Antidysrhythmic Drugs Flashcards
Adenosine
Functional Classification
Antidysrhythmic
Adenosine
Mechanism of Action
Slows conduction through AV node, can interrupt reentry pathways through AV node, and can restore normal sinus rhythm in patients with paroxysmal supraventricular tachycardia (PSVT)
Adenosine
Uses
PSVT, as a diagnostic aid to assess myocardial perfusion defects in CAD, Wolff-Parkinson-White (WPW) syndrome
Adenosine
Contraindications
Hypersensitivity, 2nd- or 3rd-degree AV block, sick sinus syndrome, atrial flutter, atrial fibrillation, ventricular tachycardia, bronchospastic lung disease, symptomatic bradycardia, bundle branch block, heart transplant, unstable angina
Adenosine
Side Effects
CNS: lightheadedness, dizziness, arm tingling, numbness, apprehension, blurred vision, headache
CV: chest pain, pressure, ATRIAL TACHYDYSRHYTHMIAS, sweating, palpitations, hypotension, Facial Flushing, AV BLOCK, CARDIAC ARREST, VENTRICULAR DYSRHYTHMIAS
GI: Nausea, metallic taste, throat tightness, groin pressure
RESP: Dyspnea, Chest Pressure, hyperventilation, BRONCHOSPASM (ASTHMATICS)
Adenosine
Nursing Considerations
ASSESS:
- I&O ratio, electrolytes (K, Na, Cl)
- CARDIOPULMONARY STATUS: BP, PULSE, RESPIRATION, RHYTHM, ECG INTERVALS (PR, QRS, QT); CHECK FOR TRANSIENT DYSRHYTHMIAS (PVCs, PACs, SINUS TACHYCARDIA, AV BLOCK)
- RESPIRATORY STATUS: RATE, RHYTHM, LUNG FIELDS FOR CRACKLES WATCH FOR RESPIRATORY DEPRESSION; BILATERAL CRACKLES MAY OCCUR IN CHF PATIENT; INCREASED RESPIRATION, INCREASED PULSE, PRODUCT SHOULD BE DISCONTINUED
- CNS effects: dizziness, confusion, psychosis, paresthesias, seizures; product should be discontinued
Adenosine
Overdose Treatment
Defibrillation, vasopressor for hypotension, theophylline
Amiodarone
Functional Classification
Antidysrhythmic (class III)
Amiodarone
Chemical Classification
Iodinated benzofuran derivative
Amiodarone
Mechanism of Action
Prolongs duration of action potential and effective refractory period, noncompetitive alpha- and beta-adrenergic inhibition; increases PR and QT intervals, decreases sinus rate, decreases peripheral vascular resistance
Amiodarone
Uses
Hemodynamically unstable ventricular tachycardia, supraventricular tachycardia, ventricular fibrillation not controlled by 1st-line agents
Amiodarone
Contraindications
Pregnancy (D), breastfeeding, neonates, infants, severe sinus node dysfunction, hypersensitivity, cardiogenic shock, 2nd-3rd degree AV block, bradycardia
Amiodarone
Side Effects
CNS: Headache, Dizziness, involuntary movement, Tremors, Peripheral Neuropathy, malaise, Fatigue, ataxia, Paresthesias, insomnia
CV: Hypotension, Bradycardia, SINUS ARREST, CHF, DYSRHYTHMIAS, SA NODE DYSFUNCTION, AV BLOCK, increased defibrillation energy requirement
EENT: blurred vision, halos, photophobia, CORNEAL MICRODEPOSITS, dry eyes
ENDO: HYPO/hyperthyroidism
GI: Nausea, Vomiting, diarrhea, abdominal pain, Anorexia, Constipation, HEPATOTOXICITY
GU: epididymitis, ED
INTEG: rash, photosensitivity, blue-gray skin discoloration, alopecia, spontaneous ecchymosis, TOXIC EPIDERMAL NECROLYSIS, urticaria, PANCREATITIS, phlebitis (IV)
MISC: flushing, abnormal taste or smell, edema, abnormal salivation, coagulation abnormalities
MS: weakness, pain in extremities
RESP: PULMONARY FIBROSIS/TOXICITY, pulmonary inflammation, ARDS; GASPING SYNDROME IF USED WITH NEONATES
Amiodarone
Nursing Considerations
ASSESS:
- PULMONARY TOXICITY: dyspnea, fatigue, cough, fever, chest pain; product should be discontinued; for ARDS, pulmonary fibrosis, crackles, tachypnea
- ECG continuously to determine product effectiveness; measure PR, QRS, QT intervals; check for PVCs, other dysrhythmias, BP continuously for hypo.hypertension; report dysrhythmias, slowing heart rate; monitor amiodarone level: therapeutic 1-2.5mcg/ml; toxic >2.5mcg/ml
- I&O ratio; electrolytes (sodium, potassium, chloride); hepatic studies: AST, ALT, bilirubin, alk phos; for dehydration, hypovolemia
- Chest x-ray, thyroid function tests
- CNS symptoms: confusion, psychosis, numbness, depression, involuntary movements; product should be discontinued
- HYPOTHYROIDISM: lethargy; dizziness; constipation; enlarged thyroid gland; edema of extremities; cool, pale skin
- HYPERTHYROIDISM: restlessness, tachycardia; eyelid puffiness; weight loss; frequent urination; menstrual irregularities; dyspnea; warm moist skin
- Ophthalmic exams at baseline and periodically (PO)
- Cardiac rate, respirations: rate, rhythm, character, chest pain; start with patient hospitalized and monitored up to 1 wk; for rebound hypertension after 1-2hr
Amiodarone
Overdose Treatment
O2, artificial ventilation, ECG, administer DOPamine for circulatory depression, administer diazepam, thiopental for seizures, isoproterenol
Atenolol
Functional Classification
Antihypertensive, Antianginal
Atenolol
Chemical Classification
Beta-Blocker, Beta1-, Beta2-blocker (High doses)
Atenolol
Mechanism of Action
Competitively blocks stimulation of Beta-adrenergic receptor within vascular smooth muscle’ produces negative chronotropic activity (decreases rate of SA node discharge, increases recovery time), slows conduction of AV node, decreases heart rate, negative inotropic activity decreases O2 consumption in myocardium; decreases action of renin-aldosterone-angiotensin system at high doses, inhibits beta2-receptors in bronchial system at higher doses
Atenolol
Uses
Mild to moderate hypertension, prophylaxis of angina pectoris; suspected or known MI (IV use); mi prophylaxis
Atenolol
Contraindications
Pregnancy (D), hypersensitivity to Beta-blockers, cardiogenic shock, 2nd- or 3rd-degree heart block, sinus bradycardia, cardiac failure, Raynaud’s disease, pulmonary edema
Atenolol
Side Effects
CNS: Insomnia, Fatigue, Dizziness, Mental Changes, memory loss, hallucinations, depression, lethargy, drowsiness, strange dreams, catatonia
CV: PROFOUND HYPOTENSION, BRADYCARDIA, CHF, Cold Extremities, Postural Hypotension, 2nd- or 3rd-Degree Heart Block
EENT: sore throat; dry, burning eyes; blurred vision; stuffy nose
ENDO: increased hypoglycemic response to insulin
GI: Nausea, Diarrhea, vomiting, MESENTERIC ARTERIAL THROMBOSIS, ISCHEMIC COLITIS
GU: impotence, decreased libido
HEMA: AGRANULOCYTOSIS, THROMBOCYTOPENIA PURPURA
INTEG: rash, fever, alopecia
RESP: BRONCHOSPASM, dyspnea, wheezing, pulmonary edema
Atenolol
Nursing Considerations
ASSESS:
- I&O, weight daily; watch for CHF (rales/crackles, jugular vein distention, weight gain, edema)
- Hypertension: BP, pulse q4hr; note rate, rhythm, quality; apical/radial pulse before administration; notify prescriber of any significant changes (<50 bpm); ECG
- Baselines in renal/hepatic studies before therapy begins
Atenolol
Overdose Treatment
Lavage, IV atropine for bradycardia, IV theophylline for bronchospasm, dextrose for hypoglycemia, digoxin, O2, diuretic for cardiac failure, hemodialysis
Diltiazem (Cardizem)
Functional Classification
Calcium Channel Blocker, Antiarrythmic class IV, antiarrhythmic class IV, antihypertensive
Diltiazem (Cardizem)
Chemical Classification
Benzothiazepine
Diltiazem (Cardizem)
Mechanism of Action
Inhibits calcium ion influx across cell membrane during cardiac depolarization; produces relaxation of coronary vascular smooth muscle, dilates coronary arteries, slows SA/AV node conduction times, dilates peripheral arteries
Diltiazem (Cardizem)
Uses
PO: Angina pectoris due to coronary artery spasm, hypertension
IV: Atrial fibrillation, flutter, paroxysmal supraventricular tachycardia
Diltiazem (Cardizem)
Contraindications
sick sinus syndrome, AV heart block, hypotension <90mmHg systolic, acute MI, pulmonary congestion, cardiogenic shock
Diltiazem (Cardizem)
Side Effects
CNS: Headache, Fatigue, Drowsiness, dizziness, depression, weakness, insomnia, tremor, paresthesia
CV: DYSRHYTHMIA, Edema, CHF, bradycardia, hypotension, palpitations, HEART BLOCK
GI: Nausea, vomiting, diarrhea, gastric upset, Constipation, increased LFTs
GU: nocturia, polyuria, ACUTE RENAL FAILURE
INTEG: Rash, flushing, photosensitivity, burning, pruritus at inj site
RESP: rhinitis, dyspnea, pharyngitis
Diltiazem (Cardizem)
Nursing Considerations
ASSESS:
- CHF: dyspnea, weight gain, edema, jugular venous distention, rales; monitor I&O ratios daily, weight
- ANGINA: location, duration, alleviating factors, activity when pain starts
- DYSRHYTHMIAS: cardiac status: BP, pulse, respiration, ECG and intervals PR, QRS, QT; if systolic BP <50 bpm, hold dose, notify prescriber
Diltiazem (Cardizem)
Overdose Treatment
Atropine for AV block, vasopressor for hypotension
Dofetilide
Functional Classification
Antidysrhythmic (Class III)
Dofetilide
Mechanism of Action
Blocks cardiac ion channel carrying the rapid component of delayed potassium current; no effect on sodium channels
Dofetilide
Uses
Atrial fibrillation, flutter, maintenance of normal sinus rhythm
Dofetilide
Contraindications
Children, hypersensitivity, digoxin toxicity, aortic stenosis, pulmonary hypertension, severe renal disease
QT prolongation, torsades de pointes, renal failure
Dofetilide
Side Effects
CNS: Syncope, Dizziness, headache
CV: Hypotension, Postural Hypotension, Bradycardia, angina, PVCs, substernal pressure, transient hypertension, precipitation of angina, QT PROLONGATION, TORSADES DE POINTES, VENTRICULAR DYSRHYTHMIAS
GI: Nausea, Vomiting, severe diarrhea, anorexia
RESP: dyspnea, respiratory infections
Dofetilide
Nursing Considerations
ASSESS:
- ECG continuously for a minimum of 3 days or 12 hr after conversion to determine product effectiveness, PVCs, other dysrhythmias; renal function, QTc at baseline; reassess QTc interval 2-3hr after each dose; if QTc >440 msec or 500 msec if ventricular conduction disturbance, discontinue until QTc at starting level; product only available to facilities educated in its administration; patient must be hospitalized
- AF patients should receive anticoagulation prior to cardioversion
- Cardiac status: rate, rhythm, character, continuously; BP
- SEVERE RENAL IMPAIRMENT CCr<20ml/min: do not use for mild to moderate renal disease; monitor BUN/creatinine; adjust dose based on creatinine clearance
Lidocaine (parenteral)
Functional Classification
Antidysrhythmic (Class Ib)
Lidocaine (parenteral)
Chemical Classification
Aminoacyl amide
Lidocaine (parenteral)
Mechanism of Action
Increases electrical stimulation threshold of ventricle, His-Purkinje system, which stabilizes cardiac membrane, decreases automatically
Lidocaine (parenteral)
Uses
ventricular tachycardia, ventricular dysrhythmias during cardiac surgery, digoxin toxicity, cardiac catheterization
Lidocaine (parenteral)
Contraindications
Hyper-sensitivity to amides, severe heart block, supraventricular dysrhythmias, Adams-Stokes syndrome, Wolff-Parkinson-White, syndrome
Lidocaine (parenteral)
Side Effects
CNS: Headache, Dizziness, involuntary movement, confusion, tremor, drowsiness, euphoria, SEIZURES, shivering
CV: Hypotension, Bradycardia, HEART BLOCK, CV COLLAPSE, ARREST
EENT: tinnitus, blurred vision
GI: nausea, vomiting, anorexia
HEMA: METHEMOGLOBINEMIA
INTEG: rash, urticaria, edema, swelling, petechiae, pruritus
MISC: febrile response, phlebitis at inj site
RESP: dyspnea, RESPIRATORY DEPRESSION
Lidocaine (parenteral)
Nursing Considerations
ASSESS:
- ECG continuously to determine increased PR or QRS segments; if these develop, discontinue or reduce rate; watch for increased ventricular ectopic beats, may have to rebolus; BP
- Blood levels: therapeutic level, 1.5-5mcg/ml
- I&O ratio, electrolytes (K, Na, Cl)
- MALIGNANT HYPERTHERMIA: tachypnea, tachycardia, changes in BP, increased temp
- Respiratory status: rate, rhythm, lung fields for crackles, watch for respiratory depression; lung fields, bilateral crackles may occur with CHF; increased respiration, pulse; product should be discontinued
- CNS effects: dizziness, confusion, psychosis, paresthesias, convulsions; product should be discontinued
Metoprolol (Lopressor)
Functional Classification
Antihypertensive, Antianginal
Metoprolol (Lopressor)
Chemical Classification
Beta1-Blocker
Metoprolol (Lopressor)
Mechanism of Action
Lowers BP by beta-blocking effects; reduces elevated renin plasma levels; blocks beta2-adrenergic receptors in bronchial, vascular smooth muscle only at high doses; negative chronotropic effect
Metoprolol (Lopressor)
Uses
Mild to moderate hypertension, acute MI to reduce cardiovascular mortality, angina pectoris, NYHA class II, III heart failure
Metoprolol (Lopressor)
Contraindications
Hypersensitivity to beta-blockers, cardiogenic shock, heart block (2nd, 3rd degree), sinus bradycardia, pheochromocytoma, sick sinus syndrome
Metoprolol (Lopressor)
Side Effects
CNS: Insomnia, Dizziness, mental changes, hallucinations, depression, anxiety, headaches, nightmares, confusion, fatigue
CV: Hypotension, BRADYCARDIA, CHF, Palpitations, dysrhythmias, CARDIAC ARREST, AV BLOCK, PULMONARY/PERIPHERAL EDEMA, CHEST PAIN
EENT: sore throat; dry, burning eyes
GI: Nausea, Vomiting, colitis, cramps, Diarrhea, constipation, flatulence, dry mouth, HICCUPS
GU: impotence
HEMA: AGRANULOCYTOSIS, EOSINOPHILIA, THROMBOCYTOPENIA, PURPURA
INTEG: rash, purpura, alopecia, dry skin, urticaria, pruritus
RESP: BRONCHOSPASM, dyspnea, wheezing
Metoprolol (Lopressor)
Nursing Considerations
ASSESS:
- ECG directly when giving IV during initial treatment
- I&O, weight daily; check for CHF (weight gain, jugular venous distention, crackles, edema, dyspnea)
- BP during initial treatment, periodically thereafter; pulse q4hr; note rate, rhythm, quality
- Apical/radial pulse before administration; notify prescriber of any significant changes or pulse <50 bpm
- Baselines of renal, hepatic studies before therapy begins
- Skin turgor, dryness of mucous membranes for hydration status
Metoprolol (Lopressor)
Overdose Treatment
Lavage, IV atropine for bradycardia, IV theophylline for bronchospasm, digoxin, O2, diuretic for cardiac failure, hemodialysis, administer vasopressor
Quinidine
Functional Classification
Antidysrhythmic (Class IA)
Quinidine
Chemical Classification
Quinine dextroisomer
Quinidine
Mechanism of Action
Prolongs duration of action potential and effective refractory period, thus decreasing myocardial excitability; anticholinergic properties
Quinidine
Uses
PVCs, atrial fibrillation, PAT, ventricular tachycardia, atrial flutter, malaria/IV quiNIDine gluconate
Quinidine
Contraindications
Hypersensitivity, idiosyncratic response, digoxin toxicity, blood dyscrasias, myasthenia gravis
History of long QT syndrome, product-induced torsades de pointes, severe heart block
Quinidine
Side Effects
CNS: Headache, Dizziness, involuntary movement, confusion, psychosis, restlessness, irritability, syncope, excitement, depression, ataxia
CV: HYPOTENSION, Bradycardia, PVCs, HEART BLOCK, CV COLLAPSE, ARREST, torsades de pointes, widening QRS complex, VENTRICULAR TACHYCARDIA
EENT: cinchonism: tinnitus, blurred vision, hearing loss, mydriasis, disturbed color vision
GI: nausea, vomiting, anorexia, abdominal pain, Diarrhea, HEPATOTOXICITY
HEMA: THROMBOCYTOPENIA, hemolytic anemia, AGRANULOCYTOSIS, hypoprothombinemia
INTEG: rash, urticaria, ANGIOEDEMA, swelling, photosensitivity, flushing with severe pruritus
RESP: dyspnea, RESPIRATORY DEPRESSION
Quinidine
Nursing Considerations
ASSESS:
- ECG continuously to determine increased PR or QRS segments, QT interval; discontinue product or reduce dose
- Blood levels (therapeutic level 2-7mcg/ml), CBC, LFTs
- BP continuously for fluctuations
- FOR CINCHONISM: tinnitus, headache, nausea, dizziness, fever, vertigo, tremor; may lead to hearing loss
- Cardiac status: rate, rhythm, character, continuously
- Respiratory status: rate, rhythm, lung fields for crackles; increased respiration, increased pulse; product should be discontinued
- CNS effects: dizziness, confusion, psychosis, paresthesias, seizures; product should be discontinued
Sotalol
Functional Classification
Antidysrhythmic group III
Sotalol
Chemical Classification
Nonselective Beta-Blocker
Sotalol
Mechanism of Action
Blockade of Beta1- and Beta2-receptors leads to antidysrhythmic effect, prolongs action potential in myocardial fibers without affecting conduction, prolongs QT interval, no effect on QRS duration
Sotalol
Uses
Life-threatening ventricular dysrhythmias; Betapace AF: to maintain sinus rhythm with symptomatic atrial fibrillation/flutter
Sotalol
Contraindications
Hypersensitivity to Beta-blockers, cardiogenic shock, heart block (2nd/3rd degree), sinus bradycardia, CHF, bronchial asthma, CCr <40ml/min
Sotalol
Side Effects
CNS: Dizziness, mental changes, drowsiness, fatigue, headache, catatonia, depression, anxiety, nightmares, paresthesia, lethargy, insomnia, decreased concentration
CV: PRODYSRHYTHMIA, PROLONGED QT, orthostatic hypotension, bradycardia, CHF, chest pain, ventricular dysrhythmias, AV block, peripheral vascular insufficiency, palpitations, torsades de pointes; LIFE-THREATENING VENTRICULAR DYSRHYTHMIAS (BETAPACE AF)
EENT: tinnitus, visual changes, sore throat, double vision; dry, burning eyes
GI: nausea, vomiting, diarrhea, dry mouth, flatulence, constipation, anorexia, indigestion
GU: impotence, dysuria, ejaculatory failure, urinary retention
HEMA: AGRANULOCYTOSIS, THROMBOCYTOPENIC PURPURA (rare), THROMBOCYTOPENIA, LEUKOPENIA
INTEG: rash, alopecia, urticaria, pruritus, fever, diaphoresis
MISC: facial swelling, decreased exercise tolerance, weight change, Raynaud’s disease
MS: joint pain, arthralgia, muscle cramps, pain
RESP: BRONCHOSPASM, dyspnea, wheezing, nasal stuffiness, pharyngitis
Sotalol
Nursing Considerations
ASSESS:
- I&O, weight daily; edema in feet, legs daily
- BP, pulse q4hr; note rate, rhythm, quality
- Potassium, magnesium levels
- QT SYNDROME: apical/radial pulse before administration: notify prescriber of any significant changes; monitor ECG continuously (Betapace AF); use QT interval to determine patient eligibility; baseline QT must be </=450msec
- Baselines of renal studies before therapy begins
- Skin turgor, dryness of mucous membranes for hydration status
Sotalol
Overdose Treatment
Lavage, IV atropine for bradycardia, IV theophylline for bronchospasm, digoxin, O2, diuretic for cardiac failure; hemodialysis is useful for removal; administer vasopressor (norepinephrine) for hypotension, isoproterenol for heart block
Verapamil
Functional Classification
Calcium channel blocker; antihypertensive; antianginal, antidysrhythmic (class IV)
Verapamil
Chemical Classification
Diphenylalkylamine
Verapamil
Mechanism of Action
Inhibits calcium ion influx across cell membrane during cardiac depolarization; produces relaxation of coronary vascular smooth muscle; dilates coronary arteries; decreases SA/AV node conduction; dilates peripheral arteries
Verapamil
Uses
Chronic stable, vasospastic, unstable angina; dysrhythmias, hypertension, supraventricular tachycardia, atrial flutter or fibrillation
Verapamil
Contraindications
Sick sinus syndrome, 2nd-/3rd-degree heart block, hypotension <90mmHg systolic, cardiogenic shock, severe CHF
Verapamil
Side Effects
CNS: Headache, Drowsiness, dizziness, anxiety, depression, weakness, insomnia, confusion, lightheadedness, asthenia, fatigue
CV: Edema, CHF, bradycardia, hypotension, palpitations, AV block, DYSRHYTHMIAS
GI: Nausea, diarrhea, gastric upset, Constipation, increased LFTs
GU: impotence, gynecomastia, nocturia, polyuria
HEMA: bruising, petechiae, bleeding
INTEG: rash, bruising
MISC: gingival hyperplasia
SYST: STEVENS-JOHNSON SYNDROME
Verapamil
Nursing Considerations
ASSESS:
- CARDIAC STATUS: BP, pulse, respiration, ECG intervals (PR, QRS, QT); notify prescriber if pulse <90mmHg
- CHF: I&O ratios, weight daily; crackles, weight gain, dyspnea, jugular venous distention
- Renal, hepatic studies during long-term treatment, serum potassium periodically
Verapamil
Overdose Treatment
Defibrillation, atropine for AV block, vasopressor for hypotension, IV calcium
Adenosine
Chemical Classification
Endogenous nucleoside
