Antiarrhythmic drugs

Class I sodium channel blockers

Membrane stabilizing/anesthetic effect on myocardium cells; largest number of drugs in this
class

Subdivided into:

IA
Generally act to prolong action potential/produce moderate slowing of cardiac
conduction. Also slows repolarization

Disopyramide(Norpace)

Decreases depolarization of myocardial fibers, prolonging refractory period,

increasing action potential/duration of cardiac cells

Use cautiously in pt w/myasthenia gravis, urinary retention, glaucoma, prostate

enlargement

Cholinergic blocking effects, urinary retention may occur/dry mouth

Quinidine

For paroxysmal ventricular tachycardia, a fib/flutter, premature

atrial/ventricular contractions

Depresses myocardial excitability/ability of myocardium to respond to electrical

stimulus; depressed myocardium ability to respond to some(not all) electrical stimuli,
pulse rate decreases and heartbeat corrected

Can cause agranulocytosis, C/I in myasthenia gravis or systemic lupus

erythematosus

Cinchonism

Qunidine toxicity, occurs when >6mcg/mL; tinnitus, hearing loss,

headache, nausea, dizziness, vertigo, lightheadedness

Procainamide

For atrial/ventricular dysrhythmias, maintenance of normal sinus rhythm after

conversion from a fib to flutter

IB
Generally act to shorten action potential duration/selectively depress cardiac
conduction. Speeds up repolarization

Lidocaine(Xylocaine)
 For PVCs or local anesthetic

Decreases diastolic depolarization, decreasing automaticity of ventricular cells,

raising threshold of ventricular myocardium

Adverse reactions: hypotension, tremors, double vision, tinnitus, confusion

Keep resuscitation equipment handy, use infusion pump for IV, have pt
on cardiac monitor, readily absorbed through mucous membranes

IC
General action includes a slight effect on repolarization/profound slowing of
conduction. May also create new dysthymias

Flecainide

For paroxysmal supraventricular tachycardia, a fib/flutter, ventricular

tachycardia

Depress fast sodium channels, decreasing height/rate of rise of action

potentials, slowing conduction of all areas of heart

C/I in 2/3rd degree heart block, recent MI, cardiogenic shock

Propafenone(Rythmol)

For life threatening ventricular dysrhythmias

Direct membrane stabilizing effect on myocardial membrane, prolonging

refractory period

Monitor K+ levels closely

Class II beta-adrenergic blockers

General action is to indirectly block calcium channels/catecholamine-cause arrhythmias

Acebutolol(Sectral)

Propranolol(Inderal)

Both of these drugs act by blocking beta-adrenergic receptors of heart/kidney,

reducing influence of sympathetic nervous system on these areas, decreasing
excitability of heart/release of renin, lowering heart rate and BP. Also have membrane
stabilizing effect that contribute to their antiarrhythmic action

Also used for pt w/MI. Diabetes & propanolol, check blood glucose levels 1-2x/d

Class III potassium channel blockers

General action is prolongation/repolarization
 Amiodarone(Cardarone)

Appears to act directly on cardiac cell membrane, prolonging refractory period,

repolarizing and increasing ventricular fibrillation threshold

No grapefruit

Ibutilide

Acts by prolonging the action potential, producing mild slowing of sinus rate/AV
conduction

Class IV calcium channel blockers

Generally act by depressing depolarizing(phase 4), lengthening phase 1 & 2 of repolarization

Verapamil(Calan)

Inhibit movement of calcium through channels across myocardial cell

membranes and vascular smooth muscle; cardiac/vascular smooth muscle depends on
movement of Ca+ ions through specific channels. Also reduces heart rate by slowing
conduction through the SA/AV nodes

When inhibited, coronary/peripheral arteries dilate, decreasing force of

cardiac contraction.

Can cause agranulocytosis, liver dysfunction, GI distress. Assist w/ambulation at start of

therapy

Amlodipine

Decreases BP/myocardial O2 demand

Adverse effects: fatigue, paresthesia, HF, dyspnea

Diltiazem

For dysrhythmias, give w/food or milk for GI, good oral care needed.

Adverse effects: HF, Steven-Johnson, cough, constipation, angina, sexual

dysfunction, aplastic anemia, gingival hyperplasia, syncope, tachycardia,
bradycardia, sinusitis, dyspnea, tremor

Nifedipine

Adverse effects: nervousness, cough, dysrhythmias

No grapefruit w/calcium channel blockers, sun protection

Class V other antiarrhythmics

 Generally used to treat PVCs, ventricular tachycardia, premature atrial contractions, paroxysmal
atrial tachycardia, other atrial arrhythmias(a fib/flutter), tachycardia when rapid but short term control
of ventricular rate desired

Digoxin

Cardiac glycoside, decreases heart rate and increases force of contraction. For HF or
atrial fibrillation

Hypokalemia can increase risk of digoxin toxicity, diuretics like furosemide can
cause hypokalemia

Therapeutic levels b/w 0.5-2ng/mL (1-2.6 nmol/L); toxicity treated w/ digoxin

immune fab

Avoid antacids/laxatives, high potassium foods

Adenosine

Magnesium sulfate

General adverse reactions for antiarrhythmics

CNS
Lightheadedness, weakness, somnolence

CARDIO
Hypotension, arrhythmias, bradycardia

OTHER
Urinary retention, local inflammation

Many antiarrhythmics cause nausea, do not crush or chew. Take w/food to reduce GI upset.
Avoid lying flat 2 hour postprandial, HOB 4 inches higher than feet

General C/I antiarrhythmics

Pregnancy/lactation, 2/3rdº AV block(w/no artificial pacemaker), severe HF, aortic stenosis,
hypotension, cardiogenic shock