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Pharmacology Exam 2 > Antiarrhythmic Agents > Flashcards

Antiarrhythmic Agents Flashcards

1
Q

What is phase 0 of the Action Potential of the Cardiac Muscle Cell?

A

Sodium ions move into cells - Depolarization phase.

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2
Q

What is phase 1 of the Action Potential of the Cardiac Muscle Cell?

A

Potassium ions move out of cells - sodium channels close. This causes a minor repolarization.

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3
Q

What is phase 2 of the Action Potential of the Cardiac Muscle Cell?

A

Calcium ions move into cells - Plateau stage. Polarization remains the same for a brief period of time (straight line)

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4
Q

What is phase 3 of the Action Potential of the Cardiac Muscle Cell?

A

Potassium ions moves out cells - quick repolarization. Calcium is no longer moving into the cells, however there is a rapid flow of potassium out of the cells.

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5
Q

What is phase 4 of the Action Potential of the Cardiac Muscle Cell?

A

Rest and start over again - Resting phase.

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6
Q

What are some causes of Cardiac Arrythmias?

A

Electrolyte disturbance that alter the action potential (Sodium & Potassium esp)
Decrease in oxygen delivered to the cells.
Structural damage changing the conduction pathway through the heart (congenial heart defect)
Acidosis or accumulation of waste products altering the action potential.
Drugs that alter the action potential or cardiac conduction.

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7
Q

What is the difference between Tachycardia and Bradycardia?

A

Tachycardia - faster than normal heart rate - higher than 100 bpm
Bradycardia - slower than normal heart rate - Below 60 bpm

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8
Q

What are Heart Blocks and Bundle Branch Blocks?

A

Alterations in conduction through the muscle.

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9
Q

What are the 4 Classifications of Antiarrythmics?

A

Class 1: Blocks the sodium channels
Class 2 : Acton on autonomic receptors
Class 3 : Block potassium channels
Class 4 : Block calcium channels

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10
Q

What are Antiarrythmics?

A

Drugs that help restore regular cardiac rate and rythm.

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11
Q

What is Cardiac Output?

A

The amount of blood the heart is pumping per beat.

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12
Q

What is hemodynamics?

A

The flow of blood through the cardiovascular system.

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13
Q

What is premature atrial contraction (PAC)?

A

When the atrium contracts early.

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14
Q

What is premature ventricle contraction (PVC)

A

When the ventricles contracts early.

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15
Q

What is Proarrhythmic?

A

When something has a tendency to cause arrythmias.

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16
Q

Are PACs and PVCs considered to be arrythmias?

A

Yes, even if they are just seen once on an ECG thay are still arrythmias.

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17
Q

What is Atrial flutter?

A

An arrythmia (even though it is regular). The Atrial is not contracting properly due to a conduction problem.

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18
Q

Which phase of the action potential does repolarization occur?

A

Phase 3.

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19
Q

What are some lifespan considerations to take into account when providing children with Antiarrhythmic agents?

A

Doses should be calculated based on age and weight.
Children should be monitored closely as they are more likely to experience adverse reactions.
Cardiac ablations have been successful in children eliminating the need for medications in some patients.
Digoxin is approved for children.

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20
Q

What are some lifespan considerations to take into account when providing adults with Antiarrhythmic agents?

A

Adults given these drugs in critical scenarios such as in the ER or ICU when coding may occur.
Frequent monitoring is necessary because event though they are given to reduce arrythmias they may cause arrythmias if there is an incorrect dose.
For patients that are using these drug long term there should be frequent follow ups and medication reconciliation.
Drugs should be avoided in pregnancy and lactation.

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21
Q

What are some lifespan considerations to take into account when providing older adults with Antiarrhythmic agents?

A

When older adult are frequently taking these drugs, the drugs should be started at the lowest dose possible.
Caution with renal and hepatic impairment.

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22
Q

What is an ablation?

A

Also known as cardiac ablation or catheter ablation, this procedure is used to treat irregular heartbeats. It involves inserting a catheter into a vein and guiding it to the heart to destroy tissue that’s causing the arrhythmia

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23
Q

What are the 3 sub-classes of class 1 Antiarrhythmic drugs?

A

1a - Procainamide, Quinidine
1b- Lidocaine
1c - Flecainide, Propafenone.

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24
Q

What is the action of class 1 Antiarrhythmic drugs?

A

Works on phase 0 of the action potential by preventing sodium from flowing into the cells.

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25
Q

In what patients/conditions would we use class 1 Antiarrhythmic drugs?

A

Tachycardia
V-fib
A-flutter and A- fib because in these conditions the sodium channels are open more frequently and the heart is therefore depolarizing more frequently and these drugs slow down the depolarization.

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26
Q

What conditions would contraindicate the use of Class 1 antiarrhythmics?

A

Bradycardia, heart block, CHF, Hypotension, shock. These conditions already have slow depolarization and we do not want to make these conditions worse.
Electrolyte disturbance could have an impact of the effectiveness of the medication.

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27
Q

When should we be cautious of giving class 1 Antiarrhythmic medications to patients?

A

Patients with renal or hepatic problems.
Pregnancy or lactation.

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28
Q

What are some adverse effects that we may see in patients who are given class 1 Antiarrhythmic medications, and what are they normally caused by?

A

All the adverse effects are due to the delay in the action potential of the cells.

CNS - Dizziness, fatigue, slurred speech, change in taste and vision changes.
GI- Nausea and vomiting
CV - Arrythmias, hypertension,
Respiratory depression
Rash, loss of hair, bone marrow suppression.

Procainamide may cause : fever, painful joints, pericarditis, hepatomegaly and potentially a fatal risk of neutropenia, liver failure, hemolytic anemia and thrombocytopenia.

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29
Q

Are there any drug-drug interactions with Class 1 Antiarrythmics?

A

Yes, there are many. Especially any other drugs that may cause arrythmias.
For example Digoxin, Cimetidine and Warfarin.

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30
Q

Are there any food interactions with class 1 Antiarrhythmics?

A

Yes.
For quinidine to be excreted the body need to have a normal level of acidity : Foods that alkalizes the urine (citrus juice, vegetables, antacids, milk products)
Grapefruit juice also interferes with the metabolism of the drug.

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31
Q

Mnemonic to help remember Class 1 Antiarrhythmic sub classes.

A

1a. Double Quarter Pounder - Disopyramide, Quinidine, Procainamide
1b. with Lettuce, Mayo and Tomato.. -
Lidocaine, Mexiletine, Tocainide
1c. and More Fries Please.. -
Moricizine, Flecainide, Propafenone

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32
Q

When would it not be appropriate to administer class 1 Antiarrhythmic medications to a patient?

A

When the patient already have a slow heart rhythm (bradycardia, shock, heart block). Giving these medications to patients with these conditions would exacerbate the problem.
Electrolyte disturbances could interfere with the effectiveness of the medication.

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33
Q

What are the suffixes, drug classes and potential outliers for class 2 Antiarrhythmics?

A

“-olol” - Beta-adrenergic blockers.
Acebutolol
Esmolol
Propranolol

Others:
Digoxin
Adenosine

34
Q

How does Class 2 Antiarrhythmics work on the body?

A

The beta-adrenergic blockers “olol” block the beta-receptors which causes a depression (raises the threshold for depolarization) on phase 4 on the action potential.

The other classes Digoxin (cardiac glycoside. Increases intracellular calcium and enchases contractility while increasing cardiac tone to slow down heart) and Adenosine (inhibits calcium channels, reducing the conduction speed through the AV node) acts on the autonomic nervous system.

35
Q

What are the actions of Class 2 Antiarrhythmics?

A

These medications block beta receptors site in the heart and kidneys this stabilizing excitable cardiac cells and reduce the strain on the heart. This decreases heart rate, cardiac excitability and cardiac output. There is a slow conduction through the AV node.

36
Q

Why would we give Class 2 Antiarrhythmics to patients?

A

To treat rapid atrial fibrillation, atrial flutter, paroxysmal (episodes of rapid heart rate), supraventricular tachycardia (SVT), Premature ventricular contractions (PVCs) and ventricular tachycardia.

Adenosine is specifically used for SVT when other measures are not effective

37
Q

When should we not give class 2 Antiarrhythmics to patients?

A

When the patients are bradycardic, have an AV block, suffering from cardiogenic shock or in respiratory depression (respiratory depression can occur in class 1 and class 2 due to CNS effect).

38
Q

When should we be cautious with giving patients class 2 Antiarrhythmics?

A

When the patient is suffering from diabetes (beta blockers can affect glucose processing), thyroid dysfunction (can be exacerbated), Asthma or COPD (beta-blockers can cause bronchoconstriction), Pregnancy and lactation, Renal or Hepatic dysfunctions.

39
Q

What are some adverse effects that we may see in patients taking class 2 Antiarrhythmics?

A

CNS effect : Dizziness, insomnia, dreams and fatigue
CV : Hypotension, bradycardia, AV block, arrythmias
Respiratory : Bronchospasms and dyspnea
GI : Nausea, vomiting, anorexia
Decreased exercise tolerance.

40
Q

What are some drug-drug interactions that we may see in patients taking class 2 Antiarrhythmics?

A

Verapamil or Diltiazem - increased risk of CV effect.
Antidiabetic medication - Class 2 drugs can mask Hyperglycemia when taken with antidiabetic medications.
Methylxanthines - may make adenosine ineffective by blocking adenosine receptors.

41
Q

What are the 3 drug classes that we need to remember for Class 3 antiarrhythmics?

A

Amiodarone
Dofetilide
Sotalol

42
Q

How does class 3 antiarrhythmics work?

A

They work in phase 3 of the action potential and they block the potassium channels which slows the outward movement of potassium - thus prolonging the action potential.

43
Q

When would we give patients class 3 antiarrhythmic medications?

A

When a patient is experiencing life-threatening ventricular arrythmias (ventricular tachycardia).
Maintenance of sinus rhythm after we have gotten the patient out of atrial fibrillation or atrial flutter (atrial arrythmias)

44
Q

When should we NOT give patients class 3 antiarrhythmic medications?

A

We should be very careful when giving them in non-life-threatening arrythmias, bradyarrhythmia, where the heart beat is less than 60 bpm

However in life or death situations there are no contraindications.

45
Q

When should we be cautious of giving patients class 3 antiarrhythmic medications?

A

We should be cautious in situations where the patient is already experiencing low contractility such as in shock, hypotension, respiratory depression.
Prolonged QT intervals - these drug could further prolong the QT interval.
Amiodarone specifically may increase the risk of thyroid hormone imbalances and may cause pulmonary toxicity.

46
Q

What are some adverse effects of class 3 antiarrhythmic agents?

A

Nausea, vomiting, weakness, dizziness and arrythmias.

47
Q

Are there any drug-drug interactions with class 3 antiarrhythmic agents and if so what are they?

A

Yes, there are numerous but some examples are Digoxin or Quinidine as there may be an toxic effect.
There may also be proarrythmias (frequent occurrence of pre-existing arrythmias) when these drugs are combined with antihistamines, tricyclic antidepressants, and phenothiazines

48
Q

Mnemonic to help remember Class 3 antiarrhythmic agents

A

SAD :(
Sotalol
Amiodarone
Dofelitide

49
Q

What are the drug names, suffix(es) and potential outlier for Class 4 antiarrhythmic agents?

A

Diltiazem
Verapamil

50
Q

How does Class 4 Diltiazem work on the body?

A

they work in Phase 1 & 2
They block the movement of calcium ions across the cell membrane, depressing the generation of action potentials and delaying phases 1 and 2 of repolarizations which slows conduction through the AV node.

51
Q

Why would we give Verapamil to patients?

A

To treat rapid supraventricular dysrhythmias (rapid atrial fibrillations, atrial flutter and paroxysmal supraventricular tachycardias.) They are also used to treat hypertension and angina.

class 4 antiarrhythmics

52
Q

When should we NOT give class 4 antiarrhythmics to a patient?

A

Sick Sinus Syndrome - when heart fluctuates between brady and tachycardia (has to do with issues with the SA node)
Heart block
CHF
Hypotension

class 4 antiarrhythmics

53
Q

When should we be cautious of giving class 4 antiarrhythmics to patients?

A

Idiopathic hypertrophic subaortic stenosis - heart muscle is extra thick. can obstruct blood flow from the left ventricle to the aorta - can become worse with these drugs.
Pregnancy and Lactation
Renal and liver impairment.

class 4 antiarrhythmics

54
Q

What are some adverse effects that we may see with Diltiazem?

A

Dizziness, Weakness, fatigue, depression, GI upset, hypotension, CHF, shock, edema

class 4 antiarrhythmics

55
Q

Are there any drug-drug interactions with Verapamil?

A

Yes, many..
Verapamil mixed with beta-blockers may lead to cardiac depression.
Digoxin may increase AV slowing and increase toxicity.

class 4 antiarrhythmics

56
Q

Mnemonic to remember Class 4 drugs.

A

Very Demure

Verapamil
Diltiazem

57
Q

What nursing assessment should be done prior to prescribing these medications? (all 4 classes)

A

contraindications or cautions
physical assessment :
Assess level of alertness, speech and vision, and reflexes
Assess pulse, blood pressure, heart rate, and rhythm; auscultate heart sounds; anticipate cardiac monitoring; obtain a baseline ECG
Monitor respiratory rate and depth and auscultate lungs
inspect abdomen; auscultate bowel sounds
Evaluate skin for color, lesions, and temperature
Monitor complete blood count, and renal and liver function tests

58
Q

What nursing diagnoses may be made prior to administering these drugs? (all 4 classes)

A

There may be altered cardiac output related to cardiac effects
Altered sensory perception (visual, auditory, kinesthetic, gustatory, tactile) related to CNS effects
Injury risk related to adverse drug effects
Knowledge deficit regarding drug therapy

59
Q

What implementations would we be prepared to make when administering these medications to patients (all 4 classes)

A

smallest amount needed to achieve control of the arrhythmia.
Continually monitor cardiac rhythm when initiating or changing dose.
Ensure that emergency life-support equipment is readily available.
Administer parenteral forms as ordered only if the oral form is not feasible.
Consult with the prescriber to reduce the dose in patients with renal or hepatic dysfunction.
Establish safety precautions, including side rails, lighting, and noise control, if CNS effects occur.
Arrange for periodic monitoring of cardiac rhythm when the patient is receiving long-term therapy.
Provide thorough patient teaching.

60
Q

Class 1 antiarrhythmics works in phase 0 of the action potential by blocking the sodium channels and thus decreasing depolarization. Why is this action useful when treating v-fib, a-flutter and tachycardia?

A

Because in these conditions the sodium channels open too often, and by slowing down the opening of the sodium channels, we can slow down these conditions.

61
Q

What class of drugs may lead to taste changes?

A

Class 1 antiarrhythmics.

62
Q

What are food that alkalinizes the urine?

A

Citrus juice, vegetables, antacids and milk products.

63
Q

Which drug will not be excreted in alkalinized urine?

A

Quinidine (Class 1 antiarrhythmics)

64
Q

Which type of juice should be avoided when taking Quinidine?

A

Grapefruit juice. Alters the metabolism of the drug.

65
Q

Which drug class works in phase 4 of the action potential where they raise the threshold for depolarization?

A

Class 2 Antiarrhythmics / Beta-Adrenergic blockers. Block the beta receptors in phase 4. (‘-olol”)

66
Q

Which class 2 antiarrhythmics act on the autonomic nervous system?

A

Digoxin and Adenosine

67
Q

Which drug reduces the potassium in the cells which makes it less likely to fire action potentials?

A

Adenosine

68
Q

What does class 1 antiarrhythmics do to the rhythm of the heart?

A

They stabilize excitable cardiac cells and reduce the strain on the heart which is helpful if you have hypoxic cardiac tissue (low oxygen level)

69
Q

Which drug slows the action potential between the SA and AV node?

A

Digoxin. Therefore useful in atrial issues.

70
Q

Which drug may make the patient go into asystole for a brief time before regular rhythm returns?

A

Adenosine. It is especially useful for SVT (Supraventricular tachycardia (SVT) is a condition where the heart’s electrical system malfunctions, causing the heart to beat abnormally fast and irregularly)

71
Q

Which two drug classes may cause reparatory depression due to the central nervous system effect?

A

Class 1 & 2

72
Q

What drug class may cause bronchoconstriction?

A

Beta blockers. This is why they shouldn’t be used with asthma and COPD.

73
Q

Which drug class might mask the signs of hyperglycemia when taken with diabetes medication?

A

Class 2

74
Q

Methylxanthines might make which drug ineffective?

A

Adenosine

75
Q

When do we give patients Amiodarone (class 3)?

A

To maintain a normal sinus rhythm AFTER we have gotten a patient out of a-fib or a-flutter or to stop V-tach.

76
Q

Which drug may increase the risk of thyroid hormone imbalances and cause pulmonary toxicity?

A

Amiodarone

77
Q

Which drugs combined with Amiodarone may cause toxic effect?

A

Digoxin or Quinidine

78
Q

Which drug class slows conduction through the AV node?

A

Class 4 drugs - Diltiazem and verapamil

79
Q

Which drug is contraindicated if the patient have sick sinus syndrome?

A

Class 4 drugs - Diltiazem and verapamil

80
Q

What happens with sick sinus syndrome?

A

Related to issues with the SA node and is characterized by episodes of tachycardia followed by episodes of bradycardia.

Pharmacology Exam 2 (20 decks)

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