Category : Science and Education
Archive   : DRUGMAN.ZIP
Filename : TOX3
III. ANTIARRHTHYMIC DRUGS: ADVERSE REACTIONS AND DRUG INTERACTIONS
Contraindications and Warnings
* Sick sinus syndrome, AV conduction defect: all antiarrhythmic
agents should be used with caution. Complete AV block is an
absolute contraindication to the use of any antiarrhythmic
unless a ventricular pacemaker is in place.
* Congestive heart failure: Beta blockers, verapamil,
disopyramide, flecainide
* Pulmonary disease: Amiodarone
* Liver disease: Amiodarone
* Hematologic disease: Quinidine, procainamide
Toxicity of antiarrhythmic drugs:
* Amiodarone:
Resp: pulmonary alveolitis and fibrosis.
CV: Arrhythmia exacerbation, bradycardia, arrest
Endocrine: Hyper- or hypothyroidism
Eye: Microcrystalline corneal deposits
Liver:Elevated enzymes, liver failure
(PgDn key for more text)
* Beta blockers (acebutolol and propranolol):
CV: Sinus arrest, AV block, congestive failure,
Resp: Bronchoconstriction
* Bretylium:
CV: Exacerbation of arrhythmias, orthostatic hypotension,
bradycardia
GI: Nausea, vomiting
* Digoxin:
CV: PVCs, AV block, ventricular tachycardia or fibrillation
GI: Nausea, vomiting, diarrhea, anorexia
* Disopyramide
ANS:Marked muscarinic block, potential for glaucoma, urinary
retention
CV: Depressed cardiac output
* Flecainide
CV: New or exacerbated arrhythmia, decreased cardiac output
and hypotension, conduction block, sinus bradycardia or
tachycardia
CNS:Dizziness, syncope, paresthesias, headache, fatigue,
confusion,
GI: Nausea, vomiting, anorexia
(PgDn key for more text)
* Lidocaine
CNS:Drowsiness, dizziness, seizures
CV: Hypotension
* Mexiletine
CNS:Dizziness,headaches,tinnitus,
CV: Palpitations, angina, hypotension
GI: Nausea, vomiting, constipation
* Phenytoin
CNS:Ataxia, nystagmus, confusion
* Procainamide
Immunologic: Positive antinuclear antibody test develops in
60-70% of patients, and a (usually) reversible lupus-like
state appears in 15-20% of those treated for 1-12 months.
Angioneurotic edema has been reported.
CV: Hypotension with parenteral administration
Hematologic: Agranulocytosis, thrombocytopenia
Overdosage: Lethargy, confusion, hypotension, cardiac
conduction defects with bizarre QRS complexes, nausea and
vomiting.
(PgDn key for more text)
* Quinidine
CNS: Headache, tinnitus, vertigo, visual disturbance
(cinchonism)
GI: Nausea, vomiting, diarrhea
CV: Widening of the QT complex associated with syncope -
probably the result of brief episodes of polymorphous
ventricular tachycardia (torsade de pointes)
Hematologic: Thrombocytopenia, agranulocytosis
Overdosage: Lethargy, coma, cardiac conduction defects,
hypotension, ventricular fibrillation
* Tocainide
CNS:Dizziness, syncope, tremor, confusion, hallucinations,
coma
GI: Nausea, vomiting, anorexia, diarrhea
CV: Hypotension, bradycardia, PVCs
* Verapamil
CV: Hypotension, bradycardia or sinus arrest, AV blockade,
congestive heart failure, peripheral edema
GI: Constipation
CNS: headache
(PgDn key for more text)
Drug Interactions
* Cardiac: verapamil and beta-blockers have additive depressant
effects on nodal function. Group IA plus IB, or group IA plus
beta-blockers may have beneficial additive effects on
arrhythmias.
* Pharmacokinetic: Increase the serum level of digoxin:
quinidine, verapamil, amiodarone
* Autonomic: Additive muscarinic block: disopyramide
* Neuromuscular: Increase block by curariform drugs:
procainamide, quinidine,
* Hematologic: Increase effect of warfarin: amiodarone,
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