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NURS 572 Pharm Ch 48
Pharm Ch 48 anti dysrhythmics
| Question | Answer |
|---|---|
| dysrhythmias can be supraventricular or ventricular - which are more dangerous | ventricular far more dangerous |
| classes of drugs used to treat dysrthymias | sodium channel blockers---Beta blockers---K channel blockers---Ca channel blockers---digoxin ---and others |
| if SA node is damaged, what is outcome | dec impulse formation results-->tachydysrhythmia |
| if AV block, what happens | AV block --> disturbance of conduction-->tachydysrythmia |
| Sodium channel blockers MOA | this class slows impulse conduction---delays repolarizaiton---with ANTICHOLINERGIC properties (increased SA automaticity, AV node conduction--> inc. HR) |
| name 6 Na channel blockers | quinidine---procainamide---lidocaine---phenytoin---mexiletine---tocainide |
| What Na channel blocker with SE of diarrhea, must be given with food | quinidine |
| Is quinidine cardiotoxic | yes, it is as well as procainamide |
| so if quinidine slows HR, but it's anticholinergic SE increases HR, how do we dose with digoxin | often digoxin given first, then quinidine |
| procainamide ADRs | serious SEs more serious/frequent than others in class---lupus like syndrome---cardiotoxicity---Torsade ---blood dyscrasias (dec platelets, WBCs) |
| lidocaine special admin | only IV admin used exclusively for ventricular dysrhythmias, esp post-MI. huge first pass effect. no anticholinergic effect |
| phenytoin also special admin | IV only---hypoTN more likely due to solvent alkalinity-->phlebitis. |
| which 2 Na channel blockers most likely TdeP | quinidine, procainamide share this |
| Which Na channel blockers not particularly prodysrhythmic | lidocaine, phenytoin, mexiletine, tocainide |
| 2 Na channel blockers that are derivatives of lidocaine---but ar ORALLY bioavailable | mexiletine and tocainide ---not commonlyused due to wicked SEs |
| mexiletine SEs | 40% compliance limiting n/v/d/c-----neuro disturbances |
| tocainide SEs | pulmonary fibrosis --- serious blood dyscrasias/agranulocytosis |
| MOA of Beta Blockers in dysrhythmias | dec SA automaticity---dec AV conductivity---dec contractility--------------coupled with Ca++ channels, so CCB actions are similar |
| Indication of Na channel blockers | used for both supraventricular and ventricular dysrhythmias |
| indication of Beta blockers | used in tachydysrhythmias - esp caused by sympathetic stimulation |
| ADRs Beta-blocker - propanolol | AV block---bronchospasm---HF bwo negative inotropy dec contractility---sinus arrest bwo dec SA automaticity |
| acebutolol unusual ADR | is B-1 specific yet causes BRONCHOSPASM---oral admin |
| esmolol Beta Blocker admin | given IV due to 9 minute half life |
| what are the only 3 beta blockers used in dysrhythmia tx | propanolol, acebutolol and esmolol |
| Name 1 K channel blocker | amiodarone |
| amiodarone is last-line drug EXCEPT for tx of ventricular tachycardia and has this half-life | a half life of 1-4 MONTHS |
| Amiodarone has wicked, wicked SEs that are | brady/AV block/HF---hepatotoxic---thyroid dysfunction---CNS disturbances, along with many others---including pulmonary fibrosis with long term use |
| Calcium channel blockers used to treat only | supraventricular dysrhythmias bwo of decreasing SA/AV/contractility |
| ADRs of calcium channel blockers being used here - verapamil and diltiazem | ADRs of brady---AV block---HF ---hypoTN---periph edema ---CONSTIPATION |
| diltiazem SEs relative to verapamil | less likely to cause cardiac effects and constipation |
| What is digoxin MOA in dysrhythmias | mostly related to dec SA/AV conduction, which is mediated by vagal stimulation----unfortunately digoxin increases HPS automaticity which contributes to its cardiac toxicitys and dysrhythmias |
| balancing act of all anti-dysrhythmics | many also have significant toxicities including pro-dysrhythmias that lead to cardiotoxicities or TdeP----limit their use or consider non-drug txs |
| what drug produces lupus-like syndrome | procainamide |
| what drug LEAST likely to cause torsade de pointes | phenytoin |
| drug LEAST likely to cause pulmonary fibrosis witih short-term use | amiodarone - only causes pulmonary fibrosis long-term, dose related use |
Created by:
lorrelaws
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