Page 366 - First Aid for the USMLE Step 1 2020, Thirtieth edition [MedicalBooksVN.com]_Neat

322 SECTION III CARDIOvASCuLAR ``CARdIOvASCulAR—PHARMACOlOGY CARDIOvASCuLAR ``CARdIOvASCulAR—PHARMACOlOGY

Antiarrhythmics— Slow or block () conduction (especially in depolarized cells).  slope of phase 0 depolarization. Are
sodium channel state dependent (selectively depress tissue that is frequently depolarized [eg, tachycardia]).
blockers (class I)
Class IA Quinidine, Procainamide, Disopyramide.
“The Queen Proclaims Diso’s pyramid.” 0 mV
Slope of
+
MECHANISM Moderate Na channel blockade. 0 mV
phase 0
 AP duration,  effective refractory period 0 mV I Na
(ERP) in ventricular action potential,  QT Slope of
phase 0
Slope of
I
interval, some potassium channel blocking phase 0
Na
effects. I Na
ClINICAl uSE Both atrial and ventricular arrhythmias,
especially re-entrant and ectopic SVT and VT.
AdvERSE EFFECTS Cinchonism (headache, tinnitus with
quinidine), reversible SLE-like syndrome
(procainamide), HF (disopyramide),
thrombocytopenia, torsades de pointes due to 0 mV
 QT interval. Slope of
phase 0
Class IB Lidocaine, MexileTine. 0 mV I Na
“I’d Buy Liddy’s Mexican Tacos.” 0 mV Slope of
phase 0
Slope of
I
Na
+
MECHANISM Weak Na channel blockade. phase 0
I
Na
 AP duration. Preferentially affect ischemic or
depolarized Purkinje and ventricular tissue.
Phenytoin can also fall into the IB category.
ClINICAl uSE Acute ventricular arrhythmias (especially post-
MI), digitalis-induced arrhythmias.
IB is Best post-MI.
AdvERSE EFFECTS CNS stimulation/depression, cardiovascular
depression. 0 mV
Class IC Flecainide, Propafenone. Slope of
“Can I have Fries, Please.” 0 mV
phase 0
0 mV I
Na
+
MECHANISM Strong Na channel blockade. Slope of
phase 0
Significantly prolongs ERP in AV node and Slope of
I
Na
accessory bypass tracts. No effect on ERP in phase 0
I
Na
Purkinje and ventricular tissue.
Minimal effect on AP duration.
ClINICAl uSE SVTs, including atrial fibrillation. Only as a last
resort in refractory VT.
AdvERSE EFFECTS Proarrhythmic, especially post-MI
(contraindicated). IC is Contraindicated in
structural and ischemic heart disease.

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