The anti-arrhythmic drugs can modify impulse generation and conduction.

1. ANTI-ARRHYTHMICANTI-ARRHYTHMIC
DRUGSDRUGS
S.SEETARAM SWAMY, M.Pharm.,
Asst. professor,
Dept. of Pharmaceutical Chemistry,
Chilkur Balaji College of Pharmacy.
E-mail:seetaram.443@gmail.com
S.SEETARAM SWAMY, M.Pharm.,
Asst. professor,
Dept. of Pharmaceutical Chemistry,
Chilkur Balaji College of Pharmacy.
E-mail:seetaram.443@gmail.com
1

2. Anti-arrhythmic agents are a group of drugs that are used to
suppress abnormal rhythms of the heart (cardiac
arrhythmias), such as atrial fibrillation, atrial
flutter, ventricular tachycardia, and ventricular fibrillation.
OR
The anti-arrhythmic drugs can modify impulse generation
and conduction.
Cardiac Arrhythmiasis are abnormalities in the rate, regularity
or site of origin of the cardiac impulse or a disturbances in
conduction of the impulse such that the normal sequence of
activation of atria and ventricles are altered.
2
Mr.S.SEETARAMSWAMY., M.Pharm

3. A-RHYTHM –IA
Definition- Arrhythmia is deviation of heart from normal
RHYTHM.
RHYTHM
1) HR- 60-100
2) Should origin from SAN
3) Cardiac impulse should propagate through
normal conduction pathway with normal velocity.
A heartbeat that is too fast is called Tachycardia.
A heartbeat that is too slow is called bradycardia. 3
Mr.S.SEETARAMSWAMY., M.Pharm

4. Heart
Mr.S.SEETARAMSWAMY., M.Pharm

5. Rhythm Disorders
Rhythm disorders are
treated with
medications that
normalize the heart
rate by affecting the
nervous system that
controls the heart
rate.
Medications for:
RHYTHM
DISORDERS
•beta blockers
•calcium channel blockers
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Mr.S.SEETARAMSWAMY., M.Pharm

6. Conduction System
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Mr.S.SEETARAMSWAMY., M.Pharm

7. The heart’s pacemaker causes regular contracting of the
myocardium resulting in a regular heartbeat or pulse.
Contraction Phases
•Polarization (resting)
•Depolarization (contracting)
•Repolarization (recharging)
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Mr.S.SEETARAMSWAMY., M.Pharm

8. CAUSES:
8Mr.S.SEETARAMSWAMY., M.Pharm

9. A fluttering in your chest.
A racing heart beat (tachycardia)
A slow heart beat (bradycardia)
Chest pain.
Shortness of breath.
Lightheadedness.
Dizziness.
Fainting (syncope)
SYMPTOMS:SYMPTOMS:
9
Mr.S.SEETARAMSWAMY., M.Pharm

10. The anti-arrhythmic drugs can be
classified according to their
predominant effects on the action
potential.
The Vaughan William’s
Classification of AAD is based on
their effects on the cardiac
action potential (AP).
CLASSIFICATIONCLASSIFICATION
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Mr.S.SEETARAMSWAMY., M.Pharm

11. Class I:
 Anti-arrhythmic drugs act by blocking
voltage-sensitive sodium channels via the
same mechanism as local anesthetics.
 The decreased rate of entry of sodium
slows the rate of rise of Phase 0 of the action
potential.
Quinidine
Procainamide
11Mr.S.SEETARAMSWAMY., M.Pharm

12. O2N COOH O2N COCl
+
NH2CH2CH2N
C2H5
C2H5
O2N C NHCH2CH2N
O C2H5
C2H5
H2N C NHCH2CH2N
O C2H5
C2H5
P-nitro benzoic acid
SOCl2
P-nitro benzoyl chloride
Sn/HCl
Reduction
N-diethyl ethanamine
Procainamide
Procainamide Synthesis
12
Mr.S.SEETARAMSWAMY., M.Pharm

13. Class II:
β-adrenergic antagonists:
These drugs diminish Phase 4
depolarization, thus depressing automaticity,
prolonging AV conduction, and decreasing
heart rate and contractility.
Class II agents are useful in treating tachy-
arrhythmias caused by increased sympathetic
activity.
They are also used for atrial flutter and
fibrillation and for AV-nodal reentrant
tachycardia.
Class II:
Beta blockers
Propranolol
Acebutalol
Sotalol
Esmolol
Timolol
Metoprolol
Atenolol
Propranolol
Therapeutic Use
of
β-Blockers
Hypertension
Angina
Myocardial infarction
Arrhythmias
Heart failure
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Mr.S.SEETARAMSWAMY., M.Pharm

14. Class III:
Potassium (K) channel blockers
(Repolarization prolongators)
Amiodarone
Ibutilide
Dofetilide
Bretylium
CLASS-III:
It mainly acts by blocking K+ channels.
It increases the refractory period.
It increases the duration without
effecting phase 0 and resting membrane
potential.
Amiodarone
14Mr.S.SEETARAMSWAMY., M.Pharm

15. Verapamil
Class IV:
Calcium (Ca+2) channel blockers
Verapamil
Diltiazem
Class IV:
Calcium-channel blockers:
They decrease the inward current
carried by calcium, resulting in a
decreased rate of Phase-4
spontaneous depolarization.
Therapeutic Use of
Calcium-Channel
Blockers
•Hypertension
(systemic & pulmonary)
•Angina
•Arrhythmias
Diltiazem
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Mr.S.SEETARAMSWAMY., M.Pharm

16. AdenosineAdenosine inhibits AV conduction.
The duration of effect is less than 60 s.
•used as an i.v. bolus in SV tachycardiaSV tachycardia
with narrow QRS complexwith narrow QRS complex.
•ADRs: bradycardia, AV block.
Other drugs used in Tachy-arrhythmias
Digoxin reduces conduction through the
AV node and is useful in the control of
atrial flutter and atrial fibrillation.
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Mr.S.SEETARAMSWAMY., M.Pharm

17. CLINICAL USES:
Sodium channel blockers are also
used as local anesthetics and
anticonvulsants.
Procainamide can be used to
treat atrial fibrillation in the setting
of Wolff-Parkinson-White
syndrome.
Supra-ventricular arrhythmias.
Nodal and ventricular arrhythmias.
Refractory ventricular arrhythmias
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Mr.S.SEETARAMSWAMY., M.Pharm

18. 18Mr.S.SEETARAMSWAMY., M.Pharm

19. PACEMAKER
A pacemaker is a small device that's placed in the chest or abdomen to
help control abnormal heart rhythms. This device uses low-energy electrical
pulses to prompt the heart to beat at a normal rate.
Pacemakers are used to treat arrhythmias. Arrhythmias are problems with
the rate or rhythm of the heartbeat.
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Mr.S.SEETARAMSWAMY., M.Pharm

20. Class II:
Beta blockers
Propranolol
Acebutalol
Sotalol
Esmolol
Timolol
Metoprolol
Atenolol
Class III:
Potassium (K) channel blockers
(Repolarization prolongators)
Amiodarone
Ibutilide
Dofetilide
Bretylium
Class V:
Variable mechanism
Adenosine
Digoxin
Magnesium sulfate
Class IV:
Calcium (Ca+2) channel blockers
Verapamil
Diltiazem
Class I:
Sodium (Na) channel blockers
(Membrane depressant drugs)
Quinidine
Procainamide
Disopyramide
Lidocaine
Phenytoin
Mexiletine
Flecainide
Tocainaide
Propafenone
Moricizine
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Mr.S.SEETARAMSWAMY., M.Pharm

21. 21Mr.S.SEETARAMSWAMY., M.Pharm