Cardiac Rhythm Flashcards
Cardiac Dysrhythmias: causes
1) electrolyte disturbance
2) overstimulation of the heart
-found anywhere in heart (atria, ventricles, conduction system)
Classes of Antidysrhythmic Drugs
1) class I = sodium channel blockers
2) class II = beta blockers
3) class III = potassium channel blockers
4) class IV = calcium channel blockers
5) other medications = adenosine; digoxin
Antidysrhythmic Drugs: therapeutic uses
1) slow or prolong conduction
2) block beta-adrenergic receptor in heart
3) prolong action potential and refractory period
4) block calcium influx
Class I Sodium Channel Blockers: medications
1) IA = procainamide (Pronestyl, Procanbid)–oral and IV
2) IB = lidocaine (Xylocaine)–IV
3) IC = propafenone (Rythmol)–oral
Class I Sodium Channel Blockers: therapeutic uses
1) IA
- supraventricular tachycardia
- ventricular tachycardia
- atrial flutter
- atrial fibrillation
2) IB
- short-term use for ventricular dysrhythmias
3) IC
- severe ventricular tachycardia
Class II Beta Blockers: medications
1) propranolol hydrochloride (Inderal)–oral, IV
2) sotalol HCl (Betapace)
3) esmolol hydrochloride (Brevibloc)
4) acebutolol hydrochloride (Sectral)
Class II Beta Blockers: therapeutic uses
1) atrial fibrillation
2) atrial flutter
3) paroxysmal SVT
4) hypertension
5) angina
Class III Potassium Channel Blockers: medications
1) amiodarone (Cordarone, Pacerone)–oral, IV
2) bretylium (Bretylol)
3) sotalol (betapace)
4) ibutilide (Corvert)
5) dofetilide (Tikosyn)
Class III Potassium Channel Blockers: therapeutic action
1) conversion of atrial fibrillation
2) recurrent ventricular fibrillation
3) recurrent ventricular tachycardia
Class IV Calcium Channel Blockers: medications
1) varapamil (Calan)–oral, IV
2) diltiazem (Cardizem)
Class IV Calcium Channel Blockers: therapeutic uses
1) atrial fibrillation and flutter
2) SVT
Other Medications: Adenosine
1) decrease electrical conduction through AV node
2) therapeutic uses:
- paroxysmal SVT
- Wolff-Parkinson-White syndrome
Other medications: digoxin (Lanoxin)
1) decrease electrical conduction through AV node
2) increase myocardial contraction
3) therapeutic uses:
- HF
- atrial fibrillation and flutter
- paroxysmal SVT
Class I: procainamide
adverse effects
1) painful, inflamed joints (lupus)
2) blood dyscrasias (neutropenia)
3) cardiotoxicity
4) hypotension
Class I: procainamide
nursing interventions/client education
1) symptoms resolve with discontinuation of medication
2) NSAIDs can be used
3) monitor weekly CBC
4) monitor for signs of infections and bleeding
5) monitor procainamide levels
6) monitor vital signs and ECG
7) notify provider if dysrhythmias occur
Class I: lidocaine
adverse effects
1) CNS effects
- drowsiness
- altered mental status
- seizures
2) respiratory arrest
Class I: lidocaine
nursing interventions/client education
1) monitor for CNS effects
2) notify provider if they occur
3) administer phenytoin (Dilantin) to control seizure activity
4) monitor vital signs
5) obtain ECG
6) make sure resuscitation is available
Class II: amiodarone
adverse effects
1) pulmonary toxicity
2) sinus bradycardia and AV block, which may lead to HF
3) visual disturbances (photophobia, blurred vision, may lead to blindness)
4) phlebitis w/ IV administration
Class II: amiodarone
nursing interventions/client education
1) monitor for cough, dyspnea, chest pain
2) monitor BP, ECG
3) if AV block occurs, stop medication
4) report visual disturbances
5) use central venous catheter
Class IV: verapamil
adverse effects
1) bradycardia
2) hypotension
3) heart failure
Class IV: verapamil
nursing interventions/client education
1) monitor ECG, blood pressure
2) reverse with calcium chloride
3) H/O HF may need reduced dose
Adenosine: adverse effects
1) sinus bradycardia (decreased conduction through AV node)
2) hypotension
3) dyspnea (bronchoconstriction)
4) flushing of face (vasodilation)
Adenosine: nursing interventions
1) monitor ECG. Effects usually last 1 min or less
2) monitor for manifestations, and notify provider if occur
Digoxin: adverse effects
1) bradycardia
2) hypotension
3) toxicity:
- nausea
- vomiting
- dysrhythmias
Digoxin: nursing interventions
1) monitor apical HR. hold dose if < 60/min
2) monitor digoxin level (0.8-2.0 ng/mL)
3) monitor serum potassium level
Procainamide, Lidocaine:
nursing administration
1) take meds as prescribed
2) do not crush or chew preparations
3) IV administration (loading dose) maintenance
4) adjust rate to cardiac response
5) leave on longer than 24 hr
6) do not use lidocaine w/ epinephrine (severe hypertension/dysrhthmias)
Amiodarone: nursing administration
1) highly toxic. monitor closely for adverse effects
2) inform clients that adverse effects may continue for extended period of time after medication is discontinued
3) provide written information on potential toxicities
Verapamil: nursing administration
1) change position slowly
2) lie flat until dizziness subsides
3) notify provider for peripheral edema or SOB
Adenosine: nursing administration
1) half life very short
2) adverse reactions short and mild
3) administration by IV bolus, flushed w/ normal saline
