ADVERSE EXTRA CARDIAC EFFECTS
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Severe extra-cardiac effects are also common with the antiarrhythmics; these tend to be drug-specific.
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Class IA drugs
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Quinidine
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Associated with cinchonism, a syndrome characterized by nausea, vomiting, diarrhea and a variety of CNS effects (tinnitus, headache, auditory and visual disturbances, and vertigo), Hypotension, Can cause elevated serum digoxin concentrations, hypersensitivity reactions (rashes, fever, angioneurotic edema, hepatitis) and reversible thrombocytopenia
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Procainamide
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Hypotension, Lupus like syndrome, gastrointestinal symptoms, Adverse CNS effects, Hypersensitivity reactions: fever, agranulocytosis (can lead to fatal infections)
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Class IB drugs
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Lidocaine
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Phenytoin
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Neurological effects: drowsiness, ataxia, vertigo, nausea, nystagmus
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Class IC drugs
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Encainide, flecainide
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Neurological effects (10-15% with flecainide): Dizziness, tremor, agitation, headache, visual disurbances
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G.I. upset
- Class II drugs
- Bronchospasm, sudden withdrawal can precipitate angina, a cardiac arrhythmia, or myocardial infarction
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Acebutolol associated with arthritis, myalgia, arthalgia, lupus-like syndrome, pulmonary complications
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Class III drugs
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Amiodarone
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Pulmonary toxicity and fibrosis, hepatic dysfunction
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Asymptomatic corneal deposits occur in all patients
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Many CNS symptoms
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Hypothyroidism or hyperthyroidism
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Cutaneous photosensitivity and blue-grey discoloration of skin
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Peripheral neuropathy
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Enhances the effect of warfarin and increases the serum concentrations of digoxin, quinidine, procainamide, and other drugs
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Bretylium
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Hypotension,Increased sensitivity to catecholamine
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Class IV drugs
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Verapamil
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Hypotension, Dizziness, headache, fatigue, Peripheral edema, G. I. effects, can increase serum concentrations of digoxin and may interact with many other drugs
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Diltiazem
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Other agents
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Digoxin
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Many adverse side effects: Anorexia, nausea, vomiting, diarrhea, abdominal pain, headache, confusion, abnormal vision
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Adenosine
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