Antidysrhythmics & Antihyperlipidemics Flashcards
(Na)sty (B)oys (K)iss (Ca)ts
Class I - IV
principles of antidysrhythmic drug therapy
- maintain normal sinus rhythm
- choose based on: cause, side effects tolerable, other heart conditions
- renal/hepatic function
How do you watch for toxicity levels with antidysrhythmics?
initiate therapy at low doses and titrate up
FOLLOW AND TRACK VERY CAREFULLY
Class I - Na Channel Blockers: how they work
- 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)
significant adverse effect of Class I (Na)
Increased QT therefore increased refractory period means possible random jolt into electrical chaos (Torsades or V Tach)
subclasses of Na channel blockers
IA: Quinidine, Procainamide
IB: Lidocaine, Mexiletine
IC: Flecainide, Propafenone
Class I indications
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 –
supraventricular tachycardia
HR > 100, usually > 150
originates above the ventricular electrical conduction system
USE: Class I - Na channel blocker
Class I side effects
- hypotension
- bradycardia
- arrhythmias
- cardiac arrest
Class II - Beta Blockers: how they work
CARDIAC SPECIFIC BETA
decrease conduction velocity
decrease automaticity
prolongs refractory period
Class II - Beta Blockers: examples
Brevibloc (esmolol)
Inderal (propanolol) – anxiety too
Betapace (sotalol)
Class II indications
Atrial: a fib, a flutter, atrial tach
Ventricular: PVC (slow down automaticity), VT (NOT EMERGENT - only sustained VT is lethal)
Class II side effects
** bradycardia **
bronchospasms
hypotension
why are class II not used for emergent situations?
Snape’s guess: slow MOA
Class III - Potassium Channel Blockers: how they work
- diminishes K movement during repolarization
- prolongs refractory period
- decrease automaticity
- increases PR interval
- widens QRS complex
Class III - K blockers: examples
Cordarone (amiodarone) —- USED MORE, huge side effect profile
Adenocard (adenosine) – specific, emergent situations
Class III indications
atrial: a fib, a flutter, SVT
ventricular: VT, VF
amiodarone half life
VERY LONG (50-70 days)
amiodarone: use and adverse effects
- 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)
amiodarone: client education
- take with food
- photosensitivity, photophobia
- regular eye exams (deposits!!!)
- NOTIFY PROVIDER: dyspnea/cough
Class IV - Ca channel blockers: how they work
- blocks slow Ca influx (decreases myocardium excitability and contractility)
- decrease contractility/HR
- decrease conduction velocity
- decrease aberrant pacemaker sites
- prolong repolarization, esp AV node
Class IV examples
cardizem (diltiazem) – negative inotrope
calan (verapamil) – non-dihydropyridine
Class IV indications
atrial: a fib, a flutter – ONE OF THE FIRST DRUGS WE GO TO – and SVT
Class IV is one of the drugs we go to for…
a fib or a flutter
