Antiarrhythmics

Front 1

(classification)
- decrease HR, force of contraction, myocardio irritability.
- to manage HTN, angin pectoris, acute MI & supraventricular tachycardia

Back 1

Beta-Adrenergic Blocker

Front 2

(classification)
- Dizziness, sleep disturbance, confusion, agitation, psychosis
- hypotension, bradycardia, heart block, acute heart failure, peripheral paresthesia resembling Raynaud's phenomenon
- laryngospasm or bronchospasm
- dry eye with gritty sensation, blurred vision, tinnitus, or hearing loss.
- dry mouth, n/v, heartburn, diarrhea, constipation, abdominal cramps, flatulence.
- agranulocytosis (failure to make WBC), hypo/hyper glycemia, hypocalcemia in pt with hyperthyroidism.

Back 2

Beta-Adrenergic Blocker

Front 3

(classification)
- restrict dietary sodium as ordered to prevent fluid overload
- ck HR b4 med, withhold if HR , 60 or systolic BP <90.
- assess hx of asthma, allergies, COPD coz it may lead to bronchospasm.
- med can mask signs of hypoglycemic - do not fasting longer than 12 hrs.
- do not dc abruptly > lead to withdrawal syndrome (tremulosness, sweating, sever HA, malaise, palpitation, rebound HTN, MI, life-theatening arrhythmias in pt with angina pectoris.

Back 3

Beta-Adrenergic Blocker
Propranolol HCL (inderal)

Front 4

(classification)
- decrease HR & BP.
- decrease angina by dilate coronary arteries & arterioles.
- decrease conductivity by blocking ca into cell.

Back 4

Calcium channel blockers

Front 5

- decrease HR, BP.
- give with food to reduce gastric irritation.
- withhold HR <60 or irregular.
- avoid grapefruit and grapefruit juice < increase drug level
- increase intake of fibers and fluids.
- HA, dizziness, nervousness, insomia, confusion, tremor, and gait disturbance, skin rash, n/v, constipation, impaired taste, postural hypotension, fluid vol. overload, heart block, profound bradycardia, HF, possible syncope.
• recumbent position for at least 1 hr after dose coz hypotension that may accompany infusion.
- can't withdrawal abruptly.
- monitor liver n renal function, get baseline coz drug cause elevateion of serum.
• Monitor I&O ratio. potential toxicity for renal impairment pt.
• Monitor ECG continuously during IV administration, monitor AV block or excessive bradycardia in pt with digitalis med.
• Decrease intake of caffeine-containing beverage (i.e., coffee, tea, chocolate).
• Notify physician of easy bruising, petechiae, unexplained bleeding.
• Do not use OTC drugs, especially aspirin, unless they are specifically prescribed by physician.

Back 5

Calcium channel blockers
Verapamil (isoptin)

Front 6

- used to Restores normal sinus rhythm in patients with paroxysmal supraventricular tachycardia.
-Assessment & Drug Effects
• Monitor for S&S of bronchospasm in asthma patients. Notify physician immediately.
• Use a hemodynamic monitoring system during administration; monitor BP and heart rate and rhythm continuously for several minutes after administration.
• Note: Adverse effects are generally self-limiting due to short half-life (10 s).
• Note: At the time of conversion to normal sinus rhythm, PVCs, PACs, sinus bradycardia, and sinus tachycardia, as well as various degrees of AV block, are seen on the ECG. These usually last only a few seconds and resolve without intervention.
• Note: Flushing may occur along with a feeling of warmth as drug is injected

Back 6

Adenosine (Adenocard)
Antiarrhythmic

Front 7

- By direct action on smooth muscle, decreases peripheral resistance and increases coronary blood flow. Blocks effects of sympathetic stimulation.
• Note: Correct hypokalemia and hypomagnesemia prior to initiation of therapy.
- photosensitivity(protective clothing., photophobia (should wear dark eye glasses)
-
• Monitor BP, HR carefully during infusion and slow the infusion if significant hypotension occurs; bradycardia should be treated by slowing the infusion or discontinuing if necessary. report promptly symptomatic bradycardia. Sustained monitoring is essential because drug has an unusually long half-life.
• drug-induced hypothyroidism or hyperthyroidism especially during early treatment period; pulmonary toxicity (progressive dyspnea, fatigue, cough, pleuritic pain, fever) throughout therapy.
- may cause hepatotoxicity and liver damage.
• Auscultate chest periodically.
• Monitor for elevations of AST and ALT. If elevations persist or if they are 2–3 times above normal baseline readings, reduce dosage or withdraw drug promptly to prevent hepatotoxicity and liver damage.
• Anticipate possible CNS symptoms within a week after therapy begins. Proximal muscle weakness, a common side effect, intensified by tremors presents a great hazard to the ambulating patient. Assess severity of symptoms. Supervision of ambulation may be indicated.
• Check pulse daily once stabilized, or as prescribed. Report a pulse <60.
• Take drug with meals.
• Follow recommendation for regular eye exams, including funduscopy and slit-lamp exam.
•

Back 7

Amiodarone (Cordaron)

Front 8

- take apical pulse for 1 full min. withhold med if <60.
- blood plasma test b4 next does or at 6 hrs for therapeutic level.
- toxicity : anorexia, n, v, diarrhea, visual disturbances.
- therapeutic range : 0.5-2ng/ml toxic level >2
- assess edema for fluid overload. weight >2lb report dr.
- no OTC med for cold, gi upset cough w/o asking dr.

-

Back 8

Digoxin (lanoxin)
Cardioctive glycoside/ antiarrhymic

Front 9

increase the contractility of the heart.

Back 9

Digoxin

Front 10

Suppresses automaticity in His-Purkinje system and elevates electrical stimulation threshold of ventricle during diastole. Prompt, intense, and long-lasting local anesthetic. It decreases pain through a reversible nerve conduction blockade.

Back 10

Lidocaine (Xylocaine)

Front 11

• Stop infusion immediately if ECG indicates excessive cardiac depression (e.g., prolongation of PR interval or QRS complex and the appearance or aggravation of arrhythmias).
• Monitor BP and ECG constantly; assess respiratory and neurologic status frequently to avoid potential overdosage and toxicity.
• Auscultate lungs for basilar rales, especially in patients who tend to metabolize the drug slowly (e.g., CHF, cardiogenic shock, hepatic dysfunction).
• Watch for neurotoxic effects (e.g., drowsiness, dizziness, confusion, paresthesias, visual disturbances, excitement, behavioral changes) in patients receiving IV infusions or with high drug blood levels.
• Therapeutic range 1.5–6 mcg/mL a Blood levels >7 mcg/mL are potentially toxic.
Patient & Family Education
• Swish and spit out when using solution for relief of mouth discomfort; gargle for use in pharynx, may be swallowed (as prescribed).
• Oral topical anesthetics may interfere with swallowing reflex. Do NOT ingest food within 60 min after drug application; especially pediatric, geriatric, or debilitated patients. Do not chew gum while buccal and throat membranes are anesthetized to prevent biting trauma.

Back 11

Lidocaine (Xylocaine)
Antirrhythmic