Monday, November 11, 2013

quinidine

商品名(trade name)

藥理作用(Pharmacological Effects)
[Heart
[[Automaticity: Conductivity: Vmax decreased (auricle, ventricle and Purkinje fibers)
[[[SA Node: Direct effect: rate decreased
[[[[Indirect effect:  rate rise (vagolytic effect)
[[[[Purkinje fiber: rate decreased (If decrease)
[[[[Ectopic focus: rate decreased(Na+ accumulation decrease)
[[[AV node: variable, AV node conduction decreased, conduction defects p’t may be conduction block, that's fatal
[[[action potential duration, APD: increased(Ix1 block)
[[[ERP: increased, Circle movement can be blocked=two way block
[[Excitability: decreased
[[[hyperpolarization: due to hypernatremia
[[[background Na+ increased
[[[Ca2+ currents block: Na-Ca pump is a complex 
[[Contractility: decreased Ca2+ influx at higher
[Blood vessel: vasodilatation
[[alpha-block--> profound hypotension--> shock
用量與用法(Dosage and Usage)
Pharmacokinetics:
]well absorbed
]high plasma protein binding
]well distribution
適應症(Indications)
{reentry arrhythmia(心律不整): prolong ERP
{Supraventricular tachycardia
{Ventricular arrhythmia
result
{P-R interval increase
{QRS icrease
{QT interval increase
副作用(Side effect)
}G-I discomfort
}Hypersensitivity
}Cinchonism(奎寧中毒): dizziness, tinnitus, headache
}Cardiotoxicity: V. fibrillation: QT prolong(Torsade de pointes)
}vagolytic effect
}ympathetic reflex
禁忌/交互作用(Contraindications / interaction)
Contraindications
?重症肌無力(Myasthenia gravis): strong anticholinergic effects
?congestive heart failure(心臟衰竭): Ca2+ influx is blocked
?conductive defect: AV delay --> heart block
interaction
?Phenobarbital: increase biotransformation-->effect increase
?Phenytoin: increase biotransformation-->effect increase
?Digoxin: do not combine with digoxin, they will compete renal secretion, prolong drug duration
?Nitroglycerin: increase hypotensive effect of nitroglycerin-->severe hypotension
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