Transition Drug Cards

  1. Cardiac Glycoside
    Digoxin (Lanoxin)
    • + inotropic=increase force of contraction.
    • -chronotropic=slows heart rate
    • -dromotropic=slow conduction
    • Bradycardia, Tachycardia, convulsion, halo vision, colored vision (green or yellow)
    • Monitor for dig toxicity (Serum Dig level 0.5-2.0. toxic>2.5)
    • Increased risk for toxicity if low K+, high Ca+, hyperthyroid, renal dysfunction, or elderly. **Apical pulse for 1 minute. Not with dairy or antacids. St. Johns Wort and psyllium decrease dig effectiveness, and ginseng, hawthorne and licorice increase dig toxicity.
    • Antidite: digoxin immune fab.
    • CHF, Afib, Aflutter, Supraventricular Tachycardia, Atriual Tachycardia, Cardiogenic shock.
  2. Phosphodiesterase Inhibitor
    Inamrinone (Inocor)-approved for use only on pt not responding to Dig, diuretics and vasodilators.
    • Inhibit phosphodiesterase to produce + inotropic, thus vasodilates (increases CA+ thus stronger force of contraction, but can also increase O2 consumption and cause arrhythmias!!!
    • Hypokalemia, hepatotoxicity with long term use, Thrombocytopenia.
    • IV---dilute only in NS!! Monitor LFT, RFT, electrolytes and PLT count. Precipitates in IV line if given with Lasix. Must use separate IV line.
    • Short term use in CHF if unresponsive to Dig, diuretics, and vasodilators.
  3. Class 1B Antiarrhythmic
    Lidocaine (Xylocaine)
    • Stabalize cell membrane by binding to Na+ channels (Na+ channel blockers) Local Anesthetics.
    • Hypotension, Bradycardia, Confusion, Convulsions.
    • Given IV route. Must state "for Cardiac use" as other forms contain epinephrine. Monitor neurologic status and provide for safety.
    • For life threatening ventricular arrhythmias. Local anesthetic.
  4. Class II Antiarrythmics
    Propranolol (Inderal)
    • Beta Blockers---block SNS, thus decreasing rate, contractility and conduction. Hypotension, Bradycardia, may precipitate CHF, syncope.
    • Oral or IV use. Monitor for CHF. May not see increased pulse with exercise. Withhold if pulse <60. D/c gradually to prevent angina. Oral before meals.
    • Sysrhythmias d/t excessive SNS activity.
  5. Class III Antiarrythmics
    amiodarone (Cordarone)
    • Potassium Channel Blockers. Prolong refractory period by prolonging action potential, delaying repolarization.
    • Photosensitivity, corneal microdeposits, pulmonary toxicity, hepatitis and thyroid dysfunction.
    • Give IV or orally. Monitor LFT and thyroid**These drugs can be used interchangably!! Toxic if taken with Dig or quinidine. Increased risk of arrhythmias with TCA or antihistamine.
    • Treatment of life threatening ventricular arrythmias unresponsive to Class 1B and 1C. **Each med in this class of antiarrhythmics works differently.
  6. Class IV Antiarrhythmics
    diltiazem (Cardizem)
    • Ca+ Channel Blockers, this-dromotropic effect (decrease conduction).
    • Hypotension, bradycardia, heart block, edema, constipation.
    • Given IV or orally. Monitor for CHF and hypotension. MUST AVOID GRAPEFRUIT JUICE.
    • PSTV (paroxysmal supraventricular tachycardia). Controls ventricular repsonse to Afib or Aflutter.
Card Set
Transition Drug Cards
Cardiotonic Agents Antiarrythmic