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Transcript of NURS 1950 Pharmacology Nancy Pares, RN, MSN. Heart beat arises outside the sinoatrial (SA) node ...
![Page 1: NURS 1950 Pharmacology Nancy Pares, RN, MSN. Heart beat arises outside the sinoatrial (SA) node Terms: ◦ Inotropic ◦ Chromotropic ◦ Domotropic.](https://reader030.fdocuments.us/reader030/viewer/2022013011/56649e0d5503460f94af7144/html5/thumbnails/1.jpg)
NURS 1950 Pharmacology
Nancy Pares, RN, MSN
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Heart beat arises outside the sinoatrial (SA) node
Terms:◦ Inotropic
◦ Chromotropic
◦ Domotropic
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Arrhythmia or dysrhythmia
Variation of normal rhythm-usually associated with cardiac ◦ An electrical activity initiated by a spontaneous
discharge
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Decrease the automaticity of the cardiac tissues distant from the sinoatrial node.
Alter the rate of conduction thru the heart Alter the refractory period between
consecutive contractions.
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Classed according to action◦ Class I: myocardial depressents-inhibit sodium ion
movement preventing depolorization Ia: prolongs electrical stimulation (in cell)
prolongs refractory time between impulses –delays repolarization
Ib: shortens the duration of the e-stimulation and the time between impulses—accelerates repolerization
Ic: most potent-slows conduction rate through atria and ventricles—no effect on repolorization
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Class II: beta-andrenergic blocking agents-block sympathetic stimulation (slows conduction and decreases HR
Class III: slows the rate of electrical conduction and prolongs refractory time-potassium channel blocking
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Class IV:blocks calcium ion flow-prolongs elec stimulation and slows AV node conduction
Misc: Adenosine and Digoxin: not related to any other agents
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Objective 5: List the side effects of antirrhythmics
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Includes:◦ Disopramide phosphate (Norpace)◦ Procainamide HCL (Pronestyl)◦ Quinidine gluconate (Duraquin)◦ Quinidine polygluconate (Cardioquin)
◦ Prototype: Procainamide (Pronestyl)
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-derived from the cinchona bark -cardiac depressant effects: reduces
excitability of the cardiac muscle, prolongs refractory period between consecutive contractions◦ Allows the sinoatrial node to take over
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Used for atrial tachycardia, flutter and fibrillation.
Side effects severe: 1/3 of clients must d/c use
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S/E:◦ GI distress◦ CV disorders◦ Rashes, respiratory arrest, hemolytic anemia,
agranulocytosis◦ Hypersensitivity
Cinchonism: tinnitus, nausea, HA, dizzinessimpaired vision, vertigo
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Nursing Implications:◦ Can reduce problems if nurse:
Avoid use in CHF patients Monitor digitalis levels (if on digitalis) Monitor potossium (K+) levels Monitor sodium (Na+) levels
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Routes:◦ Oral with meals◦ Parenteral: give slowly
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Uses:ventricular arrhythmias (best), atrial fibrillation(helpful), paroxysmal atrial tachycardia (PAT)
S/E: GI distress, ventricular tachy, hypotension and hypersensitivity◦ Allergy most likely if allergic to ‘caine’ drugs (related to
local anesthetics)◦ Can cause agranulocytosis: lupus like syndrome
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S/E: hypotension, tachyarrythmias, anticholinergic effects
Has lower incidence of adverse effects than quinidine or procainamide
Oral dosing
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Lidocaine (Xylocaine) Mexiletine (Mexitil) Phenytoin (Dilantin) Tocainide (Tonocard)
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Use:Preventricular contractions (PVC), cardiac glycoside-induced tachyarrhythmias, cardioversion
Action: very rapid onset (IV), short acting◦ Shortens the duration of elec stim◦ Gives precise control of cardiac status
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S/E/Route:◦ Excessive decrease in cardiac electrical
conductivity ◦ Hypotension, bradycardia, dizziness; CNS effects◦ Hypermetabolism (malignant hyperthermia ◦ ineffective if given orally (metabolized in liver)
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Nursing Interventions:◦ Continuous EKG
◦ Look at bottle before giving-should not contain preservatives or epinephrine
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-standard classification is neuroleptic, but used for arrythmias caused by cardiac glycoside intoxication
Action: decreases automaticity of cardiac muscle, increases rate of conduction of the cardiac electrical impulses
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S/E/ Route:◦ Neurological disturbances: peripheral neuropathy,
diplopia, ataxia, vertigo, drowsiness, confusion◦ GI disturbances◦ Skin rash
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Similar to lidocaine Nursing Interventions:
◦ Given orally only◦ Monitor EKG◦ Client teaching: s/e and when to call MD
S/E:◦ Dizziness, nausea, parethesia, numbness, restlessness,
tremor, GI distress, blood dyscrasias◦ Should not be used in 2nd or 3rd degree AV block without a
pacemaker
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Action: similar to lidocaine Use: ventricular arrhythmias S/E/route:
◦ N/V, heartburn, dizziness, tremor, impaired coordination
◦ Given orally
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Flecainide (Tambocor)
Encainide (Enkaid)
Rythmol
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Action: local anesthetic Use: ventricular arrhythmias S/E/route:
◦ Can cause new or worsen arrhythmias◦ High degree of negative inotropy◦ Dizziness, visual disturbances, HA, nausea,
fatigue, chest pain
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Local anesthetic, membrane stabalizing, some beta blocking effect
Use: life threatening ventricular arrhythmias S/E: may cause new or worsen existing
arrhythmias, dizziness, GI disturbances, may see 1st degree AV block
Nursing Interventions: monitor with EKG Contraindications: uncontrolled CHF, brady,
bronchospasm, severe hypotension
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Acebutolol (Sectral) Esmolol (Brevibloc) Propranolol (Inderal) Action:
◦ Inhibits cardiac response to sympathetic nerve stimulation by blocking the beta receptors; reduces heart rate, systolic BP and cardiac output.
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Use: ◦ Ventricular arrhythmias◦ Sinus tachycardia◦ Paroxysmal atrial tachycardia (PAT)◦ Premature ventricular contractions (PVC)◦ Tachycardia associated with atrial flutter,or
fibrillation
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S/E:◦ What would we expect to see?
Slow HR, orthostatic hypotension, SOB, painful urination, wt gain > 2 lbs/day, insomnia, drowsiness, confusion
Mask the signs of hypoglycemia
Nursing Interventions: Take pulse and report below 50, rise slowly, report
symptoms, diabetics monitor BS closely
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Amiodarone (Cordarone)
Dofetilidide (Tikosyn)
Sotalol (Betaspace)
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Action:◦ Prolongs the action potential of the atrial and
ventricular tissues◦ Antagonizes (non competitive) the alpha and beta
receptors causing vasodilation Use:
◦ Life threatening arrythmias non responsive to other agents
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S/E/Route:◦ Fatigue, tremors, sleep disturbances, numbness,
ataxia, confusion, exertional dyspnea, non-productive cough, pleuritic chest pain, photosensitivity
◦ s/e often cause clients to d/c use◦ > 400mg/day cause problems◦ Given oral or IV
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Nursing interventions:◦ Loading dose is needed◦ Watch monitor for new arrhythmias◦ Dose adjustment is difficult◦ Monitor/teach about post treatment arrhythmias◦ Wear sunscreen
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Action/Use: ◦ slows conduction through the AV node causing
relaxation of the coronary and peripheral vessels◦ Dysrhythmias
S/E:◦ HA, dizziness, lower extremity edema, increases
digoxin and quinidine levels
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Nursing interventions:◦ Do not crush or chew extended release tablets◦ Use with caution with other CV agents: digoxin,
beta adrenergic blockers◦ Monitor for partial or complete heart block, heart
failure
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Adenosine (Adenocard)
Digoxin (Lanoxin)
Ibutilide ( Corvert)
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Action/Use:◦ Strong depressant effect on SA and AV nodes-
slowing conduction◦ Treatment of paroxysmal supraventricular
tachycardia (PST)◦ Physiologic roles: energy transfer, prostoglandin
release, inhibits platelet aggregation, coronary vasodilation, suppresses heart rate
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S/E◦ Flushing, SOB, chest pressure, nausea, HA,
dizziness, peripheral edema, anxiety◦ Half life is 10 seconds—s/e are not lasting
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Give meds on scheduled time Assess 6 cardinal signs of CV disease
◦ Chest pain, dyspnea, edema, fatigue, syncope, palpitations (C-D-E-F-S-P)
Lab tests: CV markers (enzymes) Physical assessment of client: include EKG
readings
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Be prepared for emergency care O2 as needed Assist with ADLs Client education
◦ Lifestyle◦ Medications◦ Report s/e and adverse effects
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Also called ‘idiopathic’
‘essentially’ no known cause
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Cardiac output◦ Increase cardiac output=increased BP
Peripheral vascular resistance (PVR)◦ Lumen inside vessels will constrict and dilate
which determines PVR Total Blood volume (see diagram in Adams)
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Carbonic anhydrase inhibitors◦ Rarely used for hypertension
Thiazides Loop diuretics Potassium sparing
◦ Used in combination therapy with thiazide or loop diuretic
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Deplete blood volume Help excrete sodium Dilate peripheral aterioles
◦ Specific action unknown Often used in combination
◦ Potentiates activity of other antihypertensives Cheap and effective
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Thiazides:◦ Most effective if creatinine clearance >30◦ Most commonly used: Hydrochlorothiazide
Loop diuretics◦ Used when creatinine clearance <30◦ Most commonly used Furosemide (Lasix)
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Potassium sparing◦ Contraindicated with renal disease, pregnancy,
gout or kidney stones◦ Nursing interventions:
Monitor labs (WBC decrease, liver and kidney) Client education
◦ Most commonly used: Spirolactone (aldactone) S/E: gynecomastia, testicular atrophy, hirsutism
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Beta-adrenergic blockers
Angiotensin converting enzyme (ACE) inhibitors
Calcium channel blockers
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Action/use:◦ Inhibit cardiac response to sympathetic nerve
stimulation (block the beta receptors) Decreases BP by decreasing cardiac output and
heart rate Drugs of choice for Stage 1 & 2 hypertension
◦ Clinical advantages: Minimal postural or exercise hypotension No effect on sexual function Minimal slowing of CNS
Propranolol (Inderol)
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S/E/contraindications:◦ Bradycardia, peripheral vascular resistance,
bronchospasm, wheezing, heart failure, hypoglycemia Dose related
◦ Avoid use in clients w asthma, type 1 diabetes, heart failure, peripheral vascular resistance disease
Nursing implications:◦ Give lowest dose giving desired effect◦ Needs days-weeks to get optimal effect◦ Do not d/c suddenly
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Action/use◦ Prevent angiotensin I converting to angiotensin II =no
vasoconstriction, no aldosterone secretion, no sodium retention
◦ Preserve cardiac output, increase renal blood flow; use with diuretic
◦ Does not aggrevate asthma, COPD, diabetes, gout, or cholesterol levels
S/E:◦ Nausea, fatigue, HA, diarrhea, orthostatic hypotention:
REPORT: swelling of face, eyes, lips, tongue and SOB
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Action:◦ Binds to angiotensin II receptor sites=no
vasoconstriction◦ Does not affect bradykinin=no chronic cough◦ As effective as ACE inhibitors◦ Need to add diuretic with African-American
population
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Action/uses:◦ Inhibits calcium movement across cell membrane:
reduces arrhythmias, slows rate of contraction of heart, relaxes smooth muscle of vessels.
◦ Antihypertensive, antianginal, alternative to beta blockers
◦ Effective in African Americans
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S/E:◦ Hypotension and syncope◦ Edema
Diltiazem (Cardizem) Nifedipine (Procardia)
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Action/Use:◦ Aterial and venous vasodilation=reduced PVR◦ Does not reduce cardiac output, does not cause produce
reflex tachycardia, reduces HDL, increases HDL◦ Additive effect with beta blockers and diuretics to
decrease BP◦ Stage 1-3 hypertensions◦ Helpful in BPH
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S/E:◦ Drowsiness, HA, dizziness, weakness, lethargy
(these are self limiting)◦ Dizziness, tachycardia, fainting
Take with food, lie down if s/s
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Action: ◦ Stimulates adrenergic receptors in brain stem; reduces
sympathetic outflow from CNS===decreases HR and PVR Uses/routes:
◦ Combination with other antihypertensive agents; when other antihypertensive agents do not work.
◦ Patch: action=one wk duration; causes more S/E:sedation, dry mouth, fatigue, sexual dysfunction
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Nursing interventions:◦ Monitor vitals◦ I&O◦ Do not d/c suddenly: causes rebound effect with
rapid rise in BP Agitation, restlessness, tremors, HA, nausea,
increased salivation.
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Nursing diagnoses:◦ Excess fluid volume◦ Risk for fluid volume deficit◦ Altered urinary elimination◦ Ineffective health maintenance
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Monitor lab values Observe for changes in LOC Monitor for hydration I/O; daily wt, diet monitor Monitor caffeine and alcohol intake photosensitivity