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Tetraethylammonium is a commonly used potassium channel blocker

Potassium channel blockers are agents which interfere with conduction through potassium channels.

Medical uses

Arrhythmia

Effect of class III antiarrhythmic agent on cardiac action potential.

Potassium channel blockers used in the treatment of cardiac arrhythmia are classified as class III antiarrhythmic agents.

Mechanism

Class III agents predominantly block the potassium channels, thereby prolonging repolarization.[1] More specifically, their primary effect is on IKr.[2]

Since these agents do not affect the sodium channel, conduction velocity is not decreased. The prolongation of the action potential duration and refractory period, combined with the maintenance of normal conduction velocity, prevent re-entrant arrhythmias. (The re-entrant rhythm is less likely to interact with tissue that has become refractory).

Examples and uses

Side effects

These agents include a risk of torsades de pointes.[6]

Anti-diabetics

Sulfonylureas, such as gliclazide, are ATP-sensitive potassium channel blockers.

Other uses

Dalfampridine, A potassium channel blocker has also been approved for use in the treatment of multiple sclerosis.[7]

Reverse use dependence

Potassium channel blockers exhibit reverse use-dependent prolongation of the action potential duration. Reverse use dependence is the effect where the efficacy of the drug is reduced after repeated use of the tissue.[8] This contrasts with (ordinary) use dependence, where the efficacy of the drug is increased after repeated use of the tissue.

Reverse use dependence is relevant for potassium channel blockers used as class III antiarrhythmics. Reverse use dependent drugs that slow heart rate (such as quinidine) can be less effective at high heart rates.[8] The refractoriness of the ventricular myocyte increases at lower heart rates.[citation needed] This increases the susceptibility of the myocardium to early Afterdepolarizations (EADs) at low heart rates.[citation needed] Antiarrhythmic agents that exhibit reverse use-dependence (such as quinidine) are more efficacious at preventing a tachyarrhythmia than converting someone into normal sinus rhythm.[citation needed] Because of the reverse use-dependence of class III agents, at low heart rates class III antiarrhythmic agents may paradoxically be more arrhythmogenic.

Drugs such as quinidine may be both reverse use dependent and use dependent.[8]

Calcium-activated potassium channel blockers

Examples of calcium-activated potassium channel blockers include:

Inwardly rectifying channel blockers

Examples of inwardly rectifying channel blockers include:

ROMK (Kir1.1)

Nonselective: Ba2+,[20] Cs+[21]

GPCR regulated (Kir3.x)

ATP-sensitive (Kir6.x)

Tandem pore domain channel blockers

Examples of tandem pore domain channel blockers include:

Voltage-gated channel blockers

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Examples of voltage-gated channel blockers include:

hERG (KCNH2, Kv11.1)-specific

KCNQ (Kv7)-specific

See also

Notes

  1. ^ Amiodarone also blocks CACNA2D2-containing voltage gated calcium channels
  2. ^ works by selectively blocking the rapid component of the delayed rectifier outward potassium current (IKr)
  3. ^ blocks potassium channels of the hERG-type
  4. ^ Primarily inhibits outward voltage-gated Kv2.1 potassium channel currents.
  5. ^ a very potent inhibitor of the rat Kv1.3 voltage-gated potassium channel

References

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