Anti-Dysrhythmic Drugs

Question 1

List the Vaughan Williams Classifications for Anti-dysrhythmic Drugs.

Answer 1

Class 1: Sodium Channel Blockers
Class 2: Beta Blockers
Class 3: Potassium Channel Blockers
Class 4: Calcium Channel Blockers (Non-DHPs)

Miscellaneous- Digoxin and Adenosine

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Question 2

What can Dysrhythmias lead to?

Answer 2

• Myocardial Infarction
• Heart Failure
• Stroke (Atrial fibrillation is a big culprit)
• Death

Question 3

When can we use Anti-Dysrhythmics?

Answer 3

• CHRONIC: May see patients on LONG TERM therapy of anti-dysrhythmia drugs
• ACUTE: In emergency situations, we may use anti-dysrhythmic to manage a dangerous dysrhythmia in the hospital (codes)

Question 4

What are some types of Dysrhythmias?

Answer 4

• Supraventricular Tachycardia (SVT)
  ~ umbrella term for dysrhythmia in upper chambers of heart
• Atrial Fibrillation (Afib)
  ~ can lead to stroke due to blood clots
• Torsades de pointes (TdP)

Question 5

What are the symptoms of Stroke?

Answer 5

BE FAST

• Balance Loss
• Eyesight Change
• Face Drooping
• Arm Weakness
• Speech Difficulty/Slurring
• Time to Call 911!

Question 6

List examples of Class 1: Sodium Channel Blockers.

Answer 6

1A: Disopyramide, Quinidine, Procainamide (short term)
1B: Lidocaine and Mexiletine
1C: Flecainide and Propafenone

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Question 7

What is an example of Class 2: Beta Blockers?

Answer 7

metoprolol

Question 8

What is metoprolol used for?

Answer 8

Can be used for Atrial Fibrillation

Question 9

Metoprolol contraindications?

Answer 9

• bradycardia
• hypotension
• decompensated heart failure
• first degree heart block

Question 10

What is an example of a Class 3: K+ Channel Blocker?

Answer 10

amiodarone

Question 11

What is Amiodarone used to treat?

Answer 11

Life-threatening ventricular tachycardia or fibrillation, atrial fibrillation or flutter that is resistant to other drugs

Question 12

Amiodarone adverse effects?

Answer 12

• Interstitial Lung Disease
• Thyroid (hypo/hyperthyroidism)
• Corneal (ocular)
• Hypotension / Hepatotoxicity / Heart

Question 13

Amiodarone contraindications?

Answer 13

• Bradycardia
• Hypotension/Shock
• Heart Blocks

Question 14

Amiodarone manifestation?

Answer 14

Blue Pigmentation of skin! (photosensitivity)

Question 15

What are examples of a Class 4: Ca2+ Channel Blocker?

Answer 15

verapamil and diltiazem

Question 16

What are Verapamil and Diltiazem used to treat?

Answer 16

• Dysrhythmias (primary use!)
  ~ Atrial fibrillation
• Angina

Question 17

Verapamil and Diltiazem adverse effects?

Answer 17

• Bradycardia
• Hypotension (postural/ortho)
• Peripheral edema
• Constipation (verapamil big time)

Question 18

Verapamil and Diltiazem drug interaction?

Answer 18

• NO GRAPEFRUIT JUICE!
• These drugs are enzyme inhibitors

Question 19

What is Adenosine used to treat?

Answer 19

Paroxsymal Supraventricular Tachycardias (SVT)

Question 20

Describe administration considerations for Adenosine.

Answer 20

• NO CAFFEINE/THEOPHYLLINE
• Instruct patients they are going to feel strange- their heart is literally going to stop
• IMMEDIATELY FLUSH THE LINE AFTERWARDS WITH NORMAL SALINE (20 ml)