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This chapter will be most useful after having a basic understanding of the material in Chapter 29, Anti-Arrhythmic Drugs in Goodman & Gilman’s The Pharmacological Basis of Therapeutics, 12th Edition. In particular, the reader is directed to the following tables, and to animations available in the online version of Goodman & Gilman’s The Pharmacological Basis of Therapeutics:
Table 29-1 Drug-Induced Cardiac Arrhythmias, which shows drugs known to cause arrhythmias (ie, proarrhythmias), the likely arrhythmogenic mechanism, the treatment, and the clinical features of the proarrhythmia
Table 29-4 Patient-Specific Anti-arrhythmic Drug Contraindications, which shows conditions and contraindicated drugs
Several animations in the online version of Goodman & Gilman’s The Pharmacological Basis of Therapeutics illustrate the electrophysiology of cardiac cells and the mechanism of action of antiarrhythmic drugs
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Know the principles of cardiac electrophysiology especially the ion channels, exchangers, and pumps that are targets of antiarrhythmic drugs.
Understand the mechanisms that cause cardiac arrhythmias.
Know the common and important tachyarrhythmias and their mechanisms.
Understand the mechanisms and classification of antiarrhythmic drugs.
Know the principles of antiarrhythmic drug pharmacotherapy.
Know the pharmacological, pharmacokinetic, and adverse effects of specific antiarrhythmic agents.
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DRUGS IN THIS CHAPTER
Adenosine (ADENOCARD)
Amiodarone (CORDARONE)
Digoxin (LANOXIN; see Chapter 17)
Diltiazem (CARDIZEM)
Disopyramide (NORPACE)
Dofetilide (TIKOSYN)
Dronedarone (MULTAQ)
Esmolol (BREVIBLOC)
Flecainide (TAMBOCOR)
Ibutilide (CORVERT)
Lidocaine (XYLOCAINE)
Mexiletine (MEXITIL)
Procainamide (PRONESTYL)
Propafenone (RYTHMOL)
Propranolol (INDERAL; see Chapter 7)
Quinidine (QUINIDEX)
Sotalol (BETAPACE)
Verapamil (CALAN; see Chapter 16)
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THE CARDIAC ACTION POTENTIAL
In fast-conducting cardiac myocytes and cells of the conducting system, Phase 0 depolarization is caused by the opening of voltage-gated Na+ channels.
In slow-conducting cells of the sinoatrial (SA) node and atrioventricular (AV) node, which have relatively few voltage-gated Na+ channels, Phase 0 depolarization is caused by opening of voltage-gated L-type Ca2+ channels.
Phase 3 repolarization is primarily caused by K+ movement out of the cell through voltage-gated K+ channels.
Figure 18-1 shows action potentials from different regions of the heart, the ion currents that contribute to these action potentials, and the ...