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Any deviation from the normal rhythm of the heart is called what?
Dysrhythmia or Arrhythmia
What is the desired action of Antidysrhythmic drugs?
to restore the cardiac rhythm to normal.
What are all the mechanisms of action for the different Antidysrhythmic drugs?
- Beta blockers: block adrenergic stimulation of the heart.
- Depress myocardial excitability & contractility
- Negative Inotrops: <conduction velocity in cardiac tissue (slow conduction down)
- ^recovery time (repolarization) of the myocardium
- Suppress automaticity (spontaneous depolarization to initiate beats)
What are the common types of Dysrhythmias?
- Supraventricular dysrhythmias: Atrial fib, Atrail flutter.
- Ventricular dysrhythias: Ventricular tachy (V.tach), Ventricular Fibrillation (V.fib)
- Ectopic foci: premature ventricular contractions (PVC), premature atrial contractions (PAC).
- Conduction blocks: 1st, 2nd or 3rd degree heart blocks.
Explain what the Vaughan Williams Classification is.
- System commonly used to classify Antidysrhythmic drugs, based on electrophysiologic effect of particular drugs on the action potential.
- 4 classes
What are the 4 classes of the Vaughan Williams Classification for Anti-dysrhythmics drugs?
- Class I: Sodium Channel Blockers
- Class II: Beta Blockers
- Class III: Prolong repolarization
- Class IV: Calcium Channel Blockers
- Other...Digoxin & adenosine
What are the meds in Class I of the Vaughan Williams Classification of Anti-dysrhythmics?
- Procainamide, quinidine & lidocaine.
- They are membrane-stabalizing medications that act on the sodium (fast)-channel
What are the s/e of the Class 1 V.W. Anti-dysrhythmic drug, Quinidine?
N/V/D, confusion, <BP
What are the s/e of the Class I V.W. Anti-dysrhythmic drug, Procainamide?
What are the s/e of the Class I, V.W. Anti-dysrhythmic drug, Lidocaine?
- bradycardia, <BP, CNS s/s (seizures, confusion), resp depression, blurred vision.
- Given IV
- WATCH IV LABLES D/T BEING USED W/EPI ALSO.
What are the Class II V.W. Anti-dysrhythmic drugs & what is their action?
- Cardioselective Beta Blockers: Atenolol, Esmolol, Metoprolol, Propranolol
- <or block SNS stimulation, thus <transmission of impulses in the heart's conduction system.
- Nonspecific Beta-blocker: propranolol
Cardioselective Beta-blockers like Atenolol, Esmolol, & Metoprolol are used for what types of cardiac issues?
- V.W. Class II Anti-dysrhythmic
What are the V.W. Class III Anti-dysrhythmic drugs what are their s/e?
- Adenosine, Amiodarone & Sotalol
- Amiodarone: can cause COPD s/s (LAST RESORT)
- S/E; hyper/hypothyroidism, visual halos, photophobias, pulmonary toxicity
- Used for dysrhythmias that are difficult to treat.
What are the V.W. Class IV Anti-dysrhythmic drugs?
- Calcium Channel Blockers: Verapamil, Diltiazem
- *inhibit slow-channel (calcium-dependent) pathways
- Reduce AV node conduction
Calcium Channel Blockers, Verapamil & Diltiazem are used to treat what different types of heart conditions?
- V.W. Class IV Anti-dysrhythmics
The V.W. Class III Anti-dysrhythmic Adenosine has what action & what half-life?
- Slows conduction through the AV node
- Used to convert paroxysmal supraventricular tachycardia to sinus rhythm
- VERY SHORT: <10 seconds!!!
- IV PUSH only!
What are the possible a/e of Anti-dysrhythmics?
- Hypersensitivity rxns
- blurred vision
What are the nursing implications for Anti-dysrhythmics?
- HR, rhythm & BP
- During therapy: monitor cardiac rhythm, general well-being, skin color, temp, heart & lung sounds, K+ levels, plasma drug levels
- NO SKIPPING DOSES
- NO CRUSHING OR CHEWING pills
What types of things should a client who is on an Anti-dysrhythmic be taught?
- Notify MD if: ^dysrythmias, or toxic effects
- SOB, Chest pain, GI distress, Blurred vision,
- Edema, dizziness, syncope
- (these are s/s of heart failure)
Clients taking Anti-dysrhythmics NEED to be taught what? (ie. beta-blockers, digoxin)
- Radial pulse for 1 FULL minute
- Notify MD if pulse <60 before taking next dose
When a client is taking an Anti-dysrhythmic the nurse needs to monitor for what therapeutic responses?
- <BP in hypertensive pts
- regular pulse rate
- Pulse rate w/o major irregularities
- improved regularity of rhythm
- improved cardiac output