Pharmacology Cardiac Dysrhythmias

Front 1

lidocaine

Back 1

-acute management of ventricular dsyrhythmias
-baseline ECG and BP
-not with Stokes-Adams syndrome, Wolff-Parkinson-White syndrome and severe degrees of SA, AV or intraventricular block in absence of electronic pacing
-caution hepatic dysfunction or impaired hepatic blood flow
-make sure labeled for IV use; IM for emergency
-continuous ECG monitoring
-plasma levels btw 1.5-5 mcg/mL
-excessive doses can cause convulsions and respiratory distress-equipment for resuscitation available; convulsions-phenytoin/ or diazepam

Front 2

amiodarone

Back 2

-atrial and ventricular dysrhythmias
-only life-threatening ventricular dysrhythmias that have been refractory to safer agents
-oral long-term-recurrent ventricular fibrillation, recurrent hemodynamically unstable ventricular tachycardia
-oral-convert atrial fibrillation to normal sinus rhythm
-delays repol
-oral-pulmonary toxicity, cardiotoxicity-increase in dysrhythmias, no preggos and lactation, corneal microdeposits, optic neuropathy, discolor skin, GI, CNS, hepatitis and thyroid dysfunction; incrase levels of digoxin, phenytoin, simvastin; grapefruit; diuretics; not combine with beta blocker or verapamil
-IV: only work on slowing AV stuff, hypotension, bradydysrhythmias; phlebitis; initial treatment and prophylaxis of recurrent ventricular tachycardia when others not work; also atrial fibrillation, AV nodal reentrant tachycardia, and shock-resistent ventricular fibrillation

Front 3

verapamil

Back 3

-HTN, angina pectoris, cardiac dysrhythmias (atrial fibrillation, atrial flutter, paroxysmal supraventricular tachycardia)
-BP, pulse rate, labs of liver and kidney function; angina pectooris-frequency and severity of anginal attacks
-not severe hypotension, sick sinus syndrome (in absence of electronic pacing), 2nd or 3rd degree AV block, caution in HF, liver impairment or those taking digoxin or beta blockers
-sustained relsease for HTN, whole-measure BP and pulse-hypotension or bradycardia-notify prescriber and withhold med
-IV-cardiac dysrhythmias-injections over 2-3 min and monitor ECG for AV block, sudden reduction in heart rate, prolongation of PR or QT interval-have facilities for cadioversion and cardiac pacing immediately available
-AP-chart time, intensity and circumstances of attacks and likely precipitating event and notify prescriber if increases; HTN-monitor BP peridically-goal 140/90-teach to self-monitor BP and maintain BP record
-peripheral edema

Front 4

verapamil

Back 4

-constipation-increase fluid and fiber
-cardiosuppression-bradycardia, AV block, HF-teach about slow heartbeat, shortness of breath, weight gain and notify prescriber if occur
-digoxin-increases risk or partial or complete AV block-monitor for missed beats, slowed ventricular rate; can increase digoxin plasma levels-reduce digoxin dose
-beta blockers-can cause bradycardia, AV block, HF-monitor closely for cardiac suppression; give IV this and beta blockers several hours apart
-toxicity-remove unabsorbed drug with gastric lavage then cathartic; IV calcium to counteract excessive vasodilation and reduced myocardial contractility; raise BP with IV NE, IV fluids and palce pt in modified trendeelenburg's position can help; bradycardia and AV block reversed with isoproterenol and atropine-or if severe, electronic pacing; ventricular tachydysrhythmias can be treated with DC cardioversion-antidysrhythmic drugs like lidocaine or procainamide can also be used
-block calcium channels in heart and blood vessels-dilation of peripheral arterioles, arteries and arterioles of heart increase coronary perfusion; blockade at SA node reduces heart rate; blockade at AV node decreases AV nodal conduction; blockade in myocardium decreases force of contraction

Front 5

adenosine

Back 5

-ending paroxysmal SVT, including Wolff-Parkinson-White Syndrome
-decreases automaticity in SA node and delays AV conduction
-IV because rapidly cleared by blood
-short lived-sinus bradycardia, dyspnea from bronchoconstriction, hypotension, facial flushing from vasodilation, chest discomfort
-with methylxanthines (aminophylline, theophylline, caffeine)-may need larger adenosine dose
-dipyridomale-antiplatelet-blocks cellular uptake so can intensify effects

Front 6

propanolol

Back 6

-blocks beta1 and beta2 adrenergic receptors (heart, lungs)
-decreased automacticity of SA node, velocity of conduction through AV node-prolonged PR interval, myocardial contractility
-treating dysrhythmias caused by excessive sympathetic stimulation of heart=sinus tachycardia, severe recurrent ventricular tachycardia, exercise-induced tachydysrhythmias and paroxysmal atrial tachycardia caused by emotion/exercise, supraventricular tachydysrhythmias--suppresses excessive discharge of SA node, slows ventriculra rate by decreasing transmission or atrial impulses through AV node
-cardiac beta 1 receptors coupled with calcium channels, so they close too-so result is from decrease calcium influx
-can cause HF, AV block, sinus arrest, hypotension secondary to reduced cardiac output
-those with asthma-can cause bronchospasm
-do not give to those with asthma, sinus bradycardia, hig-degree heart block, HF
-reduce heart rate, decrease force of ventricular contraction, suppress impulse conduction through AV node-reduce CO
-HTN, AP, MI too
-inhibits glycogenolysis and mask tachycardia
-severe allergy

Front 7

digoxin

Back 7

-suppresses supraventricular
dysrhythmias by decreasing conduction through AV node and decreasing automaticity in SA node
-oral preferred
-cardiotoxicty/dysrhytmias, risk increased by hypokalemia-keep within 3.5-5 mEq/L range; GI, CNS
-slow ventricular rate with atrial fibrillation and atrial flutter
-acute/chronic supraventricular tachycardia-by increasing cardiac vagal tone and by decreasing sympathetic tone