Cardiac - Unit 2 - Electrical Drugs & Interventions Flashcards
What do antidysrhythmic medications do?
They suppress dysrhythmia’s by inhibiting abnormal pathways of electrical conduction through the heart.
What are Class 1 antidysrhythmic drugs?
Sodium Channel Blockers.
What do class 1 antidysrhythmic drugs do?
Decrease automaticity. There are three classes.
What are the three classes of Class 1 ?
1A, 1B, 1C
What are some side effects for all class 1 drugs?
Hypotension, heart failure, worse or new dysrhythmia’s, N, V, D
What are some Class 1A drugs?
Procainamide, Dysopyramide, Propafenone, Quinidine Sulfate
What do class 1A drugs do?
slow conduction and prolong repolarization.
What are class 1A drugs used for?
SVT, V Tach, PVC/s, Atrial Flutter, Atrial Fib - a lot of EXTRAVENTRICULAR rhtyhm’s.
What are some things to watch for in someone on Class 1A drugs?
Monitor for systemic lupus syndrome, blood dyscrasias, make sure QRS doesn’t get too wide.
What is a class 1B drug? What do they do?
Lidocaine - it shortens repolarizations/treats ventricular dysrhythmia’s
What dysrhythmia’s do we use lidocaine for? How long?
Used in the short term for V Tach, PVC’s and V Fib
What do we monitor for with IB Drugs?
CNS effects (drowsiness, decreased LOC, seizures), respiratory, etc.
What does Class IC do?
Slow conduction and widen the QRS complex
What are class 1C drugs used for?
Treating A Fib, PSVT, life threatening ventricular dysrhythmia’s.
What drugs are class 1C?
Flecainide acetate, propafenone hydrochloride, moricizine.
What are some side effects of 1C drugs?
Bradycardia, hypotension, heart failure, worsened or new dysrhythmia’s.
Which drugs are Class 2?
Beta blockers.
What do beta blockers do? Used for?
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.
What are some examples of beta blockers?
Acebutolol, esmolol, propranolol, sotalol
What are some side effects of beta blockers?
Dizziness, fatigue, hypotension, bradycardia, heart failure, dysrhythmia’s, heart block, bronchospasms, GI upset.
Should we check the HR/BP before giving a beta blocker?
YES. HR above 60 and Systolic above 90.
What are class 3 drugs?
Potassium channel blockers
What are some examples of class 3 drugs?
Amiodarone, bretylium, dofetillide, ibutilide fumarate
What do class 3 drugs do?
Convert a-fib, prevent or treat life threatening ventricular dysrhythmia’s (PVC’s, V tach, vfib)
What do we watch for with Class 3 drugs?
Pulmonary toxicity, bradycardia and AV blocks, visual disturbances, photosensitivity
What are class 4 drugs?
Calcium Channel Blockers
What do class 4 drugs do? Used for?
depress the automaticity of the SA and AV nodes (slows the HR). They are used for atrial fib and flutter, and SVT
What are a few examples of class 4 drugs?
Verapamil, Dilitiazem
What are some side effects of Class 4 drugs?
Heart failure, bradycardia, hypotension
What is an endogenous glucoside used for?
Decreases electrical conduction through the AV node (interrupts extra pathways) - Paroxsymal SVT, wolf-Parkinson-white
What are some examples of an endogenous glucoside?
Adenosine, Covert
What are some endogenous glucoside side effects? How long does it last for?
Sinus brady, dyspnea, flushing of face - it has a very short half-life (1 minute) so side effects can disappear quickly!
what does lanoxin do?
Increaes vagal tone (slows conduction) - used for CHF, a-fib, a-flutter, PSVT.
What are some side effects of lanoxin? What happens if there is bradycardia?
N/V, yellow vision - brady might mean toxic levels have been reached!
Hypokalemia and renal dysfunction decrease risk for lanoxin toxicity - T/F?
FALSE - they increase the risk.
What are some interventions with antidysrhythmics?
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.
what are some vagal maneuvers?
Valsalva maneuver, coughing, gagging, immersing your face in cold water, blowing hard, carotid sinus massage
What is cardioversion? What is it used for?
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.
Is cardioversion elective?
YES - so get consent.
Cardioversion - synchronized with the ___ wave.
R wave.
What are some pre-op things to do for cardioversion?
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.
What are some post-op things to do for cardioversion?
Document the procedure, monitor EKG, diet as tolerated, assess LOC, etc.
Defibrillation - what strength is it?
200-360 joules.
What is defibrillation used for?
Unconscious V-Tach, V-Fib
Before defibrillation, should we remove Nitro paste or any gels on chest?
YES
What do we chart after defibrillation?
Observe/document rhythm, number of defibrillations, energy settings, post-defib vitals, etc.
What’s an ICD?
Implantable defibrillator!
After having a defibrillator implanated, what should the pt. do?
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.
What are some different types of defibrillators? (3)
Abdominal ICD, Transvenous ICD, S-ICD (Subcutaneous ICD)
What does the S-ICD do?
Sub-Q - It converts V-Tach to V-Fib - no leads and no risk for infection!
What are three types of PACING for pacemakers?
External (emergency situation), Transvenous (temp or permanent), Epicardial (post CABG)
If HR is slower than the set limit for the pacemaker, what is happening?
The pacemaker went on vacation and is not working.
What is the pacemaker sensitivity?
Minimum electrical activity that is needed by the pacemaker (mV)
What is the pacemaker voltage?
Power required to stimulate the electrical activity of the heart
What’s synchronous pacing?
Pacemaker Sees patients heart rate and only paces when needed.
What is asynchronous pacing?
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.
Wide QRS - is it expected a lot with a pacemaker?
Yes
What is VVI Pacemaker pacing?
Ventricle Sensed
Ventricle Paced
Inhibited
What is pacemaker DDD pacing?
Dual sensed
Dual paced
Dual triggered and inhibited
Pacemaker - what are some things to tell patients afterwards?
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.
