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26 Cards in this Set
- Front
- Back
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What is a dysrythmia?
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A disturbance or abnormality in the heart rhythm due to abnormally functioning cardiac cells
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What are types of dysrhthmias?
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-Supraventricular dysrythmias
-Atrial fibrillation (AF) -Atrial flutter -Supraventricular tachycardia (SVT) -Ventrical dysrhythmias - fatal -Ventricular tachycardia (VT) -Ventricular fibrillation (VF) -Torsades de pointes - looks like VF and VT- treated differently -Ecotopic Foci -Conduction blocks - 2nd and 3rd degree heart blocks |
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What are antidysrhthmic drug classes?
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--Class I- membrane stabilizing, fast Na channel blockers
--Class II - Beta- blocking drugs --Class III- increase cardiac cell action potential --Class IV- Calcium channel blockers --Other- Adenosine and Digoxin |
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Describe class 1a?
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-Procainamide (pronestyl); Quinidine
-Depress myocardial excitiblity -Prolong refractory period -Indications: AF, PVC's, VT, PAC's |
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Describe class 1b?
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-Lidocaine - ONLY IV
-Decreases myocardial excitibility in veentricles -indication: ventricular dysrhthmias only |
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Describe class 1c?
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- Flecainide (Tambocor); Propafenone (Rhythmol)
- Slow cardic conduction in atria, AV node, and ventricles - indications severe VT, SVT, AF - rarely used, bad side effects |
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What side effect will class 1a cause?
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severe nausea and vomitting
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What are class I contraindications?
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-Bradycardia
-Heart block -Heart failure -Hypotension -Shock -Renal or hepatic failure |
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What are indications for class II antidysrthmias?
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-Supraventricular and ventricular dysrthmias (myocardial depressants)
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Describe class II?
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-beta blockers
-Metoprolol (Toprol); atenolol (Tenormin) -decrease spontaneous depolarization -affects phase 4 of action potential -cardioprotective -reduce/block sympathetic nervous system stimulation to cardiac conduction system -also anti-anginal and anti-hypertensives |
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What are Class II contraindications?
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-Sinus bradycardia
-AV block -Cardiogenic shock -Asthmal respiratory depression -Diabetes - increase blood sugars -Thyroid dysfunction -Renal and hepatic dysfunction |
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What are indications of class III antidysrhythmias?
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-Lide threatening ventricular tachycardia or fibrillation
-Atrial fibrillation or arterial flutter resistant to other drugs |
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What are class III antidysrhythmias? What do they do? What are they used for?
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-Amiodrone (cordarone), Sotalol (Betaspace)
-Most widely used -Increase action potential duration by prolonging repolarization in phase 3 -used for difficult to treat dysrhythmias |
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What are Class III contraindications?
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-Hypotension
-Heart Failure -Liver dsyfunction -Cardiogenic Shock -SA node dysfunction -2nd and 3rd degree heart block |
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What are Class IV antidysrhythmias? what do they do?
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-Diltiazem (cardizem), Verapamil (cabin)- IV or PO
-Block calcium channels, reducing the influx of Catt ions into cardiac cells during action potentials -Depress phase 4 depolarization -Also anti-anginal and anti-hypertensives |
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What are Class IV indications?
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-Paroxysmal SVT and rate control for atrial fibrilation and flutter
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What are Class IV contraindications?
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-Sick sinus syndrome
-Heart block -Heart failure -Hypotension -Impaired renal or liver function |
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What are unclassified antidysrhythmias?
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-ADENOSINE (Adenocard)
-Slows electrical conduction through AV node -Indicated for conversion of paroxymal supraventricular tachycardia to sinus rhythm -Half life of 10 seconds -Administered fast, IV push -Causes a few seconds of asystole before sinus rhythm resumes -DIGOXIN |
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What are common Adverse effects?
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-hypersensitivity reactions
-N & V Diarrhea -Dizziness -Headache -Blurred vision -Onset of new dysrhythmias -Prolongation of QT interval -Hypotension -Syncope -Bradycardia -Tachycardia -Heart block -Chest Pain -Palpations |
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What are the adverse effects of lidocaine?
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-Metallic Taste
-Seizure |
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What are the adverse effects of quinidine and flecainide?
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Visual disturbances
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What are the adverse effects of beta-blockers?
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-Bronchospasm
-Fatigue -Decrease libido |
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What are the adverse effects of Amiodarone?
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-Pulmonary toxicity
-Torsades de pointes -Blue-gray skin -Liver toxicity -Impaired memory -Derma toiogic reactions -Corneal microdeposits |
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What are antidysrthmic interactions?
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-Potentiation of anticoagulant warfarin (Coumadin)
-Antidysrhthmic increases te INR by 50%(Especially in amiodrone) -Grapefruit juice inhibits metabolism -Increase digoxin levels (quinidine, amiodrone)- but SHOULDNT be used together |
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What are nursing considerations for antidysrhthmias?
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-Monitor EKG, BP, HR
-Monitor renal and hepatic lab studies -Assess baseline neurological function -if taking warfarin, monitor PT/INR -Assess for bleeding |
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What is important patient teaching?
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-Avoid grapefruit juie if taking amiodrone or quinidine
-teach patients to measure pulse and BP -weigh daily; notify physician if 2lb or more gain in 24hr or 5lb in one week -encourage journaling of vital signs and weight -carry medical alert bracelet -Report new or worsening S/S -Encourage careful position changes or moving quickly |
