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(Text replacement - "beta blocker" to "β-blocker")
 
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==Lidocaine==
==Table==
===Adult Dosing===
*Loading dose = 1-1.5 mg/kg
**Additional boluses of 0.5-0.75 mg/kg q5-10min up to max of 3mg/kg
**If effective start infusion of 2mg/min


===Contraindications===
{| class="wikitable" style="width: 641px; height: 711px;"
*High SA or AV block
|-
! Class
! Known as
! Examples
! Mechanism
! Clinical uses
|-
! Ia
| fast-channel blockers-Affect QRS complex
|
*Quinidine
*[[Procainamide]]
*Disopyramide


===Indications===
| (Na<sup>+</sup>) channel block (intermediate association/dissociation)
*Treatment of ventricular arrhythmias and ectopy
|
**Considered 2nd-line to amiodarone for tx of V-fib and pulseless v-tach
*Ventricular arrhythmias  
*prevention of paroxysmal Recurrent atrial fibrillation (triggered by Vagus nerve overactivity)
*procainamide in [[Wolf Parkinson White (WPW)]]


===Mechanism of Action===
|-
*Class Ib
! Ib- Do not affect QRS complex
**Binds to fast Na channels in inactive state thereby inhibiting recovery after repolarization
|
**Acts preferentially on ischemic tissue
|
***Elevates V-fib threshold
*[[Lidocaine]]
***Suppresses ventricular ectopy
*Phenytoin
*Little effect on vascular tone, contractility or cardiac output
*Mexiletine
*Tocainide


===Adverse Drug Rxns===
| (Na<sup>+</sup>) channel block (fast association/dissociation)
*CNS
|
**Abrupt change in MS, drowsiness, confusion, sz
*treatment and prevention during and immediately after Myocardial infarction, though this practice is now discouraged given the increased risk of Asystole
*Ventricular tachycardia
*[[Atrial Fibrillation (Main)|Atrial fibrillation]]


===Kinetics===
|-
*Onset of action = 45-90s
! Ic
*Duration of action = 10-20min
|
|
*[[Flecainide]]
*Propafenone
*Moricizine


==Procainamide==
| (Na<sup>+</sup>) channel block (slow association/dissociation)
|
*prevents Paroxysmal atrial fibrillation
*treats Recurrent tachyarrhythmias of abnormal conduction system.
*contraindicated immediately post-myocardial infarction.


===Adult Dosing===
|-
*Continuous infusion rate has fewer adverse effects
! II
**20mg/min for 25-30min
| [[Beta-blockers]]
***If effective start cont infusion of 1-4mg/min
|
*Propranolol
*[[Esmolol]]
*Timolol
*[[Metoprolol]]
*[[Atenolol]]
*Bisoprolol
*[[Labetalol]]


===Contraindications===
| beta blocking<br>Propranolol also shows some class I action
*Not recommended for V-fib or pulseless V-tach (too long to dose)
|
*2nd or 3rd AV block
*decrease Myocardial infarction mortality
*Severe glycoside intoxication
*prevent recurrence of Tachyarrhythmias
*Prolonged QT
*Myasthenia gravis


===Indications===
|-
*Wide-complex tachycardia of unknown type (in pts w/ preserved LV function)
! III
*Stable V-tach
|
*
|
===Mechanism of Action===
*[[Amiodarone]]
*Class Ia
*[[Sotalol]]
**Binds to fast Na channels in inactive state thereby inhibiting recovery after repolarization
*[[Ibutilide]]
**Prolongs action potential and reduces speed of impulse conduction
*Dofetilide
***Depresses myocardial conduction
*Dronedarone
**May act as negative inotrope, cause hypotension (peripheral vasodilation)
*E-4031


===Adverse Drug Rxns===
|
*Myocardial depression
K<sup>+</sup> channel blocker
*Watch for QRS/QT prolongation, V-tach, Vfib, complete AV block, torsades
===Kinetics===
*Onset of action = 5-10min


===Overdose Mgmt===
Sotalol is also a β-blocker


Amiodarone has Class I, II, and III activity


|
*In [[Wolf Parkinson White (WPW)]]
*(sotalol:) Ventricular tachycardias and Atrial fibrillation
*(Ibutilide:) Atrial flutter and [[Atrial Fibrillation (Main)|Atrial fibrillation]]


|-
! IV
| slow-channel blockers
|
*Verapamil
*[[Diltiazem]]


| Ca<sup>2+</sup> channel blocker
|
*prevent recurrence of Paroxysmal supraventricular tachycardia
*reduce Ventricular rate in patients with [[Atrial Fibrillation (Main)|Atrial fibrillation]]


|-
! V
|
|
*[[Adenosine]]
*[[Digoxin]]
*[[Magnesium sulfate]]


| Work by other or unknown mechanisms (Direct nodal inhibition).
|
Used in supraventricular arrhythmias,


===Adult Dosing===
Or in the case of [[magnesium sulfate]], used in [[torsade de pointes]].
===Contraindications===
===Indications===
===Mechanism of Action===
===Adverse Drug Rxns===
===Kinetics===
===Overdose Mgmt===


|}


==See Also==
*[[Arrhythmias (DDX)]]
*[[Atropine]]
*[[Isoproterenol]]


==References==
<references/>
*Katzung &amp; Trevor's Pharmacology


 
[[Category:Pharmacology]] [[Category:Cardiology]]
 
 
 
===Source===
 
Tintinalli
 
[[Category:Drugs]]
[[Category:Cards]]

Revisión actual - 18:13 14 ago 2017

Table

Class Known as Examples Mechanism Clinical uses
Ia fast-channel blockers-Affect QRS complex (Na+) channel block (intermediate association/dissociation)
  • Ventricular arrhythmias
  • prevention of paroxysmal Recurrent atrial fibrillation (triggered by Vagus nerve overactivity)
  • procainamide in Wolf Parkinson White (WPW)
Ib- Do not affect QRS complex (Na+) channel block (fast association/dissociation)
  • treatment and prevention during and immediately after Myocardial infarction, though this practice is now discouraged given the increased risk of Asystole
  • Ventricular tachycardia
  • Atrial fibrillation
Ic (Na+) channel block (slow association/dissociation)
  • prevents Paroxysmal atrial fibrillation
  • treats Recurrent tachyarrhythmias of abnormal conduction system.
  • contraindicated immediately post-myocardial infarction.
II Beta-blockers beta blocking
Propranolol also shows some class I action
  • decrease Myocardial infarction mortality
  • prevent recurrence of Tachyarrhythmias
III

K+ channel blocker

Sotalol is also a β-blocker

Amiodarone has Class I, II, and III activity

IV slow-channel blockers Ca2+ channel blocker
  • prevent recurrence of Paroxysmal supraventricular tachycardia
  • reduce Ventricular rate in patients with Atrial fibrillation
V Work by other or unknown mechanisms (Direct nodal inhibition).

Used in supraventricular arrhythmias,

Or in the case of magnesium sulfate, used in torsade de pointes.

See Also

References


  • Katzung & Trevor's Pharmacology
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