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ATI: PHARM 2 - (Drug Classes) > Antidysrhythmic Drugs > Flashcards

Antidysrhythmic Drugs Flashcards

1
Q

Adenosine

Chemical Classification

A

Endogenous nucleoside

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2
Q

Adenosine

Mechanism of Action

A

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)

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3
Q

Adenosine

Uses

A

PSVT, as a diagnostic aid to assess myocardial perfusion defects in CAD, Wolff-Parkinson-White (WPW) syndrome

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4
Q

Adenosine

Contraindications

A

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

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5
Q

Adenosine

Side Effects

A

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)

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6
Q

Adenosine

Nursing Considerations

A

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
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7
Q

Adenosine

Overdose Treatment

A

Defibrillation, vasopressor for hypotension, theophylline

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8
Q

Amiodarone

Functional Classification

A

Antidysrhythmic (class III)

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9
Q

Amiodarone

Chemical Classification

A

Iodinated benzofuran derivative

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10
Q

Amiodarone

Mechanism of Action

A

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

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11
Q

Amiodarone

Uses

A

Hemodynamically unstable ventricular tachycardia, supraventricular tachycardia, ventricular fibrillation not controlled by 1st-line agents

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12
Q

Amiodarone

Contraindications

A

Pregnancy (D), breastfeeding, neonates, infants, severe sinus node dysfunction, hypersensitivity, cardiogenic shock, 2nd-3rd degree AV block, bradycardia

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13
Q

Amiodarone

Side Effects

A

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

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14
Q

Amiodarone

Nursing Considerations

A

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
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15
Q

Amiodarone

Overdose Treatment

A

O2, artificial ventilation, ECG, administer DOPamine for circulatory depression, administer diazepam, thiopental for seizures, isoproterenol

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16
Q

Atenolol

Functional Classification

A

Antihypertensive, Antianginal

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17
Q

Atenolol

Chemical Classification

A

Beta-Blocker, Beta1-, Beta2-blocker (High doses)

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18
Q

Atenolol

Mechanism of Action

A

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

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19
Q

Atenolol

Uses

A

Mild to moderate hypertension, prophylaxis of angina pectoris; suspected or known MI (IV use); mi prophylaxis

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20
Q

Atenolol

Contraindications

A

Pregnancy (D), hypersensitivity to Beta-blockers, cardiogenic shock, 2nd- or 3rd-degree heart block, sinus bradycardia, cardiac failure, Raynaud’s disease, pulmonary edema

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21
Q

Atenolol

Side Effects

A

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

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22
Q

Atenolol

Nursing Considerations

A

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
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23
Q

Atenolol

Overdose Treatment

A

Lavage, IV atropine for bradycardia, IV theophylline for bronchospasm, dextrose for hypoglycemia, digoxin, O2, diuretic for cardiac failure, hemodialysis

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24
Q

Diltiazem (Cardizem)

Functional Classification

A

Calcium Channel Blocker, Antiarrythmic class IV, antiarrhythmic class IV, antihypertensive

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25
Q

Diltiazem (Cardizem)

Chemical Classification

A

Benzothiazepine

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26
Q

Diltiazem (Cardizem)

Mechanism of Action

A

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

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27
Q

Diltiazem (Cardizem)

Uses

A

PO: Angina pectoris due to coronary artery spasm, hypertension
IV: Atrial fibrillation, flutter, paroxysmal supraventricular tachycardia

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28
Q

Diltiazem (Cardizem)

Contraindications

A

sick sinus syndrome, AV heart block, hypotension <90mmHg systolic, acute MI, pulmonary congestion, cardiogenic shock

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29
Q

Diltiazem (Cardizem)

Side Effects

A

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

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30
Q

Diltiazem (Cardizem)

Nursing Considerations

A

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
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31
Q

Diltiazem (Cardizem)

Overdose Treatment

A

Atropine for AV block, vasopressor for hypotension

32
Q

Dofetilide

Functional Classification

A

Antidysrhythmic (Class III)

33
Q

Dofetilide

Mechanism of Action

A

Blocks cardiac ion channel carrying the rapid component of delayed potassium current; no effect on sodium channels

34
Q

Dofetilide

Uses

A

Atrial fibrillation, flutter, maintenance of normal sinus rhythm

35
Q

Dofetilide

Contraindications

A

Children, hypersensitivity, digoxin toxicity, aortic stenosis, pulmonary hypertension, severe renal disease
QT prolongation, torsades de pointes, renal failure

36
Q

Dofetilide

Side Effects

A

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

37
Q

Dofetilide

Nursing Considerations

A

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
38
Q

Lidocaine (parenteral)

Functional Classification

A

Antidysrhythmic (Class Ib)

39
Q

Lidocaine (parenteral)

Chemical Classification

A

Aminoacyl amide

40
Q

Lidocaine (parenteral)

Mechanism of Action

A

Increases electrical stimulation threshold of ventricle, His-Purkinje system, which stabilizes cardiac membrane, decreases automatically

41
Q

Lidocaine (parenteral)

Uses

A

ventricular tachycardia, ventricular dysrhythmias during cardiac surgery, digoxin toxicity, cardiac catheterization

42
Q

Lidocaine (parenteral)

Contraindications

A

Hyper-sensitivity to amides, severe heart block, supraventricular dysrhythmias, Adams-Stokes syndrome, Wolff-Parkinson-White, syndrome

43
Q

Lidocaine (parenteral)

Side Effects

A

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

44
Q

Lidocaine (parenteral)

Nursing Considerations

A

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
45
Q

Metoprolol (Lopressor)

Functional Classification

A

Antihypertensive, Antianginal

46
Q

Metoprolol (Lopressor)

Chemical Classification

A

Beta1-Blocker

47
Q

Metoprolol (Lopressor)

Mechanism of Action

A

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

48
Q

Metoprolol (Lopressor)

Uses

A

Mild to moderate hypertension, acute MI to reduce cardiovascular mortality, angina pectoris, NYHA class II, III heart failure

49
Q

Metoprolol (Lopressor)

Contraindications

A

Hypersensitivity to beta-blockers, cardiogenic shock, heart block (2nd, 3rd degree), sinus bradycardia, pheochromocytoma, sick sinus syndrome

50
Q

Metoprolol (Lopressor)

Side Effects

A

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

51
Q

Metoprolol (Lopressor)

Nursing Considerations

A

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
52
Q

Metoprolol (Lopressor)

Overdose Treatment

A

Lavage, IV atropine for bradycardia, IV theophylline for bronchospasm, digoxin, O2, diuretic for cardiac failure, hemodialysis, administer vasopressor

53
Q

Quinidine

Functional Classification

A

Antidysrhythmic (Class IA)

54
Q

Quinidine

Chemical Classification

A

Quinine dextroisomer

55
Q

Quinidine

Mechanism of Action

A

Prolongs duration of action potential and effective refractory period, thus decreasing myocardial excitability; anticholinergic properties

56
Q

Quinidine

Uses

A

PVCs, atrial fibrillation, PAT, ventricular tachycardia, atrial flutter, malaria/IV quiNIDine gluconate

57
Q

Quinidine

Contraindications

A

Hypersensitivity, idiosyncratic response, digoxin toxicity, blood dyscrasias, myasthenia gravis
History of long QT syndrome, product-induced torsades de pointes, severe heart block

58
Q

Quinidine

Side Effects

A

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

59
Q

Quinidine

Nursing Considerations

A

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
60
Q

Sotalol

Functional Classification

A

Antidysrhythmic group III

61
Q

Sotalol

Chemical Classification

A

Nonselective Beta-Blocker

62
Q

Sotalol

Mechanism of Action

A

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

63
Q

Sotalol

Uses

A

Life-threatening ventricular dysrhythmias; Betapace AF: to maintain sinus rhythm with symptomatic atrial fibrillation/flutter

64
Q

Sotalol

Contraindications

A

Hypersensitivity to Beta-blockers, cardiogenic shock, heart block (2nd/3rd degree), sinus bradycardia, CHF, bronchial asthma, CCr <40ml/min

65
Q

Sotalol

Side Effects

A

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

66
Q

Sotalol

Nursing Considerations

A

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
67
Q

Sotalol

Overdose Treatment

A

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

68
Q

Verapamil

Functional Classification

A

Calcium channel blocker; antihypertensive; antianginal, antidysrhythmic (class IV)

69
Q

Verapamil

Chemical Classification

A

Diphenylalkylamine

70
Q

Verapamil

Mechanism of Action

A

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

71
Q

Verapamil

Uses

A

Chronic stable, vasospastic, unstable angina; dysrhythmias, hypertension, supraventricular tachycardia, atrial flutter or fibrillation

72
Q

Verapamil

Contraindications

A

Sick sinus syndrome, 2nd-/3rd-degree heart block, hypotension <90mmHg systolic, cardiogenic shock, severe CHF

73
Q

Verapamil

Side Effects

A

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

74
Q

Verapamil

Nursing Considerations

A

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
75
Q

Verapamil

Overdose Treatment

A

Defibrillation, atropine for AV block, vasopressor for hypotension, IV calcium

76
Q

Adenosine

Functional Classification

A

Antidysrhythmic

ATI: PHARM 2 - (Drug Classes) (40 decks)

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