Antidysrhythmic Drugs Flashcards
Adenosine
Chemical Classification
Endogenous nucleoside
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