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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
Diltiazem (Cardizem) | Chemical Classification
Benzothiazepine
26
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
27
Diltiazem (Cardizem) | Uses
PO: Angina pectoris due to coronary artery spasm, hypertension IV: Atrial fibrillation, flutter, paroxysmal supraventricular tachycardia
28
Diltiazem (Cardizem) | Contraindications
sick sinus syndrome, AV heart block, hypotension <90mmHg systolic, acute MI, pulmonary congestion, cardiogenic shock
29
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
30
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
31
Diltiazem (Cardizem) | Overdose Treatment
Atropine for AV block, vasopressor for hypotension
32
Dofetilide | Functional Classification
Antidysrhythmic (Class III)
33
Dofetilide | Mechanism of Action
Blocks cardiac ion channel carrying the rapid component of delayed potassium current; no effect on sodium channels
34
Dofetilide | Uses
Atrial fibrillation, flutter, maintenance of normal sinus rhythm
35
Dofetilide | Contraindications
Children, hypersensitivity, digoxin toxicity, aortic stenosis, pulmonary hypertension, severe renal disease QT prolongation, torsades de pointes, renal failure
36
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
37
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
38
Lidocaine (parenteral) | Functional Classification
Antidysrhythmic (Class Ib)
39
Lidocaine (parenteral) | Chemical Classification
Aminoacyl amide
40
Lidocaine (parenteral) | Mechanism of Action
Increases electrical stimulation threshold of ventricle, His-Purkinje system, which stabilizes cardiac membrane, decreases automatically
41
Lidocaine (parenteral) | Uses
ventricular tachycardia, ventricular dysrhythmias during cardiac surgery, digoxin toxicity, cardiac catheterization
42
Lidocaine (parenteral) | Contraindications
Hyper-sensitivity to amides, severe heart block, supraventricular dysrhythmias, Adams-Stokes syndrome, Wolff-Parkinson-White, syndrome
43
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
44
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
45
Metoprolol (Lopressor) | Functional Classification
Antihypertensive, Antianginal
46
Metoprolol (Lopressor) | Chemical Classification
Beta1-Blocker
47
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
48
Metoprolol (Lopressor) | Uses
Mild to moderate hypertension, acute MI to reduce cardiovascular mortality, angina pectoris, NYHA class II, III heart failure
49
Metoprolol (Lopressor) | Contraindications
Hypersensitivity to beta-blockers, cardiogenic shock, heart block (2nd, 3rd degree), sinus bradycardia, pheochromocytoma, sick sinus syndrome
50
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
51
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
52
Metoprolol (Lopressor) | Overdose Treatment
Lavage, IV atropine for bradycardia, IV theophylline for bronchospasm, digoxin, O2, diuretic for cardiac failure, hemodialysis, administer vasopressor
53
Quinidine | Functional Classification
Antidysrhythmic (Class IA)
54
Quinidine | Chemical Classification
Quinine dextroisomer
55
Quinidine | Mechanism of Action
Prolongs duration of action potential and effective refractory period, thus decreasing myocardial excitability; anticholinergic properties
56
Quinidine | Uses
PVCs, atrial fibrillation, PAT, ventricular tachycardia, atrial flutter, malaria/IV quiNIDine gluconate
57
Quinidine | Contraindications
Hypersensitivity, idiosyncratic response, digoxin toxicity, blood dyscrasias, myasthenia gravis History of long QT syndrome, product-induced torsades de pointes, severe heart block
58
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
59
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
60
Sotalol | Functional Classification
Antidysrhythmic group III
61
Sotalol | Chemical Classification
Nonselective Beta-Blocker
62
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
63
Sotalol | Uses
Life-threatening ventricular dysrhythmias; Betapace AF: to maintain sinus rhythm with symptomatic atrial fibrillation/flutter
64
Sotalol | Contraindications
Hypersensitivity to Beta-blockers, cardiogenic shock, heart block (2nd/3rd degree), sinus bradycardia, CHF, bronchial asthma, CCr <40ml/min
65
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
66
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
67
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
68
Verapamil | Functional Classification
Calcium channel blocker; antihypertensive; antianginal, antidysrhythmic (class IV)
69
Verapamil | Chemical Classification
Diphenylalkylamine
70
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
71
Verapamil | Uses
Chronic stable, vasospastic, unstable angina; dysrhythmias, hypertension, supraventricular tachycardia, atrial flutter or fibrillation
72
Verapamil | Contraindications
Sick sinus syndrome, 2nd-/3rd-degree heart block, hypotension <90mmHg systolic, cardiogenic shock, severe CHF
73
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
74
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
75
Verapamil | Overdose Treatment
Defibrillation, atropine for AV block, vasopressor for hypotension, IV calcium
76
Adenosine | Functional Classification
Antidysrhythmic

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

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