

IB – LIDOCAINE – Weak Strength - Less impact on lowering HR

**Lidocaine Toxicity – nervousness, confusion, dizziness, tinnitus, seizures, respiratory arrest,
cardiac arrest
(For pain management and cardiac dysrhythmias…Lidocaine reduces pain perception by
temporarily blocking pain signals along nerves. It does this by stopping the sodium entering the
nerve ending at the site of the pain. This prevents an electrical signal building up and passing
along the nerve fibers to the brain. In addition, lidocaine hydrochloride acts by decreasing the
sensitivity of heart muscle to electrical impulses. This slows the conduction of electrical signals
in the heart muscle, which in turn, helps to restore a regular heart rhythm. This enables the
heart to pump blood effectively around the body.

METOPROLOL & PROPANOLOL – Beta Blockers

Shuts down sympathetic nervous system! Decreases myocardial oxygen demand and consumption, decreases
contractility (negative inotrope), decreases heart rate (negative chronotrope), and blocks AV nodal conduction
(negative dromotrope).
Monitor HR & BP prior to administration. Request parameters for administration. Typically held for HR
< 60, SBP < 100.
**Contraindicated for patients with severe bradycardia, 2nd or 3rd degree HB, HF, cardiogenic shock,
non-selective BB contraindicated with dx asthma/COPD
**DO NOT stop taking abruptly

AMIODARONE – Potassium Channel Blocker

Regulates! Lengthens absolute refractory period so impulses cannot disrupt the rhythm.
Assess for AV blocks, bradycardia, ventricular arrhythmias, and hypotension

DILTIAZEM & VERAPAMIL – Calcium Channel Blockers

Slows & opens! Slows calcium moving into cell, slowing impulse conduction (negative dromotrope), HR in fast
rhythms (negative chronotrope), and decreasing contractility (negative inotrope), BP, and myocardial oxygen
demand; vasodilation action.
Request parameters for administration. Typically held for HR < 60, SBP < 100.
Non-dihydropyridines (diltiazem & verapamil) are preferred for arrhythmia management versus the
dihydropyridines (amlodipine, nicardipine, felodipine) because of their powerful vasodilator effects.
Assess for dizziness, nausea, hypotension, bradycardia, edema, constipation, HF, AV block, V fib,
asystole.

T. Oxley, Last revised 9/20/16

ADENOSINE (Adenocard)
Stops! Interrupts reentrant pathways, stops AV nodal conduction (negative dromotrope), decreases
automaticity in SA node, very short half-life (< 10 seconds)

Give rapid IV push: 6mg over 1-2 seconds, may repeat in 1-2 minutes with
12mg bolus for up to two consecutive doses. Follow with NS flush.

DIGOXIN (Lanoxin)
Slows, steadies, & strengthens! Cardiac glycoside; increases contractility (positive inotrope) and decreases HR
(negative chronotrope). Does not convert rhythms.

**Monitor for Dig Toxicity (arrhythmias, visual disturbances, N/V/D, change in mental status/fatigue).
Notify PCP if suspected.
Therapeutic Drug Monitoring (0.5 – 2.0ng/mL)
Obtain level within 24 hours after 1st dose, subsequent levels drawn 6-10 hours after last dose
HOLD FOR HR < 60, or if Dig Toxicity is suspected
Antidote: Digibind – binds to Digoxin molecules, making them unavailable. Serum levels will still be high
even after administering Digibind because it cannot differentiate from bound and unbound Digoxin.

Conditions that increase risk of dig toxicity: hypo/hyperkalemia, hypoxia, hypothyroidism,

hypercalcemia, renal impairment, advanced age, concurrent use of many medications and herbs

ATROPINE
Speeds up! Blocks effect of vagus nerve on cardiac conduction (positive chronotrope)

DO NOT use for patients with urinary retention (can worsen) or glaucoma (s pressure)
Side effects: tachycardia, dry mouth, constipation, hallucinations

EPINEPHERINE (Adrenalin)
Makes something out of nothing! A hormone found naturally in our body secreted by the adrenal glands. Acts
as a sympathomimetic, mimicking the sympathetic nervous system by increasing HR, BP, and vasoconstriction of
the blood vessels. Can be used interchangeably with Vasopressin (a potent vasoconstrictor) during asystole
management.

T. Oxley, Last revised 9/20/16