Antiarrhythmic &

Cardiotonic

College Teacher : Novia Sinata,M.Si.,Apt

Arranged By : Indri Cyintia(1800022)

sub chapter
• Understanding
• Classification of drugs
• Work mechanism
• Indication
• Counter indication
• Examples of drugs
• Side effects
Antiarrhythmic

Antiarrhythmia is a group of drugs used to treat

arrhythmia conditions.
Arrhythmia is a condition that refers to when the
heartbeat beats too fast, too slow, or irregular.
Causes of arrhythmias

• Take colds or allergic drugs

• Sleep apnea
• Hypertension
• Diabetes
• Electrolyte disturbances, such as excess or lack of
potassium.
• In addition to medical conditions, arrhythmias can also be
triggered by unhealthy lifestyles, such as: Unable to
manage stress properly, lack of sleep, smoking, excessive
consumption of alcoholic beverages or caffeinated, drug
abuse.
Antiarrhythmic classification
1. Antiarrhythmia group I
inhibits the sodium channel voltage sensitive by the same
mechanism as local anesthetics. a decrease in the rate at which
sodium is introduced slows the rate of increase in phase 0 of the
action potential. Drugs that belong to group 1, namely:
Lidocaine
• Indications: stop itching and pain from certain skin conditions
• Contraindications:
• hypovolemia, total heart block; Do not use adrenaline-
containing solutions for anesthesia in appendages.
• Dosage:
• Arrhythmia Conditions
• - Inject (emergency) Adults: 300 mg given through the
shoulder muscles. Can be repeated after 60-90 minutes, if
needed.
• -Inject (stable) Adult: 1-1.5 mg / kgBB, can be repeated if
needed. Maximum dose: 3 mg / kg body weight. Can be
repeated once or twice. The dosage needs to be reduced if the
drug is used longer than 24 hours.
• •Side effects:
• effects on the central nervous system include confusion,
respiratory depression, and convulsions; hypotension and
bradycardia (can cause cardiac arrest)
• Trademarks: Colme, Extracaine, Emla Ultraproct N,
Lignovel, Liposin, Lemocin, Nelicort, Otilon,
Pehacain, Topsy, Xylocaine.
2. Antiarrhythmic group ll
• is an adrenergy antagonist. This drug reduces phase
depolarization so that it depresses automation, prolongs A
conduction, and can decrease heart rate and contraction.
This class of drugs is useful for the treatment of
tachyarrhythmias due to increased sympathetic activation.
this drug is also used for atrial fibrillation and flutter, and
tachycardia
• re-entrant the AV node. Examples of these drug classes are:
• Propranolol
• • Indications: Treat various disorders related to the heart
and blood vessels
• • Contraindications: Cardiovascular disease, allergy to
propranolol hydrochloride, metabolic acidosis
• Dosage: Adult arrhythmia conditions 30-160 mg
per day, which are divided into several
consumption schedules.
• Children 0.25-0.5 mg / kg, 3-4 times a day.
• Side effects: Nausea and vomiting, Constipation,
Diarrhea, Abdominal cramps, Insomnia, Impotence.
• • Trademarks: Farmadral 10, Libok, Propranolol
•
3. Antiarrhythmic group III
• Inhibits potassium canals thereby reducing the flow of
potassium out during polarization of heart cells. this drug
prolongs the action potential without delaying phase 0
depolarization or resting membranes. Examples of these
drugs are:
• Amiodarone
• • Indications: deal with irregular heart rhythms
• • Contra indications: sinus bradycardia, SA block; except
when used pacemakers to avoid severe conduction
disorders or SA node disease; thyroid dysfunction;
pregnancy and breastfeeding.
• Dosage:
• Form of the drug: Inject (intravenously)
• Pulseless ventricular fibrillation (VF) or pulseless vetricular
tachycardia (VT)
• -Adult: Initial dose is 300 mg or 5 mg / kgBB, with rapid
injection. Continued dose is 150 mg or 2.5 mg / kgBB.
• -Lansia: Starting with a lower dose than the adult dose.
•
• Ventricular or supraventricular arrhythmias
• Adult: The initial dose is 5 mg / kg body weight for 20-120
minutes. Can be repeated if needed, with a maximum dose of
1200 mg per day.
• -Lansia: The dose will be reduced from the adult dose.
• Form of medicine: Tablet
• Ventricular or supraventricular arrhythmias
• -Adult: Initial dose is 200 mg, 3 times a day, for one week.
The next dose can be reduced to 200 mg, 2 times a day. The
maintenance dose is less than 200 mg per day.
• -Lansia: The dose will be reduced from the adult dose.
• Side effects: Limp, no appetite, constipation, headache,
dizziness.
• Trademarks: Lamda, Kendaron, Cordarone, Rexodrone,
Amiodarone HCL, Tiaryt, Cortifib, Cordarone
4. Antiarrhythmic class IV drugs
This class of drugs reduces the inflow carried by
calcium, causing a decrease in spontaneous
depolarizing phase 4. Drugs that belong to this class
are:
Dialtiazem
• Indications: overcome high blood pressure and
prevent chest pain (angina).
• Contraindications: Patients who are hypersensitive
or allergic to diltiazem. Patients with acute
myocardial infarction and pulmonary congestion
evidenced by X-rays, hypotension
• Dosage:
• arrhythmias: 60 mg three times a day (old age initially
twice a day) if necessary increase up to 360 mg a day
according to age and symptoms;
• - mild to moderate essential hypertension, oral adults
100-200 mg once a day;
• -angina variant, oral adult 100 mg once a day, if there is
no change it can be increased to 200 mg once a day.
• • Side effects: bradycardia, sinoatrial blockade, AV
blockade, palpitations, dizziness, hypotension, malaise,
asthenia, headache, hot and red face, gastrointestinal
disorders, edema (especially at the ankles);
• Trademarks: Cordila SR, Dilmen, Diltiazem,
Farmabes, Herbesser
Cardiotonic
• a drug used to strengthen the work of the heart.
Used in a heart disorder called cardiac
decompensation (heart failure).
Heart failure
• the condition when the heart pump weakens, so it is
unable to drain enough blood throughout the body.
This condition is also known as congestive heart failure.
Heart failure can be caused by hypertension, anemia,
and heart disease.
• The main manifestations of heart failure are
• 1. shortness of breath and feeling tired, which limits
physical activity
• 2. fluid retention, which causes pulmonary congestion
and peripheral edema
Classification of cardiotonic drugs
1. Heart glycosides
• Mechanism of action: reversible binding to the cell
membrane of heart cells. Therefore, there is an obstacle to
(Na + / K +) -ATPase, which carries Na + ions out of cells and K
+ ions into cells resulting in an increase in intracellular Na =
levels. Examples of drug classes are:
Digoxin
• Indications: Congestive heart failure, atrial fibrillation,
proximal atrial tachycardia and atrial fitter.
• Contra indications: patients with ventricular
fibrillation.
• Dosege: Congestive Heart Failure, the dose of
digoxin is: Tablet. Initial doses ranging from 500 to
750 mcg usually show an effect within 0.5-2 hours
with a maximum effect within 2-6 hours.
• Side effects: Mental disorders, Dizziness,
Headaches, Diarrhea, Nausea and vomiting, Skin
rashes, Anorexia, Arrhythmia in children
• Trademarks: Digoxin, Fargoxin.
2. Dopaminergika
• Mechanism of action: Stimulates adrenergic and
dopamienergic receptors, lower doses mainly stimulate
dopaminenergic and produce renal and mesenteric
vasodilation, higher doses stimulate dopaminergic and beta
1-adrenergic and cause stimulation of the heart and renal
vasodilatation, large doses of stimulating and receptor alfa .
Examples of drugs that belong to this group are:
Dobupamine
• Indications: help short-term treatment in individuals with
cardiac decompensation due to contractile stress caused by
organic heart disease or cardiac surgery.
• Dosage: acute heart failure
• Adult: 2.5-10 mcg / kg / minute. Doses around 0.5-
40 mcg / kg / minute can be given. Give according
to the patient's blood pressure, heart rate, heart
and urine. Children: Neonates up to 18 years.
• Side effects: Nausea and vomiting, Fever, tingling,
Headaches, Leg cramps.
• Trademarks: Cardiotone, Dobuject, Inotrop,
Cardiject, Dobuca, Dobucef, Dobutamin Giulini.
3. Phosphodiesterase inhibitors
• The drugs in this class are inhibitors of the
phosphodiesterase enzyme that selectively acts on
the heart. The inhibition of this enzyme causes an
increase in cyclic AMP (cAMP) levels in myocardial
cells which will increase intracellular calcium levels.
Examples of drugs included in this class are:
Amrinon
• Indications: Congestive heart failure
• Contraindications: Hypersensitivity, hypertrophic
cardiomyopathy and aortic stenosis
• Dosage: Adult loading dose: 750 mcg / kgBB with
slow injection for 2-3 minutes (can be repeated
after 30 minutes if necessary). Maintenance: 5-10
mcg / kgBB / minute with infusion. Maximum
cumulative dose: 10 mg / kg in 24 hours.
• Side effects: Fever, diarrhea, nausea, arrhythmias,
thrombocytopenia and hepatotoxicity