ID 51 ID 58 ~ Rx 71

Pharmacology II-Midterm Sem 5th

Antiarrythmic drugs

- Superventricular Tachycardia (SVT) /

( )

Paroxysmal Atrial Tachycardia (PAT)

- Atrial Flutter :

Arrythmia(AR)
- ,
,
- ,

- Atrial Fibrillation :
- Wolf-Parkinson-White Syndrome : loop
Atrial Ventricle
2) VAR (Ventricular AR) : Ventricle

SAR

1) SA Node

- Premature Superventricular Complexes (PVC)

2) SA Node ,

- Ventricular Tachycardia

3) Heart Block

- Ventricular Fibrillation :

- Coronary ischemia & O2
-

Management

- Sympathetic

AR

, ( QT

- ()

Prolongation, QRS amplitude )

- Sinus

:

: Stethoscope, ECG, EPS
AR
1) SAR (Superventricular AR) : Atrium, AV
Node
- Sinus AR : HR
- Sinus Tachycardia
- Sick Sinus Syndrome : Sinus node
( /)
- Premature Superventricular Contractions /
Premature Atrial Contraction (PAC)

- , AR

1) Drug : Side Effect AR worse

2) Electrical Shock (Cardioversion) :

3) Automatic Implantable Defibrilators :
Ventricular Contraction
4) Artificial Pacemaker :
Bradycardia
5) Surgery

1) Pacemaker (Slow Response)
- Phase 1 2

 ID 51 ID 58 ~ Rx 71

Pharmacology II-Midterm Sem 5th

- Action Potential Na Leakage

Threshold
- Phase 0 (Depolarization)
Ca
- Phase 3 : Ca Channel inactive / K Channel
open
- Phase 4 : Non-Real Resting State
Sodium Pump Na
leak Threshold

2) Myocardium (Fast Response)

- Phase 0 (Depolarization)
Na
- Phase 1 : Na Channel inactive / K Channel
open
- Phase 2 Ca Channel open (Ca
SR SR-Ca Channel ) / K
Channel open (Plateau)
- Phase 3 Ca Channel inactive / K Channel
open
- Phase 4 : Sodium Pump

PR Interval SA
Node Atrium AV Node
QT interval AV
Node Ventricle
Pathophysiology of AR
1) Abnormal Impluse Formation (
)
- Altered / Increased Automaticity :
AV Node
SA Node (Ectopic Focus)

- Triggered Activity :
Afterdepolarization Ca
Relative Refractory Period
2) Abnormal Impulse Conduction (
)
- Reentry :
Depolariztion Unidirectional Block
Slowed Retrograde Conduction Velocity
- Conduction Block :
Unexcitable Tissue
- Accessory Tract Pathway : (Bypass)
Atrium
Ventricle Bundle of Kent AV
Node




1) Resting Membrane Potential
( Automaticity) K open
2) Refractory Period
( Reentry) Phase 3,4
3) Threshold (
) Phase 0
4) Action Potential
( Automaticity) Phase 0

 ID 51 ID 58 ~ Rx 71

Pharmacology II-Midterm Sem 5th

Class IB Na+ Ch. Inactive > Active

(Antiarrythmic agent)

phase 0

- Vaugnam Willians Class

phase 3 repolarization

4 ion ch.

Class I : Na+ Ch. Blocker

Inactive Na

Class II : Beta - Blocker

(Ischemic tissue)

ClassIII: K+ Ch. Blocker

Ventricular arrhythmia

ClassIV: Ca2+ Ch. Blocker

Class IC

Na

Ch

Ch. Active > Inactive

Class IA

1) Class I : Na+ Ch. Blocker

K+ Ch. phase 3

- fast Na+ Ch.

repolarization

* Pacemaker cell -> phase 4

Atrial Ventrilcular

Na

arrhythmia

cell

threshold potential resting state

Ischemia,

Myocardial infraction

phase 4 depolarization

Left ventricle

(automaticity)
Class IA -> Quinidine, Procainamide, Disopyramide

* -> phase 0
Na+ cell

phase 0

Quinidine

PK : - t1/2 ~ 6-8 hrs.

depolarization
phase 0

- 80% (CYP3a4)

phase 0 depolarization

- 20%

tachycardia

DOSE : - Quinide sulfate 200-400 mg 4-6 hrs.

reentry
Class I 3 Na+ Ch.
Class IA Na+ Ch. Active > Inactive
phase 0

depolarization ectopic automaticity

K

Ch. phase 3

action potential

- Quinidine gluconate (sustain release)

324 -600 mg 8-12 hrs.
dose
,

ADR : GI irritate

- Quinidine syncopy ()
Torsades de pointes

 ID 51 ID 58 ~ Rx 71

Pharmacology II-Midterm Sem 5th

- Cinchonism

, ,

- Psychosis Delirium ()

- Bronchospasm

- Antimuscarinic Activity

- WBC Platelet

Reflex tachycardia

** HF **

DI : - QT interval
TCA, Cisapride

- Enzyme Inhibitor & Inducer

- Digoxin clearance
Class IB -> Lidocaine,Tocainide,Phenytoin

Lidocaine (Local anesthetics)

PK : Injection ONLY!!
- t1/2 ~ 1.5 hrs.

2) Class II : Beta adrenergic blockers

Propranolol,Acebutolol,Esmolol,Sotalol
- beta receptor
Symph. Activity

- Ca2+ Influx in phase 0 depolarization

AV conduction , Rate , Force

ADR : - Bradycardia
- Hypertension

- Depress, Nightmare

DOSE : Loading dose 1-3mg/kg iv

Maintenance dose 2-4 mg/min
ADR : - Neurotoxic
,,

DI : Beta blockers Lidocaine

Class IC -> Flecainide,Propafenone,Moricizine

Flecainide

PK : - t1/2 ~ 20 hrs.

3) Class III : K+ Ch. Blocker

Amiodarone,Sotalol,Dofetilide
- K+ Ch.

Phase 3 repolarization
K+

refractory period
reentry

- 60%
- 30%
DOSE : - Paroxysmal Supraventricular tarch.
Paroxysmal Atrial Fibrillatn /Flutter
Dose 50 mg 12 hrs.

Amiodarone

MoA : 4

300 mg/

Na+ Ch. Blocker (Class I)

ADR : -

Beta Blocker (Class II)

 ID 51 ID 58 ~ Rx 71

Pharmacology II-Midterm Sem 5th

K+ Ch. Blocker (Class III)

ADR : Hypotension,Bradycardia Beta

Ca2+ Ch. Blocker (Class IV)

blocker

- Potency

- Torsades de pointes

- Arrhythmia
-

PK : - bind plasma protein

- On set ~ 2-30 days , t1/2 ~ 20 -133 days

Dofetilide

- K+ Ch.
PK : Onset < 3 hrs.

- CYP3A4

- CYP3A4

Desethylamiodarone -> Active metabolite

- (~ 66%)

DOSE : Loading dose 800-1600 mg/day(1-3 week)

Maintenance dose 400 mg/day

4) Class IV : Ca2+ Ch. Blocker

ADR : - Iodine Toxic

Hyper/Hypothyroidism

Verapamil,Diltiazem
- Ca2+ Ch.

- Photosensitivity

* Pacemaker cell -> phase 0

- Blue-grey skin decoloration

Ca

- Corneal microdeposits

phase 0 depolarization

** Fatal ADR -> Pneumonitis & Fibrosis

2+

cell

(automaticity)

Iodine

- * -> phase 2

Dronedarone

2+

Ca

cell phase 2

Satolol

MoA : Beta Blocker (Class II)

ADR : - Bradycardia, Hypotension

** Systolic dysfunction

K Ch. Blocker (Class III)

- Refratory period
- Force , Rate
PK : - t1/2 ~ 15 hrs.

DOSE : 80 mg bid. 3 (
640 mg/day)

5) Miscellaneous
Digoxin

MoA : - Inhibit Na+/K+ ATPase

- Stimulate Symp & Inh. Parasym

Pharmacology II-Midterm Sem 5th

USE : Heart failure : Systolic dysfunction

Atrial Flutter/Fibrillation/Supravent tachy
ADR: Heart block, Ca2+ overload
Arrhythmia
Adenosine

MoA : - Purine receptor agonist

- Ca2+ Ch. Blocker
PK : t1/2 ~ 10 sec. ~
-
USE : - wild-QRS-complex
arrhythmia
- Reentrant supravent arrhythmia
ADR : Arrhythmia
** Sick sinus syndrome,Heart block,
COD, Asthma
DI : - Dipyridamole Adenosine
Block reuptake

- Caffeine & Theophyline

Adenosine receptor antagonist
Magnesium

- IV. ventricle
Atrial fibrillation

MoA : Block Na+ Ch./ K+ Ch. /Ca2+

*** Antiarrthythmic agent

Arrhythmia

ID 51 ID 58 ~ Rx 71