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51 Cards in this Set

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List (6) physiologic roles of the antidysrhythmic agent Adenosine:
1)Energy Transfer
2)Promotes prostaglandin release.
3)Inhibits platelet aggregation
4)Anti-adrenergic effects
5)Coronary vasodilation
6)Suppresses heart rate
Adenosine is not related to other antidysrhythmic agents.
What is recommended for treatment of paroxysmal supraventricular tachycardia due to its strong depressant effects on the SA and AV nodes?
Adenosine
Involves conduction in the SA node, atrium, or AV node!
What are the (6) cardinal signs of cardiovascular disease?
1) Dyspnea
2) Chest pain (not all pt's w/ dysrhythmia have this)
3) Fatigue
4) Edema
5) Syncope
6) Palpitations
What are the most common side effects to expect with adenosine?
The most common adverse reactions include flushing of the face(18%), SOB (12%), Chest Pressure (7%), nausea (3%), & headache w/ lt-headedness (2%).
Adverse effects are short-lived, due to a short half-live (<10secs).
What is the primary therapeutic outcome expected from adenosine therapy?
Conversion of supraventricular tachycardias to normal sinus rhythm.
Adenosine (Adenocard) can be administered by?
6 mg rapid IV bolus injection (over 1 to 2 seconds) followed by a saline flush. A f/u dose of 12 mg by rapid IV bolus is recommended if initial dose unsuccessful in restoring normal heat rate. (12 mg dose repeated once if required)
Drugs that enhance therapeutic & toxic effects of adenosine?
Dipyridamole & Carbamazapine
Smaller doses of adenosine can be used if these therapies are required.
Drugs that reduce therapeutic effects of adenosine?
Theophylline, aminophylline, & caffeine competitively antagonize adenosine.
Larger doses of adenosine are required with concurrent use.
This class III agent acts by prolonging the action potential of atrial & ventricular tissue & by increasing the refractory period without altering the resting membrane potential, thus delaying repolarization.
amiodarone hydrochloride (Cordarone)
This drug has been shown to antagonize non-competitively both alpha- & beta- adrenergic receptors, causing systemic & coronary vasodilation.
What is amiodarone hydrochloride used to treat?
It is used in the management of life-threatening supraventricular tachyarrhythmias, atrial fibrillation & flutter, bradycardia-tachycardia syndromes, ventricular tachycardia & fibrillation, & hypertophic cardiomyopathy.
If resistant to currently available therapy.
What are the common side effects with the use of amiodarone in patients receiving more than 400mg/day.?
Fatigue
Approximately 15% to 20% of patients discontinue therapy because of adverse effects.
What are the common side effects observed with amiodarone hydrochloride (Cordarone) therapy?
Fatigue, tremors, involuntary movements, sleep disturbances, numbness/tingling, dizziness, ataxia, confusion.
Amiodarone is contraindicated in patients with?
severe sinus-node dysfunction that causes sinus bradycardia, with second- & third-degree AV block, & when episodes of bradycardia have caused syncope (except in the presence of a pacemaker).
What is required for the loading dosaging of amiodarone?
Patients must be hospitalized while the loading dose is given, and the response often requires 2 weeks or more.
Implementation!
What are the beta-adrenergic blocking agents that inhibit cardiac response to sympathetic nerve stimulation by blocking the beta receptors.
Acebutolol, esmolol, & propranolol reduce the heart rate, systolic blood pressure, & cardiac output.
Antidysrhythmic agents
What is the primary therapeutic outcome expected from beta blocker therapy?
Conversion to and maintenance of NSR.
Name the various dysrhythmias effectively treated by beta blocker therapy:
Ventricular dysrhythmias, sinus tachycardia, paroxysmal supraventricular tachycardia, premature ventricular contractions, and tachycardia associated with atrial flutter or fibrillation because atrioventricular conduction is diminished.
What adrenergic blocking agent inhibits the release of norepinephrine?
Bretylium tosylate (Bretylol)
Give me a "B"
What class of antidysrhthmic agent bretylium belong to?
Bretylium is a class III used for short-term suppression of life-threatening ventricular dysrhythmias, primarily tachycardia and fibrillation, that have not responded to other widely used antidysrhythmic drugs.
Bretylium is NOT a?
cardiac suppressant, and is useful in patients with poor myocardial contractility and low cardiac output.
What are the common side effects observed with bretylium tosylate (Bretylol) therapy is?
Dizziness, lightheadedness. Hypertension, Hypotension.
After injection of bretylium the site should be assessed for?
Observe the site for signs of inflammation and necrosis.
Bretylium is cautioned with this medication and can cause a toxic drug interaction?
Digoxin. The sudden release of norepinephrine caused by the initiation of bretylium therapy may seriously aggravate the digitalis toxicity.
What class does disopyramide (Norpace) belong to?
Class Ia
Antidysrhythmic agent!
What is disopyramide (Norpace) used to treat?
Atrial fibrillation, Wolff-Parkinson-White syndrome, paroxysmal supraventricular tachycardia, premature ventricular tachycardia, & ventricular tachycardia.
It may be used both digitalized and nondigitalized patients. It is also useful as an alternative to quinidine or procainamide when patients develop an intolerance to or side effects.
What are the common side effects observed with disopyramide (Norpace) therapy?
Dry mouth, nose & throat.
What class does Flecainide acetate (Tambocor) belong to?
Class Ic - taken orally
Antidysrhythmic agent!
Flecainide acetate (Tambocor) is usually used for?
It is used for more serious ventricular dysrhythmias that have not responded to traditional therapy.
A particular advantage is the b.i.d dosage.
What negative aspects must be considered while using flecainide acetate (Tambocor)?
Flecainide has a negative inotropic effect & may cause or worsen heart failure, particularly in patients with preexisting severe heart failure. Flecainide may also aggravate an existing dysrhythmia and precipitate new ones, esp in patients with underlying heart disease.
What are the common side effects observed with flecainide acetate (Tambocor) therapy?
Dizziness, headache, constipation, nausea.
Flecainide acetate (Tambocor) should NOT be used in patients with?
second- or third-degree AV block in the absence of an artificial ventricular pacemaker and must be used with caution in patients with known heart failure.
What class does lidocaine (Xylocaine) belong to?
Class 1b agent.
Lidocaine (Xylocaine) is used in treatment of?
Premature ventricular contractions, ventriular tachycardia, and ventricular fibrillation.
What are the common side effects observed from lidocaine (Xylocaine) therapy is?
Lightheadedness, muscle twitching, hallucinations, agitation, euphoria. Respiratory depression.
Before administering lidocaine (Xylocaine) what on the label should you verify?
Lidocaine used to treat dysrhythmias is NOT the same lidocaine used as a local anesthetic. Make sure the label states "lidocaine (or Xylocaine) for cardiac dysrhythmia," or that it is lidocaine without preservatives.
Label for IV use.
Lidocaine (Xylocaine) should NOT be used in patients with?
Complete Heart Block
What class does mexiletine (Mexitil) belong to?
Class Ib - similar to lidocaine
What are the advantages of mexiletine (Mexitil)?
Good oral absorption with minimal initial hepatic metabolism, thus allowing for oral administration.
Primary therapeutic outcome expected is conversion of dysrhythmia to NSR.
What should be observed when lidocaine is administered with succinylcholine which is a neuromuscular blocking agent.
Observe for respiratory depression.
Surgical muscle relaxants (tubocurarine & succinylcholine)can cause respiratory depression when combined with which antidysrhythmic agent?
procainamide hydrochloride (Procanbid)
What antidysrhythmic agent may prolong the effects of the surgical muscle relaxants (tubocurarine & succinylcholine)?
Quinidine baby!
A pt on disopyramide (Norpace) develops a productive cough. The nurse should?
Perform a respiratory assessment.
adenosine (Adenocard) is ordered for a pt; this drug must by administered w/?
5% dextrose, 0.9% NaCl
IV
Lidocaine used on a pt w/ heart irregularity would be?
1% lidocaine
Quinidine increases the effects of which two drugs?
Digoxin & Warfarin
(3) facts about amiodarone (Cordarone)?
1)Tx of life-threatening supraventricular tachyarrhythmias.
2)Hospitalization during initial tx.
3)GI complaints occur in 25% of pts.
If the Purkinje system is damaged, conduction of the electrical impulse is impaired through the?
Ventricles!
Which antidysrhythmic has a negative inotropic effect that may cause or worsen heart failure?
Flecainide
Inotropic agents:
Stimulate the heart to increase the force of contractions, thus boosting cardiac output (CO). This also helps in improving tissue perfusion, and reduce pulmonary congestion.
Amiodarone is contraindicated in people with?
Severe sinus node dysfunction that causes bradycardia.
Which antiarrhythmic agent is used for short-term suppression of life-threatening ventricular dysrhythmias that have not responded to other widely used drugs?
Bretylium