Nursing Pharmacology: Antidysrhythmias
Terms
undefined, object
copy deck
- What is Dysrhythmias?
- Electrical conduction abnormalities of the heart.
- What are the 3 classes of drugs used in the treatment of Dysrhythmias?
-
A. Sodium channel Blockers: quinidine (Quinidex)
B. Beta-adrenergic blockers: propranolol (Inderal)
C. Calcium channel blockers: verapamil (Calan) -
Main example of
Sodium channel Blockers - quinidine (Quinidex)
-
Main example of
Beta-adrenergic blockers - propranolol (Inderal)
-
Main example of
Calcium channel blockers - verapamil (Calan)
-
class of:
quinidine (Quinidex) -
Antiarrhythmic
Sodium channel Blockers -
Mechanism of:
quinidine (Quinidex) -
- Blocks sodium ion channels in myocardial cells thereby:
i. reducing automaticity in ventricles
ii. slowing conduction of action
potential across myocardium.
- Reduces the excitability of cardiac muscle to electrical stimulation.
- Decreases the velocity of electrical
conduction through the myocardium.
- Decrease HR and reduce or obliterate
ectopic pacemaker activity.
- Exerts anticholinergic (vagal
blocking) action on the heart. -
usage of:
quinidine (Quinidex) - Quinidine is use in the treatment of atrial & ventricular dysrhythmias (tachycardia, flutter and fibrillation).
-
Side effects/Adverse reaction:
quinidine (Quinidex) - diarrhea, nausea, vomiting, cardiac arrthythemias, cinchonism
- what drug may interact with quinidine (Quinidex)?
-
Digoxin
-increased digoxin levels and toxicity- - What type of patient should use quinidine (Quinidex) with caution?
-
- Clients with CHF
- Clients using digoxin.
- Hypo or hyperkalemic clients.
- Client with fluid or electrolyte imbalance.
- Must administer a test dose. - what should patient taking quinidine (Quinidex) be observe for?
-
- changes in EKG
(Increase in PR and QT intervals or widening of QRS complex)
- BP
- LOC
- Respiratory status
- Drug plasma levels - When Pt. is taking quinidine, what should Pt. education includes?
-
- Do not skip doses
- Do not take two doses at one time
- Comply with monitoring of lab tests as ordered.
- Report these symptom immediately: SOB, changes in vision or hearing, diarrhea, or dizziness. - What symtom(s) should Pt taking quinidine report immediately?
-
1. SOB
2. changes in vision or hearing
3. diarrhea
4. dizziness. -
give an example of
Beta-Adrenergic Blockers - propranolol (Inderal)
-
Main use of
propranolol (Inderal) - main use is to treat atrial dysrhythmias HF
-
other uses of
propranolol (Inderal) - Hypertension, MI, HF.
-
MAO of
propranolol (Inderal) -
- Act by blocking Beta-adrenergic receptor thereby decreases sympathetic influences on the heart.
- Resulted in decreasing:
1. HR (negative chronotropic effect)
2. cardiac workload
3. contractillity
4. myocardial oxygen consumption.
5. conduction velocity through AV node
6. myocardial automaticity
7. release of renin = lower BP
8. vasocinstriction -
Common Adverse Effects of
propranolol (Inderal) -
1. Hypotension
2. Hypoglycemia
others: fatigue, gastric pain, flatulence, constipation, diarrhea, nausea, vomiting, bradycardia, CHF, cardiac arrhythmias, SA or AV block, impotent, decreased libido, decrease excercise intolerance. -
Drugs that may interact with
propranolol (Inderal) -
1. Phenothiazines
2. Beta-adrenergic agonists (Albuterol)
3. MAO inhibitors -
Contraindications for
propranolol (Inderal) -
clients with
1. obstructive pulmonary disease
2. CHF
3. heart block
4. bradycardia
5. DM. -
What assessment should the nurse take prior to administration of
propranolol (Inderal)? -
1. PR and
2. cognitive status in elderly -
what Special consideration for Pt. prior to administration of
propranolol (Inderal) - Asians: due to the lack of drug metabolizing enzyme mephenytoin hydrizylase.
- what should Patient Education includes for propranolol (Inderal)?
-
1. Take PR prior to drug administration (w/h if PR is <60 or >100)
2. Rise sitting or lying position slowly.
3. Signs of hypoglycemia in diabetes such as fatigue or headaches.
4. Report the following symptoms immediately:
1) SOB
2) Feeling of skipping heart beat
3) Painful or difficult urination
4) Dizziness, drowsiness, confusion - When taking propranolol, what symptoms should Pt. report immediately?
-
1) SOB
2) Feeling of skipping heart beat
3) Painful or difficult urination
4) Dizziness, drowsiness, confusion -
give example of
Calcium channel blockers - verapamil (Calan)
-
Drug classes of
verapamil (Calan) -
- Calcium channel-blocker
- Antianginal agent
- Antiarrhythmic
- Antihypertensive -
MOA of
verapamil (Calan) - Inhibits the movement of calcium ions across the membranes of cardiac and arterial muscle cells
-
Desired actions of
verapamil (Calan) -
1. decreased cardiac workload
2. decrease oxygen demand
3. decreased cardiac energy consumption
4. increased delivery of oxygen to myocardial cells -
indication of
verapamil (Calan) - Supraventricular dysrhythmias
-
Adverse effects of
verapamil (Calan) -
constipation
bradycardia -
interactions with:
verapamil (Calan) -
1. Grapefruit juice
2. digoxin -
Nursing implications for
verapamil (Calan) -
1) Take BP and report changes
2) Take pulse and notify if less than 60 bpm
3) Report irregular heart beat, shortness of breath, swelling of the hands or feet (edemas) -
What symptom should Pt taking
verapamil (Calan)
report immediately? -
1. irregular heart beat
2. shortness of breath
3. swelling of the hands or feet (edemas)