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Procainamide (procan SR):
- Class I-A (fast sodium channel blockers)
- -Slows rate of impulse conduction in atria and ventricles. Depresses myocardial contractility, excitability and prolonging the refractory period. Widens QRS >25%. Can be given IV, IM, or PO for Vent tachycardia & Vent Fibrillation.
Adverse effects: Severe immunologic reactions-lupus, neutropenia, cardiotoxicity, GI symptoms, hypotension
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Lidocaine (xylocaine)
Class I-B
- -Increases electrical threshold of ventricle during diastole, suppresses automaticity in the Bundle of His Purkinje system. Used for Ventricular arrhythmias. Bolus first, then infusion. Monitor for: prolonged PR interval and widened QRS.
- Adverse effects: drowsiness, confusion, paresthesia. [toxic effects: convulsions, resp arrest]
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Beta-blockers
Class II
-Usually used to control excessive sympathetic stimulation (decreased automaticity of SA node, decreased velocity of conduction through AV node)
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Amiodorone (cordurone)
Class III (potassium channel blockers)
- -Used for life-threatening arrhythmias, ventricular fibrillation and tachycardia.
- Used to convert an atrial fibrillation to normal sinus. Half life 25-110 days!!! MOST TOXIC of all arrhythmias (lung/heart toxicity, vision problems)
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Calcium Channel Blockers
Class IV
-Slows SA and AV conduction. Used to slow rate in atrial flutter/fibrillation
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Cardiac Glycosides
- DIGOXIN
- -decreases conduction in AV node, prolongs PR interval
- *ONLY good for A-Fib or A-Flutter and supraventricular tachycardia
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Cardioversion
synchronized electrical current delivered at levels as low as 50 joules. (usually for a-fib)
-chemical cardioversion: usually amiodorone
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Cardiac Ablation
tissue is identified causing the dysrrhythmia by a catheter and it's destroyed. It is often permamant.
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