How can a drug not have an effect on Action Potential Duration but Prolong ERP?

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Jay2910

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Hi everyone,
Am reading First Aid and wanting clarification on couple of things:
1) Am confused like with Class IC drugs, they prolong ERP, but have no effect on action potential duration?
2) What does this all have to do with the QT interval?

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Hi everyone,
Am reading First Aid and wanting clarification on couple of things:
1) Am confused like with Class IC drugs, they prolong ERP, but have no effect on action potential duration?
2) What does this all have to do with the QT interval?
So you are just starting MS2 and have no idea about Pharm and mechanism of drug action, what they target etc. You haven't covered organ systems yet (including cadio-vascular), haven't covered pathology etc. So I can asnwer those questions, but it's just a drop in the ocean. You need to study your classes - focus on them, they will explain everything. There is no use to read FA or do UW questions that early. This is why it's recommended to start prep at around December/January when you'll have at least majority of things covered.
 
Take a look at the IC chart here carefully.

https://d1z8zkw1yi6kd7.cloudfront.n...ures/data/000/000/211//content/class_ia-c.jpg

Notice that although the ERP is prolonged (ERP is essentially right when the plateau phase becomes slightly more negative relative to the maximum peak of the upstroke, so SOME Na+ channels are reactivated). What you can notice in the pic is that the upstroke never quite reaches the normal height, so it doesn't reach to that depolarized state at which most Na+ channels become inactivated.

However, the AP duration is the same because the slope dives down at the same time as the original via the outward K+ current.

The way that I think of it is: The more positive the cell is, the more Na+ channels are inactivated. So since the maximum peak of the upstroke is blunted and the slope is prolonged, the AP spends a longer time in the ERP, that is, the state at which the cell is depolarized enough to where you can't get a full blown AP upstroke, but to where it's slightly negative enough to have at least SOME Na+ channels available for another weaker AP.

EDIT: Although it may seem counterintuitive to keep arrhythmic cells in the ERP (the state at which another weaker AP can be generated), it's better than letting the cell hyperpolarize to the point where you can get a full blown AP upstroke. Also, by looking at the chart of the class IC, you see that even when the potential goes back to resting, you still can't get a full blown AP because the slope is blunted.

This next part i'm not 100% sure on, but here's what I think: ERP is just a term that means that not enough Na+ channels are recovered to have a full blown AP upstroke, but there are some that still can activate. So whether you have a "longer ERP" from a depolarized membrane, or by virtue of the Na+ channels being blocked by a drug, the effect is the same.
 
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