Cardiac - Unit 2 - Electrical Drugs & Interventions Flashcards

1
Q

What do antidysrhythmic medications do?

A

They suppress dysrhythmia’s by inhibiting abnormal pathways of electrical conduction through the heart.

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2
Q

What are Class 1 antidysrhythmic drugs?

A

Sodium Channel Blockers.

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3
Q

What do class 1 antidysrhythmic drugs do?

A

Decrease automaticity. There are three classes.

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4
Q

What are the three classes of Class 1 ?

A

1A, 1B, 1C

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5
Q

What are some side effects for all class 1 drugs?

A

Hypotension, heart failure, worse or new dysrhythmia’s, N, V, D

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6
Q

What are some Class 1A drugs?

A

Procainamide, Dysopyramide, Propafenone, Quinidine Sulfate

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7
Q

What do class 1A drugs do?

A

slow conduction and prolong repolarization.

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8
Q

What are class 1A drugs used for?

A

SVT, V Tach, PVC/s, Atrial Flutter, Atrial Fib - a lot of EXTRAVENTRICULAR rhtyhm’s.

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9
Q

What are some things to watch for in someone on Class 1A drugs?

A

Monitor for systemic lupus syndrome, blood dyscrasias, make sure QRS doesn’t get too wide.

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10
Q

What is a class 1B drug? What do they do?

A

Lidocaine - it shortens repolarizations/treats ventricular dysrhythmia’s

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11
Q

What dysrhythmia’s do we use lidocaine for? How long?

A

Used in the short term for V Tach, PVC’s and V Fib

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12
Q

What do we monitor for with IB Drugs?

A

CNS effects (drowsiness, decreased LOC, seizures), respiratory, etc.

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13
Q

What does Class IC do?

A

Slow conduction and widen the QRS complex

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14
Q

What are class 1C drugs used for?

A

Treating A Fib, PSVT, life threatening ventricular dysrhythmia’s.

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15
Q

What drugs are class 1C?

A

Flecainide acetate, propafenone hydrochloride, moricizine.

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16
Q

What are some side effects of 1C drugs?

A

Bradycardia, hypotension, heart failure, worsened or new dysrhythmia’s.

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17
Q

Which drugs are Class 2?

A

Beta blockers.

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18
Q

What do beta blockers do? Used for?

A

Control dysthythmia’s associated with excessive beta-adrenergic stimulation by competing with the same receptors. They also decrease HR and conduction. They are used for atrial dysrhythmia’s.

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19
Q

What are some examples of beta blockers?

A

Acebutolol, esmolol, propranolol, sotalol

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20
Q

What are some side effects of beta blockers?

A

Dizziness, fatigue, hypotension, bradycardia, heart failure, dysrhythmia’s, heart block, bronchospasms, GI upset.

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21
Q

Should we check the HR/BP before giving a beta blocker?

A

YES. HR above 60 and Systolic above 90.

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22
Q

What are class 3 drugs?

A

Potassium channel blockers

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23
Q

What are some examples of class 3 drugs?

A

Amiodarone, bretylium, dofetillide, ibutilide fumarate

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24
Q

What do class 3 drugs do?

A

Convert a-fib, prevent or treat life threatening ventricular dysrhythmia’s (PVC’s, V tach, vfib)

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25
Q

What do we watch for with Class 3 drugs?

A

Pulmonary toxicity, bradycardia and AV blocks, visual disturbances, photosensitivity

26
Q

What are class 4 drugs?

A

Calcium Channel Blockers

27
Q

What do class 4 drugs do? Used for?

A

depress the automaticity of the SA and AV nodes (slows the HR). They are used for atrial fib and flutter, and SVT

28
Q

What are a few examples of class 4 drugs?

A

Verapamil, Dilitiazem

29
Q

What are some side effects of Class 4 drugs?

A

Heart failure, bradycardia, hypotension

30
Q

What is an endogenous glucoside used for?

A

Decreases electrical conduction through the AV node (interrupts extra pathways) - Paroxsymal SVT, wolf-Parkinson-white

31
Q

What are some examples of an endogenous glucoside?

A

Adenosine, Covert

32
Q

What are some endogenous glucoside side effects? How long does it last for?

A

Sinus brady, dyspnea, flushing of face - it has a very short half-life (1 minute) so side effects can disappear quickly!

33
Q

what does lanoxin do?

A

Increaes vagal tone (slows conduction) - used for CHF, a-fib, a-flutter, PSVT.

34
Q

What are some side effects of lanoxin? What happens if there is bradycardia?

A

N/V, yellow vision - brady might mean toxic levels have been reached!

35
Q

Hypokalemia and renal dysfunction decrease risk for lanoxin toxicity - T/F?

A

FALSE - they increase the risk.

36
Q

What are some interventions with antidysrhythmics?

A

Monitor vitals, do not administer w/food, watch for fluid retention, monitor respiratory/thyroid/neuro function, watch for orthostatic hypotension (so have your patients get up slowly!) and increase fiber.

37
Q

what are some vagal maneuvers?

A

Valsalva maneuver, coughing, gagging, immersing your face in cold water, blowing hard, carotid sinus massage

38
Q

What is cardioversion? What is it used for?

A

It’s when you mildly “shock” (20-200 joules) someone to get them in a normal rhythm. It’s used for a-fib, a-flutter and SVT.

39
Q

Is cardioversion elective?

A

YES - so get consent.

40
Q

Cardioversion - synchronized with the ___ wave.

A

R wave.

41
Q

What are some pre-op things to do for cardioversion?

A

Withhold antidysrhythmic drugs, check potassium, hook up electrodes to monitor and defibrillator, have at least 1 IV, have consent signed, give a sedative, document rhythm, make sure they are anticoagulated, etc.

42
Q

What are some post-op things to do for cardioversion?

A

Document the procedure, monitor EKG, diet as tolerated, assess LOC, etc.

43
Q

Defibrillation - what strength is it?

A

200-360 joules.

44
Q

What is defibrillation used for?

A

Unconscious V-Tach, V-Fib

45
Q

Before defibrillation, should we remove Nitro paste or any gels on chest?

A

YES

46
Q

What do we chart after defibrillation?

A

Observe/document rhythm, number of defibrillations, energy settings, post-defib vitals, etc.

47
Q

What’s an ICD?

A

Implantable defibrillator!

48
Q

After having a defibrillator implanated, what should the pt. do?

A

Take it easy for a few weeks, no driving until stable, avoid swimming alone, don’t lift over 25 lbs, avoid electrical and magnetic fields, be wanded at the airport, etc.

49
Q

What are some different types of defibrillators? (3)

A

Abdominal ICD, Transvenous ICD, S-ICD (Subcutaneous ICD)

50
Q

What does the S-ICD do?

A

Sub-Q - It converts V-Tach to V-Fib - no leads and no risk for infection!

51
Q

What are three types of PACING for pacemakers?

A

External (emergency situation), Transvenous (temp or permanent), Epicardial (post CABG)

52
Q

If HR is slower than the set limit for the pacemaker, what is happening?

A

The pacemaker went on vacation and is not working.

53
Q

What is the pacemaker sensitivity?

A

Minimum electrical activity that is needed by the pacemaker (mV)

54
Q

What is the pacemaker voltage?

A

Power required to stimulate the electrical activity of the heart

55
Q

What’s synchronous pacing?

A

Pacemaker Sees patients heart rate and only paces when needed.

56
Q

What is asynchronous pacing?

A

Pacemaker fires at a set rate irregardless of what the heart is doing. It’s not used as much anymore - the “eyes” have been turned off.

57
Q

Wide QRS - is it expected a lot with a pacemaker?

A

Yes

58
Q

What is VVI Pacemaker pacing?

A

Ventricle Sensed
Ventricle Paced
Inhibited

59
Q

What is pacemaker DDD pacing?

A

Dual sensed
Dual paced
Dual triggered and inhibited

60
Q

Pacemaker - what are some things to tell patients afterwards?

A

Do not drive for 2 weeks, avoid lifting, pushing or pulling heavy objects for 4 weeks, no above the shoulder activities for 2 weeks, may use arms for adl’s, take pulse daily for a couple of months, keep cell phone 6 inches away from pacemaker, and call Dr. if pulse is about 5 beats below set level or if feeling dizzy.