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NURP 423 > Exam 1 - Week 3 - Dysrhythmias > Flashcards

Exam 1 - Week 3 - Dysrhythmias Flashcards

1
Q

When do you choose rate control?

A

Class 2 & 4
Use AV nodal agents
Asymptomatic
Without CHF

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2
Q

When do you choose rhythm control?

A

Class 1 & 3
Interfering cellular level, interfering electrical/pharm
symptomatic, with CHF

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3
Q

What is class 1?

A

Na channel blockers

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4
Q

What is class 1a?

A

quinidine, procainimide, disopyramide

Older meds, rarely used

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5
Q

What rhythms are class 1a drugs used for?

A

ventricular arrythmias, recurrent afib, WPW syndrome

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6
Q

What is class 1b?

A

lidocaine, phenytoin, Mexiletine

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7
Q

What rhythms are class 1b drugs used for?

A

MI (discouraged now)
Cause asystole, vtach, and afib
Used by specialist only

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8
Q

What is class 1c?

A

flecainide, propafenone

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9
Q

What is class 1c used for?

A

Doesn’t affect action potention (no shift)

Prevents paroxysmal afib, tx of recurrent tachy, contraindicated post MI

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10
Q

What labs do you want with class 1c?

A

LFTs, CBC, ANA, kidney fx, urine pH (affects drug excretion)

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11
Q

What diagnostic test do you want with class 1c?

A

EKG–look at QRS

Should see 10% increase to know drug is effective

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12
Q

Special considerations for admin of class 1c?

A

Use with AV nodal agents (BB and CCB)

Without use of AV nodal agent you can contribute to ventricular rhythm which can be fatal

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13
Q

What are class 2 drugs?

A

Beta-Blockers

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14
Q

How do class 2 drugs work?

A

Decrease conduction through AV node and block catecholamine response

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15
Q

What do class 2 drugs treat?

A

SVT (atrial tachy)

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16
Q

Name four class 2 drugs.

A

Atenolol
Metoprolol (tartrate & succinate)
Nadolol
Propranolol

17
Q

What do class 2 drugs do?

A

Control rate and rhythm

18
Q

Can class 2 drugs be used alone?

A

Effective as monotherapy

19
Q

What are class 3 drugs?

A

K+ channel blockers

20
Q

What is the MOA of class 3 drugs?

A

Block K+prolong repolarization

21
Q

What is different about the class 3 drug sotalol?

A

It is a beta blocker and does not convert

22
Q

Name four class 3 drugs

A

Amiodarone, sotalol, dofetilide, drondedarone

23
Q

What is significant about class 3 drugs?

A

Pt needs to stay in hospital to observe for side effects before discharge

24
Q

What are special considerations for dofetilide?

A

If you miss a dose, do NOT double, take next dose.

If you miss a dose again, go to the hospital to start over. Compliance is important.

25
Q

What is significant about drondedarone?

A

BLACK BOX WARNING–contraindicated in NYHA stages II-IV.

Contributes to HF and death in stage 2 & 3

26
Q

What is significant about amiodarone?

A

Best drug for afib.

Can turn patient’s skin blue

27
Q

What labs do you monitor with amiodarone?

A

TSH, LFT, BMP (can damage, lungs, liver & thyroid)

28
Q

What are class 4 drugs?

A

Calcium Channel Blockers

29
Q

What is MOA for class 4 drugs

A

Decrease conduction through AV node -shorten Phase 2-plateau- (shorten Action Potential)

Allow adrenergic control of HRT and contractility

30
Q

Why is class 4 questionable in HF?

A

Decreases contractility of heart

31
Q

What are nondihydropyridines?

A

Older class, more antianginal properties, minimal effect on BP, negative inotropic effect, constipation

Verapamil and diltiazem

32
Q

Special considerations for diltiazem?

A

Not as many AE as BB
Good negative inotropic effect
Can cause constipation in elderly

33
Q

What drugs are in class 5?

A

Digoxin, mag sulfate, adenosine

34
Q

Digoxin

A

Decreases conduction through AV node
Increases Vagal activity
Action is central-on CNS

35
Q

Adenosine

A

Resets heart, 2 doses of 6mg

ED to convert SVT, AVRT, AVNRT

36
Q

Mag Sulfate

A

Torsades de pointes

NURP 423 (16 decks)

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