Antidysrhythmic AgentsConductivity: continuous cycles of the cardiac contraction and relaxationAutomaticity: refers to the ability of the cardiac cells to depolarize spontaneouslyHemodynamics: the study of forces that move blood throughout the cardiovascular system
  • Dysrhythmias change the mechanics of blood circulation
  • Dysrhythmias can interrupt delivery of blood from the brain, other tissues, and the heart
    • Resulting in:
      • Syncope
      • Stroke
      • Exacerbation of atherosclerosis
      • Angina and MI
Cardiac Dysrhythmias involve changes in the automaticity or conductivity of the heart cells:
  • caused by:
    • electrolyte imbalances
    • decreased oxygen delivery
    • structural changes
    • acidosis or waste accumulation
    • adverse effects of drugs



Class I – Antidysrhythmic


Sodium channel Blockers
Drug Name

quinidine,
procainamide


Lidocaine


flecainide
Indication

Atrial and Ventricular Dysrhythmia

ventricular dysrhythmias only


atrial fibrillation
atrial flutter
Mechanism of Action

Block sodium channels: ↓ the action potential of the cardiac cell
Special Considerations

-infusion pump
-monitor I&0
-heart rate
-BP
-Daily weights
Side Effect/Adverse Effects

-Dysrhythmia
-Dizziness
-Blurred vision
-Headache
Nursing Implications
Class II - Antidysrhythmic

Beta Blockers

“The Olols”
Atenolol (Tenormin)
Metoprolol (Lopressor)
Propranolol (Inderal)
Nadolol (Corgard)
-Dysrhythmia
-supraventricular and ventricular
-Hypertension
-Angina
-Migraine Prophylaxis
Blocks sympathetic nervous system stimulation causes: ↓Conductility
↓Rate
↓Contractility
Contraindications:
-systolic heart failure
-serious dysrhythmia
-bronchial asthma
-nonselective only
-Diabetes
-Dysrhythmias
-Bradycardia
-Hypotension
-Dyspnea
-Blurred vision
-Headache
-Constipation
-radial pulse for 1 full minute.
-notify physician:
pulse is <60 or >120 beats/min
Class III – Antidysrhythmic

Potassium Channel Blockers


Category
Amiodarone
Sotalol


Drug Name
Life threatening dysrhythmias


Indication
Block potassium channels: ↓the action potential of the cardiac cell


Mechanism of Action
IV Pump


Special Considerations
-Dysrhythmias
-Dizziness
-Blurred vision
-Headache


Side Effects
Patient Teaching
Class IV –Antidysrhythmic

Calcium Channel Blockers
-Verapamil
(Calan, Isoptin)
-Diltiazem
(Cardizem, Dilacor)
-Amlodipine (Norvasc)
-Nifedipine (Procardia)
Hypertension
Angina
Hypertension
Dysrhythmias
Migraine headaches
Raynaud’s disease
Block calcium channels: ↓ the action potential of the cardiac cell.
-Slows AV node conduction

Hypotension, Palpitations, Tachycardia, Peripheral edema
Constipation

Unclassified Anidysrhtymic
Adenosine (Adenocard)
Rescue Drug - convert supraventricular tachycardia to sinus rhythm
Slows conduction through the AV node
-Very short half-life—less than 10 seconds
- fast IV push
-May cause asystole for a few seconds
Dysrhythmias

Unclassified Antidysrhymic
Atropine
Bradycardia

Used to increase heart rate!
ENHANCES SV nodal automaticity and AV nodal conduction
Blocks acetylcoline – anticholinergic
Used in a MONITORED clinical setting for dysrhythmias causing Symptomatic Bradycardia
-Dysrhymias
-Decreased secretions from nose, mouth,
pharynx, bronchi
See Anticholinergics

Petges,N. (2011,Feburary 22). Antidysrhythmic Agents, Pharmacological Concepts. Aurora, IL


Antianginal Agents

**When the blood supply of oxygen and nutrients in the blood is insufficient to meet the demands of the heart, the heart muscle “aches”
Types of Angina
· Chronic Stable angina- Atherosclerosis is primary cause, triggered by exertion or stress
· Unstable angina- early stage of progressive Coronary Artery Disease (CAD), in later stages pain occurs at rest
· Vasospastic angina- spasms of smooth muscle around the atherosclerotic coronary arteries
Antianginal Therapy
· Increase blood flow to ischemic heart muscle and/or decrease myocardial oxygen demand
· Minimize the frequency of attacks and decrease the duration and intensity of anginal pain
· Improve patient’s functional capacity with as few side effects as possible
· Prevent or delay the worst possible outcome, MI

|| Antianginal

Nitrates
Nitroglycerin
-Acute Attack
-Also available in sustained release forms

isosorbide dinitrate
(Isordil)
-Long-term therapy

isosorbide mononitrate
(Imdur, Monoket)

-Long-term therapy

-Angina
- Perioperative HTN
-Heart Failure
-HTN Emergencies
Vasodilation

-↑blood flow to ischemic heart muscle
-↓ myocardial oxygen demand
Large first-pass effect with oral forms
Nitrogylercin:
-Take 1 sublingual tab every 5 minutes until chest pain relieved, but no more than 3 tabs within 15 min.
-If chest pain is unrelieved: activate EMS by calling 911
-Headache
-Reflex tachycardia
-Contact dermatitis
- Dizziness
-hypotension


nitrate free periods are scheduled to prevent tolerance

Discourage use of :
-Alcohol
-hot baths
-whirlpools
- hot tubs, or saunas

- Teach pts to keep a record of their anginal attacks





Beta Blockers- Atentolol (Tenormin), Metoprolol (Lopressor), Propranolol (Inderal), Nadolol (Corgard)
Calcium Channel Blockers- Verapamil (Calan), Diltiazem (Cardizem), Nifedipine
· Reduces contractility
· Promotes relaxation of smooth muscle that surround the coronary arteries
Blood levels should be monitored to ensure that they are therapeutic; Oral CCBs should be taken before meals as ordered, limit caffeine intake
*Patients should report blurred vision, persistent headache, dry mouth, dizziness, edema, fainting episodes, weight gain of 2 pounds in 1 day or 5 or more pounds in 1 week, pulse rates less than 60 and any dyspnea*

Petges,N. (2011,Feburary 22). Antianginal Agents, Pharmacological Concepts. Aurora, IL**