Antiarrhythmic agent resident survival guide

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Template:Antiarrhythmic agent Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:

Definition

Causes

Life Threatening Causes

Common Causes

Prognosis

Vaughan-Williams classification of antiarrhythmic agents

 
 
 
 
 
 
 
 
 
 
 
 
Vaughan-Williams classification of antiarrhythmic agents
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Class IA
 
Class IB
 
Class IC
 
Class II
 
Class III
 
Class IV
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Mechanism
 
Predominantly sodium channel blocker
with some potassium channel blocking activity
 
*Mainly predominant β1 agonist (↑ cardiac contractility)
* some α1 agonist(Vasoconstrictive)
 
*V1 receptor of GIT vasculatures
*Antidiuretic effects
 
*Pure α1 agonist(Vasoconstrictive)
*No β1
 
*Predominant β1 agonist (↑contractility)
*β2 arterial smooth muscle (Hypotensive)
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Agents
 
Quinidine, procainamide, disopyramide
 
2nd line septic shock
 
2nd line septic shock
 
1st line Neurogenic shock
3rd-4th line septic shock
 
*1st line cardiogenic shock
* low output septic shock
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Effect
 
Slows conduction, & prolongs repolarization
 
2-20 mcg/min
 
0.03 unit/min
 
20-300 mcg/kg/min
 
2.5-20 mcg/kg/min
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Indications
 
Pre-excited atrial arrhythmias
PSVT, Ventricular tachycardia
 
Arrhythmia (more β1)
 
*Coronary spasm
*Splanchnic vasoconstriction
 
Reflex bradycardia
(only α1)
 
Hypotension (β2)
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Complications
 
abdominal cramping, diarrhea, rash cinchonism (hearing decrease, tinnitus, and blurred vision, thrombocytopenia, hemolytic anemia, lupus syndrome , granulomatous hepatitis, QRS widening and ventricular arrhythmias (may reverse with sodium lactate or sodium bicarbonate).
 
*Not in cardiogenic shock
*Arrhythmia
*Ischemia induced cardiotoxicity
 
*Ischemic heart
*Gut ischemia
 
*Bradycardia
*Heart block
 
*Hypotension (add α1 agonist)
 
 

Do's

  • Assess the cause of shock
  • Always volume fluid resuscitation first
  • Norepinephrine in undifferentiated shock.
  • Titrate dobutamine according to clinical response slowly ( 2-20 ug/kg/min ) to avoid tachycardia (10% increase from the baseline). The benefit that dobutamine has as minimal effect on myocardial oxygen demand is lost if it is not well titrated.

Don'ts

  • Do not start with low dose Dopamine dose to perfuse the kidney.

References

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