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Pharm II unit 9
cardio
93
Nursing
Undergraduate 1
11/12/2011

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Cards

Term
What is Automaticity
Definition
the ability to generate an impulse spontaneously
Term
What is a Ectopic foci
Definition
abnormal sites of impulse generation
Term
What is Proarrhythmia?
Definition
the property of antidysrhythmics to cause new dysrhythmias or exacerbate the dysrhythmia they are treating
Term
What is the Re-entry phenomenon
Definition
  1. when cardiac impulses encounter a block in conduction, instead if being extinguished, the impulse is carried along the unopposed side and re-enters the conduction branch from the opposite side causing repetitive cardiac stimulation 
Term
What is Refractory?
Definition
time during the cardiac cycle when the heart is unable to respond to a new stimulus
Term
What are Dromotropic drugs?
Definition

affecting the speed with which impulses pass through the conduction system;

positive dromotrophic medications increase speed of impulses negative dromotropic medications decrease speed of impulse

Term
What are Chronotropic drugs?
Definition

affecting the heart rate


positive chronotropic medications increase HR,

negative chronotropic medications decrease HR

Term
What are Inotropic drugs?
Definition

affecting force of contraction;

positive inotropic medications increase the force of contraction and therefore increase CO (cardiac output)

negative inotropic drugs decrease the force of contraction and therefore decrease CO

Term
What ion channel does Class I antiarrhythmics affect?
Definition

sodium 


Class I antiarrhythmics are sodium channel blockers and have direct membrane action upon the sodium channel

Term

What receptors  does Class II antiarrhythmics affect?

Definition

beta receptors

Class II antiarrhythmics are the beta-blockers and affect the heart by sympatholysis (beta blocking).

Term

What ion channel does Class III antiarrhythmics affect?

Definition

potassium channels


Class III antiarrhythmics prolong repolarization by affecting the potassium channel 

Term

What ion channel does Class IV antiarrhythmics affect?

Definition

calcium channel


Class IV antiarrhythmics are calcium channel 

Term

  In addition to these classes what other

antiarrhythmics are there?

Definition
purinergic agonists and the digitalis glycosides
Term

How does depolarization occur?

Wha ions are involved

What happens tothe heart?

Definition

cell membrane becomes more permeable to sodium. Calcium ions follow sodium 

As sodium and calcium ions move into the cells, potassium moves out of cells.  The movement of the ions changes the membrane from its resting state of electrical neutrality to an activated state of electrical energy buildup.

When the electrical energy is discharged (depolarized),

muscle contraction occurs

Term

All the Class I agents are sodium channel blockers that affect Phase 0 of depolarization.


What does this mean?

Definition
it blocks the rapid inflow of sodium through the sodium channels slowing the action potential
Term
What are the subclasses of Class I antiarrhythmic drugs?
Definition

1A - quinidine, procainamide, and disopyramide. 

1B-  lidocaine, mexiletine, and phenytoin.  

IC- flecainide and others 

Term
What are Class IA agents such as Quindine used to treat?
Definition

 ventricular and supraventricular dysrhythmias— PAC’s, PVC’s,

 maintenance of SR after AF, VT and prevention of VF

Term

How does Class IA agents such as Quindine work?

 

Definition

 Depresses: conduction, excitability, and contractility

Prolongs refractoriness of the atrial His-purkinje and ventricular tissue


These antidysrhythmics are:


vagolytic:  A therapeutic or chemical agent that has inhibitory effects on the vagus nerve


negative inotropes: decrease the force of contraction and therefore decrease CO 

 

Term

What EKG changes will you likly see with

Class IA agents such as Quindine?

Definition
increase in the PR interval and an increase in the QRS duration
Term

What is a sing of Toxicity of Class IA agents such as Quindine

 R/T an EKG change?

Definition

Toxicity occurs as the corrected QT interval increases

-this can be as much as 30% increase

Term

What Class IA agents also has calcium channel blockade making it a potent anticholinergic.

 

Definition
disopyramide
Term

What are the most common adverse effect of  Class IA agents such as Quindine?

 

Definition

GI Related: N/V, diarrhea, abdominal pain, anorexia


Syndrome of cinchonism: auditory changes, dizziness, vertigo, disturbed vision

Term

If a pt has a small heart block a Class IA agents such as Quindine may be used because the benifit outways the risk.


True or False?

Definition

False

 

Don’t give to those with any degree of AV block!!! 

Term
What are the serious adverse effect of  Class IA agents such as Quindine?
Definition

 Cardiotoxicity: increased PR and QT intervals, Vtach, asystole, arterial embolism, PVC’s, complete heart block


Lupus-like syndrome (long-term use)

Term

Your pt is taking Quinidine (Quinora).

What labs do you want to look at?

Why?

Definition

CBC-  discrasias r/t lupis- like syndrome 

LFT’s- can be hepatotoxic

K+ level  -  low levels will reduce effects and induce torsades de pointes

(a lethal form of ventricular tachycardia)  

 

 

 

 

 

 

 

 

 

 

Term
What is the normal  serum range of Quinidine (Quinora)?
Definition

 2-6 mg/mL

Term
If the pt is too receive Quinidine (Quinora) IV what must be in place before starting this med?
Definition
Continuous cardiac and rhythm monitoring
Term

What is the nusres action if the QRS complex increase >25%, disappearance of P waves, or restoration of sinus rhythm

 and the pt is taking Quinidine (Quinora) ?

Definition
Notify the MD 
Term
Lidocaine, mexiletine and phenytoin all fall into what class of druges?
Definition
Class  IB Antidysrhythmic
Term
What is Lidocaine (class 1B) used to treat?
Definition

Acute treatment of ventricular tachycardia

r/t cardiac surgery or acute MI

Term

A nurse is preparing to give  Lidocaine (class 1B) IV.

How should the nurse give this med?

Definition
First a a bolus, then   a maintenance infusion must follow
Term
Why must a nurse give Lidocaine (class 1B) IV as a bolus then maintenance?
Definition

       Short half-life:

First phase: 5-10 min

  Second phase: 80-110 min

Term
Caution and lower doses of Lidocaine (class 1B) are needed in what types of pts?
Definition

CHF, reduced CO, digitalis toxicity w/ AV block, hypovolemia

and shock, all heart blocks

Term
What are the common side effects of Lidocaine (class 1B)
Definition
CNS: dizziness, lightheadedness, fatigue and drowsiness.
Term

What are the seriuos side effects of Lidocaine (class 1B)

Definition

 CV effects: arrhythmias and hypotension, cardiac arrest


CNS effects: hallucinations, seizures, LOC

 

Seizures and coma >6 µg

Term
What are the normal serum levels of Lidocaine (class 1B)
Definition
1.5-6 µg/mL
Term
If the pt is too receive Lidocaine (class 1B) IV what must be in place before starting this med?
Definition
Continuous ECG monitoring 
Term
A nurse is about to give Lidocaine IV. What should the nurse have near by as a precaution?
Definition
Emergency resuscitative equipment
Term
What two drugs represent the Class IC antidisrythmics?
Definition
Flecainide (Tambocor), Propafenone (Rythmol)
Term
What are Flecainide/ propafenone used to treat?
Definition
Long-term life threatening dysrhythmias
Term

What are the most common sife effects of

Flecainide/ propafenone?

Definition
Prolonged QT
Term

What are the most serious sife effects of

Flecainide/ propafenone?

Definition

 Conduction of the heart

Profound negative inotrope

Term

How does Class II propanolol work?

 

Definition

 Nonspecific beta blocker

Slows HR, ↓ O2 demand

Depress AV conduction

Decreases CO 

Reduces BP

Term
Whta is Class II propanolol used to treat?
Definition

Reentry and ectopic supraventricular tachycardia-  s/t digoxin toxicity

  Sinus tachycardia s/t thyrotoxicosis

Exercised-induced ventricular tachycardia

Term
What types of pt should you question an order of Class II propanolol being started?
Definition

  COPD, bronchospasm

    Sinus bradycardia

Second and Third degree HB

Term
What is the most common adverse effects of Class II propanolol 
Definition

postural hypotension. bronchospasm 

Term

What is the most serious adverse effects of Class II propanolol 

Definition
myocardial infarction 
Term
Anurse has just given a pt Class II propanolol  for the first time. What is the nurses #1 concern?
Definition
SAFETY- R/T postural hypotension
Term
A pt reports to you that they ran out of their Rx of propanolol  and can't fill it for three days do to finacial strain. What is the nurse most conncerned about in this pt?
Definition

Sudden Discontinuation can cause rebound tachycardia.

Term

Propanolol  has a 3 hour half life so a nurse knows that the pt should recive the drug:


A. Q3Hr while awake

B. Q6Hr around the clock

C. BID

Definition
B. Q6Hr around the clock
Term
What is the prototype drug for Class III K+ - channel blockers
Definition
amiodarone (Cordarone)
Term
How does Class III amiodarone (Cordarone) works?
Definition

 Produces prolonged phase of repolarization

 Negative chronotropic effect from blocking slow calcium channels

U waves appear and T waves are altered


IV: relaxes smooth muscle, ↓ peripheral vascular resistance

Term
What is Class III amiodarone (Cordarone) used to treat?
Definition

Life-threatening ventricular dysrhythmias

 Suppression of supraventricular tachycardias

IV in initiation of therapy and prophylaxis for recurring V fib and hemodynamically  unstable V tach

Term
What type of pts should not take Class III amiodarone (Cordarone) ?
Definition

 Severe sinus bradycardia

  2nd or 3rd degree AV heart block

Hx. Of bradycardia w/ syncope

Term
What are the most common side effects of Class III amiodarone (Cordarone)
Definition

CNS: dizziness, fatigue, drowsiness, paresthesia, tremor, HA, insomnia.

GI Related: N/V, constipation, abdominal pain, anorexia  Photosensitivity (IV): blue-gray discoloration

IV most common is hypotension: slow rate

Term

What are the most serious side effects of Class III amiodarone (Cordarone)

Definition

 Pulmonary toxicity: cough, progressive dyspnea, phosopholipidosis, abnormal tests

  Exacerbation of treated arrhythmia

    Liver disease

Term
Why should you not give Class III amiodarone (Cordarone) to a pregnant pt?
Definition

  Pregnancy D

causes Gasping syndrome in premature infants

Term
A pt is taking Class III amiodarone (Cordarone), Why is it important for the nurse to correct electrolyte imbalances before starting the med?
Definition
hypokalemia, hypomagnesemia can cause  QT prolongation
Term
What tests should done before a pt starts Class III amiodarone (Cordarone)?
Definition

Baseline LFT’s, thyroid function, respiratory

Term
How should IV amiodarone (Cordarone) be prepaired to decreases absorption? 
Definition
mix in glass bottles or polyolefin bags of D5
Term

A pt is to recive amiodarone (Cordarone) what to monitering devices should the nurse know to have in place?

Why?

Definition

pulse ox and ABG’s for resp. function

MED can cause Pulmonary toxicity



Report new onset of cough, SOB, and changes in visual acuity!!!!!

Term
What should a nurse know about amiodarone (Cordarone) when giving it PO?
Definition
give w/food for GI effects, do not give w/grapefruit
Term

What is the class IV antidysrhythmic?

 

Definition
Verapamil
Term

How does the Class IV Verapamil work?

Definition

Inhibits movement of Ca2+ across cardiac and arterial muscle cell membrane.

Slows conduction through AV node

Depresses myocardial contractility, automaticity

Dilates coronary and peripheral arteries

Term
What is Class IV Verapamil used to treat?
Definition

 IV for supraventricular tachycardia

Temporally control the rapid ventricular response to A-fib or flutter

Prophalactic w/ Digoxin tor repetitive SVT

Angina resulting from coronary artery spasms

HTN

Term
What types of pts should not use Class IV Verapamil ?
Definition

Sick sinus syndrome: ↓ cardiac function, CHF

Second or third degree HB

Hypotension: systolic <90 mmHg

Term

What are the most common sede effects of 

Class IV Verapamil?

Definition

     Constipation

 Dizziness, weakness, fainting (bradycardia or hypotension)

Swelling of the lower extremities

Rash

HA

Term

What are the most serious sede effects of 

Class IV Verapamil?

Definition

Difficulty breathing or wheezing (worsening HF)

Lethal ventricular arrhythmias

May cause abnormal LFT’s

Term

What age groups should you use caution when giving Class IV Verapamil?

Why?

Definition

Elderly- more prone to hypotensive events.


 neonates/infants- no IV administation

Term
Your pt is to recive IV  Class IV Verapamil. What type of monitering do you need to have in place?
Definition
cardiac and BP monitoring 
Term
Your pt is to recive IV  Class IV Verapamil. What must you include in your head to toe assessment?
Definition

JVD, cardiac signs, mentation, edema,


hx of palpitations, and PND.

Term
Your pt is to recive IV  Class IV Verapamil. What must you assess before giving the med.
Definition

Take apical pulse, hold drug if too low or irregular beats and call MD.

Term
What education should the nurse give the pt who has started  Class IV Verapamil
Definition

Education should include: compliance, report weight gain

Increase fluids and fiber to ↓ constipation

Term
What drug is used for Hypertensive Crisis?
Definition
nitroprusside (Nitropress)
Term
How does nitroprusside (Nitropress) work?
Definition

Relaxes vascular smooth muscle

Dilates peripheral arteries and veins

Reduces preload and afterload

 Moderate doses induce renal vasodilation

Term
What are the uses of nitroprusside (Nitropress) 
Definition

Lower BP in acute hypertensive crisis

Reduce bleeding during surgery

Acute CHF

Term
What types of pts should you not give nitroprusside (Nitropress) 
Definition

 Compensatory HTN from aortic coarctation or arteriovenous shunting

 Inadequate cerebral circulation in surgery

Term
What are the most common side effects of nitroprusside (Nitropress) 
Definition

 N/V, HA

Palpitations, Ectopic Beats

Dyspnea, angina

Term

What are the most serious side effects of nitroprusside (Nitropress) 

Definition

 

 Ventricular dysrhythmias

Increased pulmonary shunting

Decrease splanchnic perfusion

Increase pulmonary wedge pressure

 

Term
What types of monitering need to be in place when giving nitroprusside (Nitropress) ? 
Definition

 Need invasive monitoring arterial lines and Swan-gantz lines

Term

A nurse has a pt that is taking nitroprusside (Nitropress) what labs should the nurse be most concerned about checking?


Why?

Definition

Watch the pt electrolytes to make sure adequate renal perfusion (Creatinine and K+)

   

Blood gases to detect acidosis as this will decrease effectiveness of dopamine

Term
What is the atidote for nitroprusside (Nitropress) 
Definition
SQ injection of phentolamine
Term

A nurse is about to give nitroprusside (Nitropress) IV.

How should the nurse give this med.


A. Use in a dedicated central line

 B. Use a pic line that has been flushed

C. Use any patent IV sight

Definition
A. Use in a dedicated central line-   d/t numerous incompatibilities
Term
What S/S should be assessed for while a pt is on nitroprusside (Nitropress)
Definition

·         Monitor BP, UO, CO, PWP

Term
What drug is a Direct-acting inotropic
Definition
dobutamine (Dobutrex)
Term

How does dobutamine (Dobutrex) work?

Definition

No effect on renal perfusion

Increase HR w/ less decrease in peripheral vascular resistance

No norepinephrine release

Term
What is dobutamine (Dobutrex) used to treat?
Definition
Adults w/ cardiac decomposition due to decreased contractibility from organic heart disease or cardiac surgery
Term
What types of pts should not use dobutamine (Dobutrex)
Definition

 Hypersensitivity: Sulfite allergies

Ventricular fibrillation or uncorrected tachycardia

Term

What are the most common side effects of

dobutamine (Dobutrex)

Definition

Ventricular ectopic activity

N, HA, SOB, palpitations

Term

What are the most serious side effects of

dobutamine (Dobutrex)

Definition

Anaphylactic Reaction

Increase of 30 bpm and systolic BP of 50 mmHg leading to tachycardia

Term
What types of monitering are needed for a pt on dobutamine (Dobutrex)?
Definition

Monitor ECG, HR, BP, Cardiac output, and pulmonary wedge pressure continuously

Term
_______ should be corrected before administrating dobutamine (Dobutrex) by giving ______
Definition

Hypovolemia should be corrected before administrating drug by giving plasma expanders

Term
What preparationshould be given  prior to admin of dobutamine (Dobutrex)  in patients with a fib w/ rapid ventricular response d/t ↑ AV conduction
Definition
Digitalis preparation 
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