Cardiac - Unit 2 - Electrical Drugs & Interventions

Question 1

What do antidysrhythmic medications do?

Answer 1

They suppress dysrhythmia’s by inhibiting abnormal pathways of electrical conduction through the heart.

Question 2

What are Class 1 antidysrhythmic drugs?

Answer 2

Sodium Channel Blockers.

Question 3

What do class 1 antidysrhythmic drugs do?

Answer 3

Decrease automaticity. There are three classes.

Question 4

What are the three classes of Class 1 ?

Answer 4

1A, 1B, 1C

Question 5

What are some side effects for all class 1 drugs?

Answer 5

Hypotension, heart failure, worse or new dysrhythmia’s, N, V, D

Question 6

What are some Class 1A drugs?

Answer 6

Procainamide, Dysopyramide, Propafenone, Quinidine Sulfate

Question 7

What do class 1A drugs do?

Answer 7

slow conduction and prolong repolarization.

Question 8

What are class 1A drugs used for?

Answer 8

SVT, V Tach, PVC/s, Atrial Flutter, Atrial Fib - a lot of EXTRAVENTRICULAR rhtyhm’s.

Question 9

What are some things to watch for in someone on Class 1A drugs?

Answer 9

Monitor for systemic lupus syndrome, blood dyscrasias, make sure QRS doesn’t get too wide.

Question 10

What is a class 1B drug? What do they do?

Answer 10

Lidocaine - it shortens repolarizations/treats ventricular dysrhythmia’s

Question 11

What dysrhythmia’s do we use lidocaine for? How long?

Answer 11

Used in the short term for V Tach, PVC’s and V Fib

Question 12

What do we monitor for with IB Drugs?

Answer 12

CNS effects (drowsiness, decreased LOC, seizures), respiratory, etc.

Question 13

What does Class IC do?

Answer 13

Slow conduction and widen the QRS complex

Question 14

What are class 1C drugs used for?

Answer 14

Treating A Fib, PSVT, life threatening ventricular dysrhythmia’s.

Question 15

What drugs are class 1C?

Answer 15

Flecainide acetate, propafenone hydrochloride, moricizine.

Question 16

What are some side effects of 1C drugs?

Answer 16

Bradycardia, hypotension, heart failure, worsened or new dysrhythmia’s.

Question 17

Which drugs are Class 2?

Answer 17

Beta blockers.

Question 18

What do beta blockers do? Used for?

Answer 18

Control dysthythmia’s associated with excessive beta-adrenergic stimulation by competing with the same receptors. They also decrease HR and conduction. They are used for atrial dysrhythmia’s.

Question 19

What are some examples of beta blockers?

Answer 19

Acebutolol, esmolol, propranolol, sotalol

Question 20

What are some side effects of beta blockers?

Answer 20

Dizziness, fatigue, hypotension, bradycardia, heart failure, dysrhythmia’s, heart block, bronchospasms, GI upset.

Question 21

Should we check the HR/BP before giving a beta blocker?

Answer 21

YES. HR above 60 and Systolic above 90.

Question 22

What are class 3 drugs?

Answer 22

Potassium channel blockers

Question 23

What are some examples of class 3 drugs?

Answer 23

Amiodarone, bretylium, dofetillide, ibutilide fumarate

Question 24

What do class 3 drugs do?

Answer 24

Convert a-fib, prevent or treat life threatening ventricular dysrhythmia’s (PVC’s, V tach, vfib)

Question 25

What do we watch for with Class 3 drugs?

Answer 25

Pulmonary toxicity, bradycardia and AV blocks, visual disturbances, photosensitivity

Question 26

What are class 4 drugs?

Answer 26

Calcium Channel Blockers

Question 27

What do class 4 drugs do? Used for?

Answer 27

depress the automaticity of the SA and AV nodes (slows the HR). They are used for atrial fib and flutter, and SVT

Question 28

What are a few examples of class 4 drugs?

Answer 28

Verapamil, Dilitiazem

Question 29

What are some side effects of Class 4 drugs?

Answer 29

Heart failure, bradycardia, hypotension

Question 30

What is an endogenous glucoside used for?

Answer 30

Decreases electrical conduction through the AV node (interrupts extra pathways) - Paroxsymal SVT, wolf-Parkinson-white

Question 31

What are some examples of an endogenous glucoside?

Answer 31

Adenosine, Covert

Question 32

What are some endogenous glucoside side effects? How long does it last for?

Answer 32

Sinus brady, dyspnea, flushing of face - it has a very short half-life (1 minute) so side effects can disappear quickly!

Question 33

what does lanoxin do?

Answer 33

Increaes vagal tone (slows conduction) - used for CHF, a-fib, a-flutter, PSVT.

Question 34

What are some side effects of lanoxin? What happens if there is bradycardia?

Answer 34

N/V, yellow vision - brady might mean toxic levels have been reached!

Question 35

Hypokalemia and renal dysfunction decrease risk for lanoxin toxicity - T/F?

Answer 35

FALSE - they increase the risk.

Question 36

What are some interventions with antidysrhythmics?

Answer 36

Monitor vitals, do not administer w/food, watch for fluid retention, monitor respiratory/thyroid/neuro function, watch for orthostatic hypotension (so have your patients get up slowly!) and increase fiber.

Question 37

what are some vagal maneuvers?

Answer 37

Valsalva maneuver, coughing, gagging, immersing your face in cold water, blowing hard, carotid sinus massage

Question 38

What is cardioversion? What is it used for?

Answer 38

It's when you mildly "shock" (20-200 joules) someone to get them in a normal rhythm. It's used for a-fib, a-flutter and SVT.

Question 39

Is cardioversion elective?

Answer 39

YES - so get consent.

Question 40

Cardioversion - synchronized with the ___ wave.

Answer 40

R wave.

Question 41

What are some pre-op things to do for cardioversion?

Answer 41

Withhold antidysrhythmic drugs, check potassium, hook up electrodes to monitor and defibrillator, have at least 1 IV, have consent signed, give a sedative, document rhythm, make sure they are anticoagulated, etc.

Question 42

What are some post-op things to do for cardioversion?

Answer 42

Document the procedure, monitor EKG, diet as tolerated, assess LOC, etc.

Question 43

Defibrillation - what strength is it?

Answer 43

200-360 joules.

Question 44

What is defibrillation used for?

Answer 44

Unconscious V-Tach, V-Fib

Question 45

Before defibrillation, should we remove Nitro paste or any gels on chest?

Answer 45

YES

Question 46

What do we chart after defibrillation?

Answer 46

Observe/document rhythm, number of defibrillations, energy settings, post-defib vitals, etc.

Question 47

What's an ICD?

Answer 47

Implantable defibrillator!

Question 48

After having a defibrillator implanated, what should the pt. do?

Answer 48

Take it easy for a few weeks, no driving until stable, avoid swimming alone, don't lift over 25 lbs, avoid electrical and magnetic fields, be wanded at the airport, etc.

Question 49

What are some different types of defibrillators? (3)

Answer 49

Abdominal ICD, Transvenous ICD, S-ICD (Subcutaneous ICD)

Question 50

What does the S-ICD do?

Answer 50

Sub-Q - It converts V-Tach to V-Fib - no leads and no risk for infection!

Question 51

What are three types of PACING for pacemakers?

Answer 51

External (emergency situation), Transvenous (temp or permanent), Epicardial (post CABG)

Question 52

If HR is slower than the set limit for the pacemaker, what is happening?

Answer 52

The pacemaker went on vacation and is not working.

Question 53

What is the pacemaker sensitivity?

Answer 53

Minimum electrical activity that is needed by the pacemaker (mV)

Question 54

What is the pacemaker voltage?

Answer 54

Power required to stimulate the electrical activity of the heart

Question 55

What's synchronous pacing?

Answer 55

Pacemaker Sees patients heart rate and only paces when needed.

Question 56

What is asynchronous pacing?

Answer 56

Pacemaker fires at a set rate irregardless of what the heart is doing. It's not used as much anymore - the "eyes" have been turned off.

Question 57

Wide QRS - is it expected a lot with a pacemaker?

Answer 57

Yes

Question 58

What is VVI Pacemaker pacing?

Answer 58

Ventricle Sensed Ventricle Paced Inhibited

Question 59

What is pacemaker DDD pacing?

Answer 59

Dual sensed Dual paced Dual triggered and inhibited

Question 60

Pacemaker - what are some things to tell patients afterwards?

Answer 60

Do not drive for 2 weeks, avoid lifting, pushing or pulling heavy objects for 4 weeks, no above the shoulder activities for 2 weeks, may use arms for adl's, take pulse daily for a couple of months, keep cell phone 6 inches away from pacemaker, and call Dr. if pulse is about 5 beats below set level or if feeling dizzy.