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Nursing Pharmacology: Antidysrhythmias


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What is Dysrhythmias?
Electrical conduction abnormalities of the heart.
What are the 3 classes of drugs used in the treatment of Dysrhythmias?
A. Sodium channel Blockers: quinidine (Quinidex)
B. Beta-adrenergic blockers: propranolol (Inderal)
C. Calcium channel blockers: verapamil (Calan)
Main example of
Sodium channel Blockers
quinidine (Quinidex)
Main example of
Beta-adrenergic blockers
propranolol (Inderal)
Main example of
Calcium channel blockers
verapamil (Calan)
class of:
quinidine (Quinidex)
Sodium channel Blockers
Mechanism of:
quinidine (Quinidex)
- Blocks sodium ion channels in myocardial cells thereby:
i. reducing automaticity in ventricles
ii. slowing conduction of action
potential across myocardium.
- Reduces the excitability of cardiac muscle to electrical stimulation.
- Decreases the velocity of electrical
conduction through the myocardium.
- Decrease HR and reduce or obliterate
ectopic pacemaker activity.
- Exerts anticholinergic (vagal
blocking) action on the heart.
usage of:
quinidine (Quinidex)
Quinidine is use in the treatment of atrial & ventricular dysrhythmias (tachycardia, flutter and fibrillation).
Side effects/Adverse reaction:
quinidine (Quinidex)
diarrhea, nausea, vomiting, cardiac arrthythemias, cinchonism
what drug may interact with quinidine (Quinidex)?

-increased digoxin levels and toxicity-
What type of patient should use quinidine (Quinidex) with caution?
- Clients with CHF
- Clients using digoxin.
- Hypo or hyperkalemic clients.
- Client with fluid or electrolyte imbalance.
- Must administer a test dose.
what should patient taking quinidine (Quinidex) be observe for?
- changes in EKG
(Increase in PR and QT intervals or widening of QRS complex)
- BP
- Respiratory status
- Drug plasma levels
When Pt. is taking quinidine, what should Pt. education includes?
- Do not skip doses
- Do not take two doses at one time
- Comply with monitoring of lab tests as ordered.
- Report these symptom immediately: SOB, changes in vision or hearing, diarrhea, or dizziness.
What symtom(s) should Pt taking quinidine report immediately?
1. SOB
2. changes in vision or hearing
3. diarrhea
4. dizziness.
give an example of
Beta-Adrenergic Blockers
propranolol (Inderal)
Main use of
propranolol (Inderal)
main use is to treat atrial dysrhythmias HF
other uses of
propranolol (Inderal)
Hypertension, MI, HF.
MAO of
propranolol (Inderal)
- Act by blocking Beta-adrenergic receptor thereby decreases sympathetic influences on the heart.
- Resulted in decreasing:
1. HR (negative chronotropic effect)
2. cardiac workload
3. contractillity
4. myocardial oxygen consumption.
5. conduction velocity through AV node
6. myocardial automaticity
7. release of renin = lower BP
8. vasocinstriction
Common Adverse Effects of
propranolol (Inderal)
1. Hypotension
2. Hypoglycemia
others: fatigue, gastric pain, flatulence, constipation, diarrhea, nausea, vomiting, bradycardia, CHF, cardiac arrhythmias, SA or AV block, impotent, decreased libido, decrease excercise intolerance.
Drugs that may interact with
propranolol (Inderal)
1. Phenothiazines
2. Beta-adrenergic agonists (Albuterol)
3. MAO inhibitors
Contraindications for
propranolol (Inderal)
clients with
1. obstructive pulmonary disease
2. CHF
3. heart block
4. bradycardia
5. DM.
What assessment should the nurse take prior to administration of
propranolol (Inderal)?
1. PR and
2. cognitive status in elderly
what Special consideration for Pt. prior to administration of
propranolol (Inderal)
Asians: due to the lack of drug metabolizing enzyme mephenytoin hydrizylase.
what should Patient Education includes for propranolol (Inderal)?
1. Take PR prior to drug administration (w/h if PR is <60 or >100)
2. Rise sitting or lying position slowly.
3. Signs of hypoglycemia in diabetes such as fatigue or headaches.
4. Report the following symptoms immediately:
1) SOB
2) Feeling of skipping heart beat
3) Painful or difficult urination
4) Dizziness, drowsiness, confusion
When taking propranolol, what symptoms should Pt. report immediately?
1) SOB
2) Feeling of skipping heart beat
3) Painful or difficult urination
4) Dizziness, drowsiness, confusion
give example of
Calcium channel blockers
verapamil (Calan)
Drug classes of
verapamil (Calan)
- Calcium channel-blocker
- Antianginal agent
- Antiarrhythmic
- Antihypertensive
MOA of
verapamil (Calan)
Inhibits the movement of calcium ions across the membranes of cardiac and arterial muscle cells
Desired actions of
verapamil (Calan)
1. decreased cardiac workload
2. decrease oxygen demand
3. decreased cardiac energy consumption
4. increased delivery of oxygen to myocardial cells
indication of
verapamil (Calan)
Supraventricular dysrhythmias
Adverse effects of
verapamil (Calan)
interactions with:
verapamil (Calan)
1. Grapefruit juice
2. digoxin
Nursing implications for
verapamil (Calan)
1) Take BP and report changes
2) Take pulse and notify if less than 60 bpm
3) Report irregular heart beat, shortness of breath, swelling of the hands or feet (edemas)
What symptom should Pt taking
verapamil (Calan)
report immediately?
1. irregular heart beat
2. shortness of breath
3. swelling of the hands or feet (edemas)

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