Class IV Antiarrhythmic Flashcards
Diltiazem
Verapamil
Block the movement of calcium ions across the cell membrane, depressing the generation of action potentials and delaying phases 1 and 2 of repolarization, which slows automaticity and conduction
THERAPEUTIC ACTION
How does this drug work in our body?
Block the movement of calcium ions across the cell membrane
Depressing the generation of action potential
Delaying phases 1 and 2 of repolarization
Slow conduction through the AV node
INDICATIONS
Why are we diving this drug?
Supraventricular tachycardia (SVT)
Control the ventricular response to rapid atrial rates
CONTRAINDICATION
When NOT to give the drug
Allergy sick sinus syndrome heart block pregnancy and lactation, CHF hypotension
CAUTION
Idiopathic hypertrophic subaortic stenosis, renal and liver impairment
ADVERSE EFFECTS
Dizziness weakness fatigue depression GI upset hypotension CHF and shock
DRUG-DRUG INTERACTIONS
Many drug-to-drug interactions
PROTOTYPE
Diltiazem
OTHER DRUGS TO TREAT ARRHYTHMIAS
Adenosine
Used to convert supraventricular tachycardia to sinus rhythm when vagal maneuvers have been ineffective
Digoxin
Slows calcium from leaving the cell, prolonging the action potential and slowing conduction and heart rate
Dronedarone
Used to reduce risk of hospitalization in patients with paroxysmal or persistent AF or flutter who have risk factors for CVD and are in sinus rhythm or scheduled to be converted to sinus rhythm
NURSING CONCIDERATIONS FOR ALL THIS CLASS
ASSESMNET
History and physical exam Known allergy Impaired kidney or liver function heart block HF hypotension shock respiratory dysfunction electrolyte disturbances Pregnancy and lactation neurological and cardiac status respirations baseline ECG appropriate lab values
NUSING DIAGNOSIS
Decreased cardiac output related to cardiac effects
Disturbed sensory perception related to CNS effects
Risk for injury related to adverse drug effects
Deficient knowledge regarding drug therapy
IMPLEMENTATION
Titrate the dose to the smallest amount needed to achieve control of the arrhythmia
Continually monitor cardiac rhythm when initiating or changing dose
Ensure that emergency life-support equipment is readily available
Administer parenteral forms as ordered only if the oral form is not feasible
Consult with the prescriber to reduce the dose in patients with renal or hepatic dysfunction
Establish safety precautions, including side rails, lighting, and noise control, if CNS effects occur
Arrange for periodic monitoring of cardiac rhythm when the patient is receiving long-term therapy
Provide thorough patient teaching
EVALUATION
Monitor patient response to the drug (stabilization of cardiac rhythm and output)
Monitor for adverse effects (sedation, hypotension, cardiac arrhythmias, respiratory depression, CNS effects)
Evaluate the effectiveness of the teaching plan
Monitor the compliance with the regimen
