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Pharmacology Exam #2 > Antiarrhythmic Agents > Flashcards

Antiarrhythmic Agents Flashcards

1
Q

What are the 5 phases of the Action Potential of the Cardiac Muscle Cell?

A

Phase 0: Sodium ions move INTO cells (depolarization)
Phase 1: Potassium ions move OUT of cells
Phase 2: Calcium ions move INTO cells (plateau stage)
Phase 3: MORE Potassium ions move OUT of cells (repolarization)
Phase 4: Back at rest and ready to start again

Summit Sodium (DEpolarization)
Plummet Potassium (REpolarization)

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2
Q

What are some causes of Cardiac Arrhythmias?

A
  • Electrolyte imbalances that alter the action potential
  • Decrease in oxygen delivered to the cells
  • Structural damage that changes the conduction pathway through the heart
  • Acidosis or accumulation of waste products that alter the action potential
  • Drugs that alter the action potential or cardiac conduction
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3
Q

How do the classifications of Antiarrhythmics work?

A

Class I: Block sodium channels
Class II: Act on autonomic receptors
Class III: Block potassium channels
Class IV: Block calcium channels

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4
Q

Lifespan considerations of Antiarrhythmics
In Children

A
  • More likely to experience Adverse effects
  • Digoxin IS approved in children
  • Doses are calculated by age and weight
  • Ablation procedures can be successful as alternative to drug therapy
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5
Q

Lifespan considerations of Antiarrhythmics
In Adults

A
  • Used frequently during emergencies
  • Monitor frequently
  • Avoid use in pregnancy and lactation (alternative feeding method needed)
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6
Q

Lifespan considerations of Antiarrhythmics
In Older Adults

A
  • Frequently prescribed
  • More likely to experience adverse effects
  • Start low
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7
Q

Class I Antiarrhythmics
Sub-Classes and Drug Names

A
  • Ia: Procainamide, quinidine
  • Ib: Lidocaine
  • Ic: Flecainide, propafenone
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8
Q

Class I Antiarrhythmics
Mechanism of Action

A
  • Block the sodium channels in the cell membrane during Phase 0 of the action potential
  • Decreases depolarization
  • Decreases automaticity of ventricular cells
  • Increases ventricular fibrillation threshold
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9
Q

Class I Antiarrhythmics
Indications

A
  • Tachycardia
  • Life-threatening ventricular arrythmias
  • Symptomatic paroxysmal atrial arrhythmias
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10
Q

Class I Antiarrhythmics
Contraindications

A

Absolute:
* Allergy
* Bradycardia, heart block
* CHF
* Hypotension, shock
* Electrolyte disturbances

Cautions:
* Renal or hepatic dysfunction
* Pregnancy or lactation

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11
Q

Class I Antiarrhythmics
Adverse Effects

A

Due to delayed action potential of all cells
* CNS: dizziness, fatigue, slurred speech
* GI: Nausea and vomiting
* CV: Arrhythmias, heart block, hypotension, vasodilation, cardiac arrest
* Respiratory depression
* Misc.: rash, loss of hair, potential bone marrow suppression

Procainamide: fever, hepatomegaly, neutropenia, painful joints, liver failure, pericarditis, hemolytic anemia

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12
Q

Class I Antiarrhythmics
Drug Interactions

A

Numerous
ie. Cemetidine, Digoxin, warfarin

Food:
Quinidine: foods that alkanalize the urine (citrus juice, vegetables, antacids, milik products); grapefruit juice

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13
Q

Class II Antiarrhythmics
Mechanism of Action

A
  • “-olol”s: Beta-adrenergic blockers block beta receptors, causing a depression of Phase 4 of the action potential (rest phase)
  • Digoxin and Adenosine act on the autonomic nervous system
  • Competitively block beta receptors in the heart and kidneys
  • Decrease HR, cardiac excitability, and cardiac output
  • Slow conduction through the AV node
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14
Q

Class II Antiarrhythmics
Indications

A
  • Rapid atrial fibrillation
  • Atrial flutter
  • Paroxysmal SVT
  • PVCs
  • Ventricular tachycardia

Adenosine is used for SVT when other measures are not effective - it is quick acting and short lasting

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15
Q

Class II Antiarrhythmics
Drug Names

A

Acebutolol
Esmolol
Propranolol

Digoxin
Adenosine

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16
Q

Class II Antiarrhythmics
Contraindications

A

Absolute:
* Allergy
* Sinus bradycardia
* AV block
* Cardiogenic shock
* Respiratory Depression

Caution:
* Diabetes
* Thyroid dysfunction
* Asthma or COPD
* Pregnancy and lactation
* Renal and hepatic dysfunction

17
Q

Class II Antiarrhythmics
Adverse Effects

A
  • CNS: Dizziness, insomnia, dreams, fatigue
  • CV: hypotension, bradycardia, AV block, arrhythmias
  • Respiratory: Bronchospasm, dyspnea
  • GI: Nausea, vomiting, anorexia
18
Q

Class II Antiarrhythmics
Drug Interactions

A
  • Verapamil or diltiazem (increased risk of CV effects)
  • Antidiabetic medications
  • Methylxanthines
19
Q

Class III Antiarrhythmics
Mechanism of Action

A
  • Block potassium channels and slow outward movement of potassium during Phase 3 of the action potential (prolonging it)
20
Q

Class III Antiarrhythmics
Indications

A
  • Life-threatening ventricular arrhythmias
  • Maintenance of sinus rhythm after conversion of atrial arrhythmias
21
Q

Class III Antiarrhythmics
Contraindications

A

Absolute:
* When used for life threatening arrhythmias - there is NO contraindication
* When used for NON-life threatening arrhythmias: bradyarrhythmias

Cautions:
* Shock, hypotension
* Respiratory depression
* Prolonged QT interval
* Renal or hepatic disease
* Amiodarone: thyroid or pulmonary disease

22
Q

Class III Antiarrhythmics
Drug Names

A

Sotalol
Amiodarone
Dofetilide
(SAD)

23
Q

Class III Antiarrhythmics
Adverse Effects

A
  • GI: Nausea and vomiting
  • CNS: dizziness, weakness
  • CV: hypotension, arrhythmia
24
Q

Class III Antiarrhythmics
Drug Interactions

A

Numerous
ie.
Digoxin, quinodine, antihistamines, TCAs, phenothiazines

25
Q

Class IV Antiarrhythmics
Mechanism of Action

A
  • Block the movement of calcium ions across the cell membrane, depressing the generation of action potentials and delaying phases 1 and 2 of repolarization
  • Slows conduction through the AV node
26
Q

Class IV Antiarrhythmics
Drug Names

A

Diltiazem
Verapamil

(Calcium Channel Blockers)

27
Q

Class IV Antiarrhythmics
Indications

A
  • Rapid supraventricular dysrhythmias (rapid afib, atrial flutter, paroxysmal supraventricular tachycardia)
28
Q

Class IV Antiarrhythmics
Contraindications

A

Absolute:
* Allergy
* Sick Sinus Syndrome
* Heart Block
* CHF
* Hypotension

Caution:
* Idiopathic hypertrophic subaortic stenosis (extra thick heart muscle)
* Pregnancy and lactation
* Renal and hepatic impairment

29
Q

Class IV Antiarrhythmics
Adverse Effects

A
  • CNS: dizziness, weakness, fatigue, depression
  • GI: upset
  • CV: hypotension, CHF, shock, edema
30
Q

Class IV Antiarrhythmics
Drug Interactions

A

Numerous
ie.
Beta Blockers
Digoxin

31
Q

Antiarrhythmic Therapy
Assessment

A
  • Assess for contraindications and cautions
  • CNS: level of alertness, speech and vision, reflexes
  • CV: pulse, BP, HR, rhythm, heart sounds, cardiac monitoring, baseline ECG
  • Respiratory: rate and depth, lung sounds
  • Abdomen: bowel sounds
  • Skin: color, lesions, temperature

Labs:
* CBC
* Renal and liver function tests

32
Q

Antiarrhythmic Therapy
Nursing Diagnoses/Conclusions

A
  • Altered cardiac output (r/t cardiac effects)
  • Altered sensory perception (r/t CNS effects)
  • Injury risk (r/t adverse effects)
  • Knowledge deficit
33
Q

Antiarrhythmic Therapy
Implementation/Patient Teaching

A
  • Titrate the dose to the smallest amount needed to achieve control of the arrhythmia
  • Continually monitor cardiac rhythm when starting or changing dose
  • Ensure that emergency life support equipment is readily available
  • Administer parenteral forms only if oral form is not feasible
  • Reduce dose in pts. with renal or hepatic dysfunction
  • Safety precautions: side rails, lighting, noise control
  • Periodic monitoring for long term therapy

Pharmacology Exam #2 (14 decks)

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