Antiarrhythmics

Question 1

Amiodarone

Answer 1

Used with nothing too crazy (arrhythmias)

Question 2

Adenosine*

Answer 2

Therapeutic class: Antiarrhythmic

Indication: SVT

Action: Slows conduction through the AV node, interrupts re-entry pathways
through AV node, restoring normal sinus rhythm

Nursing Considerations:
● There will be a period of asystole after administration
● Warn the client - it will feel like someone kicked them in the chest!
● Warn the family - they will flatline on the monitor!
● Rapid push - or it will not work - pick IV closest to pt heart
● Use with extreme caution in asthmatics = bronchospasm

Question 3

Atropine*

Answer 3

Therapeutic class: Antiarrhythmic; anticholinergic

Indication: excessive secretions, sinus bradycardia, heart block

Action: Inhibition of acetylcholine, increasing the HR, causing bronchodilation,
and decreasing secretions

Nursing Considerations:
● Monitor for urinary retention and constipation
● Avoid in clients with glaucoma - anticholinergic = dry up eyes

Question 4

Cardiac Glycoside = Digoxin

Answer 4

Therapeutic class: Cardiac glycoside

Indication: Heart failure, a-fib, a-flutter, CHF, cardiogenic shock

Action: Increases contractility (how strong the heart pumps), and decreases the rate (how fast the heart beats). Acts on the cellular sodium-potassium ATPase, making the heart more efficient!

Monitor for toxicity in any client taking digoxin! Monitor for these s/s + report them to HCP early!

● Early signs/symptoms:
  ○ Nausea & vomiting
  ○ Anorexia
  ○ *Vision changes - yellow/green halos*
● Late signs/symptoms
  ○ Bradycardia → arrhythmias

RF for toxicity
● Patients with hypokalemia (K<3.5)
○ If your client is on a loop diuretic + digoxin = more likely to become toxic!
○ Licorice extract (black licorice) acts like aldosterone (Na/water retention & K loss) → hypokalemia → Dig Toxicity
● Patients with hypomagnesemia (Mg<1.8)
● Patients with hypercalcemia (Ca>10.5)
● The elderly!
○ These clients have decreased renal + liver function = harder for them to clear any drugs, so digoxin levels can build up and become toxic more quickly!

Pulse <60 hold digoxin
Antidote: digoxin immune fab