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Procainamide
What drug category does it belong to?
What dysrhythmias is it indicated for?
What line of therapy is it?
- Sodium Channel Blocker
- For A-Fib & Flutter, PVCs, VTs, V-Fib
- Second line therapy
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This Na Channel Blocker may cause drug-induced lupus syndrome
Procainamide
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Lidocaine
What drug category does it belong to?
What dysrhythmias is it indicated for?
- Sodium Channel Blocker
- Ventricular dysrhythmias like PVCs, VTs, V-Fib
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Which dysrhythmias do beta blockers treat?
How do they work?
What are some nursing interventions?
Name a few.
SVTs, A-Fib & Flutter, PVCs
- Lowers HR, BP, myocardial contractility
- Slows down AV conduction
- Watch for hypotention, AV block, bradycardia, HF
- Choose ones that are cardio selective
- Metoprolol
- Atenolol
- Esmolol
- Carvedilol
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Amiodarone
What drug category does it belong to?
What dysrhythmias is it indicated for?
What are common adverse effects?
Potassium Channel Blocker
- A-Fib & Flutter (converts it to NSR)
- PVCs, VT, V-Fib
- Pulmonary toxicity
- Visual changes
- Thyroid & liver problems
- Photosensitivity
- Bluish discoloring of skin
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How potassium channel blockers work on the heart?
- Slows repolarization
- Prolongs the refractory period
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How do sodium channel blockers work on the heart?
Slows conduction, prolongs repolarization
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This class of medication blocks sympathetic receptors to the heart & slows AV conduction
Beta Blockers
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This class of medication decreases automaticity of the SA node & delays AV node conduction
Calcium Channel Blockers
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What are the atrial arrhythmias?
A-Fib & Flutter, PACs, Junctional Rhythms
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Adenosine
What is it used for?
How do you give it?
Paroxysmal SVTs
- Warm to room temperature
- Administer IV bolus 6mg (do not dilute)
- Follow with saline flush
- Drug has 6-8 second half life (so push fast!)
- Causes 5-6 seconds of asystole before coming back (they do come back)
- If not work, give 12mg and try again
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Digoxin
What does it treat?
What are the signs of toxicity?
Notify provider if apical is below _____ in an adult
Atrial dyshythmias
- Bradyxardia
- GI issues (NVD)
- Seeing the halo
60 bpm
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Atropine
What does it treat?
What are adverse effects?
What are contraindications?
Treats: Bradycardia
Adverse Effects: BPH, Urinary retention
Contraindicated: Narrow angle glaucoma
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Name some examples of sodium channel blockers
- Procainamide
- Lidocaine
- Disopyramide
- Propafenone
- Flecainide
- Quinidine
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Name some examples of potassium channel blockers
- Amiodarone
- Dronedarone (Multaq)
- Sotalol (Betapace, which also has beta blocker properties to it)
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_______ is for asystole while _________ is for bradycardia. Route for both is _______
- Epi (epinephrine)
- Atropine
- IVP
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Conduction pathway of the conduction of the heart…go!
- SA Node
- AV Node
- Bundle of His
- L&R Bundle Branches (Left branches into posterior & anterior)
- Purkinje Fibers
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Heart rates of SA, AV, & ventricular pacemaker in bpm
- SA: 60-100
- AV: 40-60
- Ventricular: 20-40
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On EKG, the following wave forms represent…
P, QRS, Ta, T
- P: Atrial Depolarization
- Ta: Atrial Repolarization
- QRS: Ventricular Depolarization
- T: Ventricular Repolarization
Depolarization = Contraction = “the squeeze”
Repolarization = Relaxation = “the relaxing”
Ta Wave is obscured by QRS (not seen on strip)
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Normal EKG Intervals for PRI, QRS, & QT
- QRS: 0.04 - 0.12
- PRI: 0.12 - 0.20
- QT: 0.36 - 0.44
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What is the absolute refractory period?
After an action potential initiates, the cardiac cell is unable to initiate another action potential for some duration of time
(which is slightly shorter than the "true" action potential duration). This period of time is referred to as the refractory period, which is 250ms in duration and helps to protect the heart.
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Excitable group of cells that cause premature beats outside normally functioning SA node
- Ectopic Focus (plural: foci)
- Also called an ectopic pacemaker
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What is the treatment for PACs?
Isolated PACs are not an issue and are often seen in in the healthy caused by stress, caffeine, cold meds
Treatment involves removing that cause
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What are the treatments for SVTs?
- If patient is stable…
- Vagal stimulation
- Cartoid massage (done by doc)
- Face in ice bath
- Ca Channel blockers
- Digoxin
- Beta Blockers
- Adenosine IVP
- If patient is NOT stable…
- Cardioversion
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What are the pharmaceutical & nonpharma treatments for A-Fib & Flutter? Name the aspects that need treatment.
- HR Rate Control Treatments
- Ca Channel Blockers
- Beta Blockers
- Digoxin (not as popular anymore)
- Rhythm Control Treatments
- Amiodarone, dronedarone
- Anticoagulates
- TEE to look for clots
- Cardioversion
- Pacer if patient is tachy or brady
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What are the treatments for Junctional Rhythms?
- Atropine
- Pacemaker (if SA node is out of commission)
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Define the following…
Ventricular Bigeminy, Trigeminy, Couplets, Tachycardia
- Ventricular Bigeminy
- Every other beat is a PVCVentricular
- Ventricular Trigeminy
- Every third beat is a PVC
- Ventricular Couplets
- Two consecutive PVCs
- Ventricular Tachycardia
- Occurs three or more PVCs are occurring (see notes on VTs)
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R on T Phenomenon
- Occurs when a PVC falls on T wave of a preceding beat
- Dangerous because it may precipitate v-tach or v-fib
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What are the treatments for PVCs?
Depends on the cause of the PVC
Correct the underlying cause (caffeine, nicotine, stress, fever, mitral valve prolapse, MI)
Amiodarone, Lidocaine, Procainamide, Beta Blockers
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The QRS of this arrhythmia is wide and bizarre looking
PVC
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What are Unifocal & Multifocal PVCs?
What do they look on ECG?
Unifocal PVCs are initiated from same foci & appear alike on EKG
Multifocal PVCs are initiated from different foci & each have different shapes from each other on EKG
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Treatment for V-Tach entails…
- If patient has a pulse & is stable
- Amiodarone, Procainamide, Lidocaine, Cardioversion
- If patient is pulseless
- V-Tach should be treated as V-Fib
- “if patient is v-fib, you de-fib”
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Patient in V-Fib presents as…
Unresponsive & in cardio arrestApneic & pulseless
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What are the medications given during V-Fib?
- Epi, vasopressin
- Amiodarone, Lidocaine, Procainamide
- Magnesium Sulfate
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