Rhythm Pharm Flashcards
Rate and Rhythm Control
Beta blockers CCB Amiodarone Adenosine Atropine Dofetilide
Beta blockers + CCN: Goal
HR < 100 BPM + Regular Sinus Rhythm
Amiodarone: MOA
Prolongs the AP duration and the effective refractory period in ALL cardiac tissues
Blocks Alpha + Beta adrenergic receptors in the SNS
-Helps convert rhythms
Amiodarone: Route
IV or PO
Amiodarone: Indication
One of the most effective antidysrhythmic for PSVT and ventricular dysrhythmias also used for AFIB and RVR
PSVT: Paroxysmal supraventricular tachycardia: Fast rhythm that happens from “time to time” that originates above the ventricles.
Amiodarone: AE
LOTS 75% have AE -Thyroid alterations (contains iodine) -Corneal microdeposits (fat) -Pulmonary toxicity (fatal in 10%) -Black BOX: PULMONARY TOXICITY , hepatotoxicity, and pro-arrhythmic effects
Amiodarone: Interactions
Digitoxin + Warfarin
- increases digitoxin levels by 50%
- Increases INR by 50-100%
- Warfarin + amiodarone = Bleeding!
EXTREMELY long half-life (many days!)
-if someone has adverse effects, may take 2-3 months for them to fully go away
CONTRAINDICATED w/severe bradycardia or heartblocks
Amiodarone: Contraindications
- Severe Bradycardia
- Heart blocks (type of rhythm)
Treatment for Sinus Brady
Atropine
Atropine: Class
Anticholinergic/Antimuscarinic
Atropine: MOA
Poisons vagal nerve
-inhibits postganglionic acetylcholine receptors and direct vagolytic action
(stimulant action)
Atropine: Route
IV push ONLY for bradycardia
- 1 mg every 3-5 mins, 3 mg MAX
- Only works for 28% of bradycardia cases
- Must be vagal induced bradycardia!
Atropine: SE
(Anticholinergic effects) Xerostomia blurry vision photophobia Tachycardia Flushing Hot skin
Atropine: Nursing Implications
Need to be on cardiac monitoring, if doesn’t work quickly, give a SECOND dose
Treatment of PSVT
Adenosine
Adenosine: MOA
Slows conduction time through the AV node
VERY SHORT HALF-LIFE
-may need multiple doses
Commonly causes a short burst of asystole until sinus rhythm returns
Adenosine: SE
Other than Burst of Asystole (flatline), Very few
Adenosine: Route
ONLY IV
Adenosine: Administration
6mg IVP, if not converted give 12mg IVP, can give 3rd time 12mg IVP
- always follow with rapid normal saline flush or 2 saline flushes
- Uses syringe and 3-way stopcock
Dofetilide (Tikosyn): Class
Antidysrhythmic
Dofetilide (Tikosyn): Indications
Conversion from AFIB/aflutter to NSR (Normal sinus rhythm)
Dofetilide (Tikosyn): MOA
Selectively blocking the rapid cardiac ion channel carrying potassium currents
Dofetilide (Tikosyn): SE
TORSADE's SVT Headache Dizziness Chest pain
Dofetilide (Tikosyn): Nursing implications
Started in-hospital with ECG monitoring due to risk of Torsade’s (Black Box Warning)
-Don’t give to patients with long QT intervals or with other drugs that may prolong QT intervals
Torsade’s
A type of VTACH
-Deadly Rhythm, start CPR!
Warfarin Stuff
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