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- III. ANTIARRHTHYMIC DRUGS: ADVERSE REACTIONS AND DRUG INTERACTIONS
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- 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
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- 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
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- (PgDn key for more text)
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- * 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
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- (PgDn key for more text)
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- * 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.
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- (PgDn key for more text)
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- * 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
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- (PgDn key for more text)
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- 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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