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Antidysrhythmics William Eggleston, PharmD
Fellow in Clinical Toxicology Upstate NY Poison Center
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Objectives Discuss the differing mechanisms of class I and class III antidysrhythmics Compare clinical manifestations of antidysrhythmic toxicity Formulate a treatment strategy for the management of antidysrhythmic toxicity
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Sudden Cardiac Death Huikuri HV et al. N Engl J Med. 2001; 345(20):
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K+ Ca2+ L-type Ito K+ IKr Na+
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Class I Antidysrhythmics
Na+
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Class I Antidysrhythmics
Recovery QRS Inotropy
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Class Ia Na+ QRS/QTc
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Holford NH et al. Br J Clin Pharmacol. 1981; 11(2):187-95
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Class Ia IKR Procainamide Quinine/Quinidine Disopyramide
Included in ACLS NAPA Quinine/Quinidine Disopyramide K+ K+ IKR
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Class Ib Na+ QTc
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Rosen MR et al. Am Heart J. 1976; 91(2):191-202
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Class Ib Lidocaine Phenytoin Refractory wide QRS Seizures
CV toxicity = propylene glycol
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Class Ic Na+ QRS
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Fonck K et al. J Toxicol Clin Toxicol. 1998; 36(3):247-51
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Class Ic Propafenone Flecainide Β-adrenergic antagonist CAST
Initiated inpatient
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ECG Findings RBBB
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ECG Assessment QRS >100 ms QRS >160 ms
Boehnert MT et al. N Engl J Med. 1985; 313(8):474-9
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Managment
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SV Preload
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Class III Antidysrhythmics
K+ Ca2+ L-type Ito K+ IKr Na+
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Class III Antidysrhythmics
K+ IKr
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Class III Antidysrhythmics
Amiodarone 40% mw = iodine Vfib/Vtach Block L-type Ca2+ channels Dofetilide Ibutilide
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