Antidysrhythmics & Antihyperlipidemics

Question 1

(Na)sty (B)oys (K)iss (Ca)ts

Answer 1

Class I - IV

Question 2

principles of antidysrhythmic drug therapy

Answer 2

• maintain normal sinus rhythm
• choose based on: cause, side effects tolerable, other heart conditions
• renal/hepatic function

Question 3

How do you watch for toxicity levels with antidysrhythmics?

Answer 3

initiate therapy at low doses and titrate up

FOLLOW AND TRACK VERY CAREFULLY

Question 4

Class I - Na Channel Blockers: how they work

Answer 4

• suppress automaticity
• decrease likelihood of ectopy
• prolong QT interval (everything after Na sloooooooows doooowwwwwwwn)

BEWARE: increased refractory period means possible jolt into electrical chaos (Torsades or V Tach)

Question 5

significant adverse effect of Class I (Na)

Answer 5

Increased QT therefore increased refractory period means possible random jolt into electrical chaos (Torsades or V Tach)

Question 6

subclasses of Na channel blockers

Answer 6

IA: Quinidine, Procainamide
IB: Lidocaine, Mexiletine
IC: Flecainide, Propafenone

Question 7

Class I indications

Answer 7

Atrial dysrhythmias: a fib, a flutter, SVT

Ventricular dysrhythmias: PVC, VT (IV ONLY), VF (URGENT)

– not used very much, but can be used in emergent situations or when patient is resistant to more conservative therapies –

Question 8

supraventricular tachycardia

Answer 8

HR > 100, usually > 150

originates above the ventricular electrical conduction system

USE: Class I - Na channel blocker

Question 9

Class I side effects

Answer 9

• hypotension
• bradycardia
• arrhythmias
• cardiac arrest

Question 10

Class II - Beta Blockers: how they work

Answer 10

CARDIAC SPECIFIC BETA

decrease conduction velocity
decrease automaticity
prolongs refractory period

Question 11

Class II - Beta Blockers: examples

Answer 11

Brevibloc (esmolol)
Inderal (propanolol) – anxiety too
Betapace (sotalol)

Question 12

Class II indications

Answer 12

Atrial: a fib, a flutter, atrial tach

Ventricular: PVC (slow down automaticity), VT (NOT EMERGENT - only sustained VT is lethal)

Question 13

Class II side effects

Answer 13

** bradycardia **
bronchospasms
hypotension

Question 14

why are class II not used for emergent situations?

Answer 14

Snape’s guess: slow MOA

Question 15

Class III - Potassium Channel Blockers: how they work

Answer 15

• diminishes K movement during repolarization
• prolongs refractory period
• decrease automaticity
• increases PR interval
• widens QRS complex

Question 16

Class III - K blockers: examples

Answer 16

Cordarone (amiodarone) —- USED MORE, huge side effect profile

Adenocard (adenosine) – specific, emergent situations

Question 17

Class III indications

Answer 17

atrial: a fib, a flutter, SVT
ventricular: VT, VF

Question 18

amiodarone half life

Answer 18

VERY LONG (50-70 days)

Question 19

amiodarone: use and adverse effects

Answer 19

• use cautiously (toxicities!)
• AE to: liver, thyroid, lungs, skin, eyes, bradycardia (THINK: half life is loooong so that is bad)

BELTTS

THE SMURF DRUG! (blue hints to the face)

Question 20

amiodarone: client education

Answer 20

• take with food
• photosensitivity, photophobia
• regular eye exams (deposits!!!)
• NOTIFY PROVIDER: dyspnea/cough

Question 21

Class IV - Ca channel blockers: how they work

Answer 21

• blocks slow Ca influx (decreases myocardium excitability and contractility)
• decrease contractility/HR
• decrease conduction velocity
• decrease aberrant pacemaker sites
• prolong repolarization, esp AV node

Question 22

Class IV examples

Answer 22

cardizem (diltiazem) – negative inotrope

calan (verapamil) – non-dihydropyridine

Question 23

Class IV indications

Answer 23

atrial: a fib, a flutter – ONE OF THE FIRST DRUGS WE GO TO – and SVT

Question 24

Class IV is one of the drugs we go to for…

Answer 24

a fib or a flutter

Question 25

Class IV adverse effects

Answer 25

vasodilatory effects!!

• flushed skin
• headache
• dizziness (orthostatic)
• hypotension

Question 26

Class: “Other” example & what it’s used for

Answer 26

Digoxin (also HF, remember) - a fib, a flutter

paroxysmal a fib and atrial tachycardia