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488 > Class 1 anti-dysrhythmic medications and cardiac glycosides (CV) > Flashcards

Class 1 anti-dysrhythmic medications and cardiac glycosides (CV) Flashcards

1
Q

Anti-dysrhythmics: General overview

A

-Classified as the Vaughan Williams classification
-Cardiac Action Potential in relation to NSR

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2
Q

Class I antidysrhythmic effects

A

-Membrane-stabilizing drugs
-Fast sodium channel blockers

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3
Q

Class Ia anti dysrhythmic drugs

A

-Disopryramide
-Quinidine
-Procainamide
-“mide” & “dine”; DQP

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4
Q

Class Ia anti dysrhythmic MOA

A

-Blocks Na+ channels
-Delays repolarization and prolongs action potential duration
-Affects phase 0

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5
Q

Class Ia anti-dysrhythmic effects

A

-Depress myocardial excitability, inotropic effect & ectopic foci stimulation
-Prolong refractory period

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6
Q

Class Ia anti-dysrhythmic indications

A

-Atrial fibrillation
-Premature contractions & ventricular tach
-Wolff-Parkinson-White syndrome

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7
Q

Class Ia anti-dysrhythmics: procainamide adverse effects

A

-Agranulocytosis
-SLE-like syndrome

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8
Q

Class Ia anti-dysrhythmic adverse events: quinidine

A

-Prolonged QT
-Anorexia
-Bitter taste, blurred vision, tinnitus

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9
Q

Class Ib anti-dysrhythmic drugs

A

-Lidocaine
-Mexiletine
-Phenytoin

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10
Q

Class Ib anti-dysrhythmic MOA

A

-Block Na+ channels
-They accelerate repolarization and decrease the action potential duration

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11
Q

Class Ib anti-dysrhythmic effects

A

-Decrease ventricular excitability

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12
Q

Class Ib anti-dysrhythmic indications

A

Ventricular dysrhythmias only:
-PVC, v-tach, v-fib

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13
Q

Class Ib anti-dysrhythmic adverse events: Lidocaine

A

-Bradycardia
-Metallic taste

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14
Q

Class Ic anti-dysrhythmic MOA

A

-Block Na+ channels
-Suppresses re-entry
-“C” suppress

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15
Q

Class Ic anti-dysrhythmic drugs

A

-Flecainide
-Propafenone
-PF

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16
Q

Class Ic anti-dysrhythmic effects

A

-Depression of conduction in the bundle of his-Purkinje system
-Have minimal effect on atrial conduction
-Flecainide: Reserved for the most serious dysrhythmias

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17
Q

Class Ic anti-dysrhythmic indications

A

-V-Tach, SVT, A fib, atrial flutter
-Wolff-Parkinson-White syndrome

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18
Q

Class Ic anti-dysrhythmic adverse events: Flecainide

A

-Dyspnea, dizziness
-Palpitations
-Visual disturbances
-N/V, diarrhea, weakness

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19
Q

Class Ic anti-dysrhythmics: propafenone (effect, indications & adverse effects)

A

-Prodysrythmic effect, angina, tachycardia, AV block
-Dizziness, dyspnea, fatigue

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20
Q

Class II anti-dysrhythmics: beta-blocker drugs

A

-Metoprolol
-Esmolol
-Acebutalol
-“lols”

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21
Q

Class II anti-dysrhythmics: beta blockers MOA

A

-Reduces spontaneous depolarization
-Block impulse transmission
-Affects phase 4

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22
Q

Class II anti-dysrhythmic: beta blocker effects

A

-Blocks beta-adrenergic heart stimulation
-Decrease atrial stimulation & ventricular contraction rate
-Decrease CO & BP

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23
Q

Class II anti-dysrhythmics: beta blockers indications

A

-SVT
-Ventricular dysrhythmias

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24
Q

Class II anti-dysrhythmics: beta blocker adverse effects

A

-AV block , HF
-Hyperglycemia, mask the symptoms of hypoglycemia
-Bronchospasm, wheezing, dry mouth
-Erectile dysfunction

25
Q

Class III anti-dysrhythmic drugs

A

-Amiodarone
-Dronedarone
-Sotalol
-Ibutilide
-AIDS

26
Q

Class III antidysrhythmic MOA

A

-Increase action potential duration by prolonging repolarization in phase 3
-Prescribed for difficult to treat dysrhythmias

27
Q

Class III anti-dysrhythmic effects

A

-Prolongs the refractory period & myocardial action potential
-Blocks both alpha and beta adrenergic stimulation

28
Q

Class III anti-dysrhythmic indications

A

-V-Tach or V-Fib
-Atrial fibrillation and flutter resistant to other drugs

29
Q

Class III anti-dysrhythmic adverse events (amiodarone)

A

-Pulmonary toxicity, thyroid disorders
-Bradycardia, hypotension
-SA node dysfunction, AV block, ataxia, QT prolongation, torsades de pointes
-Omitting, constipation
-Photosensitivity, visual disturbances
-abn Liver function tests, jaundice
-Hyperglycemia or hypoglycemia
-Toxic epidermal necrolysis, vasculitis, blue-grey colouring of the skin

30
Q

Class III anti-dysrhythmics: Ibutilide: Adverse events

A

-V-Tach, ventricular extra systoles, tachycardia, AV block
-Hypotension, headache, nausea

31
Q

Class III anti-dysrhythmic sotalol: Adverse events

A

-Chest pain, palpitations, dyspnea, bradycardia
-Fatigue, dizziness, weakness

32
Q

Class IV anti-dysrhythmic drugs

A

-Diltiazem
-Verapamil

33
Q

Class IV anti-dysrhythmic MOA

A

-Inhibit calcium channels and reduces the influx of calcium ions during action potentional
-Depression of phase 4 depolarization

34
Q

Class IV anti-dysrhythmic effects

A

-Prolong AV refractory period
-Reduce AV conduction
-Reduce rapid ventricular conduction caused by atrial flutter

35
Q

Class IV anti-dysrhythmic indications

A

-SVT
-Rate control for A-fib and flutter

36
Q

Class IV anti-dysrhythmic adverse events

A

-Constipation
-Bradycardia, heart block
-Hypotension, dizziness, dyspnea

37
Q

Unclassified anti-dysrhythmic: Adenosine MOA

A

-Slows the conduction time through the AV node

38
Q

Unclassified anti-dysrhythmic indications: Adenosine

A

-When SVT has failed with verapamil
-Pt has co-existing conditions such as HF, hypotension, or LV dysfunction

39
Q

Unclassified anti-dysrhythmic: Adenosine contraindications

A

-2nd or 3rd degree heart block
-Sick sinus syndrome
-Atrial flutter or atrial fib
-V-Tach

40
Q

Unclassified anti-dysrhythmic: Adenosine nursing considerations

A

Patients feel impending doom when administered, must be monitored with accessible airway, expect asystole prior to return to rhythm

41
Q

Cardiac glycosides: Digoxin MOA for conduction

A

Decrease in rate of conduction and a prolonged refractory period between the SA and AV node

42
Q

Cardiac glycosides: Digoxin MOA for contractility

A

-Increases contractility d/t the inhibition of the Na+-K+ adenosine triphosphatase pump leaving more sodium and calcium available enhancing contractility

43
Q

Cardiac glycosides: Digoxin effects

A

-Positive inotropic effect
-Negative chronotropic & dromotropic effect
-Reduction in heart size during diastole
-Decrease in venous BP and vein engorgement

44
Q

Cardiac glycosides: Digoxin effects cont’d

A

-Increase in coronary circulation
-Promotion of tissue perfusion and diuresis
-Decrease in dyspnea, cough, and cyanosis

45
Q

Cardiac glycosides: Digoxin indications

A

-A fib and systolic HF

46
Q

Cardiac glycosides: Digoxin contraindications

A

-2nd or 3rd degree heart block, a fib, v tach or fibrillation, HF resulting from diastolic dysfunction
-Subaortic stenosis
-Reduced kidney function

47
Q

Cardiac glycosides: Digoxin adverse effects (CV)

A

-Bradycardia, tachycardia, HTN

48
Q

Cardiac glycosides: Digoxin adverse effects (CNS)

A

-Headache, fatigue, confusion, convulsion

49
Q

Cardiac glycosides: Digoxin adverse events (visual)

A

-Coloured vision, halo vision

50
Q

Cardiac glycosides: Digoxin adverse events (GI)

A

-Anorexia
-N/V
-Diarrhea

51
Q

Digoxin toxicity

A

-Toxic is > 2.0 g/L
-Low potassium and magnesium levels or decrease in kidney function may increase potential for toxicity
-Digoxin toxicity treatment may be to hold medication, treat the symptoms, or administer antidote which is digoxin immune Fab

52
Q

Digoxin drug to drug interactions

A

-Amiodarone, quinidine, verapamil (increase digoxin levels)

53
Q

Digoxin drug to food interactions

A

-Bran (decreases oral absorption of digoxin)

54
Q

Digoxin drug to natural health product interactions

A

-Ginseng (increases digoxin levels)
-St. John’s Wart (reduces digoxin levels)
-Hawthorne (increases digoxin effects)
-Licorice (increase risk for digoxin toxicity due to potassium loss)

55
Q

Digoxin use in pediatrics

A

-HF
-A one decimal point placement error will result in a 10-fold dosage error
-Watch for worsening heart failure: Increased fatigue, sudden weight gain, respiratory distress

56
Q

Anti-dysrhythmics and cardiac glycosides: Nursing considerations & patient teaching

A

-All anti-dysrhythmics can cause dysrhythmias
-Grapefruit juice: Amiodarone, Class Ia’s - Disopyramide, and quinidine

57
Q

Anti-dysrhythmics and cardiac glycosides: Prodysrhythmias clinical significance

A

-Antidysrhythmic drugs may cause life-threatening dysrhythmias
-Risk increases in presence of:
-Severe LV dysfunction
-Digoxin and class IA, IC, and III antidysrhythmia drugs

58
Q

Anti-dysrhythmics and cardiac glycosides: Prodysrhythmias treatment

A

-First several days of drug therapy represent the vulnerable period for development of prodysrhythmias
-Many oral antidysrhythmia drug regimens are initiated in a monitored hospital setting

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