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Volume 1: Number 13 Let’s Talk About Drugs

Drugs that are PRIMARILY eliminated through the liver (hepatic elimination)

Quinidine Mexiletine Propafenone Verapamil

Procainamide Flecainide Moricizine Diltiazem
Lidocaine Encainide Amiodarone

Drugs that are PRIMARILY eliminated through the kidneys (renal elimination)

Disopyramide Sotalol
Tocainide Digoxin
Bretylium

Adenosine is eliminated through the vascular endothelium, erythrocytes (red

blood cells).

Drug Absorption:

Rule of thumb - any drug that uses a sustained release formula should be avoided in patients with rapid transit times through the gut,
such as colostomy patients. Likewise, and perhaps not so obvious (and, therefore, a good test question) timed released drugs should
NOT be used in acutely ill patients where absorption may be impaired.

Some factors affecting absorption:

1. Gut flora - especially if the patient is on antibiotics - Digitalis is especially affected

2. Interaction with other drugs

Factors affecting distribution: (volume of distribution is defined as the difference between the dose and the plasma
concentration)

1. Heart Failure - reduced volume of distribution

2. Elderly - reduced volume of distribution

For these patients, the dosage for drugs that are rapidly distributed should be reduced.

Half-life - the rate of elimination of a drug from plasma.

Composed of:
1. Distribution Half-Life where the drug is distributed systemically
2. Elimination Half-Life composed of:
a. Metabolism
b. Excretion

Antiarrhythmic Drug Interactions

Drugs that increase the digoxin level:

1. Quinidine
2. Flecainide
3. Propafenone
4. Amiodarone
5. Verapamil

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newsletters is to STIMULATE thought and self-help research. Your comments and suggestions are welcomed.
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Beta blocker effects:

1. Additive Negative Inotropic Effect

a. Disopyramide
b. Flecainide

2. Increase Beta Blocking effect

a. Propafenone
b. Amiodarone

3. Other
a. Verapamil - additive bradycardia and negative inotropic effect
b. Lidocaine - beta blockers increase Lidocaine level

Calcium Channel Blocker effects:

1. Additive negative inotropic effect

a. Disopyramide
b. Flecainide
c. Propafenone

2. Other
a. Moricizine - inhibits diltiazem metabolism
b. Amiodarone - potential bradycardia

Vaughn Williams Antiarrhythmic Drug Classification

Type IA Type IB Type IC Type II Type III Type IV

Disopyramide Lidocaine Flecainide Beta-blockers Amiodarone Calcium channel blockers
Procainamide Mexiletine Moricizine Bretylium Verapamil
Quinidine Propafenone Dofetilide Diltiazem
Ibutilide
Sotalol
J Am Coll Cardiol.2001;38:1231

Drugs that affect the Pacing Threshold: Drugs that affect the Defibrillation Threshold

Increase threshold Decrease threshold Unknown Increase DFT Decrease DFT Other
Quinidine Digitalis Bretylium Lidocaine Digitalis Procainamide
Procainamide Clofilium (or no change) no change or ?
Flecainide increase
Beta Blockers Diphenylhydantoin Bretylium Verapamil - ?
Verapamil Quinidine Clofilium
. Flecainide

I hope that's enough for today. Please let me know if you want additional info. I don't know of any easy way to memorize all the
possible drug effects and interactions. Any suggestions? The drug section seems to cause the most stress for test takers.

Most of the info in this mailing came from Section 5 of the EPSAP. Principal author: Peter R. Kowey, MD

1
Not really. Motivation, intellect and a willingness to spend only 1 minute answering each question are also required. The real purpose of these
newsletters is to STIMULATE thought and self-help research. Your comments and suggestions are welcomed.