Antiarrhythmic Agents - General Flashcards
Phase 0
- Sodium ions move into cells
- Depolarization
Phase 1
- Potassium ions move out of the cells
- Plummet
Phase 2
- Calcium ions move into the cells
- Contraction
Phase 3
- Potassium ions move out of the cells
- Repolarization
Phase 4
-Back at rest and ready to start over again
Causes of cardiac arrhythmias
- Electrolyte disturbances that alter the action potential
- Decreases in oxygen delivered to the cells
- Structural damage changing the construction pathway through the heart
- Acidosis or accumulation of waste products altering the action potential
- Drugs that alter the action potential
Types of cardiac arrhythmias
- Tachycardia
- Bradycardia
- Premature atrial contractions (PACs) and premature ventricular contractions (PVCs)
- Atrial flutter
- Atrial fibrillation or ventricular fibrillation
- Alterations in conductions through the muscle
Considerations for children
- Monitor closely- more likely to experience ADE
- Digoxin is approved in children
- Dosages should be based on age and weight
Considerations for adults
- Used frequently during emergencies
- Monitor frequently
- Avoid use in pregnancy and lactation
Considerations in older adults
- Frequently prescribed
- More likely to experience ADE
- Start at a lower dose
Other drugs used to treat arrhythmias
- Adenosine
- Digoxin
- Dronedarone
Adenosine
-Used to convert supraventricular tachycardia to sinus rhythm when vagal maneuvers have been ineffective
Digoxin
-Slows calcium from leaving the cell, prolonging the action potential and slowing conduction and HR
Dronedarone
-Used to reduce risk of hospitalization in patients with paroxysmal or persistent AF or flutter who have risk factors for CVD and are in sinus rhythm or scheduled to be converted to sinus rhythm
Assessment
- History: check for any contraindications or cautions
- Physical: neurological and cardiac status, respirations, baseline ECG, and appropriate lab values
Nursing diagnoses
- Decreased CO r/t cardiac effects
- Disturbed sensory perception r/t CNS effects
- Risk for injury r/t adverse drug effects
- Deficient knowledge regarding drug therapy
Implementation
- Titrate the dose to the smallest amount needed to achieve control of the arrhythmia
- Continually monitor cardiac rhythm
- Ensure emergency life-support equipment is readily available
- Consult with provider to reduce dose in patients with renal or hepatic dysfunction
- Establish safety precautions
- Provide pt teaching
Evaluation
- Evaluation patient response to the drug (alleviation of signs and symptoms of heart failure)
- Monitor for adverse effects
- Evaluate the compliance with the regimen
- Evaluate the effectiveness of the teaching plan
