Acute Flashcards
CLASSIFICATION OF:
METOPROLOL (Lopressor)
- Class II Antiarrhythmic
* Beta Blocker
Generic name for LOPRESSOR
METOPROLOL
USES FOR:
METOPROLOL (Lopressor)
- Control of rapid VENTRICULAR RATES in ATRIAL FIBRILLATION/FLUTTER
- Management of SINUS TACHYCARDIA and SUPRAVENTRICULAR DYSRHYTHMIAS
- Early MI
ACTION OF:
METOPROLOL (Lopressor)
- Blocks stimulation of Beta-1 adrenergic receptors (sympathetic nervous system)
- Decreases heart rate and AV conduction
- Decreases Myocardial contractility & automaticity
CONTRAINDICATIONS OF:
METROPROLOL (Lopressor)
- CHF
- Pulmonary Edema
- Cardiogenic Shock
- Bradycardia or Heart Block
- Known alcohol intolerance
SIDE EFFECTS:
METOPROLOL (Lopressor)
CNS: fatigue; agitation; confusion; dizziness; weakness
CV: Second or Third Degree Heart Block; CHF; Cardiogenic Shock; HYPOtension; BRADYcardia; Peripheral Ischemia
GI: Nausea; vomiting
*****HYPERSENSITIVITY
ROUTE/DOSE:
METOPROLOL (Lopressor)
IV/PO - Adult: 3 bolus injections of 5 mg at 2 minute intervals FOLLOWED BY 50 mg PO q6 hours for 48 hours; FOLLOWED BY 10 mg bid
PO: 12.5-100 mg bid
NURSING CARE FOR:
METOPROLOL (Lopressor)
** Client must be on ECG monitoring
** Monitor BP & Pulse BEFORE and DURING administration
CLASSIFICATION OF:
PROCAINAMIDE (Pronestyl)
- Class 1 Antiarrhythmics
* Class 1-A- Sodium channel blockers
USES FOR:
PROCAINAMIDE (Pronestyl)
Treatment of a wide variety of atrial and ventricular arrhythmias including: PVC, PAC, Ventricular tachycardia, and maintenance of normal sinus rhythm after conversion from atrial fibrillation or flutter.
ACTION OF:
PROCAINAMIDE (Pronestyl)
- Decreases myocardial excitability
- Slows conduction velocity
- May depress myocardial contractility
- Membrane stabilizer
CONTRAINDICATIONS OF:
PROCAINAMIDE (Pronestyl)
- AV Block
- Systemic Lupus
**Use cautiously with: MI, CHF, or renal or hepatic insufficiency
SIDE EFFECTS OF:
PROCAINAMIDE (Pronestyl)
*Seizures, asystole, heart block, ventricular dysrhythmias, blood disorders, diarrhea, GI symptoms
ROUTE/DOSE OF:
PROCAINAMIDE (Pronestyl)
- IV: Administer 20mg/min until dysrhythmia is suppressed, hypotension occurs, or 1000 mg have been given. Follow with a 2-6mg/min continuous infusion
- PO- 50mg/kg/day in divided doses
- IM- only when IV or PO not feasible
NURSING CARE FOR:
PROCAINAMIDE (Pronestyl)
**Do not exceed recommended infusion rate. Dilution of 1gram/250= 4mg/ml
Generic name for XYLOCAINE
LIDOCAINE
CLASSIFICATION OF:
LIDOCAINE (Xylocaine)
- Class 1 Antiarrhythmics
* Class 1B- Sodium channel blockers
USES FOR:
LIDOCAINE (Xylocaine)
- Acute therapy for ventricular dysrhythmias
* Suppression and prevention of ventricular dysrhythmias
ACTION OF:
LIDOCAINE (Xylocaine)
- Depresses excessive automaticity of ectopic impulses in the His-Purkinje system by its local anesthetic effects.
- Very effective in suppressing premature ventricular beats that arise from ischemic cells.
- Onset and peak are immediate, duration is 10-20 minutes
CONTRAINDICATIONS FOR:
LIDOCAINE (Xylocaine)
- Hypersensitivity
- AV Block
- Wolff-Parkinson-White syndrome
- Bradycardia
- Adams-Stokes syndrome
SIDE EFFECTS FOR:
LIDOCAINE (Xylocaine)
- CNS: dizziness, restlessness, confusion, unconsciousness, convulsions, blurred vision, slurred speech, numbness, lethargy, tremors
- CV: hypotension, cardiac arrest, bradycardia
- DERM: phlebitis at injection site
- GI: nausea, vomiting
- RESP: respiratory arrest
ROUTE/DOSE FOR:
LIDOCAINE (Xylocaine)
- IV Bolus: 1mg/kg (May repeat 0.5 mg/kg q10 minutes up to a total of 3mg/kg total)
- IV Infusion: 1-4 mg/min drip
NURSING CARE FOR:
LIDOCAINE (Xylocaine)
- Administer IV bolus over 1-2 minutes
* Administer infusion through an infusion pump
Generic name for RHYTHMOL
PROPAFENONE
CLASSIFICATION OF:
PROPAFENONE (Rhythmol)
- Class 1 Antiarrhythmics
* Class 1C- Sodium channel blockers
USE OF:
PROPAFENONE (Rhythmol)
- Life-threatening ventricular arrhythmias
- Paroxysmal atrial fibrillation
- Paroxysmal supraventricular tachycardia
ACTION OF:
PROPAFENONE (RHYTHMOL)
*Slows conduction in cardiac tissues by altering transport of ions across cell membranes and depress depolarization
CONTRAINDICATIONS FOR:
PROPAFENONE (Rhythmol)
- CHF
- Less severe ventricular arrhythmias
- Heart blocks
- Sick sinus syndrome
**Use CAUTIOUSLY in potassium imbalances
SIDE EFFECTS OF:
PROPAFENONE (Rhythmol)
- CNS: dizziness, shaking, weakness
- EENT: blurred vision
- CV: supraventricular arrhythmias, ventricular arrhythmias, conduction disturbances, angina, hypotension, bradycardia
- GI: Altered taste, constipation, dry mouth
- DERM: rash
- MS: Joint pain
ROUTE/DOSE OF:
PROPAFENONE (Rhythmol)
- PO (Adults): 150 mg q8 hours.
* May be gradually increased at 3-4 day intervals as required up to 300 mg q8-12 hours
NURSNG CARE FOR:
PROPAFENONE (Rhythmol)
- Therapy should be initiated in a hospital with facilities for cardiac rhythm monitoring as most serious side effects are seen within the first 2 weeks of therapy
- Monitor BP and pulse periodically throughout therapy
- May cause prolongation of PR or QT intervals
- Assess client for signs of CHF. May require reduction of d/c of therapy
Generic name for CORDARONE
AMIODARONE
CLASSIFICATION OF:
AMIODARONE (Cordarone)
Class III Antiarrhythmics
USE OF:
AMIODARONE (Cordarone)
- Control of supraventricular and ventricular dysrhythmias unresponsive to less toxic agents
- Management and prophylaxis of recurring ventricular fibrillation and unstable ventricular tachycardia unresponsive to other drug therapy
ACTION OF:
AMIODARONE (Cordarone)
- Prolongs action potential and refractory period; inhibits adrenergic stimulation by preventing the release of norepinephrine from the sympathetic nerve sites
- Slows the sinus rate, increases PR and QT intervals, and decreases peripheral vascular resistance (vasodilates)
CONTRAINDICATIONS OF:
AMIODARONE (Cordarone)
- Bradycardia
- Sinus node dysfunction
- Second and third degree AV block
- Cardiomegaly
*Used cautiously in liver, pulmonary and thyroid disease
SIDE EFFECTS OF:
AMIODARONE (Cordarone)
- CNS: peripheral neuropathy, tremors, paresthesia, headache, malaise, fatigue, insomnia, abnormal taste and smell
- CV: CHF, hypotension, bradycardia
- DERM: blue-gray skin discoloration
- ENDO: thyroid dysfunction
- GI: abnormal liver function
ROUTE/DOSE OF:
AMIODARONE (Cordarone)
- IV: 150 mg over 10 minutes, followed by 360 mg over the next 6 hours and then 540 mg over the next 18 hours. Continue infusion at 0.5 mg/minute until oral therapy is initiated
- ACLS guidelines for pulseless VTACH/VFIB: 300 mg IVP, may repeat once after 3-5 minutes with 150 mg IVP
- PO: 400 mg/day
NURSING CARE FOR:
AMIODARONE (Cordarone)
- When giving to a client on Digoxin, be aware that the dose of Digoxin should be reduced by 50%
- Hypokalemia should be corrected before therapy
- Instruct client to avoid sun exposure
- IV administration should occur through a central line. IV solution must be administered using glass bottles and a filter.
GENERIC NAME FOR:
CARDIZEM
DILTIAZEM
CLASSIFICATION OF:
DILTIAZEM (Cardizem)
Class IV Antiarrhythmics (Calcium channel blockers)
USES FOR:
DILTIAZEM (Cardizem)
- Treatment of supraventricular tachyarrhythmias and rapid ventricular rates in atrial fibrillation or flutter
- Management of all forms of angina pectoris
- Treatment of mild to moderate hypertension
ACTION OF:
DILTIAZEM (Cardizem)
- Inhibits the transport of calcium into myocardial and vascular smooth muscle cells.
- Systemic vasodilation resulting in decreased BP.
- Coronary vasodilation resulting in decreased frequency and severity of angina.
- Suppression of dysrhythmias.
CONTRAINDICATIONS OF:
DILTIAZEM (Cardizem)
- Hypersensitivity
- Sick sinus syndrome
- Second and third degree AV block
- Blood pressure <90mmHG
- Recent MI
- Pulmonary congestion
- CHF
- Cardiogenic shock
- Wolff-Parkinson-White syndrome
SIDE EFFECTS OF:
DILTIAZEM (Cardizem)
- CV: sympathetic and orthostatic hypotension, bradycardia, conduction disturbances, heart failure, edema
- DERM: flushing, sweating
- CNS: headache, tremors
- GI: esophageal reflux, constipation
- GU: urinary retention
ROUTE/DOSE OF:
DILTIAZEM (Cardizem)
PO- Adults: 30-120 mg, 3-4 times/day or 60-120 mg BID as SR capsules or 180-240 mg daily as CD or XR capsules
IV-Adults: 0.25 mg/kg. May repeat in 15 minutes with a dose of 0.35 mg/kg. May follow with a continuous infusion at 10 mg/hour (range 5-15mg/hr) for up to 24 hours
NURSING CARE FOR:
DILTIAZEM (Cardizem)
- Client must be on EKG monitor.
- Monitor BP and pulse before and frequently during administration.
- Assess for signs of CHF.
- Report bradycardia or prolonged hypotension promptly.
- Do not open, crush, break, or chew sustained release capsules/tablets.
- Direct IV may be administered undiluted.
- Monitor digoxin levels for toxicity.
GENERIC NAME FOR:
ADENOCARD
ADENOSINE
CLASSIFICATION OF:
ADENOSINE (Adenocard)
Miscellaneous Antiarrhythmics
USES FOR:
ADENOSINE (Adenocard)
- Conversion of paroxysmal supraventricular tachycardia (PSVT) to normal sinus rhythm (NSR) when vagal maneuvers are unsuccessful
- Diagnostic agent to assess myocardial perfusion defects
- ACLS: First-line drug therapy in ACLS protocol for PSVT
ACTION OF:
ADENOSINE (Adenocard)
- Slows AV conduction and interrupts re-entry through accessory pathways. Also produces coronary artery vasodilation.
- Has extremely short half-life of <10 seconds
- Onset- Immediate
- Peak-within seconds
- Duration: 1-2 minutes
CONTRAINDICATIONS OF:
ADENOSINE (Adenocard)
- Hypersensitivity
- Sick sinus syndrome
- Second and third degree AV block
- Use with caution in asthma
SIDE EFFECTS OF:
ADENOSINE (Adenocard)
- CNS: dizziness, headache, apprehension, blurred vision, tingling, numbness
- CV: palpitations, chest pain, hypotension, transient dysrhythmias, bradycardia
- DERM: facial flushing, sweating, burning sensation
- RESP: dyspnea, bronchospasm in asthmatics, hyperventilation
- GI: metallic taste, tight throat
ROUTE/DOSE OF:
ADENOSINE (Adenocard)
IV-Adults: 6mg by rapid IV bolus. If no result, repeat 1-2 minutes later as 12 mg rapid bolus. This dose may be repeated (single dose not to exceed 12 mg)
NURSING CARE FOR:
ADENOSINE (Adenocard)
- Client must be on EKG monitor.
- Administer over 1-2 seconds via direct IV or into proximal IV line. Follow with rapid NSS flush to ensure injection reaches systemic circulation.
- Crystals may form when the drug is refrigerated; warm to room temperature to dissolve.
- Give undiluted.
GENERIC NAME FOR:
LANOXIN
DIGOXIN
CLASSIFICATION OF:
DIGOXIN (Lanoxin)
Miscellaneous Antiarrhythmics
USES OF:
DIGOXIN (Lanoxin)
Treatment of CHF, tachyarrhythmias, atrial fibrillation or flutter with rapid ventricular response; paroxysmal atrial tachycardia
ACTION OF:
DIGOXIN (Lanoxin)
- Increases the force of myocardial contraction (Positive Inotrope)
- Prolongs refractory period of the AV node and slows conduction through the SA and AV nodes (Negative Chromotrope)
CONTRAINDICATIONS OF:
DIGOXIN (Lanoxin)
- Bradycardia
- Ventricular tachycardia or fibrillation
- AV block
- Constrictive pericarditis
**Use with caution in electrolyte imbalance (Hypokalemia, Hypomagnesemia, Hypercalcemia)
***Use with caution in renal failure due to decreased renal excretion of the drug
SIDE EFFECTS OF:
DIGOXIN (Lanoxin)
- CV: arrhythmias, bradycardia
- CNS: fatigue, headache, weakness
- EENT: blurred vision, yellow vision, HALO APPEARANCE (A HALLMARK SIGN OF DIGOXIN TOXICITY)
- GI: anorexia, nausea, vomiting
ROUTE/DOSE OF:
DIGOXIN (Lanoxin)
- Digitalizing dose: for rapid effect, a larger initial loading dose should be given in several divided doses over 12-24 hours
- IV- ADULT: 0.6-1 mg given as 50% of the dose initially and additional fractions given at 4-8 hour intervals
- PO- ADULT: 0.75-1.25 mg given as above
- Maintenance dose: Adult PO 0.063-0.5 mg/day
**NORMAL THERAPEUTIC BLOOD LEVEL: 0.5-2
NURSING CARE FOR:
DIGOXIN (Lanoxin)
- Monitor apical pulse for 1 full minute before administration, hold and notify physician if pulse<60 bpm in an adult
- Notify physician before giving dose if client has electrolyte imbalances; (hypokalemia, hypomagnesemia, or hypercalcemia) May make client more susceptible to digitalis toxicity
- IV doses may be given undiluted over 5 minutes
- Y-site incompatible with propofol, amphotericin B and fluconazole
GENERIC NAME FOR:
ATROPEN
ATROPINE
CLASSIFICATION OF:
ATROPINE (AtroPen)
Miscellaneous Antiarrhythmics
USES FOR:
ATROPINE (AtroPen)
- Multiple uses; also an anticholinergic drug
- IV: treatment of sinus bradycardia and heart block
- IM: pre-op use is to decrease oral and respiratory secretions
- PO: adjunctive therapy in the management of peptic ulcer disease and irritable bowel syndrome
ACTION OF:
ATROPINE (AtroPen)
- Blocks the effect of stimulation of cholinergic receptors by acetylcholine
- Inhibits the effects of stimulation of the parasympathetic nerves, thus permitting the effects of the sympathetic nervous system to predominate
CONTRAINDICATIONS OF:
ATROPINE (AtroPen)
- Narrow-angle glaucoma
- Asthma
- Urinary or GI obstruction
- Intestinal atony
- Paralytic Ileus
- Myasthenia Gravis
- Ulcerative Colitis
- Hiatal Hernia
- Serious hepatic and renal disease
SIDE EFFECTS OF:
ATROPINE (AtroPen)
- CNS: Ataxia, restlessness, confusion
- CV: tachycardia, palpitations, hypertension
- GI: Dry mouth, constipation
- GU: urinary hesitancy, retention
- EENT: blurred vision, increased intraocular pressure
- DERM: decreased sweating, flushing, rash, elevated body temperature
ROUTE/DOSE OF:
ATROPINE (AtroPen)
- IV-ADULTS: 0.5-1.0 mg; may repeat as needed q 5 minutes; (q3-5 minutes in ACLS guidelines) May administer via endotracheal tube- use 2-10 times the IV dose
- IV-CHILD: 0.01-0.03 mg/kg (range is 0.1-0.5 mg in child or up to 1 mg in adolescents); May repeat q 5 minutes up to a total dose of 1 mg in child (2mg in teens)
NURSING CARE FOR:
ATROPINE (AtroPen)
- Direct IV may give undiluted or dilute in 10 ml sterile water.
- Do not add to IV solution.
- Administer as a rate of 0.6 mg over 1 minute.
- When given over 1 minute, may cause paradoxical bradycardia, which usually resolves in approximately 2 minutes.
Generic name for PRONESTYL
PROCAINAMIDE
