Quinidine Procainamide

Atenolol, hydralazine, procainamide, quinidine, carbamazepine, chlorpromazine, ethosuximide, isoniazid, methyldopa, minocycline, penicillamine, phenylbutazone, phenytoin, thiazides, and valproic acid... 

Acetazolamide, amprenavir, captopril, hydralazine, hydrochlorothiazide, methyldopa, procainamide, quinidine, ticlopidine, and triamterene... 

Procainamide, quinidine, quinine, disopyramide, phenytoin, and (i-adrenergic blockers, calcium channel blockers... 

In symptomatic patients, medical therapy can be tailored either to control ventricular response or to restore sinus rhythm. Nondihydropyridine calcium antagonists (e.g., verapamil) are considered first-line drug therapy for decreasing ventricular response. Type I agents (e.g., procainamide, quinidine) are only occasionally effective in restoring sinus rhythm. DCC is ineffective, and /3-blockers are usually contraindicated because of coexisting severe pulmonary disease or uncompensated HF. 

Drugs that may affect amiodarone include hydantoins, cholestyramine, fluoroquinolones, rifamycins, ritonavir, and cimetidine. Drugs that may be affected by amiodarone include anticoagulants, beta-blockers, calcium channel blockers, cyclosporine, dextromethorphan, digoxin, disopyramide, fentanyl, flecainide, hydantoins, lidocaine, methotrexate, procainamide, quinidine, and theophylline. Drug/Lab test interactions Amiodarone alters the results of thyroid function tests, causing an increase in serum T4 and serum reverse T3 levels and a decline in... 

T Pancreatic insulin release Metformin Peripheral insulin sensitivity hepatic glucose output/production i intestinal glucose absorption Dose Ist-line (naive pts), 1.25/250 mg PO daily-bid 2nd-line, 2.5/500 mg or 5/500 mg bid (max 20/2000 mg) take w/ meals, slowly T dose hold before 48 h after ionic contrast media Caution [C, -] Contra SCr >1.4 mg/dL in females or >1.5 mg/dL in males hypoxemic conditions (sepsis, recent MI) alcoholism metabolic acidosis liver Dz Disp Tabs SE HA, hypoglycemia, lactic acidosis, anorexia, N/V, rash Additional Interactions T Effects W/ amiloride, ciprofloxacin cimetidine, digoxin, miconazole, morphine, nifedipine, procainamide, quinidine, quinine, ranitidine, triamterene,... 

Uses Rapid conversion of AF/artmal fluto Action Class III antiarrhythmic Dose Adults >60 kg. 0.01 mg/kg (max 1 mg) IV inf over 10 min may repeat x 1 <60 kg Use 0.01 mg/kg (ECC 2005 D/C cardioversion preferred) Caution [C, -] Contra w/ class I/III antiarrhythmics (Table VI-7) QTc >440 ms Disp Inj SE Arrhythmias, HA Interactions t Refractory effects W7 amiodarone, disopyra-mide, procainamide, quinidine, sotalol t QT int val W7 antihistamines, antidepressants, erythromycin, phenothiazines, TCAs EMS Use antihistamines w/ caution, may T QT interval OD May cause increased repolarization leading to arrhythmias, bradycardia, hypotension leading to cardiac arrest symptomatic and supportive... 

An tiarrhy thmics Amiodarone, disopyramide, ibutilide procainamide, quinidine, sotalol... 

The negative inotropic effects of class I antidysrhythmic agents, such as disopyramide, procainamide, quinidine, and tocainide can be accentuated by beta-blockers this is most pronounced in patients with pre-existing myocardial disease and can result in left ventricular failure or even asystole (413). Digoxin can obviate the negative inotropic effect of beta-blockers in patients with poor left ventricular function. 

A Sotalol has nonselective beta-blocking properties that may cause bronchospasm in patients with asthma and COPD. Although amiodarone has beta-blocking activity, this effect is specific to the heart and therefore is not contraindicated in patients with asthma. Also, the patient has not taken amiodarone for a long enough period to develop pulmonary fibrosis. Procainamide, quinidine, and lidocaine are unlikely to cause bronchospasm. 

CARDIAC DEPRESSANTS are little used in medicine, however, some are used to slow the heartbeat in tachycardias and a number of these are often analogues or derivatives of other drugs with optimized activity for this purpose in the heart (e.g. procainamide, quinidine) - these are dealt with under antiarrhythmic agents. 

ANTIARRHYTHMIC agents (Class I agents, e.g. disopyramide, flecainide. lignocaine. procainamide, quinidine) are sodium-channel blockers and are mainly used to treat atrial and ventricular tachycardias (see antiarrhythmic agents). ANTIEPILEPTICS have a number of mechanisms of action, but some appear to have a component involving modulation of sodium-channel function, e.g. carbamaxepine and phenytoin (see anticonvulsants). 

Clinically important, potentially hazardous interactions with amiodarone, bepridil, cisapride, disopyramide, droperidol, erythromycin, flecainide, levodopa, pentamidine, procainamide, quinidine, sotalol, sparfloxacin, terfenadine, thioridazine... 

Clinically important, potentially hazardous interactions with amiodarone, azithromycin, bepredil, bosentan, bretylium, cisapride, clarithromycin, disopyramide, erythromycin, erythromycin fluconazole, fluoxetine, fluvoxamine, grapefruit juice, indinavir, itraconazole, ketoconazole, metronidazole, miconazole, nefazodone, nilotinib, paroxetine, pimozide, probucol, procainamide, quinidine, quinine, ritonavir, saquinavir, sertraline, sotalol, SSRIs, terfenadine, troleandomycin, voriconazole, zileuton, ziprasidone... 

Clinically important, potentially hazardous interactions with aminophylline, amiodarone, antacids, antineoplastics, arsenic, bepridil, bismuth, bismuth subsalicylate, bretylium, calcium salts, cocoa, didanosine, disopyramide, duloxetine, erythromycin, iron, magnesium salts, meptazinol, methylxanthines, NSAIDs, phenothiazines, procainamide, quinidine, rasagiline, sotalol, sucralfate, tizanidine, tricyclic antidepressants, zinc... 

---