Chapter 41: Drugs to Treat Hypertension, Chapter 42: Drugs to Treat Heart Failure, Chapter 43: Antidysrhythmics Flashcards
drugs to tx HTN
Diuretics
Beta Blockers: Metoprolol tart, atenolol
ACEi and ARBs
CCB (negative inotropes)
drugs to tx HF
ACEi and ARBs
Diuretics
Digoxin*
Beta Blockers:
Carvedilol (Coreg)
Bisoprolol (Zebeta)
SR metoprolol succinate (Toprol XL)
1st line for Antidysrhythmias
BB
1st line for HF
ACEI
Digoxin
A cardiac Glycoside
dig uses
Use: Indicated for HF and antidysrhythmic
Due to toxicity, it is considered a second line treatment for HF
Dig MOA
Positive inotropic increasing myocardial contractility
decrease rate
Dig safety and monitoring
Monitor pulse, report any changes in rate or irregularities. Hold med if HR< 50 (anywhere from 50-60)
dig SE
Hypokalemia, elevated dig levels (0.5-2.0), dysrhythmias, dig toxicity
dig drug interactions
diuretics, ACEi and ARBs
dig toxicity
yellow, white, green spots in vision, N/V, <50-60 bpm (excite vagus nerve)
dig and K
K and Dig inversely proportionate
dig prescribing considerations
Therapeutic Goal: To treat dysrhythmias and HF
Baseline Data: EKG, electrolytes and kidney function
Identify High Risk Patients: Caution with renal insufficiency and hypokalemia
Evaluating Therapeutic Effectiveness: Assess for reduction In orthopnea, dyspnea on exertion, JVD, edema, and crackles.
Minimizing Adverse Effects: Teach patient to report early signs of hypokalemia and to inform the provider regarding signs of toxicity, including visual disturbances or nausea and vomiting
2 basic types of dysrhythmias
Tachy dysrhythmias
Brady dysrhythmias
Dysrhythmia- Abnormal heart rhythm
antidysrythmic SE
Pro arrhythmic*
Drugs cause dysrhytmias
Only employ when benefit outweighs risk
Antidysrhythmic tx to replace medications
Ablation and implantable defibrillators
Class I antidysrhythmics
NA channel blockers
Separated by strength. Block Na influx into cardiac cell. Ex. Lidocaine used to treat ventricular dysrhythmias.
A: quinidine, procainamide , disopyramide. use for maintenance of NSR after conversion of a fib or a flut. TX of symptomatic PVCs, SVT, and VT, prevention of v fib,.
B: lidocaine, mexietine. use for tx of symptomatic PVCs and VT, prevention of v-fib.
C: flecainide and propafenone. use for tx of symptomatic PVCs and VT; prevention of v fib.
Class II antidysrhythmics
beta blockers
ex. propanolol, acebutolol, esmolol, sotalol
Block K from reentering the cell at the end of AP.
Used for atrial dysrhythmias. Any atrial tachycardia –SVT, a fib, a flut
class III antidysrhythmics
K channel blockers
block K from leaving the cell in AP.
ex/ amiodarone, dofetilide, ibutlide, sotalol
Amiodarone is used to treat ventricular dysrhythmias like v tach and v fib. Maintenance of NSR. Also a fib an a flut when other atrial medications like BBB or CCB don’t work.
Blocks K from leaving cell in AP -> decrease excitability of cell.
class IV antidysrhythmics
calcium channel blockers
block calcium influx into cells.
ex. ditilizem and verapamil
used to tx SVT
unclassified antidysrhtymics
dig, adenosine, Mag
tx of tachydysrhythmias
adenosine -SVT
mag -torsades de pointes
lido uses and dosages
stable VT: 1-1.5 mg/kg IV/IO + 0.5-0.75 mg/kg Q5-10min; 1-4 mg/min infusion after rhythm corrected
pulseless VT/VF: 1-1.5 mg/kg IV/IO + 0.5-0.75 mg/kg Q5-10min; 1-4 mg/min infusion after return of perfusion
status epilepticus: off label. 2 mg/kg IV, wait 2 min then 0.5 mg/kg IV, then 30ug/kg/min continuous IV
lido SE
CV depression, resp depression, audiovisual disturbance, dizziness, sz, MH, methemogloibmia, lethargy, nausea (common)
lido contraindications
hypersensitivity
amide anesthetic HS
adams-stokes
WPW
severe SA/AV/IV block
lido preg category
B
lido MOA
inhibit NA conduction. decrease AP initiation and propagation. cardiac and neuronal membrane stabilized.
lido metabolism
hepatic, active metabolites CYP1A2/2A4 substrate, CYP2D6 inhibitor
lido 1/2 life
1.5-2h
lido excretion
renal
lido cost
$4.59/mL 1% lido vial
lido toxicity
Slurred speech or difficult speech. paresthesia, numb of lips and tongue.
Altered CNS. drowsiness, dizziness, arrhythmias, restlessness, confusion
Muscle twitching. tremors
Seizures. convulsions, resp depression, resp and cardiac arrest
antidysrhythmic nonmonic
sure (S = class I) beats (B = II) picking (P = III) corn (C = IV)
Sotolol
BB and PCB
pro-arrhythmic
asso with torsades de pointes
amiodarone
lipophilic
slow HR and AV node conduction
block K channels -delays repolarization, prolong AP and effective refractory period.
Effective against both atrial and ventricular dysrhythmias
amiodarone serious toxicities
Lung: pulmonary fibrous. If on ami long-term, need CXR every year dt chance of lung scarring
Eyes: corneal microdeposits. Causing visual disturbance. Need yearly eye exam.
Thyroid: can cause issues, need T3, T4, and TSH every year.
Liver: toxic. r/o cirrhosis. Need LFT every year.
Skin: blue hue. Especially in sun. Photosensitivity.
CV: Sinus bradycardia.
amiodarone prep
oral and IV
amiodarone drug interactions
lots
esp grapefruit juice
torsade’s de pointes
Monitor QT intervals to monitor ventricular depolarization and repolarization. As this prolongs, can cause TDP –QRS axis swings f or positive to negative direction in single lead.
Treat TDP with Mag
some causes:
precipitated by drugs that prolong QT interval
Class IA and IC antidysrhtmics
cyclic AD
droperidol
dofetilide
sotalol
phenothiazines
erythromycin
methadone
E disorders (hypoMag, hypo K)
general antidysrhythmic SE
all can cause dysrhythmias
HS reactions: N/V/D, dizziness, blurred vision, HA
