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What does Atropine do?
- It picks up the pace!
- Increases HR
- Used to increase HR in sinus brady and heart blocks
- Increasing HR also increases cardiac demand and workload
- Assess for CP after admin, monitor HR and rhythm
- Allows SNS to increase HR
What are the side effects of Atropine?
- Blurred vision
- Dry mouth
- Urinary hesitancy
What is the antidote to Atropine?
When is Atropine contraindicated?
Glaucoma and BPH
What does Adenosine do?
- Slows conduction through the AV node
- "SLAPS THAT IRRITABLE SITE!"
- Allows SA node to take back the control as the pacemaker
What is Adenosine used for?
- Does not react w/ other antidysrhythmics, like Dig & BB
- Give over 1-2 sec b/c half life of 10 sec
- Flush with 20 mL of NS in 1-2 sec afterwards
What is the major side effect of Adenosine?
Bradycardia resistant to Atropine
What is diltiazem (Cardizem)?
- Calcium channel blocker
- Used in a fib/flutter and SVT
What does Cardizem do?
- Slows conduction in SA and AV nodes
- Decreases cell excitability
- Negative chronotrop (decreases HR)
What are the side effects of Cardizem?
- S/S HF
- Peripheral edema
What do all antiarrhythmics do?
Sedate the heart
Class 1 antiarrhythmics
- Sodium channel blockers
- Work primarily on ventricular dysrhythmias
- Negative inotropes that decrease automaticity of the ventricles, delay ventricular depolarization, and decrease conduction velocity
- Prolong QT segment
Interactions w/ class 1
- Increase hypotension w/ anti-HTN, diuretics, and narcotics
- Period blood tests necessary b/c of anemia, leukopenia, thrombocytopenia
Class 1 A
- Quinidine, Pronestyl, Norpace
- Lengthen QT and may predispose to Torsades, esp if pt is also taking Levita
Class 1 B
- Lidocaine, Mexitil, Tonocard
- Cardiac depressant if used concurrently w/ Pronestyl, Inderal, Quinidine
Class 1 C
- Tambocor, Rhythmol
- Contraindicated w/ AICDs (req more energy to get pts out of lethal arrhythmias)
Class 2 antiarrhythmics
- Beta blockers
- Block excessive SNS activity
- Can be cardio- or non-cardioselective
- Used for atrial arrhythmias ONLY
Side effects of Class 2 (Beta blockers)
Can increase bradycardia if fiven with other negative chronotropics (synergistic effect)
Class 3 antiarrhythmics
- Potassium channel blockers
- Prolong repolarization/refractory period
- Prolongs QT leading to VT or Torsades
- FIRST line for VENTRICULAR arrhythmias: VT/VF/Torsades - Amiodarone
- SECOND line for ATRIAL arrhythmias: Amiodarone, Tikosyn, Multaq (dose lower than for vent. arr.)
Side effects of Amiodarone
Monitor labs q. 6 mo. for hypothyroidism, elevated LFT