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antidysrhythmic drug

pharm exam 3

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
Created by: 1818554924