Antiarrhythmics Flashcards by Kevin Park

What drug is classified as Cardiac Glycosides?

Digoxin.

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What is the MOA of Digoxin?

Inhibits Na-K ATPase, promotes increased force of cardiac contractions, cardiac output, and tissue perfusion, decreases ventricular rate

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What is Digoxin used for?

Heart Failure, and A-Fib.

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What are the contraindications of Digoxin?

Hypersensitivity, and V-FIB

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What are the side effects of Digoxin?

Dizziness, mental disturbances, diarrhea, headache, nausea, vomiting, weakness, confusion

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What are the administration instructions of Digoxin?

Administer slowly by direct IV injection over minimum of 5 mins, tablet and oral solution

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What should a nurse teach to a patient taking Digoxin?

In Heart Failure, higher dosages give no additional benefit and can increase toxicity.

Decreased renal clearance may lead to increased toxicity.

In geriatric patients, use lean body weight to calculate dose.

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What is another name for digoxin?

Digitalis

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What are the actions/intended effects of Digoxin?

Positive inotropic: Increases myocardial contraction stroke volume.

Negative chronotropic: Decreases heart rate

Negative dromotropic: decreases conduction of heart cells.

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What is the half life of Digoxin?

30-40 hours

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What are some common signs of Digitalis?

Anorexia, diarrhea, n/v, bradycardia, PVCs, heart block, HA, malaise, confusion, delirium, visual illusions.

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What does DIG stand for?

D= Digoxin levels greater than 2ng/mL is toxic

I = increases myocardial contractility

G = GI or CNS signs indicate adverse effects

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What is the antidote of Digoxin?

Digoxin-Immune fab; Binds with digoxin and gets excreted in urine

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What drug interactions would place a patient with digoxin for risk of toxicity?

Diuretics: Furosemide and hydrochlorothiazide can cause potassium loss which increases effect of digoxin at myocardial cell sites.

Cortisone: Promotes sodium retention and potassium excretion

Antacids: decreases absorption if taken together.

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What should a nurse assess for before giving Digoxin?

Signs of toxicity, if HR < 60 hold and call provider, , obtain apical pulse, drug/herbal history, evaluate for risk for hypokalemia, edema/HF signs

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What should the nurse teach to a patient on Digoxin?

Check pulse daily before taking digoxin, eat foods high in potassium

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What lab values should a nurse monitor for a patient on digoxin?

Serum digoxin and potassium levels

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If a patient on digoxin has a HR < 60, what should the nurse do?

Hold the drug and call the provider

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What drug is classified as a Phosphodiesterase inhibitor>

Milrinone Lactate

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What are the actions of Milrinone Lactate?

Inhibits PDE, increases myocardial contraction stroke volume and vasodilation, and cardiac output

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What are some cautions that a nurse should know about Milrinone Lactate?

given IV no greater than 48 -72 hours otherwise severe cardiac dysrhythmia can result. EKG would be required for that situation.

Patient on IV should be on cardiac status monitoring

What are some of the other agents used to treat heart failure?

Vasodilators- decrease venous blood flow to heart, decrease preload and oxygen demand of heart

Angiotensin-converting enzyme (ACE) inhibitors- dilate venules and arterioles, improves renal blood flow and decrease blood fluid volume

Angiotensin II receptor antagonists (ARBs)- those intolerant to ace inhibitors

Diuretics- decrease fluid volume

Some beta blockers- improve cardiac performance

Nesiritide- inhibits ADH, promotes vasodilation and naturesis

BiDil- combo hydralazine (for BP) and isosorbide dinitrate (dilator)

What are the three types of Angina?

Classic (stable) angina occurs with predictable stress of exertion.

Unstable (preinfarction) angina occurs frequently with progressive severity unrelated to activity; unpredictable regarding stress/exertion and intensity

Variant (Prinzmetal, vasospastic) angina occurs during rest

What is the 6 S’s for Stable Angina?

Sudden Onset 
Substernal
Spreads to arm 
Squeezing in character 
Short Duration 
Sublingual nitro relieves pain

What are the 4 R's of Unstable Angina?

Recent onset Resistant (progressive) Rest Angina Recurrent (in early post infarction period)

What drug is classified as antianginal?

Nitroglycerin

What is the MOA of Nitroglycerin?

Acts directly on smooth muscle of blood vessels to cause relaxation and dilation; Increases oxygen supply

What is nitroglycerin used for?

Control angina, hypertensive emergency, pulmonary edema and heart failure

What are the side effects of Nitroglycerin?

Headache, N/V, hypotension, dizziness, weakness, syncope, edema

What are the ASE of nitroglycerin?

Orthostatic hypotension, tachycardia, paradoxical bradycardia, circulatory collapse

What should a nurse teach to a patient with nitroglycerin?

Doses should be tapered when discontinuing to prevent rebound myocardial ischemia, caring for tablets.

What are the contraindications of nitroglycerin?

Increased intracranial pressure, anemia, cardiomyopathy, shock

What are the administration instructions of Oral, IV, and topical Nitroglycerin?

IV should be titrated. Ointment should be removed at night to allow for 12 hour nitrate free period. For topical, avoid contact with fingers and do not apply on chest in areas of defib paddle placement.

What should a nurse be monitoring for a patient with nitroglycerin?

Acute MI, hypotension, hypovolemia, head trauma, pregnancy, breastfeeding's

What are the actions of Beta blockers?

Blocks Beta 1 and Beta 2 receptor sites. Decreases SNS effects by blocking epinephrine and norepinephrine. It essentially causes decreased HR, decreased force of contraction and decreased rate of AV conduction

What is beta blockers used for?

Best for chronic stable angina, post-op bypass surgery, HF

What are the main effects of Beta blockers?

Bronchoconstriction, Decrease HR and BP

If a patient has HR < 60, what should be done with their Beta blockers?

Hold beta blocker if HR < 60

What are the side effects of Beta Blockers?

Lethargy, GI disturbance, CHF, Decreased BP, Depression

What do calcium channel blockers do?

Relaxes arteries, decreases cardiac workload and oxygen demand, decreases cardiac contractility, decrease SVR

What are the side effects of Calcium Channel Blockers?

Dizziness, hypotension, Peripheral Edema, Bradycardia, Abdominal discomfort, decreased BO

What does VND mean for Calcium channel blockers?

VERY NICE DRUGS. V = verapamil N = nifedipine D = diltiazem

For treatment of Classic and variant angina pectoris, Nitrates, calcium channel blockers and Coronary artery bypass graft surgeries are all interventions that can be done. What is one type of drug that is specific for Classic angina pectoris treatment?

Beta blockers are specific for stable angina. Not for variant.

What should be assessed for prior to giving antianginal drugs?

Vital signs, health, drug histories especially for drugs that can cause hypokalemia

What are some nursing interventions associated with antianginal drugs?

Monitor vs, slow positional changes, report any unrelieved angina.

What are the four classes of antidysrhythmic drugs?

Class 1, Class II, Class III, Class IV

What drug is classified as Class I and what is their MOA?

Sodium channel blockers Decreases sodium influx into cardiac cells. Decreases conduction velocity Suppression of ectopic foci Increased recovery time

What drug is classified as Class II and what is their MOA?

Beta Blockers Decreases conduction velocity, automaticity, and recovery time.

What drug is classified as Class III and what is their MOA?

Amiodarone (aka K+/Potassium blocker) Prolongs repolarization Emergency treatment of ventricular dysrhythmias when other antidysrhythmics are ineffective Increases refractory eriod and prolongs action potential duration

What drug is classified as Class IV and what is their MOA?

Calcium Channel Blockers Decreases excitability and contractility of the myocardium Increases refractory period of AV node which decreases ventricular response.

What are the Cardiac Action Potential Phases?

Phase 0 = Rapid depolarization caused by influx of sodium ions. Phase 1 = Initial Repolarization. Phase 2 plateau = Influx of calcium ions prolonging action potential and promotes atrial and ventricular contractions. Phase 3 = Rapid repolarization caused by influx of potassium ions. Phase 4 = Resting Membrane potential between heartbeats.

What should be monitored for patients on antidysrhythmics?

Health, drug histories, VS, ECG, cardiac enzymes, EKG