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NurseReview.Org - Antidysrhythmics Updates (pharmacology principles for nursing)
 

NurseReview.Org - Antidysrhythmics Updates (pharmacology principles for nursing)

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Visit NurseReview.Org for more medical / nursing slides for your nclex, nle, ang cgfns exams.

Visit NurseReview.Org for more medical / nursing slides for your nclex, nle, ang cgfns exams.

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    NurseReview.Org - Antidysrhythmics Updates (pharmacology principles for nursing) NurseReview.Org - Antidysrhythmics Updates (pharmacology principles for nursing) Presentation Transcript

    • Antidysrhythmic Agents
    • Antidysrhythmics
      • Dysrhythmia
      • Any deviation from the normal rhythm of the heart
      • Antidysrhythmics
      • Drugs used for the treatment and prevention of disturbances in cardiac rhythm
    • Cardiac Cell
      • Inside the cardiac cell, there exists a net negative charge relative to the outside of the cell.
    • Resting Membrane Potential: RMP
      • This difference in the electronegative charge.
      • Results from an uneven distribution of ions (sodium, potassium, calcium) across the cell membrane.
      • An energy-requiring pump is needed to maintain this uneven distribution of ions.
      • Sodium-potassium ATPase pump
    • Instructors may wish to insert: EIC Image # 61: Heart and Conduction System EIC Image # 63: Resting Membrane Potential of a Cardiac Cell
    • Action Potential
      • A change in the distribution of ions causes cardiac cells to become excited.
      • The movement of ions across the cardiac cell’s membrane results in the propagation of an electrical impulse.
      • This electrical impulse leads to contraction of the myocardial muscle.
    • Action Potential
      • Four Phases
      • The SA node and the Purkinje cells each have separate action potentials.
    • Instructors may wish to insert: EIC Image # 64: Action Potentials: Phases (SA Node) EIC Image # 65: Action Potentials: Purkinje Fiber EIC Image # 66: Action Potentials: Intervals
    • Vaughan Williams Classification
      • System commonly used to classify antidysrhythmic drugs
    • Vaughan Williams Classification
      • Class 1
        • Class Ia
        • Class Ib
        • Class Ic
      • Class II
      • Class III
      • Class IV
      • Other
    • Vaughan Williams Classification
      • Class I
      • Membrane-stabilizing agents
      • Fast sodium channel blockers
      • Divided into Ia, Ib, and Ic agents, according to effects
    • Vaughan Williams Classification
      • Class I
      • moricizine
      • General Class I agent
      • Has characteristics of all three subclasses
      • Used for symptomatic ventricular and life-threatening dysrhythmias
    • Vaughan Williams Classification
      • Class Ia
      • quinidine, procainamide, disopyramide
      • Block sodium channels
      • Delay repolarization
      • Increase the APD
      • Used for atrial fibrillation, premature atrial contractions, premature ventricular contractions, ventricular tachycardia, Wolff-Parkinson-White syndrome
    • Vaughan Williams Classification
      • Class Ib
      • tocainide, mexiletine, phenytoin, lidocaine
      • Block sodium channels
      • Accelerate repolarization
      • Decrease the APD
      • Used for ventricular dysrhythmias only (premature ventricular contractions, ventricular tachycardia, ventricular fibrillation)
    • Vaughan Williams Classification
      • Class Ic
      • encainide, flecainide, propafenone
      • Block sodium channels (more pronounced effect)
      • Little effect on APD or repolarization
      • Used for severe ventricular dysrhythmias
      • May be used in atrial fibrillation/flutter
    • Vaughan Williams Classification
      • Class II
      • Beta blockers: atenolol, esmolol, petaprolol, propranolol
      • Reduce or block sympathetic nervous system stimulation, thus reducing transmission of impulses in the heart’s conduction system
      • Depress phase 4 depolarization
      • General myocardial depressants for both supraventricular and ventricular dysrhythmias
    • Vaughan Williams Classification
      • Class III
      • amiodarone, bretylium, sotalol, ibutilide
      • Increase APD
      • Prolong repolarization in phase 3
      • Used for dysrhythmias that are difficult to treat
      • Life-threatening ventricular tachycardia or fibrillation, atrial fibrillation or flutter—resistant to other drugs
      • Sustained ventricular tachycardia
    • Vaughan Williams Classification
      • Class IV
      • verapamil, diltiazem
      • Calcium channel blockers
      • Depress phase 4 depolarization
      • Used for paroxysmal supraventricular tachycardia; rate control for atrial fibrillation and flutter
    • Vaughan Williams Classification
      • Other Antidysrhythmics
      • digoxin, adenosine
      • Have properties of several classes and are not placed into one particular class
    • Antidysrhythmics
      • Digoxin
      • Cardiac glycoside
      • Inhibits the sodium-potassium ATPase pump
      • Positive inotrope—improves the strength of cardiac contraction
      • Allows more calcium to be available for contraction
      • Used for CHF and atrial dysrhythmias
      • Monitor potassium levels, drug levels, and for toxicity
    • Antidysrhythmics
      • adenosine (Adenocard)
      • Slows conduction through the AV node
      • Used to convert paroxysmal supraventricular tachycardia to sinus rhythm
      • Very short half-life
      • Only administered as fast IV push
      • May cause asystole for a few seconds
      • Other side effects minimal
    • Antidysrhythmics: Side Effects
      • ALL antidysrhythmics can cause dysrhythmias!!
      • Hypersensitivity reactions
        • Nausea
        • Vomiting
        • Diarrhea
        • Dizziness
        • Blurred vision
        • Headache
    • Antidysrhythmics: Nursing Implications
      • Obtain a thorough drug and medical history.
      • Measure baseline BP, P, I & O, and cardiac rhythm.
      • Measure serum potassium levels before initiating therapy.
    • Antidysrhythmics: Nursing Implications
      • Assess for conditions that may be contraindications for use of specific agents.
      • Assess for potential drug interactions.
      • Instruct patients regarding dosing schedules and side effects to report to physician.
    • Antidysrhythmics: Nursing Implications
      • During therapy, monitor cardiac rhythm, heart rate, BP, general well-being, skin color, temperature, heart and breath sounds.
      • Assess plasma drug levels as indicated.
      • Monitor for toxic effects.
    • Antidysrhythmics: Nursing Implications
      • Instruct patients to take medications as scheduled and not to skip doses or double up for missed doses.
      • Patients who miss a dose should contact their physician for instructions if a dose is missed.
      • Instruct patients not to crush or chew any oral sustained-release preparations.
    • Antidysrhythmics: Nursing Implications
      • For class I agents, monitor ECG for QT intervals prolonged more than 50%.
      • IV infusions should be administered with an IV pump.
    • Antidysrhythmics: Nursing Implications
      • Patients taking propranolol, digoxin, and other agents should be taught how to take their own radial pulse for 1 full minute, and to notify their physician if the pulse is less than 60 beats/minute before taking the next dose of medication.
    • Antidysrhythmics: Nursing Implications
      • Monitor for therapeutic response:
        • Decreased BP in hypertensive patients
        • Decreased edema
        • Regular pulse rate or
        • Pulse rate without major irregularities, or
        • Improved regularity of rhythm