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22 Cards in this Set
- Front
- Back
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Primary action of antiarrhythmic drugs
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change in ion flux in cardiac muscle cell
alter action potential |
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Class I antiarrhythmic drugs
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Inhibit fast Na+ channels, affect primarily mycocardial muscle
sub classes |
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Class II antiarrhythmic drugs
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Beta adrenergic blockers
decrease HR and automaticity, increase refractory period of AV node, decreases contractility |
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Class III antiarrhythmic drugs
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Prolong action potential, slows AV conduction, prolongs QT int., widens QRS
Not great for long term therapy |
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Class IV antiarrythmic drugs
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Calcium channel blockers
Reduce AV conduction, increase AV refractory period, decreased automaticity in AV node, decreases myocardial contractility Worsen CHF, watch hypotension and bradycardia |
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Quinidine
class, use, adverse, nursing |
Class I
Antiarrhythmic, may slow HR Widen QRS and QT int, lots of drug interactions (esp. digoxin), diarrhea, toxicity, ototoxicity Cardiac monitor at first teach report adverse effects |
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Lidocaine (Xylocaine)
class, use, adverse, nursing |
Class I - no decrease contractility, little effect on BP or HR
Vent. dysrhythmias, less effect on atria. ACUTE only. IV bolus followed by drip Widened QRS, dose-related numbness/tingling/drowsiness, seizures Cardiac monitoring, watch for toxicity |
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Propranolol (Inderal)
class, use, adverse, nursing |
Class II (beta blocker)
Vent. dysrhythmias, prophylactically after MI, slow vent. w/ a-fib (won't convert, just improves CO) Decrease contractility |
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Amiodarone (Corarone)
class, use, adverse, nursing |
Class III
Vent. tach and fib, prolong action potential, slows AV conduction, long term use not ideal Prolongs QRS and QT int., hypotension, bradycardia Monitor liver enzymes, thyroid levels, pulmonary toxicity, n/v, loss of appetite, watch brady and hypotension |
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Diltiazem (Cardizem, Ziac)
class, use, adverse, nursing |
Class IV (Ca+ channel blocker)
Supraventricular tachyscardias, slow vent. rate in a-fib and flutter, affects AV node Decreases contractility, worsens CHF, brady, hypotension Give IV slowly, cardiac monitoring, hold for syst <100 and HR <60 |
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Adenosine (Adenocard)
class, use, adverse, nursing |
Class IV (Ca+ channel blocker) - COOL drug
Depress AV node activity, chemical cardioversion, convert supraventricular tachycardia May see chest pressure, n/v Give rapid IV bolus, requires cardiac monitoring, observe short term (~5sec) asystole |
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Heparin
action, therapeutics, test to monitor, nursing |
Accelerates rate at which antithrombin factors neautralize clotting factors
Only IV or SQ in abd (never IM), dose verified by 2nd nurse aPTT (activated partial thromboplastin time) used for monitoring, goal is 1.5 to 2 x control/normal level Monitor bleeding (guiacc stool test, etc.), safety, d/c'd 12-24hrs before surgery |
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HIT - heparin induced thrombocytopenia
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immune reaction to heparin, platelet aggregation = clots, can embolize organs, onset usually longer than 5 days on heparin (that's a long time), monitor platelet counts
If occurs, can never have heparin again |
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Enoxaparin (Lovenaox)
what, use, nursing |
Low molecular weight heparin
Prevent DVT (esp. post-op), treat unstable angina Watch for bruising on abd (SQ injections), safety, monitor platelet counts, monitor liver enzyme tests |
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Coumadin, Warfarin
action, therapeutics, uses, nursing |
Alters synthesis of clotting factors, interferes with vit K
PO (rarely IV), slow onset, may overlap heparin therapy, lots of drug reactions, highly protein bound Prevent/treat thrombosis, reduce risk of stroke/MI/PE, follows heparin therapy, d/c'd several days before surgery, teratogenic Safety, monitor prothrombin time (int. normalized ratio goal is 2.0-3.0), diet (consistent vit. k consumption), no IM injections, keep app's for lab work, report other meds |
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Vitamin K
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Coumadin/Warfarin reversal
PO when INR >5, IV when >8 |
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Abciximab (Reopro)
what, therapeutics, use, nursing |
Platelet aggregation inhibitor, acute only
Blocks final pathway in platelet aggregation, inhibits binding of fibrinogen to platelets Given IV after MI, angioplasty, stent placement (prevent occlusion) Safety, monitor for bleeding, GI upset, rash |
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Clopidogrel (Plavix)
what, therapeutics, use, adverse |
Platelet aggregation inhibitor
cAMP phosphodiesterase, receptor inhibitor Reserved for ASA intolerance neutropenia, thrombocytopenia, rare thrombotic thrombocytopenia purpura, interaction w/ Clopidogrel and Omeprazole (Prilosec) |
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Acetylsalicylic Acid (Aspirin)
therapeutics, use, adverse |
Blocks production of a platelet aggregation inducer in platelets, action is permanent on each platelet (platelet life span 7-10 days), repeated doses have cumulative effect
Low doses, once per or BID, prevent stroke/MI Watch for allergy, GI bleeding, GI upset |
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Tissue plasmingoen activators or tPA
(Alteplase, Activase) what, therapeutics, use, nursing |
Fibrinolytic agents, "clot busters"
Activates bound plasminogen (targets clots) to breakdown, IV in ER/ICU w/ cardiac monitoring Used to go get clot in MI/stroke/PE, new use in frostbite? Given w/ ASA, heparin Observe for therapeutic response (specific to intended use), monitor for bleeding (GI, IV sites, etc) |
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Contraindications of fibrinolynic agents
tPA (Alterplase, Activase) |
Bleeding risks:
surgery w/in 10 days, trauma, CPR, GI bleed w/in 3 months, uncontrolled hypertension (diastolic >110), previous CVA, acute pericarditis |
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Safety and monitoring for anticoagulants
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No bare feet, soft toothbrushes, no flossing, hyper aware of safety, come in to ER if bleeding won't stop, report onset of new symptoms
Guiacc stools, hemo test urine, IV removal - direct pressure for minimum 5min, pay attention to sudden headache/abd pain/hypotension |
