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bsn 315
Class I Antidysrhythmic Therapy (Sodium Channel Blockers)
| Question | Answer |
|---|---|
| Class IA drugs | Disopyramide Procainamide Quinidine |
| Class IA drugs | slow the conduction rate and prolong repolarization. indicated for atrial and ventricular dysrhythmias and supraventricular dysrhythmias. |
| Class IB drugs | slow the conduction rate and shorten repolarization. indicated for acute ventricular dysrhythmias. |
| Class IB drugs | Lidocaine (prototype) Mexiletine Phenytoin |
| Class IC drugs | prolong conduction with little or no effect on repolarization. They are indicated only for life-threatening ventricular dysrhythmias. |
| Class IC drugs | Flecainide (prototype) Propafenone |
| Quinidine | Decrease myocardial excitability in the atria, ventricles, and His-Purkinje system Prolong recovery time (repolarization) Eliminate or reduce ectopic foci stimulation Decrease inotropic effect Have anticholinergic (vagolytic) activity |
| Quinidine Therapeutic Uses | Arrhythmias (atrial, ventricular, supraventricular) |
| Lidocaine | Decrease myocardial excitability in the ventricles Increase repolarization Have min effect on the sinoatrial (SA) node and automaticity Have min effect on the atrioventricular (AV) node and conduction Have min anticholinergic (vagolytic) activity |
| Lidocaine Therapeutic Uses | Ventricular arrhythmias Pulseless ventricular tachycardia |
| Flecainide | Produce dose-related depression of myocardial excitability, especially in the His-Purkinje system Have minimal effect on atrial conduction Eliminate or reduce ectopic foci stimulation in the ventricles Have minimal anticholinergic (vagolytic) activity |
| Flecainide Therapeutic Uses | reserved for the most serious dysrhythmias, secondary to risk of sudden cardiac death, such as sustained ventricular tachycardia and paroxysmal supraventricular tachycardia |
| Class IA antidysrhythmic drugs block primarily which channels? Sodium Potassium Calcium Magnesium | Sodium Class IA antidysrhythmic drugs block cardiac sodium channels. This slows the electrical impulses along the electrical pathway of the heart. |
| Which antidysrhythmic drug is indicated for atrial dysrhythmia? Flecainide Lidocaine Mexiletine Quinidine | Quinidine Quinidine is a Class IA antidysrhythmic drug indicated for atrial and ventricular dysrhythmias. |
| Which antidysrhythmic drug is indicated for pulseless ventricular tachycardia? Quinidine Flecainide Sotalol Lidocaine | Lidocaine is indicated for pulseless ventricular tachycardia. |
| Contraindications to the use of quinidine | hypersensitivity, thrombocytopenic purpura resulting from previous therapy, complete AV block, left bundle-branch block, intraventricular conduction defects, and torsades de pointes. |
| Drug-to-Drug Interactions quinidine | fluoxetine, flecainide, amiodarone, amitriptyline, erythromycin, sotalol, moxifloxacin, ondansetron, and statin drugs prolong QT intervals can double digoxin increase the anticoagulant effects of warfarin |
| Side effects of quinidine | headache, dizziness, bradycardia, and diarrhea |
| Contraindications and Interactions With Lidocaine | patients who are hypersensitive to it, who have severe SA or AV intraventricular block, or who have Stokes-Adams or Wolff-Parkinson-White syndrome |
| Drugs that interact with (alter the metabolism of) lidocaine | amiodarone, azole antifungals, beta blockers, erythromycin, verapamil, cimetidine, and tolvaptan. This leads to an increased serum level of lidocaine. |
| Contraindications and Interactions with Flecainide | Cardiogenic shock is an absolute contraindication. |
| The nurse is teaching Mr. A symptoms of cinchonism, which is related to quinidine toxicity. Which symptoms would the nurse include? Tinnitus Nausea Itching Visual disturbances Shortness of breath | Tinnitus Nausea Visual disturbances |
| The presence of which disease process constitutes a contraindication for quinidine antidysrhythmic therapy? Urinary tract infection Myasthenia gravis Atrial fibrillation Frequent premature ventricular contractions | Myasthenia gravis Quinidine is contraindicated in patients who are also adversely affected by anticholinergics, such as patients with myasthenia gravis. |
| Which outcome may be the result of a drug-drug interaction when quinidine and digoxin are administered concurrently? Tachycardia due to quinidine Increased dysrhythmia due to quinidine Digoxin toxicity Heart failure | Digoxin toxicity can occur if quinidine and digoxin are taken concurrently. Quinidine displaces digoxin, which increases serum digoxin. To reduce digoxin toxicity, the digoxin dose must be reduced. |
| The nurse will immediately alert the health care provider of which adverse outcome in a patient taking flecainide? Dizziness Decreased renal function Constipation Heart failure | Heart failure and worsening arrhythmias are adverse drug effects of flecainide. Assessment of these effects would constitute a reason for the nurse to alert the health care provider. |
| Which electrocardiogram (ECG) change will the nurse monitor for when a patient is being treated with quinidine? Widening QRS complex Widening PR interval Increasing height of the T-wave Inversion of the P-wave | Widening of the QRS prolongs the QT interval. This finding can be indicative of quinidine toxicity; therefore it is important for the nurse to monitor for this ECG change when a patient is being treated with quinidine. |
| The patient with which medical condition will most likely benefit from lidocaine administered intravenously? Acute ventricular tachycardia Deep laceration to the leg Atrial fibrillation Dental caries | Acute ventricular tachycardia |
| The nurse will monitor for which therapeutic effect while administering quinidine? Shortened repolarization Reduced blood pressure Decreased heart rate Reduced secretions | Decreased heart rate |
| Which time frame after administration of flecainide would the nurse expect the onset of action to occur? 15 minutes 3 hours 12 to 27 hours 1 to 2 days | 3 hours |
| Before administering quinidine, the nurse would assess the patient for which contraindication? Atrial fibrillation Complete heart block Atrial flutter Ventricular tachycardia | Complete heart block |
| Which symptom, if reported by a patient recently started on quinidine, would the nurse find most concerning? Headache Diarrhea Dizziness Shortness of breath | Shortness of breath |
| quinidine to be admin to pt to w ventricular dysrhythmia. Which dose of quinidine would cause the nurse to notify the health care provider before administering? 100 mg every 4 hours 324 mg every 8 hours 324 mg every 12 hours 648 mg every 8 hours | 100 mg every 4 hours |
| While administering lidocaine, the nurse will monitor for which adverse drug effect? Hypertension Tachycardia Seizure Tachypnea | Seizure |
Created by:
adricela55