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Pharm E2 (Antiarrhythmic)
Parts of an ECG
PQRST
P Wave
Atrial Depolarization
QRS Complex
Ventricular Depolarization
T Wave
Ventricular Repolarization
2 mins
ECG Interpretation
Rate
Rhythm
P Waves
Upright, Rounded, Before Every QRS
PR Interval (< 0.20 seconds)
Normal QRS (< 0.12 seconds)
2 mins
ECG: Atrial Flutter
Rate
Variable
Rhythm
Regular or Irregular
P Wave
Saw Tooth, Multiple Before Every QRS
PR Interval
Non-measurable
QRS Interval
< 0.12 seconds
2 mins
ECG: Atrial Fibrillation
Rate
Variable Rate
Rhythm
Irregular Rhythm
P Wave
No P Wave
PR Interval
No PR Interval
QRS Interval
QRS < 0.12 Seconds
1 min
ECG: Sinus Bradycardia
Rate
< 60 bpm
Rhythm
Regular
P Wave
Present, Upright, Every QRS
PR Interval
< 0.20 seconds
QRS Interval
< 0.12 seconds
Treatment
Atropine
1 min
ECG: Sinus Tachycardia
Rate
> 100 bpm
Rhythm
Regular
P Wave
Present, Upright, Every QRS
PR Interval
< 0.20 seconds
QRS Interval
< 0.12 seconds
Treatment
Treat Underlying Cause
2 mins
Class I Antiarrhythmics (Na+ Channel Blockers) Overview
Indications
Arrhythmias
Local Anesthesia
Mechanism of Action
Block or Slow Conduction
Block Na+ Channels
Raise Threshold
State Dependent
Contraindication
Hyperkalemia
1 min
Class IA Antiarrhythmics (Na+ Channel Blockers)
Indications
Arrhythmias
Mechanism of Action
Increase AP, ERP, and QT interval.
Drugs
Disopyramide
Procainamide
Drug-induced Lupus
Quinidine
Cinchonism
Shared Side Effects
Thrombocytopenia
Torsades de Pointes
1 min
Class IB Antiarrhythmics (Na+ Channel Blockers)
Indications
Arrhythmias
After Myocardial Infarction
Mechanism of Action
Affect Ischemic Tissue
Decrease AP duration
Drugs
Mexiletine
GI Upset
Lidocaine
CNS Depression
Tocainide
Phenytoin
Hirsutism
2 mins
Class IC Antiarrhythmics (Na+ Channel Blockers)
Indications
Used as Last Resort
V-Tach
Mechanism of Action
No Effect on AP Duration
Drugs
Propafenone
Flecainide
Contraindications
Post-Myocardial Infarction
56 secs
Class III Antiarrhythmics (K+ Channel Blockers)
Indications
Arrhythmias
Mechanism of Action
Increase AP Duration, ERP, and QT Interval
Drug Names
Amiodarone
Check Function Tests
Dirty Drug
Ibutilide
Dofetilide
Sotalol
Beta-Blocker
2 mins
Class IV Antiarrhythmics (Ca2+ Channel Blockers)
Indications
SVT
Subarachnoid Hemorrhage
Mechanism of Action
Decrease Conduction Velocity
Increase PR Interval and ERP
Drugs
Verapamil
Diltiazem
Nimodipine
Side Effects
Cardiovascular
Constipation
2 mins
Adenosine (Adenocard)
Mechanism
Slows AV Conduction
Indications
Supraventricular Tachycardia (Paroxysmal)
Side Effects
Bradycardia
Flushing
Dyspnea
Considerations
Rapid IV Push
Caffeine and Theophylline Decrease Effectiveness
Dipyridamole May Intensify Effects
2 mins
Digoxin Mechanism and Indication
Direct inhibition of Na K ATPase
Indirect inhibition of Na Ca exchanger
Increase Ca in cell
Positive Inotropy
CHF
Stimulates Vagus Nerve
Decreased conduction at AV node
Atrial Fibrillation
1 min
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