Anti arrhythmics drugs

Cont.. drug
anti arrhythmic

 An arrhythmia is an abnormality of the heart

rate, cardiac rhythm, site of origin of the
cardiac impulse or an abnormality in the
impulse conduction.
They may be classified as tachy arrhythmias in
which the heart rate is increased or brady
arrhythmias, in which the heart rate is
decreased.
Arrhythmia occur due to disturbance in
impulse formation and conduction.
 Cont..
Anti arrhythmics drugs are used to treat
abnormal electrical activity of the heart.
These are the drugs used to prevent or treat
irregularities of cardiac rhythm caused by
ischemia, mechanical injury, stretching, drug
influence, electrolyte and pH imbalance.
 Cont..
MOA:

Anti arrhythmic drugs used to treat, suppress or

prevent three major mechanisms of
arrhythmias, i.e.decreased automaticity,
decreased conductivity and re-entry. They
limit cardiac electrical activity to normal
conduction pathways and decrease
abnormally fast heart rate by following
mechanisms:
 Cont..
1. Decrease self-activation:
 Many of the dysrhythmias and premature
beats are due to the ability of cardiac cells to
fire an impulse (self-activation or auto-
maticity).
2. Decrease re-entry phenomena: Myocardial
tissue has the ability to reactivate for the
second time by the same impulse.
3.
 Cont..
3. Decrease conduction: By blocking sodium
channels in myocardial cells that results in
slow heart rate.
 Accelerate repolrization by stabiling the cell
membrane.
4. Decrease ischemia: By decreasing heart rate
and oxygen demand.
5. Decrease conduction rate: By blocking
calcium influx into the myocardial cells.
 Cont..
Classification:
1. Class IA: The drug are: a. procainamide , b. quinidine ,
c. disopyramide.

 Action: this class control arrhythmia by altering

myocardial cell membrane and interfering with
autonomic nervous system.
 Dose: a. procainamide( tab pronestyl ) loading dose
15-18 mg slowly over 25-30 min,100mg available)
 b. quinidine( brand name: natcardine) : 200 - 300mg
tab,p/o, 6 hourly for atrial fibrillation, for PSVT 400-
600MG ,P/O BD.
 c. disopyramide: 150mg,p/o, 6 hourly.
 Cont..
Indication : atrial fibrillation
paroxysmal atrial tachycardia
premature ventricular contraction.
Contraindication :
myasthenia gravis
Hypersensitivity
severe heart block
Hypotension
Lactation
 Cont..
Class IB : lidocaine .
 Mexi letine
 Tocaina mide

Dose: lido caine(slow IV 1-1.5 mg/kg

 Mexi letine (capsule mexitil) loading dose 400mg then
200mg after 8 hr )
 Tocaina mide

Action: these class of drug work by blocking the rapid influx of

sodium ions during the depolarization phase of heart
depolarization.

Indication: ventricular tachycardia, during cardiac surgery.

 Cont.
Contraindication:
hypersensitivity
cardiogenic shock
pregnancy
lactation
liver disease
myasthenia gravis.
Class IC: moricizine
flecainide
 Cont..
Dose: moricizine( 200mg orally very 8 hrly)
brand name: ethmozine.

Flecainide ( 50mg ,p/o, BD )brand name:

tambocor.

Action: it primarly slow conduction along heart

conducting system.
it depress the depolarization rate.
 Cont.
Indication: used to treat certain ventricular
arrhythmia.

Side effect:
blurred vision
disturbed colour vision
 hearing loss
 vomiting
Hepatotoxicity
hypotension,
Bradycardia
 Cont..
 Swelling
 hemolytic anaemia
 Respiratory depression
 Skin rash
 Syncope
 Irritability
 Thrombocytopenia
Pharmacokinetics: orally onset of action1/2 hr.
Peak concentration 5-6 hr, duration of action 8 hr ,
metabolizd in liver and excreted through urine.
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Role of nurse:
 To monitor blood pressure 6 hourly to observe
fluctuations To assess cinchonism(headache,
vomiting, nausea, vertigo hearing loss) if occurs
discontinue drug.
 To assess, dyspnea , respiratory depression,
increased pulse if occurs discontinue drug.
 there is no improvement with drug after 10
days, then discontinue drug.In emergency
quinidine may be given intravenously with
extreme care.To assess confusion, psychosis,
convulsions if occurs drug may be discontinued.
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 administer dose (loading dose) with food to
decrease nausea vomiting .
Monitor ECG, to determine dose of
amiodarone effectiveness.
 To assess chest pain, pulse rate, respiration
rate rhythm.
Advice patient not to break and chew the
drug.
To advice patient not to take other medicine
unless prescribe.
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Drug interection : increased anticoagulant
effect with warfarin.
Smoking decrease the action of drug.