Miscellaneous Heart Medications-MJ

Question 1

Describe the Vaughan Williams classification system for antidysrhythmic drugs.

Answer 1

Class I: Sodium Channel Blockers
Class 2: Beta Blockers
Class 3: Potassium Channel Blockers
Class 4: Calcium Channel Blockers
Other antidysrhythmic drugs: amiodarone and digoxin

Question 2

Why is the use of antidysrhythmic drugs declining?

Answer 2

Benefits are limited to symptomatic relief; the risk of toxicity is substantial

Question 3

What is the most common sustained dysrhythmia?

Answer 3

A-fib

Question 4

What is a-fib caused by?

Answer 4

Multiple atrial foci firing randomly, each contracting their local area of the atrium–results in a chaotic and irregular rhythm atrial rhythm

Question 5

A-fib may cause an increased risk for ____ due to potential for _____ developing in the heart from this rhythm.

Answer 5

Stroke, blood clots

Question 6

What fibrillation is a life threatening emergency that requires immediate treatment?

Answer 6

Ventricular fibrillation

Question 7

How does ventricular fibrillation occur?

Answer 7

Many different foci firing sporadically, each contracting their local areas of the ventricle–results in localized twitching taking place all over the ventricles, making coordinated ventricular contraction impossible!

Question 8

What does PVC stand for?

Answer 8

Premature ventricular complexes

Question 9

What are PVCs?

Answer 9

Beats that occur before they should in the cardiac cycle

Question 10

How are PVCs causes?

Answer 10

Ectopic ventricular foci–perhaps one or several foci

Question 11

Are PVCs a cause for concern?

Answer 11

No, UNLESS they are accompanied with additional signs of heart disease

Question 12

What is atypical, rapid, undulating ventricular tachydsrhythmia that can evolve into potentially fatal ventricular fibrillation?

Answer 12

Torsades de pointes

Question 13

What is the main factor associated with development of torsades?

Answer 13

Prolongation of the QT interval

Question 14

What are some drugs that prolong the QT interval?

Answer 14

Class IA and class III antidysrhythmic agents

Question 15

How do you acutely manage torsades de points?

Answer 15

IV magnesium plus cardioversion for sustained ventricular tachycardia

Question 16

What class of anti-dysrhythmias are amiodarones?

Answer 16

Primarily Class III (K+ channel blockers)..but it works on all of the classes

Question 17

Is amiodarone lipid soluble or polar?

Answer 17

HIGHLY lipid soluble

Question 18

Does amiodarone have a short or long half life?

Answer 18

LONG–like 25-110 days long

Question 19

T/F: Amiodarone has severe adverse effects.

Answer 19

True

Question 20

What are the 6 adverse effects that may happen when taking amiodarone?

Answer 20

1. Pulmonary fibrosis
2. Dysrhythmias
3. Hypo/hyperthyroidism
4. Hepatotoxicity
5. Optic neuropathy
6. Photosensitivity

Question 21

Amiodarone: Adverse effect pulmonary fibrosis…What baseline data do we need to get to be able to monitor this effect?

Answer 21

Baseline chest x-ray and pulmonary function test; monitor throughout treatment

Question 22

Amiodarone: Adverse effect dysrhythmias..What should be checked often and why?

Answer 22

Have blood levels checked often because of the risk of dysrhythemias with low or high levels; do not use if pre-existing HF

Question 23

Amiodarone: Adverse effect hypo/hyperthyroidism.. What should be checked before giving this drug?

Answer 23

Baseline thyroid function test before and monitor thyroid levels closely

Question 24

Amiodarone: Adverse effect hepatoxicity..What should be checked before giving this drug?

Answer 24

Check baseline liver function test before and monitor liver function levels closely

Question 25

Amiodarone: Adverse effect optic neuropathy…what can this lead to? What needs to be checked prior to giving the drug?

Answer 25

Can lead to blindness; obtain ophthalmic tests at baseline and periodically thereafter

Question 26

Amiodarone: Adverse effect photosensitivity..What do we need to teach the client?

Answer 26

Wear sunscreen or protective clothing, can make skin turn bluish grey

*if patients skin turns bluish grey, after stopping the drug it can take months before the discoloration goes away

Question 27

Amiodarone is __% iodide.

Answer 27

40%

Question 28

Discuss the latest research regarding incidence of amiodarone hypersensitivity in patients with previous allergy to iodine.

Answer 28

Iodine is an atom which means its too small to be allergic too. People who claim to be allergic to iodine may not actually be allergic to it, but sensitive to something that the iodine is apart of.

Question 29

What are the two major indications for digoxin therapy?

Answer 29

HF (blocks the Na-K-ATPase pump so it causes increased contractility)

Dysrhythmias (stimulates the vagus nerve, which releases an increased amount of Ach [parasympathetic], so it slows down the HR)

Question 30

Does digoxin have a wide or narrow therapeutic range?

Answer 30

NARROW

Question 31

What is the therapeutic range for digoxin?

Answer 31

0.5-0.8 ng/mL

Question 32

What if the digoxin levels are below 0.5 ng/mL?

Answer 32

The underlying dysrhythmia will continue

Question 33

What if the digoxin levels are above 0.8 ng/mL?

Answer 33

Toxicity will result

Question 34

What are the EARLY sings of digoxin toxicity?

Answer 34

Anorexia
Nausea
Vomiting

Question 35

What are the LATE sings of digoxin toxicity?

Answer 35

Dysrhythmias
Visual changes (yellowing and "halos")
Mental status changes (can progress to coma)

Question 36

Both K and digoxin compete for the same sites of action. A normal K level is 3.5-5.0. What happens if someone who is taking digoxin has a K level is above 5?
What happens if someone who is taking digoxin has a K level below 3.5?

Answer 36

Above 5: Less digoxin binds to the Na-K-ATPase pump–>reduced therapeutic responses

Less than 3.5: More digoxin binds to the Na-K-ATPase bump–>toxicity

Question 37

If your patient is to take digoxin, what needs to be done FIRST? Then what else will need to be done?

Answer 37

FIRST: Check the apical pulse (hold if HR below 60)

• Watch for early signs of toxicity (Anorexia,N/V)
• Monitor digoxin and K levels

Question 38

If a patient is on digoxin, what can we teach them so they would know their K levels are too low?

Answer 38

They may experience muscle cramps and/or heart alterations

Question 39

Digoxin is effective in treating the symptoms of HF, but does not prolong a client’s life. Why?

Answer 39

It helps to reverse the issues of HF, but doesn’t change the underlying cause of HR and may actually shorten the life of women!

Question 40

Why do people who take digoxin also take an ACE?

Answer 40

ACE inhibitors are cardioprotective!