Antidysrhythmic Drugs Flashcards Preview

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Flashcards in Antidysrhythmic Drugs Deck (76):
0

Adenosine
(Functional Classification)

Antidysrhythmic

1

Adenosine
(Chemical Classification)

Endogenous nucleoside

2

Adenosine
(Mechanism of Action)

Slows conduction through AV node, can interrupt reentry pathways through AV node, and can restore normal sinus rhythm in patients with paroxysmal supraventricular tachycardia (PSVT)

3

Adenosine
(Uses)

PSVT, as a diagnostic aid to assess myocardial perfusion defects in CAD, Wolff-Parkinson-White (WPW) syndrome

4

Adenosine
(Contraindications)

Hypersensitivity, 2nd- or 3rd-degree AV block, sick sinus syndrome, atrial flutter, atrial fibrillation, ventricular tachycardia, bronchospastic lung disease, symptomatic bradycardia, bundle branch block, heart transplant, unstable angina

5

Adenosine
(Side Effects)

CNS: lightheadedness, dizziness, arm tingling, numbness, apprehension, blurred vision, headache
CV: chest pain, pressure, ATRIAL TACHYDYSRHYTHMIAS, sweating, palpitations, hypotension, Facial Flushing, AV BLOCK, CARDIAC ARREST, VENTRICULAR DYSRHYTHMIAS
GI: Nausea, metallic taste, throat tightness, groin pressure
RESP: Dyspnea, Chest Pressure, hyperventilation, BRONCHOSPASM (ASTHMATICS)

6

Adenosine
(Nursing Considerations)

ASSESS:
-I&O ratio, electrolytes (K, Na, Cl)
-CARDIOPULMONARY STATUS: BP, PULSE, RESPIRATION, RHYTHM, ECG INTERVALS (PR, QRS, QT); CHECK FOR TRANSIENT DYSRHYTHMIAS (PVCs, PACs, SINUS TACHYCARDIA, AV BLOCK)
-RESPIRATORY STATUS: RATE, RHYTHM, LUNG FIELDS FOR CRACKLES WATCH FOR RESPIRATORY DEPRESSION; BILATERAL CRACKLES MAY OCCUR IN CHF PATIENT; INCREASED RESPIRATION, INCREASED PULSE, PRODUCT SHOULD BE DISCONTINUED
-CNS effects: dizziness, confusion, psychosis, paresthesias, seizures; product should be discontinued

7

Adenosine
(Overdose Treatment)

Defibrillation, vasopressor for hypotension, theophylline

8

Amiodarone
(Functional Classification)

Antidysrhythmic (class III)

9

Amiodarone
(Chemical Classification)

Iodinated benzofuran derivative

10

Amiodarone
(Mechanism of Action)

Prolongs duration of action potential and effective refractory period, noncompetitive alpha- and beta-adrenergic inhibition; increases PR and QT intervals, decreases sinus rate, decreases peripheral vascular resistance

11

Amiodarone
(Uses)

Hemodynamically unstable ventricular tachycardia, supraventricular tachycardia, ventricular fibrillation not controlled by 1st-line agents

12

Amiodarone
(Contraindications)

Pregnancy (D), breastfeeding, neonates, infants, severe sinus node dysfunction, hypersensitivity, cardiogenic shock, 2nd-3rd degree AV block, bradycardia

13

Amiodarone
(Side Effects)

CNS: Headache, Dizziness, involuntary movement, Tremors, Peripheral Neuropathy, malaise, Fatigue, ataxia, Paresthesias, insomnia
CV: Hypotension, Bradycardia, SINUS ARREST, CHF, DYSRHYTHMIAS, SA NODE DYSFUNCTION, AV BLOCK, increased defibrillation energy requirement
EENT: blurred vision, halos, photophobia, CORNEAL MICRODEPOSITS, dry eyes
ENDO: HYPO/hyperthyroidism
GI: Nausea, Vomiting, diarrhea, abdominal pain, Anorexia, Constipation, HEPATOTOXICITY
GU: epididymitis, ED
INTEG: rash, photosensitivity, blue-gray skin discoloration, alopecia, spontaneous ecchymosis, TOXIC EPIDERMAL NECROLYSIS, urticaria, PANCREATITIS, phlebitis (IV)
MISC: flushing, abnormal taste or smell, edema, abnormal salivation, coagulation abnormalities
MS: weakness, pain in extremities
RESP: PULMONARY FIBROSIS/TOXICITY, pulmonary inflammation, ARDS; GASPING SYNDROME IF USED WITH NEONATES

14

Amiodarone
(Nursing Considerations)

ASSESS:
-PULMONARY TOXICITY: dyspnea, fatigue, cough, fever, chest pain; product should be discontinued; for ARDS, pulmonary fibrosis, crackles, tachypnea
-ECG continuously to determine product effectiveness; measure PR, QRS, QT intervals; check for PVCs, other dysrhythmias, BP continuously for hypo.hypertension; report dysrhythmias, slowing heart rate; monitor amiodarone level: therapeutic 1-2.5mcg/ml; toxic >2.5mcg/ml
-I&O ratio; electrolytes (sodium, potassium, chloride); hepatic studies: AST, ALT, bilirubin, alk phos; for dehydration, hypovolemia
-Chest x-ray, thyroid function tests
-CNS symptoms: confusion, psychosis, numbness, depression, involuntary movements; product should be discontinued
-HYPOTHYROIDISM: lethargy; dizziness; constipation; enlarged thyroid gland; edema of extremities; cool, pale skin
-HYPERTHYROIDISM: restlessness, tachycardia; eyelid puffiness; weight loss; frequent urination; menstrual irregularities; dyspnea; warm moist skin
-Ophthalmic exams at baseline and periodically (PO)
-Cardiac rate, respirations: rate, rhythm, character, chest pain; start with patient hospitalized and monitored up to 1 wk; for rebound hypertension after 1-2hr

15

Amiodarone
(Overdose Treatment)

O2, artificial ventilation, ECG, administer DOPamine for circulatory depression, administer diazepam, thiopental for seizures, isoproterenol

16

Atenolol
(Functional Classification)

Antihypertensive, Antianginal

17

Atenolol
(Chemical Classification)

Beta-Blocker, Beta1-, Beta2-blocker (High doses)

18

Atenolol
(Mechanism of Action)

Competitively blocks stimulation of Beta-adrenergic receptor within vascular smooth muscle' produces negative chronotropic activity (decreases rate of SA node discharge, increases recovery time), slows conduction of AV node, decreases heart rate, negative inotropic activity decreases O2 consumption in myocardium; decreases action of renin-aldosterone-angiotensin system at high doses, inhibits beta2-receptors in bronchial system at higher doses

19

Atenolol
(Uses)

Mild to moderate hypertension, prophylaxis of angina pectoris; suspected or known MI (IV use); mi prophylaxis

20

Atenolol
(Contraindications)

Pregnancy (D), hypersensitivity to Beta-blockers, cardiogenic shock, 2nd- or 3rd-degree heart block, sinus bradycardia, cardiac failure, Raynaud's disease, pulmonary edema

21

Atenolol
(Side Effects)

CNS: Insomnia, Fatigue, Dizziness, Mental Changes, memory loss, hallucinations, depression, lethargy, drowsiness, strange dreams, catatonia
CV: PROFOUND HYPOTENSION, BRADYCARDIA, CHF, Cold Extremities, Postural Hypotension, 2nd- or 3rd-Degree Heart Block
EENT: sore throat; dry, burning eyes; blurred vision; stuffy nose
ENDO: increased hypoglycemic response to insulin
GI: Nausea, Diarrhea, vomiting, MESENTERIC ARTERIAL THROMBOSIS, ISCHEMIC COLITIS
GU: impotence, decreased libido
HEMA: AGRANULOCYTOSIS, THROMBOCYTOPENIA PURPURA
INTEG: rash, fever, alopecia
RESP: BRONCHOSPASM, dyspnea, wheezing, pulmonary edema

22

Atenolol
(Nursing Considerations)

ASSESS:
-I&O, weight daily; watch for CHF (rales/crackles, jugular vein distention, weight gain, edema)
-Hypertension: BP, pulse q4hr; note rate, rhythm, quality; apical/radial pulse before administration; notify prescriber of any significant changes (<50 bpm); ECG
-Baselines in renal/hepatic studies before therapy begins

23

Atenolol
(Overdose Treatment)

Lavage, IV atropine for bradycardia, IV theophylline for bronchospasm, dextrose for hypoglycemia, digoxin, O2, diuretic for cardiac failure, hemodialysis

24

Diltiazem (Cardizem)
(Functional Classification)

Calcium Channel Blocker, Antiarrythmic class IV, antiarrhythmic class IV, antihypertensive

25

Diltiazem (Cardizem)
(Chemical Classification)

Benzothiazepine

26

Diltiazem (Cardizem)
(Mechanism of Action)

Inhibits calcium ion influx across cell membrane during cardiac depolarization; produces relaxation of coronary vascular smooth muscle, dilates coronary arteries, slows SA/AV node conduction times, dilates peripheral arteries

27

Diltiazem (Cardizem)
(Uses)

PO: Angina pectoris due to coronary artery spasm, hypertension
IV: Atrial fibrillation, flutter, paroxysmal supraventricular tachycardia

28

Diltiazem (Cardizem)
(Contraindications)

sick sinus syndrome, AV heart block, hypotension <90mmHg systolic, acute MI, pulmonary congestion, cardiogenic shock

29

Diltiazem (Cardizem)
(Side Effects)

CNS: Headache, Fatigue, Drowsiness, dizziness, depression, weakness, insomnia, tremor, paresthesia
CV: DYSRHYTHMIA, Edema, CHF, bradycardia, hypotension, palpitations, HEART BLOCK
GI: Nausea, vomiting, diarrhea, gastric upset, Constipation, increased LFTs
GU: nocturia, polyuria, ACUTE RENAL FAILURE
INTEG: Rash, flushing, photosensitivity, burning, pruritus at inj site
RESP: rhinitis, dyspnea, pharyngitis

30

Diltiazem (Cardizem)
(Nursing Considerations)

ASSESS:
-CHF: dyspnea, weight gain, edema, jugular venous distention, rales; monitor I&O ratios daily, weight
-ANGINA: location, duration, alleviating factors, activity when pain starts
-DYSRHYTHMIAS: cardiac status: BP, pulse, respiration, ECG and intervals PR, QRS, QT; if systolic BP <50 bpm, hold dose, notify prescriber

31

Diltiazem (Cardizem)
(Overdose Treatment)

Atropine for AV block, vasopressor for hypotension

32

Dofetilide
(Functional Classification)

Antidysrhythmic (Class III)

33

Dofetilide
(Mechanism of Action)

Blocks cardiac ion channel carrying the rapid component of delayed potassium current; no effect on sodium channels

34

Dofetilide
(Uses)

Atrial fibrillation, flutter, maintenance of normal sinus rhythm

35

Dofetilide
(Contraindications)

Children, hypersensitivity, digoxin toxicity, aortic stenosis, pulmonary hypertension, severe renal disease
QT prolongation, torsades de pointes, renal failure

36

Dofetilide
(Side Effects)

CNS: Syncope, Dizziness, headache
CV: Hypotension, Postural Hypotension, Bradycardia, angina, PVCs, substernal pressure, transient hypertension, precipitation of angina, QT PROLONGATION, TORSADES DE POINTES, VENTRICULAR DYSRHYTHMIAS
GI: Nausea, Vomiting, severe diarrhea, anorexia
RESP: dyspnea, respiratory infections

37

Dofetilide
(Nursing Considerations)

ASSESS:
-ECG continuously for a minimum of 3 days or 12 hr after conversion to determine product effectiveness, PVCs, other dysrhythmias; renal function, QTc at baseline; reassess QTc interval 2-3hr after each dose; if QTc >440 msec or 500 msec if ventricular conduction disturbance, discontinue until QTc at starting level; product only available to facilities educated in its administration; patient must be hospitalized
-AF patients should receive anticoagulation prior to cardioversion
-Cardiac status: rate, rhythm, character, continuously; BP
-SEVERE RENAL IMPAIRMENT CCr<20ml/min: do not use for mild to moderate renal disease; monitor BUN/creatinine; adjust dose based on creatinine clearance

38

Lidocaine (parenteral)
(Functional Classification)

Antidysrhythmic (Class Ib)

39

Lidocaine (parenteral)
(Chemical Classification)

Aminoacyl amide

40

Lidocaine (parenteral)
(Mechanism of Action)

Increases electrical stimulation threshold of ventricle, His-Purkinje system, which stabilizes cardiac membrane, decreases automatically

41

Lidocaine (parenteral)
(Uses)

ventricular tachycardia, ventricular dysrhythmias during cardiac surgery, digoxin toxicity, cardiac catheterization

42

Lidocaine (parenteral)
(Contraindications)

Hyper-sensitivity to amides, severe heart block, supraventricular dysrhythmias, Adams-Stokes syndrome, Wolff-Parkinson-White, syndrome

43

Lidocaine (parenteral)
(Side Effects)

CNS: Headache, Dizziness, involuntary movement, confusion, tremor, drowsiness, euphoria, SEIZURES, shivering
CV: Hypotension, Bradycardia, HEART BLOCK, CV COLLAPSE, ARREST
EENT: tinnitus, blurred vision
GI: nausea, vomiting, anorexia
HEMA: METHEMOGLOBINEMIA
INTEG: rash, urticaria, edema, swelling, petechiae, pruritus
MISC: febrile response, phlebitis at inj site
RESP: dyspnea, RESPIRATORY DEPRESSION

44

Lidocaine (parenteral)
(Nursing Considerations)

ASSESS:
-ECG continuously to determine increased PR or QRS segments; if these develop, discontinue or reduce rate; watch for increased ventricular ectopic beats, may have to rebolus; BP
-Blood levels: therapeutic level, 1.5-5mcg/ml
-I&O ratio, electrolytes (K, Na, Cl)
-MALIGNANT HYPERTHERMIA: tachypnea, tachycardia, changes in BP, increased temp
-Respiratory status: rate, rhythm, lung fields for crackles, watch for respiratory depression; lung fields, bilateral crackles may occur with CHF; increased respiration, pulse; product should be discontinued
-CNS effects: dizziness, confusion, psychosis, paresthesias, convulsions; product should be discontinued

45

Metoprolol (Lopressor)
(Functional Classification)

Antihypertensive, Antianginal

46

Metoprolol (Lopressor)
(Chemical Classification)

Beta1-Blocker

47

Metoprolol (Lopressor)
(Mechanism of Action)

Lowers BP by beta-blocking effects; reduces elevated renin plasma levels; blocks beta2-adrenergic receptors in bronchial, vascular smooth muscle only at high doses; negative chronotropic effect

48

Metoprolol (Lopressor)
(Uses)

Mild to moderate hypertension, acute MI to reduce cardiovascular mortality, angina pectoris, NYHA class II, III heart failure

49

Metoprolol (Lopressor)
(Contraindications)

Hypersensitivity to beta-blockers, cardiogenic shock, heart block (2nd, 3rd degree), sinus bradycardia, pheochromocytoma, sick sinus syndrome

50

Metoprolol (Lopressor)
(Side Effects)

CNS: Insomnia, Dizziness, mental changes, hallucinations, depression, anxiety, headaches, nightmares, confusion, fatigue
CV: Hypotension, BRADYCARDIA, CHF, Palpitations, dysrhythmias, CARDIAC ARREST, AV BLOCK, PULMONARY/PERIPHERAL EDEMA, CHEST PAIN
EENT: sore throat; dry, burning eyes
GI: Nausea, Vomiting, colitis, cramps, Diarrhea, constipation, flatulence, dry mouth, HICCUPS
GU: impotence
HEMA: AGRANULOCYTOSIS, EOSINOPHILIA, THROMBOCYTOPENIA, PURPURA
INTEG: rash, purpura, alopecia, dry skin, urticaria, pruritus
RESP: BRONCHOSPASM, dyspnea, wheezing

51

Metoprolol (Lopressor)
(Nursing Considerations)

ASSESS:
-ECG directly when giving IV during initial treatment
-I&O, weight daily; check for CHF (weight gain, jugular venous distention, crackles, edema, dyspnea)
-BP during initial treatment, periodically thereafter; pulse q4hr; note rate, rhythm, quality
-Apical/radial pulse before administration; notify prescriber of any significant changes or pulse <50 bpm
-Baselines of renal, hepatic studies before therapy begins
-Skin turgor, dryness of mucous membranes for hydration status

52

Metoprolol (Lopressor)
(Overdose Treatment)

Lavage, IV atropine for bradycardia, IV theophylline for bronchospasm, digoxin, O2, diuretic for cardiac failure, hemodialysis, administer vasopressor

53

Quinidine
(Functional Classification)

Antidysrhythmic (Class IA)

54

Quinidine
(Chemical Classification)

Quinine dextroisomer

55

Quinidine
(Mechanism of Action)

Prolongs duration of action potential and effective refractory period, thus decreasing myocardial excitability; anticholinergic properties

56

Quinidine
(Uses)

PVCs, atrial fibrillation, PAT, ventricular tachycardia, atrial flutter, malaria/IV quiNIDine gluconate

57

Quinidine
(Contraindications)

Hypersensitivity, idiosyncratic response, digoxin toxicity, blood dyscrasias, myasthenia gravis
History of long QT syndrome, product-induced torsades de pointes, severe heart block

58

Quinidine
(Side Effects)

CNS: Headache, Dizziness, involuntary movement, confusion, psychosis, restlessness, irritability, syncope, excitement, depression, ataxia
CV: HYPOTENSION, Bradycardia, PVCs, HEART BLOCK, CV COLLAPSE, ARREST, torsades de pointes, widening QRS complex, VENTRICULAR TACHYCARDIA
EENT: cinchonism: tinnitus, blurred vision, hearing loss, mydriasis, disturbed color vision
GI: nausea, vomiting, anorexia, abdominal pain, Diarrhea, HEPATOTOXICITY
HEMA: THROMBOCYTOPENIA, hemolytic anemia, AGRANULOCYTOSIS, hypoprothombinemia
INTEG: rash, urticaria, ANGIOEDEMA, swelling, photosensitivity, flushing with severe pruritus
RESP: dyspnea, RESPIRATORY DEPRESSION

59

Quinidine
(Nursing Considerations)

ASSESS:
-ECG continuously to determine increased PR or QRS segments, QT interval; discontinue product or reduce dose
-Blood levels (therapeutic level 2-7mcg/ml), CBC, LFTs
-BP continuously for fluctuations
-FOR CINCHONISM: tinnitus, headache, nausea, dizziness, fever, vertigo, tremor; may lead to hearing loss
-Cardiac status: rate, rhythm, character, continuously
-Respiratory status: rate, rhythm, lung fields for crackles; increased respiration, increased pulse; product should be discontinued
-CNS effects: dizziness, confusion, psychosis, paresthesias, seizures; product should be discontinued

60

Sotalol
(Functional Classification)

Antidysrhythmic group III

61

Sotalol
(Chemical Classification)

Nonselective Beta-Blocker

62

Sotalol
(Mechanism of Action)

Blockade of Beta1- and Beta2-receptors leads to antidysrhythmic effect, prolongs action potential in myocardial fibers without affecting conduction, prolongs QT interval, no effect on QRS duration

63

Sotalol
(Uses)

Life-threatening ventricular dysrhythmias; Betapace AF: to maintain sinus rhythm with symptomatic atrial fibrillation/flutter

64

Sotalol
(Contraindications)

Hypersensitivity to Beta-blockers, cardiogenic shock, heart block (2nd/3rd degree), sinus bradycardia, CHF, bronchial asthma, CCr <40ml/min

65

Sotalol
(Side Effects)

CNS: Dizziness, mental changes, drowsiness, fatigue, headache, catatonia, depression, anxiety, nightmares, paresthesia, lethargy, insomnia, decreased concentration
CV: PRODYSRHYTHMIA, PROLONGED QT, orthostatic hypotension, bradycardia, CHF, chest pain, ventricular dysrhythmias, AV block, peripheral vascular insufficiency, palpitations, torsades de pointes; LIFE-THREATENING VENTRICULAR DYSRHYTHMIAS (BETAPACE AF)
EENT: tinnitus, visual changes, sore throat, double vision; dry, burning eyes
GI: nausea, vomiting, diarrhea, dry mouth, flatulence, constipation, anorexia, indigestion
GU: impotence, dysuria, ejaculatory failure, urinary retention
HEMA: AGRANULOCYTOSIS, THROMBOCYTOPENIC PURPURA (rare), THROMBOCYTOPENIA, LEUKOPENIA
INTEG: rash, alopecia, urticaria, pruritus, fever, diaphoresis
MISC: facial swelling, decreased exercise tolerance, weight change, Raynaud's disease
MS: joint pain, arthralgia, muscle cramps, pain
RESP: BRONCHOSPASM, dyspnea, wheezing, nasal stuffiness, pharyngitis

66

Sotalol
(Nursing Considerations)

ASSESS:
-I&O, weight daily; edema in feet, legs daily
-BP, pulse q4hr; note rate, rhythm, quality
-Potassium, magnesium levels
-QT SYNDROME: apical/radial pulse before administration: notify prescriber of any significant changes; monitor ECG continuously (Betapace AF); use QT interval to determine patient eligibility; baseline QT must be -Baselines of renal studies before therapy begins
-Skin turgor, dryness of mucous membranes for hydration status

67

Sotalol
(Overdose Treatment)

Lavage, IV atropine for bradycardia, IV theophylline for bronchospasm, digoxin, O2, diuretic for cardiac failure; hemodialysis is useful for removal; administer vasopressor (norepinephrine) for hypotension, isoproterenol for heart block

68

Verapamil
(Functional Classification)

Calcium channel blocker; antihypertensive; antianginal, antidysrhythmic (class IV)

69

Verapamil
(Chemical Classification)

Diphenylalkylamine

70

Verapamil
(Mechanism of Action)

Inhibits calcium ion influx across cell membrane during cardiac depolarization; produces relaxation of coronary vascular smooth muscle; dilates coronary arteries; decreases SA/AV node conduction; dilates peripheral arteries

71

Verapamil
(Uses)

Chronic stable, vasospastic, unstable angina; dysrhythmias, hypertension, supraventricular tachycardia, atrial flutter or fibrillation

72

Verapamil
(Contraindications)

Sick sinus syndrome, 2nd-/3rd-degree heart block, hypotension <90mmHg systolic, cardiogenic shock, severe CHF

73

Verapamil
(Side Effects)

CNS: Headache, Drowsiness, dizziness, anxiety, depression, weakness, insomnia, confusion, lightheadedness, asthenia, fatigue
CV: Edema, CHF, bradycardia, hypotension, palpitations, AV block, DYSRHYTHMIAS
GI: Nausea, diarrhea, gastric upset, Constipation, increased LFTs
GU: impotence, gynecomastia, nocturia, polyuria
HEMA: bruising, petechiae, bleeding
INTEG: rash, bruising
MISC: gingival hyperplasia
SYST: STEVENS-JOHNSON SYNDROME

74

Verapamil
(Nursing Considerations)

ASSESS:
-CARDIAC STATUS: BP, pulse, respiration, ECG intervals (PR, QRS, QT); notify prescriber if pulse <90mmHg
-CHF: I&O ratios, weight daily; crackles, weight gain, dyspnea, jugular venous distention
-Renal, hepatic studies during long-term treatment, serum potassium periodically

75

Verapamil
(Overdose Treatment)

Defibrillation, atropine for AV block, vasopressor for hypotension, IV calcium