Antiarrhythmic medications Flashcards
Class IA Action
Moderate depression of depolarization
Prolongs repolarization
Treats and prevents atrial and ventricular dysrhythmias
Class IA drug names
quindine (Quinaglute, Quindix, Cardioquin)
procainamide (Pronestyl, Procan SR)
disopyramide (Norpace)
Class IA Side Effects
Dec. cardiac contractility Prolonged QRS, QT Proarrhythmic Hypotension with IV admin Diarrhea with quindine, constipation with dysopyramide Cinochonism with quindine Lupuslike syndrome with procainamide Anticholinergic effects: dry mouth, urinary hesitancy with disopyramide
Class IA Nursing Intervenion
Observe for HF
Monitor BP with IV admin
Monitor QRS duration for inc. >50% from baseline
Monitor fr prolonged QT
Monitor N-acetyl procainamide (NAPA) lab values during procainamide therapy
If admin for AFIB, ensure pt has been pretreated with medications to control AV conduction
Class IB Action
Minimal depression of depolarization
Shortened repolarization
Treat ventricular dysrhythmias
Class IB Drugs
lidocaine (Xylocaine)
mexiletine (Mexitril)
tacanide (Tonocard)
Class IB Side Effects
CNS changes ( confusion, lethargy)
Bradycardia
Gi distress
Tremors
Class IB Nursing interventions
Monitor for CNS changes and tremors
Discuss with primary provider dec. lidocaine dose in older adult pt and pt with cardiac/liver dysfuction
Class IC Action
Marked depression of depolarization
Little effect on repolarization
Treat atrial and vetricular dysrhythmias
Class IC Drugs
Flecainide (tambocor)
propafenone (Rhythmol)
Class IC Side Effects
Proarrhythmic
HF
Dizzness, visual disturbances, dyspenea
Class IC Nursing intervenions
Dec. dose with renal dysfuntion and strict vgeterian diets
Avoid use in pt with structural heart disease (CAD, HF)
Class II Action
Dec. automaticity and conduction
Treat atrial and ventriclar dysrhythmias
Class II Drugs
acebutolol (Sectral) atenlol (Tenormin) bisoprolol/HCTZ(Hydroclorothiazide) (Ziac, Zebeta) esmolol (Brevibloc) labetalol (Trandate) Metropolol (lopressor, Toprol-XL) nadolol (Corgard) nevibolol (Bystolic) propranolol (Inderal) sotalol (Betapace; Sorine; also Class III actions)
-lol beta-blockers
Class II Side Effects
Bradycardia, AV Block Dec contractility Brinchospasm Nausea Asymptomatic and symptomatic hypotension Masks hypoglycemia and thyrotoxicosis CNS disturbances (confusion, dizziness, fatigue, depression)
Class II Nursing interventions
Monitor HR, PR interval, S/S of HF, especially in those taking CCBs)
Monitor blood glucose level in pt with type 2 diabetes
Caution the pt about abrupt withdrawal to avoid tachycardia, hypertension, and myocardial ischemia
Class III Actions
Prolongs repolarization
Amiodarone treats and prevents ventricular and atrial dysrhythmias, especially in pt with ventriuclar dysfunction
Dofetilide and abutilide treat and prevents atrial dysrhythmias.
Class III Drugs
amidarone (Cordarone)
dofetilide (Tikosyn)
ibutilide (Convert)
Class III Side Effects
Pulmonary toxicity (amiodarone) Corneal microdeposits (amiodarone) Photosensitivity ( Amiodarone) Bradycardia Hypotension, especially with IV admin Polymorphic ventricular dysrhythmia (rare with amidarone) N/V Potentiates digoxin (amiodarone) Sotalol?
Class III Nursing interventions
Make sure pt is sent for baseline pulmonary funtion tests (amiodarone)
Closely monitor pt
Assess for contraindications prior to admin
Monitor QT duration
Continuous ECG monitoring with initiation of dofetilide and ibutilide
Monitor renal function
Class IV Actions
Blocks calcium channel
Treats and prevents paroxysmal atrial dysrhythmias
Class IV Drugs
verapamil (Calan, Isoptin)
dilitiazem (Cardizem, Dilacor, Tiazac, Diltia, Cartia)
Class IV Side Effects
Bradycardia, AV blocks
Hypotension with IV admin
HF, peripheral edema
Constipation, dizziness, headache, nausea
Class IV Nursing interventions
Monitor for signs and symptoms of HF
Monitor for HR, PR interval
Monitor for BP, closely with IV admin.
Do not crush sustained-release meds
