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9 Cards in this Set
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Class I (A,B,C) - Quinidine - Disopyramide phosphate (Norpace) - Procainamide (Pronestyl) - Moricizine (Ethmozine) - Lidocaine (Xylocaine) - Mexiletine (Mexitil) - Tocainide HCI (Tonocard) - Phenytoin sodium (Dilantin) - Propafenone (Rhythmol) - Flecainide acetate (Tambocor) |
Indication: - premature beats, atrial flutter, a-fib - contraindicated in heart block - ventricular dysrhythmias - unlabeled use: digitalis for induced dysrhythmias
Adverse reaction: diarrhea, hypotension, ECG change, cinchonism, interact with many common drugs, hypotension, CNS effects, seizures, GI distress, bradycardia, dizziness, slurred speech, ventricular dysrhythmias
Nursing implication: - instruct client to monitor pulse rate and rhythm - monitor ECG - monitor for tinnitus and visual disturbances - lidocaine administered IV bolus and by infusion - monitor for confusion, drowsiness, slurred speech, seizures with lidocaine - administered oral drugs with food - may cause digoxin toxcitity |
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Class II - Propranolol HCI (Inderal) - Metoprolol (Lopressor) - Atenolol (Tenormin)
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Indications - supraventricular and ventricular tachydysrhythmias
Adverse reaction: - hypotension - bradycardia - bronchospasm
Nursing implication: monitor vital sign & contraindicated in asthma |
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Class III (Inotropics) - Amiodarone HCI (Cordarone) - Sotalol ( Betapace) - Dofetilide (Tikosyn) - Dronedarone (Multaq) - Ibutilide (Convert) IV |
Indication: ventricular dysrhythmias
Adverse reaction: dysrhythmias. HTN or hypotension, muscle weakness, tremors, photophobia
nursing implication: - amiodarone is now one of the first choice drug - monitor vital signs ECG - instruct client taking amiodarone to wear sunglasses and sunscreens when outside |
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Class IV - Verapamil HCI (Isoptin, Calan) - Diltiazem (Cardizem) |
Indication: supraventricular dysrhythmias
Adverse reaction: hypotension, bradycardia, constipation
nursing implication: - monitor BP and pulse - instruct client to change positions slowly |
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Atropine sulfate (Atropisol) |
Indication: bradycardia
Adverse reaction: chest pain, urinary retention, dry mouth
nursing implication: monitor HR & pulse, assess for chest pain, urinary retention, and avoid use with glaucoma |
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Digoxin (Lanoxin) |
Indication: supraventricular dysrhythmias, a-fib
Adverse reaction: bradycardia, dysrhythmias, anorexia, nausea, vomiting, diarrhea, visual disturbances
nursing implication: - monitor pulse rate and rhythm - check apical pulse for one full minute before administering hold if bp is less 60 bpm & notify physician - instruct client to report signs of toxicity - hypokalemia increases the risk for toxicity - causes hypercalcemia |
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Epinephrine (adrenaline) |
indication: cardiac arrest
adverse reaction: tachycardia, HTN
nursing implication: - impaired renal function can cause toxicity; monitor BUN and creatinine - monitor pulse return in asystole - monitor vital sign |
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Vasopressors - Norepinephrine bitartrate (Levophed) |
Indication: Dilated coronary arteries and causes peripheral vasoconstriction for emergency hypotensive states not caused by blood loss, vascular thrombosis, or anesthesia using cyclopropane or halothane
adverse reaction: can cause severe tissue necrosis, sloughing, and gangrene if infiltrates (blanching along vein pathway is preliminary sign of extravasation)
nursing implication: - rapidly inactivated by various body enzymesl need to ensure IV patency - use cautiously in previously hypertensive clients - check BP every 2-5 min - use large veins to avoid complication of prolonged vasoconstriction - pressor effects potentiated by many drugs; check drug-drug interactions - have phentolamine (Regitine) diluted per protocol for local injection if infiltrates |
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Cardiotonic/Vasoldilator (Human B-type Natriuretic Peptide: HBNP - Nesiritide (Natrecor) |
Indication: - treatment of acutely decompensated HF in clients who have dyspnea at rest or with minimal activity - reduce PCWP and reduces dyspnea
Adverse reaction: - hypotension is primary side effect and can be dose limiting - dysrhythmias - headaches, dizziness, insomnia, tremors, parasthesias - abdominal pain, nausea and vomiting
nursing implication: - many drug-drug interactions - monitor bp and telemetry - as diuresis occurs, monitor electrolytes, especially k+ - watch for overresponse to treatment in older adults |
