Anti-arrhythmic Medications

Question 1

CAST

Answer 1

Cardiac Arrhythmia Suppression Trial

-Looked at mortality rate of long term use of antiarrhythmic medications for non-life threatening arrhythmias

Question 2

Anti-arrhythmic Medication

-Overview

Answer 2

1. Suppress dysrhythmias with depressing automaticity by decreasing conduction
   - Work by increasing refractoriness to premature stimulation
2. Divided into 4 main categories

Question 3

4 Properties of Cardiac Tissue

Answer 3

1. Automaticity
2. Contractility
3. Conductivity
4. Excitability

Any antiarrhythmic med can become a proarrhythmic

Question 4

Anti-arrhythmic

-Class 1 (Action)

Answer 4

1. Class 1= Sodium CHannel Blockers

2. Used for Ventricular Arrhythmias

Question 5

Anti-arrhythmic

-Class 1 (Specifics)

Answer 5

1. Fallen out of use due to side effects
2. Procainamide / Lidocaine

Increased risk of mortality when used long term

Question 6

Anti-arrhythmic

-Class 2 Beta-Blockers (Action)

Answer 6

1. Decrease HR and Stroke Volume

2. Used in Atrial & Ventricular arrhythmias

Question 7

Anti-arrhythmic

-Class 2 (Contraindications)

Answer 7

1. COPD and Asthma- bronchoconstriction
2. Diabetes –masks signs of hypoglycemia
3. Hold med if HR is <60

Bradycardia, cardiogenic shock, asthma

Question 8

Anti-arrhythmic

-Class 2 Beta Blockers (Adverse effects)

Answer 8

1. FATIGUE
2. Sexual Dysfunction
3. Increases effects of hypoglycemics

Hypotension, bradycardia, bronchospasms

Question 9

Anti-arrhythmic

-Class 2 Beta Blockers (Specific Meds)

Answer 9

End in “olol”

Esmolol
Acebutolol
Propranolol

Question 10

Anti-arrhythmic

-Class 3 (Action)

Answer 10

1. Potassium Channel Blockers
2. Works on atrial and ventricular dysrhythmias
3. Increase the action potential duration an affect fast tissue
4. Can CAUSE ARRHYTHMIAS

Question 11

Anti-arrhythmic

-Class 3 (Specific Meds)

Answer 11

Aminodarone

Question 12

Anti-arrhythmic

-Class 3 (Adverse Effects)

Answer 12

1. Pulmonary fibrosis test
   - Assess lung sounds for crackles TEST can sound like Velcro
2. photosensitivity (BE CAREFUL IN THE SUN)*TEST
3. Cataracts
4. QT prolongation
5. Hypotension and bradycardia

Question 13

Anti-arrhythmic

-Class 3 (Drug interactions)

Answer 13

1. DIgoxin

2. Warfarin

Question 14

Anti-arrhythmic

-Class 3 (Contraindications

Answer 14

1. Bradycardia
2. Heart block
3. Cardiogenic shock
4. Pregnancy

Question 15

Anti-arrhythmic

-Class 4 CCB (Action)

Answer 15

1. Block the calcium-dependent channels
2. Used for Atrial dysrhythmias
3. Decrease HR and Stroke Volume

Question 16

Anti-arrhythmic

-Class 4 CCB (Specific Meds)

Answer 16

1. End in “pine” except for:
   
   • Diltiazem
   • Verapamil

Question 17

Anti-arrhythmic

-Class 4 CCB (Contraindications)

Answer 17

1. Never use with liver disease
2. Avoid grapefruit and grapefruit juice
3. Avoid IV Beta blockers with IV CCB

Question 18

Anti-arrhythmic

-Class 4 CCB (Pt Teaching)

Answer 18

1. Measure daily weight and report and increase of 2lbs in 24 hrs
2. Avoid grapefruit and grapefruit juice

Question 19

Anti-arrhythmic

-Class 4 CCB (Adverse Effects)

Answer 19

1. Hypotension
2. CHF
3. Edema (peripheral)
4. Dizziness
5. Fatigue
6. Headache

Question 20

Amiodarone

-What to monitor?

Answer 20

Monitor Potassium

Question 21

Class 2 and 4

-What to monitor?

Answer 21

Monitor Weight gain in these classes and report 2lb increase in 24 hours