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antidysrhythmic drug
pharm exam 3
| Question | Answer |
|---|---|
| define dysrhythmia | irregularities in heart rate or rhythm |
| origin of normal pulse impulse | SA node to atria; AV node to ventricle |
| define automaticity | hearts ability to generate electrical impulse |
| What node in the heart has a high degree of automaticity? | SA node |
| describe Ca-respondent cells | slow channels; located in SA/AV nodes; take longer to recover |
| describe Na-respondent cells | fast channels; depolarization of atria and ventricles |
| define excitability (aka: irritability) | ability of cardiac muscle cells to respond to electrical stimulus |
| What must occur for contraction to be produced? | electrical stimulus must reach certain intensity (threshold) |
| what happens after contraction? | decrease excitability (refractory) cannot respond to another stimulus |
| 3 problems with automaticity | sinus bradycardia; straining; sinus tachycardia |
| define sinus bradycardia | heart rate is too slow |
| define straining | increased parasympathetic (vagus) stimulation |
| define sinus tachycardia | heart rate is too fast (100-160 bpm) |
| what causes sinus tachycardia | sympathetic stimulation, stress, inflammation, irritable tissue |
| define ectopic | impulse from other than SA node |
| effects of ectopic | ventricular tachycardia; premature ventricular contraction |
| causes of ectopic | ischemia, stimulants, lack of sleep |
| define conductivity | ability of cardiac tissue to transmit electrical impulse |
| Conductivity in the heart occurs like what common day event | dominoes |
| define re-entry excitation | block in normal conduction pathway |
| types of dysrhythmias | sinus, atrial, ventricular |
| define sinus dysrhythmias | impulse originates in SA node; only significant if severe or prolonged |
| define atrial dysrhythmia | ectopic site(s) replace SA node as pacemaker |
| define ventricular dysrhythmia | impulse forms in ventricle |
| What is the most serious class of dysrhythmia? | ventricular - needs immediate attention; can impair pumping ability of hear |
| Actions of dysrhythmic agents | reduce automaticity; increase threshold; prolonged refractory period; slow conduction velocity; adrenergic blocking |
| describe reduce automaticity action of dysrhythmic agents | act on membrane of ectopic pacemakers: influx of sodium and calcium ions |
| describe increase threshold action of dysrhythmic agents | ectopic pacemakers spontaneously depolarizes until threshold is reached; drugs elevate the threshold from 60-30; delays the time required for ectopic pacemaker to spontaneously deplarize |
| describe prolonged refractory period action of dysrhythmic agents | time following depolarization in which pacemaker incapable to being excited |
| describe slow conduction velocity action of dysrhythmic agents | inhibit rapid influx of sodium into cells (needed to depolarize) |
| describe adrenergic blocking action of dysrhythmic agents | inhibit adrenergic influence on heart |
| class IA sodium channel blockers action (2) | inhibit fast sodium channels; suppress pacemaker |
| how do class IA sodium channel blockers inhibit fast sodium channels? | decrease refractory period; decrease rate of depolarization; increase threshold for excitability; decreased conduction |
| How do class IA sodium channel blockers suppress pacemaker? | slow atrial and ventricular conduction |
| what type of medication is quinidine (Auinaglute, cardioquin)? | class IA sodium channel blocker; antimalarial drug |
| 3 actions of quinidine (Auinaglute, Cardioquin) | depresses heart excitability; slow conduction; suppress pacemaker |
| Therapeutic uses of quinidine (Auinaglute, Cardioquin) | atrial flutter, fibrillation, tachycardia |
| Kinetics of quinidine (Auinaglute, Cardioquin) | oral (mainly long term), IM, IV |
| GI side effects of quinidine (Auinaglute, Cardioquin) | n/v diarrhea |
| cardiac side effects of quinidine (Auinaglute, Cardioquin) | hypotension, heart block, asystole |
| Hypersensitivity side effects of quinidine (Auinaglute, Cardioquin) | cinchonism (bark of cinchona) |
| What can happen with high doses of quinidine (Auinaglute, Cardioquin) | tinnitus, thrombocytopenia |
| contraindication for quinidine (Auinaglute, Cardioquin) | heart block |
| Nursing considerations for quinidine (Auinaglute, Cardioquin) | inspect oral cavity, watch for interactions |
| What type of medication is lidocaine | class 1b sodium channel blocker; local anesthetic |
| What emergencies would lidocaine be used? | slows spontaneous firing or ectopic ventricular rhythm; does not slow rate of conduction (AV), little on atria or cardiac output |
| Therapeutic uses for lidocaine | ventricular arrhythmia (PVC) |
| Kinetics of lidocaine | IV only, |
| onset and duration of lidocaine | onset immediate; duration 10-20 minutes; may need loading dose |
| side effects of lidocaine | drowsiness, lightheaded, hot/cold sensation; numbness of lips/tongue; confusion; hypotension; bradycardia |
| What type of medication is flecainide (Tambocar)? | class 1 c sodium channel blockers |
| flecainide (tambocar) action | decrease conduction in ventricles |
| flecainide (tambocar) uses | prevention or treatment of sustained ventricular dysrhythmias |
| flecainide (tambocar) side effects | increase rate of sudden cardiac death; use only in life threatening dysrhythmias |
| Class II beta-adrenergic blocking agents action | block catecholamine from SNS; slow heart rate; decreases force of conduction; slows AV conduction |
| How do class II beta-adrenergic blocking agents slow heart rate? | decrease SA node rate |
| uses for class II beta-adrenergic blocking agents | slow ventricular arrhythmias, tachycardia |
| What type of medicaiton is Propronol (Inderal) | class II beta-adrenergic blocking agent |
| Kinetics for propronol (inderal) | po, IV |
| propronol (inderal) side effects | dizziness, fatigue, hypotension, bradycardia, heart block, bronchospasm, impotence |
| How class III potassium channel blockers act | slow depolarization/prolong refractory period |
| What type of medication is amiondarone (Cordarone) | class III potassium channel blocker |
| amiondarone (cordarone) kinetics | po, IV |
| What type of medicaiton is bretylium (Bretylol) | class III potassium channel blocker |
| Kinetics for bretylium (Bretylol) | IV |
| Side effects of class III potassium channel blockers | hypotension, bradycardia, n/v, several drug interactions |
| Class IV calcium channel blocker action | reduce automaticity of SA node and ectopic pacemakers, slows conduction through AV |
| Class IV calcium channel blocker uses | atrial dysrrhythmias |
| What type of medication is verapamil (Calan) | class IV calcium channel blocker |
| what type of medication is amlodipine (Norvasc) | class IV calcium channel blocker |
| What type of medication is nifedipine (Procardia) | class IV calcium channel blocker |
| What type of medicaiton is diltiazem (Cardizem) | class IV calcium channel blocker |
| side effects of class IV calcium channel blockers | dizziness, hypotension, edem, constipation, muscle ache, gum hyperplasia (Procardia) |
| What side effect is unique to Procardia in class IV calcium channel blockers? | gum hyperplasia |
| What interaction occurs with class IV calcium channel blockers and digitalis (digoxin)? | causes increased toxicity |
| What interaction occurs with class IV calcium channel blockers and beta-blockers/antihypertensives | decreases BP |
| What type of medicaiton is atropine? | cholinergic blocker |
| What is atropine used for? | bradycardia arrhythmias |
| Dynamics of atropine | block action of vagus |
| side effects of atropine | heart block, CODE situations |
| nursing considerations for atropine | always check apical pulse and BO |
| Diagnostic tools to detect dysrrythmias | assess lab values; kinetics; electrolytes (sodium/potassium); liver function |
| vital signs to check with antidysrrhythmic drugs | BP, AV pulse, arrhythmias, dyspnea, chest pain, mental confusion, syncope |
| therapeutic considerations for patients on antidysrrhytmic drugs | keep supine or elevate HOB slowly, ambulate slowly, administer meds with means to GI upset, give meds on pump |
| Teaching for patients on antidysrrythmics | avoid caffeine, alcohol, smoking, heavy meals; take own pulse/BP; know action and SE of drugs; don't stop suddenly |
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