Rhythm Pharm

Question 1

Rate and Rhythm Control

Answer 1

Beta blockers
CCB
Amiodarone
Adenosine
Atropine
Dofetilide

Question 2

Beta blockers + CCN: Goal

Answer 2

HR < 100 BPM + Regular Sinus Rhythm

Question 3

Amiodarone: MOA

Answer 3

Prolongs the AP duration and the effective refractory period in ALL cardiac tissues
Blocks Alpha + Beta adrenergic receptors in the SNS
-Helps convert rhythms

Question 4

Amiodarone: Route

Answer 4

IV or PO

Question 5

Amiodarone: Indication

Answer 5

One of the most effective antidysrhythmic for PSVT and ventricular dysrhythmias also used for AFIB and RVR

PSVT: Paroxysmal supraventricular tachycardia: Fast rhythm that happens from “time to time” that originates above the ventricles.

Question 6

Amiodarone: AE

Answer 6

LOTS
75% have AE 
-Thyroid alterations (contains iodine)
-Corneal microdeposits (fat)
-Pulmonary toxicity (fatal in 10%)
-Black BOX: PULMONARY TOXICITY , hepatotoxicity, and pro-arrhythmic effects

Question 7

Amiodarone: Interactions

Answer 7

Digitoxin + Warfarin

• increases digitoxin levels by 50%
• Increases INR by 50-100%
• Warfarin + amiodarone = Bleeding!

EXTREMELY long half-life (many days!)
-if someone has adverse effects, may take 2-3 months for them to fully go away

CONTRAINDICATED w/severe bradycardia or heartblocks

Question 8

Amiodarone: Contraindications

Answer 8

• Severe Bradycardia

- Heart blocks (type of rhythm)

Question 9

Treatment for Sinus Brady

Answer 9

Atropine

Question 10

Atropine: Class

Answer 10

Anticholinergic/Antimuscarinic

Question 11

Atropine: MOA

Answer 11

Poisons vagal nerve
-inhibits postganglionic acetylcholine receptors and direct vagolytic action
(stimulant action)

Question 12

Atropine: Route

Answer 12

IV push ONLY for bradycardia

• 1 mg every 3-5 mins, 3 mg MAX
• Only works for 28% of bradycardia cases
• Must be vagal induced bradycardia!

Question 13

Atropine: SE

Answer 13

(Anticholinergic effects)
Xerostomia
blurry vision
photophobia
Tachycardia
Flushing 
Hot skin

Question 14

Atropine: Nursing Implications

Answer 14

Need to be on cardiac monitoring, if doesn’t work quickly, give a SECOND dose

Question 15

Treatment of PSVT

Answer 15

Adenosine

Question 16

Adenosine: MOA

Answer 16

Slows conduction time through the AV node

VERY SHORT HALF-LIFE
-may need multiple doses

Commonly causes a short burst of asystole until sinus rhythm returns

Question 17

Adenosine: SE

Answer 17

Other than Burst of Asystole (flatline), Very few

Question 18

Adenosine: Route

Answer 18

ONLY IV

Question 19

Adenosine: Administration

Answer 19

6mg IVP, if not converted give 12mg IVP, can give 3rd time 12mg IVP

• always follow with rapid normal saline flush or 2 saline flushes
• Uses syringe and 3-way stopcock

Question 20

Dofetilide (Tikosyn): Class

Answer 20

Antidysrhythmic

Question 21

Dofetilide (Tikosyn): Indications

Answer 21

Conversion from AFIB/aflutter to NSR (Normal sinus rhythm)

Question 22

Dofetilide (Tikosyn): MOA

Answer 22

Selectively blocking the rapid cardiac ion channel carrying potassium currents

Question 23

Dofetilide (Tikosyn): SE

Answer 23

TORSADE's
SVT
Headache
Dizziness
Chest pain

Question 24

Dofetilide (Tikosyn): Nursing implications

Answer 24

Started in-hospital with ECG monitoring due to risk of Torsade’s (Black Box Warning)
-Don’t give to patients with long QT intervals or with other drugs that may prolong QT intervals

Question 25

Torsade’s

Answer 25

A type of VTACH

-Deadly Rhythm, start CPR!

Question 26

Warfarin Stuff

Answer 26

Put in here