Cardiac Meds Flashcards by Brandy Wilson

What are s/sx of symptomatic dysrhythmia?

Hypotension
SOB, dyspnea, tachypnea, cough
Syncope and confusion
Chest pain
Oliguria (from low perfusion)

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Class 1A Sodium channel blockers

What are their uses?

Quinidine QUINN-UH-DEEN
Procainamide
Disopryramide DIE-SO-PEER-UH-MIDE

—Slows things down–
PSVTs
Maintenance after conversion from tach

Not used often

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SE of procainamide?

Widens QRS
Lupus like syndrome

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Class 1B Sodium channel blockers?
Route for each?

Uses?

Lidocaine–IV
Mexiletine–PO MEXIL-UH-TINE

PVCs, VTach, prevent VFib

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Class 1C Sodium channel blockers?

Route?

Uses?

Flecainide–PO– FLUH-CANE-IDE
Propafenone–PO PRO-PUH-FEE-NON

Last resort meds

Vtach
Vfib
Unresponsive SVT

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Beta adrenergic blockers

Uses?

PropranoLOL
AcebutoLOL
MetaproLOL
EsmoLOL —Most powerful–
SotaLOL (also a potassium channel blocker)

Tx of SVT and VTach=IV
afib, aflutter=PO mainentance or IV emergency

HTN, angina, cardiomyopathy

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Beta blocker effects on heart?

Slows conduction
Increases refractory period
Prevent v fib

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Propranolol brand name?

Inderal

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Contraindications for beta blockers?

Asthma or any dyspnea
HR <60
Heart blocks
Verapamil (increases effects)
IBuprofen (decreases effects of BB)
Indomethacin (NSAID) (decreases effects of BB)

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What is black box warning on propranolol for?

Never abrupt D/C
Always taper off for 2 weeks
Can cause cardiac events if stop abruptly

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Which med is a beta and potassium blocker?

Sotalol
In lower doses=beta blocker
In higher doses=potassium channel blocker

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What meds are classed as potassium channel blockers?

Amiodarone
Dronedarone
Dofetilide
Ibutilide
Sotalol (both beta and K+)

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CV effects of potassium channel blockers?

Decreases HR
Vasodilator
Slows conduction
Decreases contractility of LV
Prolong refractory period

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Uses of K+ channel Blockers?

Tachy dysrhythmias:
Vtach
Afib
Aflutter

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Caution when giving amiodarone?

Give in central line-can cause phlebitis in peripheral line

Hepatotoxic so liver function tests needed

Pulmonary toxicity can occur

Iodine rich so can alter thyroid function

Contraindicated in hypokalemia, bradycardia

No grapefruit juice

Don’t give with beta blockers, verapamil, diltiazam

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What is dofetilide used for?
Cautions?

Maintaining NSR with afib hx
Increased risk of torsades
Can cause decrease in creatinine clearance so watch renal function
Not given with verapamil

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What is donedarone used for?

Advantage over amiodorone?

Ventricular dysrhythmias
No thyroid, pulmonary toxicity
Does cause liver toxicity

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What is ibutilide used for?

Advantage over amiodorone?

Manage afib/flutter that has recent onset
Does not cause hypotension like amiodarone

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What are the 2 calcium channel blockers?

Uses?

Diltiazem
Verapamil

Slows conduction
Used in SVT, afib, aflutter, NOT ventricular tachycardias

SE of calcium channel blockers?

Peripheral edema
Bradycardia
Hypotension
Nausea/constipation
Dizziness/headache/weakness

What effect does diltiazem and verapamil have on digoxin?
What other meds are not given with diltiazem?

Increases risk of toxicity

Beta blockers
Amiodorone

Grapefruit juice interferes with

Calcium channel blockers
Potassium channel blockers

What should be our first action trying to convert a atrial tachycardia?

Vagal manuevers

What is use of adenosine?
Info?

PSVT
Given as a fast IVP as close to the heart as possible
Half life of 10 seconds
Does a hard reset of heart conduction
Will go into asystole and then convert

What is use of mag sulfate? Side effects? Also epsom salts

Torsades Tachy dysrhythmias Digoxin toxicity Hypotension, drowsiness, diarrhea, muscle tightness, headache

Two routes epi is given?

IV or ET 1 mg Q 3-5 min Always used when pulseless patient

Med to increase HR

Atropine IV or ET

What lab is used to monitor warfarin? Heparin?

PT/INR aPTT

Brand name of digoxin

Lanoxin

1st line drugs for HF

Beta blockers ACE ARBs Diuretics 2nd line: Digoxin

How does digoxin work?

Increases heart's pumping strength In atrial fib dig slows down the AV node to stop all the fibrillation. Stimulates the vagus nerve to slow sympathetic NS down

Uses of digoxin

2nd line tx for HF Chronic a fib

How does impaired renal function affect dig levels? How is the dose adjusted?

Primarily excreted by kidneys so if impaired dig levels will rise Doses can be adjusted to every other day instead of every day

Normal dose of digoxin Therapeutic range?

0.125--.25 mg daily Therapeutic range is AFib= 0.8--2.0 mg/ml HF=0.5--0.8 mg/ml

What is the relationship of potassium and digoxin?

Inverse Hypokalemia>increased dig Hyperkalemia>decreased dig

S/sx of dig toxicity

1st=GI problems>N/V/anorexia/abd. pain Other=PVCs Headache, dizziness, drowsiness, confusion Visual disturbances

What meds increase digoxin effects?

Epinephrine Isoproterenol (similar to epi) Calcium Antithyroid meds Amiodorone Quinidine Nifedipine (Procardia) Verapamil Ginseng VAAIN GQ EC

What meds decrease digoxin effects?

Antacids Aminoglycoside Laxatives Psyllium fiber St Johns wort LAAPS

What should we always assess before admin digoxin?

HR at apical pulse for 1 full minute If <60 BPM hold med

Med of choice for symptomatic sinus tachy?

Propranolol

Med of choice for PSVT?

Vagal maneuvers Adenosine

Med of choice for a fib?

Diltiazem Beta blockers Cardioversion Anticoags

Med of choice for a flutter

Ibutilide (doesn't cause hypotension) or amniodorone (causes hypotension)

Med of choice in v tach with pulse

Amniodorone

Med of choice in torsades

Mag sulfate

Med of choice in asystole

Epi