#cardiology #tables See: [Dunn - Anti-arrhythmic drugs](x-devonthink-item://FE405015-3AC8-4509-992A-A4662DBF13C0), [Dunn - Ventricular arrhythmias](x-devonthink-item://747079B5-0629-433D-A6A2-5282259F31B6), [Tintinalli - cardiac dysrhythmia drugs](x-devonthink-item://8268F88D-7AAB-4DBD-B29D-B1896DA9B8CF?page=48), [tintinalli - cardiac arrest drugs](x-devonthink-item://A00C55A2-ADEC-4659-A7F6-16B070F19B63?page=15), [Clinical Pharmacology of Antiarrhythmic Drugs](x-devonthink-item://8BF89628-0067-4AE8-B9E9-9AC30C8BC764), [36 - Therapy for cardiac arrhythmias](x-devonthink-item://A270D0D9-9275-4AA9-9883-395FA3C75AD0) See also: [[Atrial fibrillation]], [[Syncope ECG patterns#WPW]], [[Ventricular Tachycardia]], [[Sodium channel blocker]] ==[[drugs in pregnancy#Safe antiarrhythmics in pregnancy]]== | Drug | Dose | Indications | Avoid in | Notes | | -------------- | ----------------------------------------------------------------------------------- | -------------------------------------------------------------------------------------------------------------------------------------- | ------------------------------------------------------------------------------------------------------------------------ | ---------------------------------------------------------------------------------------------------------------------------- | | [[Amiodarone]] | 5mg/kg (150-300mg) in 5% dextrose | - SVT and ventricular tacyarrhythmias<br>- decent to use in presence of LV dysfunction | - elderly<br>- toxicology<br>- on digoxin<br>- thyrotoxic<br>- pregnancy<br>- long QT<br>- TdP, don’t give ppx after AMI | main use in arrest is persistent VT or VF after defibrillation and adrenaline | | Flecainide | - 2mg/kg IV over 20 min<br>- 200-300 mg po <br>PPx 100mg BD | - SVT<br>- Afib/flut<br>- **WPW AF**<br> | - ischaemic or structural heart disease<br>- EF < 30%<br>- sick sinus | Ic<br>- best agent for SVT prophylaxis<br> | | Lignocaine | - 1.5mg/kg bolus over 1-2 min<br>- 50-75 g boluses Q 5-10 min<br>- infusion 2mg/min | - Ischaemic VF, monomorphic VT (not first line). Recurrent VT after amio, monomorphic VT and cardiac arrest after defib and adrenaline | - hypotension, AIVR (post-thrombolysis WCT that is not VT; can cause asystole). Don’t give ppx after AMI | Ib<br>- [[Local anaesthetic systemic toxicity\|LAST]]<br>- no evidence of ↓ mortality ; ↑ asystolic deaths, no longer in ALS | | procainamide | 17mg/kg<br>12 mg/kg (if pulm oedema) | - SVT<br>- ventricular arrhythmias<br>- AFib/Flut<br>- broad complex tachy unclear cause | - bradycardia<br>- cardiac failure (negative ionotropic effects) | Ia; slow conduction and prlong repolarisation<br>widens QRS and QT<br>hard to find in australia | | Sotalol | - 0.5-1.5 mg/kg | ischaemic [[Ventricular Tachycardia\|VT]] | - asthma<br>- DM<br>- PVD<br>- EF <40%<br>- ↓ K - TdP<br>- ↓ HR<br>- long QT | beta blocker with K-channel action | | [[Magnesium]] | 1-2g in 10mL dexrose | - [[Torsades de Pointes\|TdP]]<br>- dysrhythmia during hypothermia<br>- eclampsia<br> | | | *** # further reading - [deranged physiology - fast voltage-gated sodium channels ](https://derangedphysiology.com/main/cicm-primary-exam/required-reading/cardiovascular-system/Chapter%20011/fast-voltage-gated-sodium-channels-cardiac-muscle) - [deranged physiology - class I antiarrhythmic agents](https://derangedphysiology.com/main/cicm-primary-exam/required-reading/cardiovascular-system/Chapter%20966/class-i-antiarrhythmic-agents)