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