class 1 specific Na antaagonist

blocks Na to increase threshold of Na

high selectivity for damaged tissue

meta depend on hepatic bloood flow.

only V arrythmia + stress (MI, cardiac surgery)

class 1 + less class 3 blocker, cardioversion

metabolite NAPA.

PAT

beta blockers: l stalol, d sotalol, dl sotalol, metoprolol, propranolol

for pt. of increased adrenergic level

stress: surgical, anesthetic, anginal, MI

CHF and ICD

hyperthyroidism

pt. of SCD

pan beta-blocker + class 3

adjunct with ICD

Arrhythmia + SCD

PAT

class 2

PAT

clcass 3, K, Na, Beta.

suppress + prevent arrhythmias with decreased CO function

suppress refractory ventricular arrhythmia: not responsive to others.

oral for long term suppression of v. arrhythmia for SCD syndrome

V arrhythmia + SCD

with dl sotalol + amiodarone

Drugs for Acute Ventricular Arrhythmia

hemodynamic instability

Drugs for acute ventricular arrhythmia

tolerable hemodynamics

class 1: procainamide

class 3: dl sotalol, amiodarone

ICD

class 3: dl sotalol, amiodarone

Rate controller: decrease rate of AV node

Cardioversion: restore Sinus rhythm to prev. thrombi

Suppression: prevent recurrency

Drugs for Atrial Flutter/Atrial Fibrillation:

rate control drugs

BCD

control ventricular response rate

increase refractory of AV node

Beta blocker:

propranolol for rapidity,

metoprolol for longevity

Ca channel blocker:

verapamil,

diltiazem for longterm.

IV Digitalis

Drugs for Atrial Flutter/Atrial Fibrillation:

cardioversion

electric PAD

decrease conduction, increase refractory of atrial re-entrant circuit

restore sinus rhythm to prevent thrombi

electrical: for hemodynamically unstable/untolerable arrhythmia

Procainamide:

Amiodarone

Dofetilide

Drugs for Atrial Flutter/Atrial Fibrillation:

suppression

FBDD

long term prevention recurrent A Flut/Fib

choose less side effect drugs than cardioversion

Flecainamide: less s.f. vs. procainamide

Beta blocker: dl sotalol, metoprolol

dofetilide: for pt. inappr. for beta, watch TDP

oral low dose digitalis

valsava maneuver

adenosine

rate controller: propranolol, verapamil, digitalis

adenosine

mostly sustained V Tach

SCD: V arrhythmia + pre-existing heart disease

most common arrhythmia requires therapy

tachycardia with hypotension and ischemia

stroke

CHF

cardiomyopathy when chronic

Break Bradycardias + blocks

vs.

Break Bradycardias + block due to MI or dig. toxicity

most by pacemaker

repeated atropin.

Toursades de pointes

associated with what

genetic + drug induced: impaired K channel

delayed repolarization

long QT syndrome

(hypokalemia)

suppress retrograde conduction: class 1

increase refractoriness of normal: class 3

1st degree: prolonged PR interval, common in BCD

2nd degree: dropped beats with ventricular rate slower than atrial rate. give class 2, 4

3rd degree via vagal hyper (MI, dig toxicity) reversed by atropine.

BBB via class 1.

Escape Pacemaker

vs.

Ectopic pacemaker

SA node is fucked

abnormal fibers take over

Nodal cell

drug for pacemaker potential

Depoarlization + repolarization

Muscarinic agonist + digitalis, both increase parasympatheticc activity, inhibit K channel closure

catecholamine: accelareate Ca and K channel.

Conduction:

when is effective refractory period

relative refractory period?

resting potential?

phase 2 (Ca open) when Na channels are inactivated

phase 3 (K open) when Na is reactivated, Beta blocker + class 3 inhibit.

phase 4. digitalis inhibits.

state of chennel anti-arrhythmic drug is used.

activated + inactivated state

stabilize inactivated state and delay reactivation.

anti-arrhythmic drug bind to where of ion channel

prefer Iks or Ikr

within the pores

Ikr b/c large pockets and hydrophobic residue.