Antidysrhythmic+&+Antianginal+Drugs

 Antidysrhythmic Agents ﻿ ﻿ ﻿ ﻿ ﻿﻿   Conductivity: continuous cycles of the cardiac contraction and relaxation  Automaticity: refers to the ability of the cardiac cells to depolarize spontaneously  Hemodynamics: the study of forces that move blood throughout the cardiovascular system Cardiac Dysrhythmias involve changes in the automaticity or conductivity of the heart cells:
 * 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
 * <span style="color: #1dd354; font-family: Arial,Helvetica,sans-serif; font-size: 120%;">caused by:
 * <span style="color: #1dd354; font-family: Arial,Helvetica,sans-serif; font-size: 120%;">electrolyte imbalances
 * <span style="color: #1dd354; font-family: Arial,Helvetica,sans-serif; font-size: 120%;">decreased oxygen delivery
 * <span style="color: #1dd354; font-family: Arial,Helvetica,sans-serif; font-size: 120%;">structural changes
 * <span style="color: #1dd354; font-family: Arial,Helvetica,sans-serif; font-size: 120%;">acidosis or waste accumulation
 * <span style="color: #1dd354; font-family: Arial,Helvetica,sans-serif; font-size: 120%;">adverse effects of drugs


 * **__ Class I – Antidysrhythmic __**

<span style="color: #000000; font-family: Calibri; font-size: 9pt; line-height: normal; margin: 0in 0in 0pt;">Sodium channel Blockers || ** Drug Name **

<span style="color: #000000; font-family: Calibri; font-size: 9pt; line-height: normal; margin: 0in 0in 0pt;">quinidine, <span style="color: #000000; font-family: Calibri; font-size: 9pt; line-height: normal; margin: 0in 0in 0pt;">procainamide

<span style="color: #000000; font-family: Calibri; font-size: 9pt; line-height: normal; margin: 0in 0in 0pt;">Lidocaine

<span style="color: #000000; font-family: Calibri; font-size: 9pt; line-height: normal; margin: 0in 0in 0pt;">flecainide || ** Indication **

Atrial and Ventricular Dysrhythmia

<span style="color: #000000; font-family: Calibri; font-size: 9pt; line-height: normal; margin: 0in 0in 0pt;">ventricular dysrhythmias only

<span style="color: #000000; font-family: Calibri; font-size: 9pt; line-height: normal; margin: 0in 0in 0pt;">atrial fibrillation <span style="color: #000000; font-family: Calibri; font-size: 9pt; line-height: normal; margin: 0in 0in 0pt;">atrial flutter || ** Mechanism of Action **

<span style="color: #000000; font-family: Calibri; font-size: 9pt; line-height: normal; margin: 0in 0in 0pt;">Block sodium channels: ↓ the action potential of the cardiac cell || ** Special Considerations **

<span style="color: #000000; font-family: Calibri; font-size: 9pt; line-height: normal; margin: 0in 0in 0pt;">-infusion pump <span style="color: #000000; font-family: Calibri; font-size: 9pt; line-height: normal; margin: 0in 0in 0pt;">-monitor I&0 <span style="color: #000000; font-family: Calibri; font-size: 9pt; line-height: normal; margin: 0in 0in 0pt;">-heart rate <span style="color: #000000; font-family: Calibri; font-size: 9pt; line-height: normal; margin: 0in 0in 0pt;">-BP <span style="color: #000000; font-family: Calibri; font-size: 9pt; line-height: normal; margin: 0in 0in 0pt;">-Daily weights || ** Side Effect/Adverse Effects **

<span style="color: #000000; font-family: Calibri; font-size: 9pt; line-height: normal; margin: 0in 0in 0pt;">-Dysrhythmia <span style="color: #000000; font-family: Calibri; font-size: 9pt; line-height: normal; margin: 0in 0in 0pt;">-Dizziness <span style="color: #000000; font-family: Calibri; font-size: 9pt; line-height: normal; margin: 0in 0in 0pt;">-Blurred vision <span style="color: #000000; font-family: Calibri; font-size: 9pt; line-height: normal; margin: 0in 0in 0pt;">-Headache || ** Nursing Implications ** ||
 * **__ Class II - Antidysrhythmic __**

<span style="color: #000000; font-family: Calibri; font-size: 9pt; line-height: normal; margin: 0in 0in 0pt;">Beta Blockers

<span style="color: #000000; font-family: Calibri; font-size: 9pt; line-height: normal; margin: 0in 0in 0pt;">“The Olols” || <span style="color: #000000; font-family: Calibri; font-size: 9pt; line-height: normal; margin: 0in 0in 0pt;">Atenolol (Tenormin) <span style="color: #000000; font-family: Calibri; font-size: 9pt; line-height: normal; margin: 0in 0in 0pt;">Metoprolol (Lopressor) <span style="color: #000000; font-family: Calibri; font-size: 9pt; line-height: normal; margin: 0in 0in 0pt;">Propranolol (Inderal) <span style="color: #000000; font-family: Calibri; font-size: 9pt; line-height: normal; margin: 0in 0in 0pt;">Nadolol (Corgard) || <span style="color: #000000; font-family: Calibri; font-size: 9pt; line-height: normal; margin: 0in 0in 0pt;">-Dysrhythmia <span style="color: #000000; font-family: Calibri; font-size: 9pt; line-height: normal; margin: 0in 0in 0pt;">-supraventricular and ventricular <span style="color: #000000; font-family: Calibri; font-size: 9pt; line-height: normal; margin: 0in 0in 0pt;">-Hypertension <span style="color: #000000; font-family: Calibri; font-size: 9pt; line-height: normal; margin: 0in 0in 0pt;">-Angina <span style="color: #000000; font-family: Calibri; font-size: 9pt; line-height: normal; margin: 0in 0in 0pt;">-Migraine Prophylaxis || <span style="color: #000000; font-family: Calibri; font-size: 9pt; line-height: normal; margin: 0in 0in 0pt;">Blocks sympathetic nervous system stimulation causes: ↓Conductility <span style="color: #000000; font-family: Calibri; font-size: 9pt; line-height: normal; margin: 0in 0in 0pt;">↓Rate <span style="color: #000000; font-family: Calibri; font-size: 9pt; line-height: normal; margin: 0in 0in 0pt;">↓Contractility || __ Contraindications: __ <span style="color: #000000; font-family: Calibri; font-size: 9pt; line-height: normal; margin: 0in 0in 0pt;">-systolic heart failure <span style="color: #000000; font-family: Calibri; font-size: 9pt; line-height: normal; margin: 0in 0in 0pt;">-serious dysrhythmia <span style="color: #000000; font-family: Calibri; font-size: 9pt; line-height: normal; margin: 0in 0in 0pt;">-bronchial asthma <span style="color: #000000; font-family: Calibri; font-size: 9pt; line-height: normal; margin: 0in 0in 0pt;">-nonselective only <span style="color: #000000; font-family: Calibri; font-size: 9pt; line-height: normal; margin: 0in 0in 0pt;">-Diabetes || <span style="color: #000000; font-family: Calibri; font-size: 9pt; line-height: normal; margin: 0in 0in 0pt;">-Dysrhythmias <span style="color: #000000; font-family: Calibri; font-size: 9pt; line-height: normal; margin: 0in 0in 0pt;">-Bradycardia <span style="color: #000000; font-family: Calibri; font-size: 9pt; line-height: normal; margin: 0in 0in 0pt;">-Hypotension <span style="color: #000000; font-family: Calibri; font-size: 9pt; line-height: normal; margin: 0in 0in 0pt;">-Dyspnea <span style="color: #000000; font-family: Calibri; font-size: 9pt; line-height: normal; margin: 0in 0in 0pt;">-Blurred vision <span style="color: #000000; font-family: Calibri; font-size: 9pt; line-height: normal; margin: 0in 0in 0pt;">-Headache <span style="color: #000000; font-family: Calibri; font-size: 9pt; line-height: normal; margin: 0in 0in 0pt;">-Constipation || <span style="color: #000000; font-family: Calibri; font-size: 9pt; line-height: normal; margin: 0in 0in 0pt;">-radial pulse for 1 full minute. <span style="color: #000000; font-family: Calibri; font-size: 9pt; line-height: normal; margin: 0in 0in 0pt;">-notify physician: <span style="color: #000000; font-family: Calibri; font-size: 9pt; line-height: normal; margin: 0in 0in 0pt;">pulse is 120 beats/min ||
 * **__ Class III – Antidysrhythmic __**

<span style="color: #000000; font-family: Calibri; font-size: 9pt; line-height: normal; margin: 0in 0in 0pt;">Potassium Channel Blockers

** Category ** || <span style="color: #000000; font-family: Calibri; font-size: 9pt; line-height: normal; margin: 0in 0in 0pt;">Amiodarone <span style="color: #000000; font-family: Calibri; font-size: 9pt; line-height: normal; margin: 0in 0in 0pt;">Sotalol

** Drug Name ** || <span style="color: #000000; font-family: Calibri; font-size: 9pt; line-height: normal; margin: 0in 0in 0pt;">Life threatening dysrhythmias

** Indication ** || <span style="color: #000000; font-family: Calibri; font-size: 9pt; line-height: normal; margin: 0in 0in 0pt;">Block potassium channels: ↓the action potential of the cardiac cell

** Mechanism of Action ** || <span style="color: #000000; font-family: Calibri; font-size: 9pt; line-height: normal; margin: 0in 0in 0pt;">IV Pump

** Special Considerations ** || <span style="color: #000000; font-family: Calibri; font-size: 9pt; line-height: normal; margin: 0in 0in 0pt;">-Dysrhythmias <span style="color: #000000; font-family: Calibri; font-size: 9pt; line-height: normal; margin: 0in 0in 0pt;">-Dizziness <span style="color: #000000; font-family: Calibri; font-size: 9pt; line-height: normal; margin: 0in 0in 0pt;">-Blurred vision <span style="color: #000000; font-family: Calibri; font-size: 9pt; line-height: normal; margin: 0in 0in 0pt;">-Headache

** Side Effects ** || ** Patient Teaching ** ||
 * **__ Class IV –Antidysrhythmic __**

<span style="color: #000000; font-family: Calibri; font-size: 9pt; line-height: normal; margin: 0in 0in 0pt;">Calcium Channel Blockers || <span style="color: #000000; font-family: Calibri; font-size: 9pt; line-height: normal; margin: 0in 0in 0pt;">-Verapamil <span style="color: #000000; font-family: Calibri; font-size: 9pt; line-height: normal; margin: 0in 0in 0pt;">(Calan, Isoptin) <span style="color: #000000; font-family: Calibri; font-size: 9pt; line-height: normal; margin: 0in 0in 0pt;">-Diltiazem <span style="color: #000000; font-family: Calibri; font-size: 9pt; line-height: normal; margin: 0in 0in 0pt;">(Cardizem, Dilacor) <span style="color: #000000; font-family: Calibri; font-size: 9pt; line-height: normal; margin: 0in 0in 0pt;">-Amlodipine (Norvasc) <span style="color: #000000; font-family: Calibri; font-size: 9pt; line-height: normal; margin: 0in 0in 0pt;">-Nifedipine (Procardia) || <span style="color: #000000; font-family: Calibri; font-size: 9pt; line-height: normal; margin: 0in 0in 0pt;">Hypertension <span style="color: #000000; font-family: Calibri; font-size: 9pt; line-height: normal; margin: 0in 0in 0pt;">Angina <span style="color: #000000; font-family: Calibri; font-size: 9pt; line-height: normal; margin: 0in 0in 0pt;">Hypertension <span style="color: #000000; font-family: Calibri; font-size: 9pt; line-height: normal; margin: 0in 0in 0pt;">Dysrhythmias <span style="color: #000000; font-family: Calibri; font-size: 9pt; line-height: normal; margin: 0in 0in 0pt;">Migraine headaches <span style="color: #000000; font-family: Calibri; font-size: 9pt; line-height: normal; margin: 0in 0in 0pt;">Raynaud’s disease || <span style="color: #000000; font-family: Calibri; font-size: 9pt; line-height: normal; margin: 0in 0in 0pt;">Block calcium channels: ↓ the action potential of the cardiac cell. <span style="color: #000000; font-family: Calibri; font-size: 9pt; line-height: normal; margin: 0in 0in 0pt;">-Slows AV node conduction ||  || <span style="color: #000000; font-family: Calibri; font-size: 9pt; line-height: normal; margin: 0in 0in 0pt;">Hypotension, Palpitations, Tachycardia, Peripheral edema <span style="color: #000000; font-family: Calibri; font-size: 9pt; line-height: normal; margin: 0in 0in 0pt;">Constipation ||  || <span style="color: #000000; font-family: Calibri; font-size: 9pt; line-height: normal; margin: 0in 0in 0pt;">- fast IV push <span style="color: #000000; font-family: Calibri; font-size: 9pt; line-height: normal; margin: 0in 0in 0pt;">-May cause asystole for a few seconds || <span style="color: #000000; font-family: Calibri; font-size: 9pt; line-height: normal; margin: 0in 0in 0pt;">Dysrhythmias ||  ||
 * **__ Unclassified Anidysrhtymic __** || <span style="color: #000000; font-family: Calibri; font-size: 9pt; line-height: normal; margin: 0in 0in 0pt;">Adenosine (Adenocard) || <span style="color: #000000; font-family: Calibri; font-size: 9pt; line-height: normal; margin: 0in 0in 0pt;">Rescue Drug - convert supraventricular tachycardia to sinus rhythm || <span style="color: #000000; font-family: Calibri; font-size: 9pt; line-height: normal; margin: 0in 0in 0pt;">Slows conduction through the AV node || <span style="color: #000000; font-family: Calibri; font-size: 9pt; line-height: normal; margin: 0in 0in 0pt;">-Very short half-life—less than 10 seconds
 * **__ Unclassified Antidysrhymic __** || <span style="color: #000000; font-family: Calibri; font-size: 9pt; line-height: normal; margin: 0in 0in 0pt;">Atropine || <span style="color: #000000; font-family: Calibri; font-size: 9pt; line-height: normal; margin: 0in 0in 0pt;">Bradycardia

**__ Used to increase heart rate! __** || __ ENHANCES __ SV nodal automaticity and AV nodal conduction <span style="color: #000000; font-family: Calibri; font-size: 9pt; line-height: normal; margin: 0in 0in 0pt;">Blocks acetylcoline – anticholinergic || <span style="color: #000000; font-family: Calibri; font-size: 9pt; line-height: normal; margin: 0in 0in 0pt;">Used in a MONITORED clinical setting for **__dysrhythmias causing__** **__Symptomatic Bradycardia__** || <span style="color: #000000; font-family: Calibri; font-size: 9pt; line-height: normal; margin: 0in 0in 0pt;">-Dysrhymias <span style="color: #000000; font-family: Calibri; font-size: 10pt; line-height: normal; margin: 0in 0in 0pt;">-Decreased secretions from nose, mouth, <span style="color: #000000; font-family: Calibri; font-size: 10pt; line-height: normal; margin: 0in 0in 0pt;">pharynx, bronchi || <span style="color: #000000; font-family: Calibri; font-size: 9pt; line-height: normal; margin: 0in 0in 0pt;">See Anticholinergics ||

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

=**Antianginal Agents**= 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 <span style="margin: 0in 0in 0pt 0.75in; mso-add-space: auto; mso-list: l0 level1 lfo2; text-indent: -0.25in;"> · Increase blood flow to ischemic heart muscle and/or decrease myocardial oxygen demand <span style="margin: 0in 0in 0pt 0.75in; mso-add-space: auto; mso-list: l0 level1 lfo2; text-indent: -0.25in;"> · Minimize the frequency of attacks and decrease the duration and intensity of anginal pain <span style="margin: 0in 0in 0pt 0.75in; mso-add-space: auto; mso-list: l0 level1 lfo2; text-indent: -0.25in;"> · Improve patient’s functional capacity with as few side effects as possible <span style="margin: 0in 0in 10pt 0.75in; mso-add-space: auto; mso-list: l0 level1 lfo2; text-indent: -0.25in;"> · Prevent or delay the worst possible outcome, MI <span style="display: block; margin: 0in 0in 10pt 0.75in; mso-add-space: auto; mso-list: l0 level1 lfo2; text-indent: -0.25in;"> || __ Antianginal __ Nitrates -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 ||
 * When the blood supply of oxygen and nutrients in the blood is insufficient to meet the demands of the heart, the heart muscle “aches”
 * Nitroglycerin

**

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 ****