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48 Cards in this Set

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  • Back
  • 3rd side (hint)
what does mexiletine (Mexitil) effectively treat?
Unifocal & multifocal premature ventricular contractions, couplets, and ventricular tachycardia.
Focus People, focus!
What does mexiletine (Mexitil) ineffectively treat?
Drug-resistant ventricular tachycardia.
More effective as a combo
mexiletine (Mexitil) dosage adjustment is necessary in patients with?
Severe renal dysfunction (creatinine clearance <10ml/min) & in patients w/ severe heart failure or acute MI.
I left my heart in Reno!
What drugs lower the therapeutic effect of mexiletine (Mexitil)?
Phenytoin & Rifampin.
The hepatic metabolism is enhanced.
Which agents lower the urine pH, causing an increase in excretion of mexiletine (Mexitil)?
Ascorbic acid & ammonium chloride.
What are the actions of moricizine (Ethmozine)?
Inhibition of influx of sodium ions into myocardial cells, slowing conduction velocity.
What class does moricizine (Ethmozine) belong to?
Class Ic, but it demonstrates characteristics of the other type I agents.
Which drugs enhance therapeutic & toxic effects of moricizine (Ethmozine)?
Digoxin, cimetidine, & propranolol.
What class does procainamide hydrochloride (Procanbid) belong to and what are some actions?
It is an effective synthetic Class Ia antidysrhythmic agent with effects similar to quinidine, but with fewer side effects.
Between procainamide (Procanbid) & quinidine, which is more effective in treating atrial fibrillation and flutter?
Blood should be drawn before the daily dose of procainamide (Procanbid) is given or?
Six hours after administration. Therapeutic blood levels are 4 to 8 mg/L.
It is important for consistency in blood draw & time med given.
What side effects should be reported for procainamide (Procanbid)?
Fever, chills, & joint/muscle pain, skin eruptions.
Monitor lab reports for leukocyte counts & the antinuclear antibody (ANA) titer.
What side effects should be reported for moricizine (Ethmozine)?
Dysrhythmias, euphoria/confusion.
What side effects should be reported for mexiletine (Mexitil)?
Dysrhythmias, neurotoxicity, seizures(paradoxical activity).
Mexiletine has dose related effects on the CNS!
What are the mechanisms of Class Ia antidysrhythmic agents.
Na channel blockers; Intermediate acting agents prolong the duration of the electrical stimulation on cells & the refractory time between electrical impulses.
Decreased conduction velocity(CV), increased refractory period(RP), decreased automacity(AM).
What are the Class I effects on the electrical conduction system of the heart?
They act as myocardial depressants by inhibiting sodium ion movement.
My heart is blue...
What are the three Class Ia antidysrhythmic agents?
quinidine (Quinadine)
procainamide (Procanbid)
disopyramide (Norpace)
What are the three Class Ib antidysrhythmic agents?
lidocaine (Xylocaine)
mexiletine (Mexitil)
tocainide (Tonocard)
What are the three Class Ic antidysrhythmic agents?
propafenone (Rythmal)
moricizine (Ethomozine)
flecainide (Tambocor)
What are the Class II effects on the electrical conduction system of the heart?
These agents are beta-adrenergic blocking agents. Many dysrhythmias are caused by stimulation of the beta cells of the sympathetic nervous system pertaining to the heart.
What are the three Class II antidysrhythmic agents?
propanolol (Inderal)
esmolol (Brevibloc)
metoprolol (Lopressor)
What are the five Class III antidysrhythmic agents?
bretylium (Bretylol)
amiodarone (Cordarone)
sotalol (Betapace)
ibutilide (Corvert)
dofetilide (Tikosyn)
What are the two Class IV antidysrhythmic agents?
verapamil (Calan)
diltiazem (Cardizem)
digoxin (Lanoxin)
Vagal Stimulation
adenosine (Adenocard)
Slows conduction
Class III antidysrhythmic agents affects?
Slow the rate of electical conduction & prolong the time interval between contractions by blocking potassium channels.
Class IV antidysrhythmic agents?
Block calcium ion flow; prolonging duration of the electrical stimulation & slowing AV node conduction.
Class Ia antidysrhythmic agents?
Prolong the duration of the electrical stimulation on cells & the refractory time between electrical impulses.
Class Ib antidysrhythmic agent effects?
Shorten the duration of the electrical stimulation & the time between the electrical impulses.
Class Ic antidysrhythmic agents?
The most potent myocardial depressants & slow conduction rate through the atria & the ventricles.
The electrical system or conduction system of the heart:
Anatomical structure that controls the sequence of muscle contractions to ensure that optimal volume of blood is pumped from the heart.
Dysrhythmias are caused by?
Firing of abnormal pacemaker cells, or blockage of normal electrical pathways, or combo of both.
Supraventricular dysrhythmias:
Atrial flutter/fibrillation, premature contractions (PAC), sinus tachycardia, sinus bradycardia, & paroxysmal supraventricular tachycardia.
Atrial flutter:
Rapid regular atrial rhythm due to reentrant circuit. Sx are palpitations. Thrombi may form & embolize. Dx by ECG.
Less common than a fib.
Atrial fibrillation:
Rapid Irregular atrial rhythm. Sx include palpitations, dyspnea, presyncope, and sometimes weakness. Thrombi often form & risk for stroke. Dx by ECG.
Paroxysmal supraventricular tachycardia:
Regular fast (160 to 200 bpm) heart rate that originates in the heart tissue other than the ventricles. It begins & ends suddenly. Most common in young people, more unpleasant than dangerous.
Dysrhythmias that develop below the bundle of His are:
Ventricular dysrhythmias; premature ventricular contractions(PVCs), ventricular tachycardia (VT), & ventricular fibrillation (VF).
Atrioventricular Blocks:
First Degree=partial block, delayed AV conduction. Second Degree=partial block w/ occasional blocked beats. Third Degree=complete block, the atria & ventricles function independently of each other.
Side effects to report for quinidine:
Cinchonism (poisoning by quinidine), Monitor pt for development of rash, chills, fever, increased metal confusion & ringing in the ears (tinnitus).
Baseline nursing assessment that should be implemented during the tx of dysrhythmias
Obtain data related to the six cardinal signs of cardiovascular disease & refer to for the evaluation of response to therapy. Initiate any requested lab testing.
What is the baseline nursing assessment for amiodarone hydrochloride (Cordarone)?
Initiate requested lab tests to evaluate pulmonary, opthalmic, thyroid, and liver functions.
What is the baseline nursing assessment for bretylium tosylate (Bretylol)?
Schedule BP readings at intervals related to status.
What is the baseline nursing assessment for disopyramide (Norpace)?
Assess usual pattern of urination & defecation
What is the baseline nursing assessment for flecainide (Tambocor)?
If any sx of heart failure are present, notify the MD before starting therapy.
What is the baseline nursing assessment for lidocaine (Xylocaine)?
Assess & record data relating to the pt's mental status such as orientation, agitation, confusion.
What is the baseline nursing assessment for mexiletine (Mexitil) & moricizine (Ethmozine)?
Record data relating to any GI Sx present before starting therapy. Assess mental status.
What is the baseline nursing assessment for propafenone (Rythmol)?
Record data relating to any GI Sx present before starting therapy.
The head is ok, butt???
What is the baseline nursing assessment for quinidine?
Assess & record Usual bowel patterns.