Antiarrhythmics
What is a major adverse effect of procainamide related to autoimmune response?
Lupus-like syndrome - About 20% to 30% of patients receiving procainamide develop drug-induced lupus erythematosus–like syndrome resulting in multiple neuromuscular and inflammatory changes. Neuromuscular changes include weakness, muscle and joint pain, joint edema, and fatigue.
What class of drug is propranolol?
Non-selective beta blocker
Nitroglycerin primarily causes dilation of which vessels?
Veins (reduces preload) - This drug relieves anginal pain by several mechanisms: Venous dilation, which reduces venous pressure and decreases venous return to the heart. This decreases blood volume and pressure within the heart (preload), which in turn decreases cardiac workload and oxygen demand.
What electrolyte imbalance is most common with furosemide?
Hypokalemia
What is the first drug used in cardiac arrest (asystole)?
Epinephrine - The 2020 AHA guidelines recommend that epinephrine be administered as early as possible and in regular doses (1 mg IV every 3 to 5 minutes)
Procainamide belongs to which class of antidysrhythmic drugs?
Class Ia Sodium Channel Blocker
What adverse effect makes propranolol contraindicated in asthma?
Bronchoconstriction - Contraindications may include cardiogenic shock, heart failure, bronchial asthma, bronchospasm, and chronic obstructive pulmonary disease
What is a common side effect of nitroglycerin?
Severe headache - The most common adverse effect is a severe headache, which is typically treated with acetaminophen. Other common adverse effects include dizziness, bradycardia, syncope, hypotension, and orthostatic hypotension.
The nurse should do this daily when patients are taking furosemide?
Daily weights - When a patient is being treated with furosemide, the nurse weighs the patient daily and reports any increase in weight of greater than 2 lb in 24 hours to the healthcare provider.
What drug is used to treat symptomatic bradycardia?
Atropine - The 2020 AHA guidelines recommend atropine (1 mg IV every 3 to 5 minutes with max dose of 3 mg) for bradycardia but no longer recommend the use of atropine for the treatment of asystole because data do not support the use of the drug
Lidocaine is most effective in treating what type of arrhythmia?
Ventricular dysrhythmias (e.g., PVCs, VT) - Used to treat serious ventricular dysrhythmias associated with acute myocardial infarction, cardiac catheterization, cardiac surgery, and digitalis-induced ventricular dysrhythmias.
What is the primary therapeutic use of propranolol in cardiac patients?
To treat hypertension, angina, and certain arrhythmias; also used post-MI. - Used in the treatment of cardiac dysrhythmias, especially supraventricular tachycardia. In addition, it has been found to be effective in the treatment of ventricular tachycardia. Other related cardiac indications for propranolol include hypertension, cardiomyopathy, and angina. Propranolol is used in the early treatment of myocardial infarction and has been noted to reduce cardiovascular mortality for patients who survive the acute phase of myocardial infarction.
HR and BP - The nurse should withhold the medication with hypotension (systolic blood pressure less than 90 Hg or 30 mm Hg below the patient’s normal blood pressure) as well as tachycardia with a heart rate greater than 100 beats/min.
Spironolactone is what type of diuretic?
Potassium-sparing / Aldosterone antagonist
These two key interventions alongside drug therapy in cardiac arrest?
High-quality CPR and defibrillation if applicable
What is the primary action of amiodarone on cardiac cells?
Prolongs repolarization and the refractory period of the cardiac action potential - Potassium channel blockers such as amiodarone prolong duration of the action potential, slow repolarization, and prolong the refractory period in both the atria and ventricles. To perform these actions, they block cardiac potassium channels.
What adverse effect limits long-term milrinone use?
Ventricular dysrhythmias or hypotension - The most serious adverse effect associated with the administration of milrinone is the development of potentially fatal ventricular dysrhythmias, which reportedly affect 12% to 14% of patients. Hypotension, supraventricular dysrhythmias, chest pain, angina, headache, thrombocytopenia, and hypokalemia may also occur.
Why should nitroglycerin tablets be kept in a dark, glass container?
Light and moisture degrade the medication - Sublingual (SL) nitroglycerin container should stay in a dry, cool, dark environment, and replacement every 6 months is necessary. Exposure to light deactivates the nitroglycerin tablets
These are known as signs of digoxin toxicity?
Signs of toxicity include potentially life-threatening heart rhythm disturbances, ranging from slow to rapid ventricular rhythm. Premature ventricular contractions (PVCs) occur commonly with digoxin toxicity and are usually perceived as “skipped” heartbeats by patients.
When is magnesium sulfate used in resuscitation?
For torsades de pointes (polymorphic VT) or suspected hypomagnesemia - Magnesium sulfate is recommended during resuscitation only in patients with drug-induced QT prolongation and development of torsades de pointes.
Why would a patient be taking oral amiodarone?
The oral form is given to treat recurrent ventricular tachycardia or ventricular fibrillation and to maintain a normal sinus rhythm after conversion of atrial fibrillation and atrial flutter.
How does milrinone affect the heart?
Increases contractility (positive inotrope) and causes vasodilation - Milrinone’s therapeutic action is to increase the force of contraction of the ventricles, providing a positive inotropic effect and improving ejection fraction. It causes systemic and pulmonary vasodilation by exerting a relaxant effect on the vascular smooth muscle, decreasing both preload and afterload.
What is the primary therapeutic use of nitroglycerin?
To relieve or prevent angina pectoris (chest pain due to myocardial ischemia).
What electrolyte imbalance increases the risk of digoxin toxicity?
Hypokalemia - Patients with hypokalemia can develop digoxin toxicity even when the serum digoxin level is not considered to be elevated
What is the route of administration for adenosine?
Rapid IV push (followed immediately by a saline flush) - Used to restore normal sinus rhythm in patients with paroxysmal supraventricular tachycardia; it is ineffective in other dysrhythmias. The drug has a very short duration of action (serum half-life of less than 10 seconds) and a high degree of effectiveness. It must be given by a rapid bolus injection, preferably through a central venous line.