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Any deviation from the normal rhythm of the heart is called what?
Dysrhythmia or Arrhythmia
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What is the desired action of Antidysrhythmic drugs?
to restore the cardiac rhythm to normal.
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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)
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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.
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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
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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
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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
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What are the s/e of the Class 1 V.W. Anti-dysrhythmic drug, Quinidine?
N/V/D, confusion, <BP
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What are the s/e of the Class I V.W. Anti-dysrhythmic drug, Procainamide?
lupus-like s/s
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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.
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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
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Cardioselective Beta-blockers like Atenolol, Esmolol, & Metoprolol are used for what types of cardiac issues?
- V.W. Class II Anti-dysrhythmic
- Anti-anginal
- Anti-hypertentive
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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.
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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
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Calcium Channel Blockers, Verapamil & Diltiazem are used to treat what different types of heart conditions?
- V.W. Class IV Anti-dysrhythmics
- Anti-anginals
- Anti-hypertensives
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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!
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What are the possible a/e of Anti-dysrhythmics?
- Hypersensitivity rxns
- N/V/D
- dizziness
- blurred vision
- HA
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What are the nursing implications for Anti-dysrhythmics?
- HR, rhythm & BP
- NO SKIPPING DOSES
- NO CRUSHING OR CHEWING pills
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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)
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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
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When a client is taking an Anti-dysrhythmic the nurse needs to monitor for what therapeutic responses?
- <BP in hypertensive pts
- <edema
- <fatigue
- regular pulse rate
- Pulse rate w/o major irregularities
- improved regularity of rhythm
- improved cardiac output
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