1. What are the different phases of action potential? Describe each phase.

For action potential, it has three phases. Depolarization, followed by repolarization and
hyperpolarization

1.Depolarization (rising phase)- this is caused by a rise in membrane potential where positively charged
sodium ions rush through open voltage-gated sodium channels. Resulting in an influx of sodium ions.

2.Repolarization (falling phase)- this is caused by sodium channels slowly closing and the opening of
potassium channels. Which in return, the permeability of the membrane to sodium decreases to resting
levels.

3.Hyperpolarization-this is the phase in which some potassium channels remain open and sodium
channels reset. Soon after, the membrane reestablishes the value of membrane potential

2. What are the different classes of anti-arrhythmic drugs? Explain their mechanism of action and their
effect on action potential.

There are 4 classes of anti-arrhythmic drugs: Class I, Class II, Class III, and Class IV.

Drug class Mechanism of Action Effects on Action Potential

Class I (Sodium-channel It blocks and binds the fast Class I are considered fast
blockers) sodium channels sodium channel blockers that is
-Class Ia responsible for phase 0
-Class Ib (depolarization) of fast response
-Class Ic cardiac action potential.

For class Ia- Moderate

reduction in phase 0, increase in
effective refractory period

For class Ib- Small reduction in

phase 0, decrease in effective
refractory period

For class Ic- Pronounced

reduction in phase 0, no effect
on effective refractory period
(ERP)

Class II (Beta-blockers)
Class III (Potassium-channel
blockers)
Class IV (Calcium-channel
blockers)
Competitively inhibits the beta-
adrenergic receptors resulting
in the reduction of calcium ions
influx that leads to decreased
sinoatrial node pacing.
Inhibits cardiac tissue potassium
channels resulting in the
prolongation of repolarization.
Binds to L-type calcium
channels located in cardiac
myocytes, cardiac nodal tissues,
and vascular smooth muscle
cells resulting in the reduction
of calcium entry and closing L-
type channels.
Class II decreases slope of phase
4 depolarization, thus decrease
in automaticity,
Class III bind and blocks
potassium channels and
lengthen the cardiac action
potential that results in the
increase in effective refractory
period.
Class IV decreases the rise of
Phase 0 result in the increase in
effective refractory period.

3. Are there non-pharmacologic treatments for arrhythmia? Explain.

Yes. Non-Pharmacological treatment may be an option or as an addition to drug therapy for

some patients with atrial fibrillation and significant symptoms. This includes radiofrequency
ablation and atrial pacing in sick-sinus syndrome. Patients tend to undergo non-pharmacological
treatments due to the limited effects or sometimes the adverse effects of antiarrhythmic drugs.