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TL Antiarrhythmics
Antiarrhythmic drugs
| Question | Answer |
|---|---|
| Name 9 class I antiarrhythmic drugs(Q, DN, ME, LX, MM, TT, PD, PR, FT) | Quinidine, Disopyramide phosphate (Norpace), Moricizine (Ethmozine), Lidocaine (Xylocaine), Mexiletine (Mexitil), Tocainide (Tonocard), Phenytoin (Dilantin), Propafenone (Rhythmol), Flecainide (Tambocor) |
| What are the indications for class I antiarrhythmic drugs (4)? | Premature beats, atrial flutter/fibrillation, ventricular dysrhythmias, (unlabled use) Digitalis induced arrhythmias |
| When are class I antiarrhythmics contraindicated? | Heart block |
| Define Cinchonism. | condition resulting from cinchona bark or its alkaloid derivatives (quinine or quinidine). Symptoms are tinnitus and slight deafness, photophobia and other visual disturbances, mental dullness, depression, confusion, headache, and nausea |
| What symptoms would alert the nurse to possible toxicity if the client is taking class 1 anti-arrhythmic therapy? | tinnitus and visual disturbance, confusion, drowsiness, slurred speech, seizures with lidocaine |
| What vital signs should be monitored when the client is taking class I anti-arrhythmic medications? | Pulse rate and rhythm (teach the client how) and ECG |
| Name a class II anti-arrhythmic drug. | Propranolol (Inderal) |
| What are the indications for Propranolol (Inderal) when used as a class II anti-arrhythmic drug? | Supraventricular and ventricular tachydysrhythmia |
| What are the main side effects of propranolol (Inderal)? | Hypotension, Bradycardia, Bronchospasm |
| What are the contraindications for propranolol (Inderal)? | asthma, COPD |
| Name 5 Class III anti-arrhythmics. | Bretylium tosylate (Bretylol), Amiodarone HCL (Cordarone), Milrinone (Primacor), Sotalol (Betapace), Amrinone (Inocor) |
| What effect does digitalis have on the heart? When should digitalis be withheld? What other step does the nurse take if digitalis is withheld? | negative chronotropic -slows the heart, pulse <60, >120, or greatly changed rhythm; Consult with HCP if withheld |
| What type of arrhythmias do Class III anti-arrhythmics treat? | ventricular dysrhythmias |
| What are the side effects associated with class three anti-arrhythmics? | Dysrhythmias, hyper- or hypotension, muscle weakness, tremors, photophobia |
| What special instructions will the client taking amiodarone (Cordarone) need? | Wear sunglasses and sunscreen |
| What assessments does the nurse watch for her patient taking a class III anti-arrhythmic? | Vital signs and ECG |
| Name a class IV drug. | Verapamil (Isoptin, Calan) |
| What are the indications for Class IV drugs? | supraventricular dysrhythmias |
| What are the main side effects of Verapamil? | Hypotension, Bradycardia, Constipation |
| What drug class is verapamil (Isoptin, Calan)? | Calcium Channel Blocker |
| What assessments are particularly important to monitor if our patient is taking Verapamil for a supraventricular dysrhythmia? | BP and pulse |
| What instructions do we give the patient taking verapamil (Isoptin, Calan)? | Change position slowly |
| Name 4 miscellaneous agents used to treat arrhythmias. | Atropine sulfate (Atropisol), Digoxin (Lanoxin), Digitoxin (Crystodigin), Epinephrine (adrenaline) |
| Atropine is therapeutic for what type of dysrhythmia? | Bradycardia |
| What are the main side effects of atropine (Atropisol)? | Chest pain, Urinary Retention, Dry mouth |
| What eye condition would make you think twice about administering atropine (Atropisol)? | glaucoma |
| What should we monitor and assess when our patient is taking Atropine (Atropisol) (3)? | Heart rate/rhythm, assess for chest pain and urinary retention |
| What type of dysrhythmias are digoxin (Lanoxin) and Digitoxin (Crystodigin) used to treat? | Supraventricular, and atrial fibrillation |
| What are the main side effects associated with digoxin (Lanoxin) and Digitoxin (Crystodigin)? | Bradycardia, Dysrhythmias, Anorexia, nausea, vomiting, diarrhea, visual disturbances |
| What instructions do we give the patient taking digoxin (Lanoxin) or Digitoxin (Crystodigin)? | Report signs of toxicity or weakness (early sign of hypokalemia) |
| What are the signs of Digoxin toxicity? | nausea, vomiting, diarrhea, blurred or yellow vision |
| What assessments are especially important for the patient on Digoxin? | pulse rate and rhythm |
| What condition greatly increases the risk for Digoxin toxicity? | hypokalemia |
| What electrolyte imbalance is associated with taking digoxin (Lanoxin) or Digitoxin (Crystodigin)? | Hypercalcemia |
| What drug is given for cardiac arrest? | Epinephrine (adrenaline) |
| What are the main side effects associated with epinephrine (adrenaline)? | tachycardia, hypertension |
| Why is it important to monitor creatinine and BUN with the administration of Epinephrine? | Impaired renal function can cause toxicity |
| What does the nurse monitor for when the patient has been given epinephrine (adrenaline) for cardiac arrest? | return of pulse, vital signs |
| Name a vasopressor that is used to promote cardiovascular perfusion in the failing heart. | Norepinephrine (Levophed) |
| How does Norepinephrine (Levophed) work to improve perfusion for clients with heart failure or emergency hypotensive states? | It dilates coronary arteries and causes peripheral vasoconstriction |
| What are the adverse reactions associated with Norepinephrine (Levophed)? | Can cause severe tissue necrosis, sloughing, and gangrene with extravasation |
| Why is it so important to maintain IV patency with Norepinephrine (Levophed)? | Because it is rapidly deactivated by many body enzymes |
| How often should the nurse check the patient’s BP while administering Norepinephrine (Levophed)? | Q 2-5 minutes |
| What drug should be diluted per protocol and ready to treat extravasation when norepinephrine (Levophed) is administered? | Regitine |
| What kind of vein should be used for administering norepinephrine? Why? | a large vein to avoid complications of prolonged vasoconstriction |
| What is the primary sign of extravasation of Norepinephrine (Levophed)? | Blanching along the vein pathway |
| What are the indications for Nesiritide (Natrecor)? | acutyely decompensated HF in clients who have dyspnea at rest or with minimal activity |
| Describe the action of Nesiritide (Natrecor). | reduces PCWP - reduces dyspnea |
| What is the primary side effect of nesiritide (Natrecor)? | hypotension |
| What adverse reactions are possible with administration of nesiritide (Natrecor)? | Hypotension, Arrhythmias, H/A, dizziness, insomnia, tremors, paresthesias, abdominal pain, N&V |
| Which population is at risk for overresponse to nesiritide (Natrecor)? | the elderly |
| What are the pertinent assessments and lab values to monitor with administration of nesiritide (Natrecor)? | BP, telemetry, electrolytes – especially K+ |
| What should keep in mind about nesiritide (Natrecor) and other drugs? | Many drug-drug interactions to watch out for |
| Name a platelet antiaggregate used to promote cardiovascular perfusion in the failing heart. | Eptifibatide (Integrilin) |
| What are some drugs used in combination with Eptifibatide (Intergrilin)? | heparin, aspirin, and selected situations, Ticlid and Plavix |
| What the most common adverse reaction associated with Eptifibatide (Integrilin)? | Bleeding |
| What are the adverse reactions associated with Eptifibatide (Integrilin)? | bleeding, hypotension, thrombocytopenia, acute toxicity |
| What are the symptoms of acute toxicity from Eptifibatide (Integrilin)? | decreased muscle tone, dyspnea, loss of righting reflex |
| What is the righting reflex? | ability to make postural adjustments in response to perturbations |
| What baseline information should be collected before eptifibatide (Intergrilin)? | PT/aPTT, H&H, platelet count, drug-drug interactions |
| What should the nurse know about Eptifibatide (Integrilin) dosing and the elderly? | Dosing adjusted by weight |
| What should the nurse know about emergency procedures and the longevity of Eptifibatide (Integrilin)? | quickly reversible so emergency procedures may still be performed shortly after discontinuing the infusion |
Created by:
Perseverandovercome
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