Term
| Class I: Sodium Channel Blockers |
|
Definition
- Quinidine (Class IA)
- Lidocaine (Class IB) |
|
|
Term
|
Definition
|
|
Term
| Class III: Drugs that delay repolarization- |
|
Definition
|
|
Term
| Class IV: Calcium Channel Blockers |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
- Class IA drug
- blocks sodium channels, slows impulse conduction
- used for supraventricular and ventricular dysrhythmias
Adverse Effects:
- diarrhea
- cinchonism
- cardiotoxicity
- arterial embolism
- hypotension
Drug Interactions
- digoxin
Dosage - 200-400mg Q6
- can drive ventricles at an excessive rate
- pt usually pretreated with digoxin, verapamil, or a beta blocker |
|
|
Term
|
Definition
- Class IA drug
- blocks sodium channels, slows impulse conduction
- used for supraventricular and ventricular dysrhythmias
- can be used to terminate V. tach and V. fib
Adverse Effects:
- lupus-like syndrome
- blood dyscrasias
- cardiotoxicity
- arterial embolism
- hypotension
- diarrhea
Drug Interactions
- digoxin
Dosage - 250-500mg Q6
- will not drive ventricles at an excessive rate |
|
|
Term
|
Definition
- Class IA drug
- blocks sodium channels, slows impulse conduction
- limited use
- used for supraventricular and ventricular dysrhythmias
Adverse Effects:
- dry mouth
- blurred vision
- constipation
- urinary hesitancy or retention |
|
|
Term
|
Definition
- Class IB
- blocks sodium channels
- accelerates repolarization
- slows conduction in the atria
- short term therapy for v. dysrhythmias
Adverse Effects
- drowsiness
- confusion
- paresthesias
- respiratory arrest
- seizures |
|
|
Term
|
Definition
- Class IB
- antiseizure drug used to treat digoxin-induced dysrhythmias
Adverse Effects
- sedation
- ataxia
- nystagmus |
|
|
Term
|
Definition
- Class IB
- oral analog of lidocaine
- accelerates repolarization
- slows conduction in the atria
- short term therapy for v. dysrhythmias
Adverse Effects
- don't use on diabetic pts w/heart disease |
|
|
Term
|
Definition
- Class IC
- blocks sodium channels
- maintenance therapy of supraventricular dysrhythmias
- potential serious side effects
- it should be reserved for severe v. dysrhythmias |
|
|
Term
|
Definition
- Class IC
- blocks sodium channels
Adverse Effects
- can decrease myocardial contractility and promote bronchospasms
- dizziness
- blurred vision
- GI distress |
|
|
Term
|
Definition
- Class II beta blocker
- decreases calcium influx
Adverse Effects
- heart failure
- av block
- sinus arrest
- hypotension
- bronchospasms |
|
|
Term
|
Definition
- Cardioselective Beta blocker
- for PVC
Adverse Effects
- bradycardia
- HF
- AV block
- bronchospasms |
|
|
Term
|
Definition
- Cardioselective Beta blocker
- for SVT
- atrial flutter
- a. fib
Adverse Effects
- hypotension
- bradycardia
- HF
- AV block
- bronchospasms |
|
|
Term
|
Definition
- Cardioselective Beta blocker
- for SVT
- atrial flutter
- a. fib
Adverse Effects
- hypotension
- bradycardia
- HF
- AV block
- bronchospasms |
|
|
Term
| Class III: Potassium Channel Blockers (Drugs that delay repolarization) |
|
Definition
- amiodarone
- dronedarone
- dofetilide
- ibutilide
- sotalol |
|
|
Term
| Class III: Potassium Channel Blockers |
|
Definition
| - drugs that prolong the QT interval |
|
|
Term
| Amioradone [Cordarone, Pacerone] |
|
Definition
- Class III: Potassium Channel Blockers
- highly effective against atrial and vent dysrhythmias
- best drug for a. fib
- most frequently prescribed
Serious Toxicities - approved only for life-threatening v. dys
- lung damage
- visual impairment
Adverse Effects
- pulmonary toxicity
- cardiotoxicity
- thyroid toxicity
- liver toxicity
- ophthalmic toxicity
Drug Interactions
- quinidine
- procainamide
- phenytoin
- digoxin
- verapamil
- diltiazem
- warfarin
- cyclosporine
- lova, simva, and atorvastatin
- diuretics (non k-sparing) |
|
|
Term
|
Definition
- Class III: Potassium Channel Blockers
- highly effective against atrial flutter and paroxysmal or persistent (not permanent) a. fib
- can also block sodium channels
Adverse Effects
- it can double the risk of death in pts with severe HF, and permanent a-fib
- diarrhea
- weakness
- nausea
- skin reactions
- doesn't cause all the other toxicities like amiodarone, except liver tox
- a derivative of amiodarone
Drug Interactions
- CYP3A4
- beta blockers
- verapamil, diltiazem |
|
|
Term
|
Definition
- Class III: Potassium Channel Blockers
- beta blocker
- highly effective against atrial flutter and fib
Adverse Effects
- torsades de pointes
- bradycardia
- AV block
- HF
- bronchospasms |
|
|
Term
|
Definition
- Class III: Potassium Channel Blockers
- highly effective against atrial flutter and fib
Adverse Effects
- torsades
- not to be used on pts with severe renal impairment
- headache
- chest pain
- dizziness
Drug Interactions
- cimetidine - trimethoprim
- ketoconazole - prochlorperazine
- megestrol
- VERAPAMIL |
|
|
Term
|
Definition
- Class III: Potassium Channel Blockers
- IV drug used to terminate a. flutter and fib of recent onset |
|
|
Term
| Class IV: Calcium Channel Blockers |
|
Definition
- Verapamil [Calan, Covera-HS, Verelan]
- Diltiazem [Cardizem, Dilacor-XR, Tiazac]
- identical to the effects of beta blockers, they promote calcium channel closure
- slow vent rate in a.fib or flutter
- not effective against v.dysrhythmias
Adverse Effects
- bradycardia
- av block
- hf
- hypotension
- peripheral edema
- constipation
Drug Interactions
- digoxin
- beta blockers |
|
|
Term
| Other Antidysrhymthmic drugs |
|
Definition
|
|
Term
|
Definition
- Other Antidysrhymthmic drugs
- for paroxysmal SVT only
- Wolff-Parkinson-White Syndrome
Adverse Effects
- they are short lived
- sinus brady
- dyspnea
- hypotension
- facial flushing
- chest discomfort
Drug Interactions
- Methylxanthines (aminophylline, theophylline, caffeine)
- Dipyridamole |
|
|
Term
|
Definition
- Other Antidysrhymthmic drugs
- used for:
- HF
- SVT
- a.fib and flutter
Adverse Effects
- cardiotoxicity (dysrhy)
- increased risk if hypokalemia present
- GI disturbances
- CNS responses |
|
|
Term
|
Definition
|
|
Term
|
Definition
- SVT ______
- Ventricle ______ |
|
|
Term
|
Definition
| disrupts cardiac pumping more than SVT |
|
|
Term
|
Definition
| txt focused on blocking impulse conduction through av node |
|
|
Term
|
Definition
NI
- Contraindicated for pts with
- complete heart block
- digoxin toxicity
- conduction disturbances
- QRS widening
- QT prolongation
- Use Caution
- pts with partial av block
- HF
- HypoT
- hepatic dysfunction
- Advise pts to take with meals and don't crush
- Minimizing Adverse Effects
- diarrhea: take with meals
- cinchonism: inform dr
- cardiotoxicity: monitor ecg and pulse
- arterial embolism: anticoag
- digoxin: reduce dig dose |
|
|
Term
|
Definition
NI
- Contraindicated for pts with
- Lupus
- complete av block
- Use Caution
- hepatic or renal dysfunction
- Advise pts to take at evenly spaced intervals around the clock and don't crush
- Minimizing Adverse Effects
- Lupus: inform pts about joint pain and inflammation, fever, soreness in mouth
- blood dyscrasias: inform dr if infection, bruising, bleeding present
- cardiotoxicity: monitor ecg for excessive QRS widening and PR prolongation, and pulse
- arterial embolism |
|
|
Term
|
Definition
NI
- Contraindicated for pts with
- stokes-adams syndrome
- wpwhite syndrome
- severe degrees of SA, AV, or intraventricular block
- Use Caution
- hepatic dysfunction or impaired hepatic blood flow
- Minimizing Adverse Effects
- have available:equip for CPR and diazepam |
|
|
Term
|
Definition
NI
- Contraindicated for pts with
- Lupus
- complete av block
- Use Caution
- hepatic or renal dysfunction
- Advise pts to take at evenly spaced intervals around the clock and don't crush
- Minimizing Adverse Effects
- Lupus: inform pts about joint pain and inflammation, fever, soreness in mouth
- blood dyscrasias: inform dr if infection, bruising, bleeding present
- cardiotoxicity: monitor ecg for excessive QRS widening and PR prolongation, and pulse
- arterial embolism |
|
|
Term
| Statins (HMG-CoA reductase inhibitors) |
|
Definition
| most effective for lowering LDL |
|
|
Term
|
Definition
- atorvastatin
- fluvastatin
- lovastatin
- simvastatin |
|
|
Term
- atorvastatin
- fluvastatin
- lovastatin
- simvastatin |
|
Definition
| their levels can be increased by CYP3A4) inhibitors (cyclosporine, erythromycin, ketoconazole, and ritonavir) |
|
|
Term
|
Definition
can cause:
- liver damage
- myopathy (measure CK) |
|
|
Term
|
Definition
- reduces LDL and TG levels
- raises HDL
- causes adverse effects |
|
|
Term
|
Definition
- can cause liver injury
- lowest risk with Niaspan |
|
|
Term
|
Definition
- colesevelam
- reduces LDL
- can cause constipation
- prevents absorption of other drugs
- admin other drugs 1hr before or 4hrs after |
|
|
Term
|
Definition
- lowers LDL
- can cause muscle injury |
|
|
Term
|
Definition
- fibrate
- most effective for lowering TG
- can cause muscle injury |
|
|
Term
| HMG-Coa Reductase Inhibitors |
|
Definition
- atorvastatin
- fluvastatin
- lovastatin
- pitavastatin
- rosuvastatin
- somvastatin |
|
|
Term
|
Definition
- contraindicated for pts with viral or alcoholic hepatitis
- caution for pts with:
- nonalcoholic fatty liver disease
- pts taking:
- fibrates
- ezetimibe
- cyclosporine
- erythromycin
- ketoconazole
- ritonavir
- the previous six can also cause myopathy |
|
|
Term
|
Definition
- contraindicated for pts with active liver disease, or gout
- use caution for pts with:
- DM
- asymptomatic hyperuricemia
- mild gout
- peptic ulcer disease
- instruct pts to take with meals
Minimizing Adverse Effects
- flushing can be reduced by taking aspirin
- hyperglycemia
- hyperuricemia |
|
|
Term
|
Definition
- Cholestyramine
- Colesevelam
- Colestipol |
|
|
Term
|
Definition
| - mix with water, soup, juice to avoid esophageal irritation and impaction |
|
|
Term
| cholestyramine and colestipol (not colesevelam) |
|
Definition
- can cause constipation
- can impair absorption of fat-soluble vitamins
Minimizing Adverse Effects
- admin other meds 1hr before or 4hrs after |
|
|
Term
|
Definition
- reduces TG
- raises HDL
- not effective on LDL
Contraindications
- liver disease
- severe renal dysfunction
- gallbladder disease
Use Caution
- pts taking statins or warfarin
Minimizing Adverse Effects
- report symptoms of gallbladder disease
- report symptoms of muscle damage
- obtain periodic liver tests
Minimizing Adverse Interactions
- enhances effects of warfarin and statins |
|
|
Term
|
Definition
Total Chol < 170
LDL < 110
HDL >= 35
TG <= 150 |
|
|
Term
|
Definition
Total Chol 170-199
LDL 110-129 |
|
|
Term
|
Definition
Total Chol >= 200
LDL > 130 |
|
|
Term
- atorvastatin
- lovastatin
- pravastatin |
|
Definition
| suitable for children > 10yrs |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| drugs to improve plasma levels of LDL,TG, and HDl |
|
|
Term
|
Definition
Etiology:
a common cardiac dysrhythmia. It is an abnormal and rapid chaotic electrical firing impulse in the atrial tissue which leads to twitching of the atrial muscle. In this dysrhythmia, the ventricular response varies resulting in an irregular heart rate. This condition may be transient or persistent.
Risk Factors
Risk factors include: structural heart diseases, inflammatory or infiltrative diseases, coronary heart disease, heart failure, sleep apnea, stroke, diabetes, hyperthyroidism, or pulmonary hypertension.
Signs and Symptoms
• The patient may be asymptomatic. • If the heart rate is rapid: dizziness, fatigue, and palpitations. • The pulse is always irregular.
Diagnostic Studies
• Irregular heart rhythm • 12 lead electrocardiogram (ECG)
Potential Issues
• Uncomfortable feelings of palpitations • Heart failure • Stroke • Premature death
Expected Patient Outcomes
• To convert patient back to normal sinus rhythm
• To control the heart rate between 60 and 100 beats per minute if it is not possible to restore the normal sinus rhythm • Prevent complications; for example, blood clot formation that can lead to thromboembolism
Treatment/Management
• Treat the underlying cause • Convert the heart rhythm to normal sinus rhythm by electrical cardioversion or medications such as amiodarone or sotalol or dofetilide • Electrophysiology studies – with possible atrial fibrillation ablation. Ablation is a non-surgical method that blocks or destroys the irritable focus that triggers the abnormal electrical impulse. • Control heart rate by medications if unable to convert to normal sinus rhythm by cardioversion. Medication that may be prescribed includes beta blockers, calcium channel blockers, or lanoxin.
For chronic atrial fibrillation, treatment includes medication to prevent formation of blood clots in the left atria that may break free and travel to the brain or arterial periphery |
|
|
Term
| Third Degree Atrioventricular Heart Block |
|
Definition
Etiology:
This can be congenital or acquired; although acquired heart block is the most common when the heart muscle and the electrical system has been damaged.
Risk Factors
Risk factors include:
• Medications such as lanoxin, calcium channel blockers, or beta blockers • Myocardial ischemia or infarction • Valvular Heart Disease • Cardiomyopathy • Lyme disease • Sarcoidosis • Cardiac Surgery
Signs and Symptoms
• Signs and symptoms are related to: decreased heart rate and decreased perfusion of the brain
• Neurological changes: Decreased level of consciousness and confusion • Cardiac: Chest pain, palpitations • Respiratory: Dyspnea, shortness of breath • Renal: Decreased urine output • Dizziness • Fatigue
Diagnostic Studies
• 12 lead ECG • Blood analysis to determine if Lyme disease is present
Potential Issues
• Syncope • Heart failure • Fatigue
Expected Patient Outcomes
• Restore conduction and cardiac output for tissue perfusion.
Treatment/Management
• Treat the underlying cause • Temporary and/or permanent pacemaker |
|
|
Term
|
Definition
Etiology:
is defined as the occurrence of three or more premature ventricular beats in a row. The irritable focus arises from the ventricle. The patient’s tolerance for this rapid rhythm depends on the ventricular rate and severity of ventricular dysfunction. The patient may or may not be awake and may or may not have a pulse. It is considered an emergency.
Risk Factors
• Ischemia of the cardiac muscle • Medications • Electrolyte imbalances, such as low potassium or low magnesium
• Hypoxia • Cardiac and valvular heart disease • Acquired or congenital long QT syndrome
Signs and Symptoms
• Palpitations • Chest pain • Dyspnea • Syncope • Rapid, thready pulse or no pulse • Unconsciousness
Diagnostic Studies
• 12 lead ECG • Serum potassium and serum magnesium
Potential Issues
• Can lead to ventricular fibrillation • Death
Expected Patient Outcomes
• Restore patient’s heart rhythm to improve perfusion to brain, heart, lungs and kidneys.
Treatment/Management
• CPR if patient has no pulse • If patient has pulse and is stable: administer antidysrhythmic medications such as amiodarone or sotalol • Electrical Treatment: Cardioversion if patient has a pulse; Defibrillation if patient has no pulse • Advanced cardiac life support (ACLS) |
|
|
Term
|
Definition
Etiology:
is a rapid, disorganized ventricular rhythm where the cardiac muscle is quivering.
is the most common dysrhythmia in patients with cardiac arrest.
Risk Factors
• Prolonged QT Syndrome • Electrolyte imbalance • Medications • Cardiac heart disease
Signs and Symptoms
• May have no symptoms until the sudden cardiac arrest • Symptoms of fast heart rate may occur before cardiac arrest • Patient has no pulse and is not responsive • The person appears dead
Diagnostic Studies
• 12 lead ECG • Electrophysiology studies
Potential Issues
• If a cardiac rhythm is not restored within 3 to 5 minutes, death ensues.
Expected Patient Outcomes
• Treat episodes of ventricular fibrillation (CPR) • Diagnose and treat underlying cause to prevent further episodes
Treatment/Management
Immediate treatment: CPR, defibrillation as per ACLS protocols, medications.
Long term: possible implantable cardioverter defibrillator (ICD) to detect and treat any further episodes of ventricular tachycardia or ventricular fibrillation. |
|
|
Term
| For the NANDA-I nursing diagnosis of Decreased cardiac output, |
|
Definition
| have the patient slowly increase the exercise regime and teach the patient about medications |
|
|
Term
| NANDA-I Nursing Diagnosis: Decreased cardiac output |
|
Definition
Definition: Inadequate volume of blood pumped by the heart to meet the body's metabolic demands Related Factor: Altered heart rate/rhythm Signs and Symptoms: Verbal report of dizziness
NANDA-I Nursing Diagnosis: Activity intolerance Definition: Insufficient energy to endure desired daily activities Related Factor: Imbalance between oxygen supply and demand Signs and Symptoms: Verbal report of fatigue |
|
|
Term
| For the NANDA-I nursing diagnosis of Activity intolerance, |
|
Definition
| allow the patient periods of rest and instruct the patient to change positions slowly |
|
|
Term
| For the NANDA-I Nursing Diagnosis of Decreased cardiac output, |
|
Definition
| the pulse rate and rhythm within normal parameters is an expected patient outcome |
|
|
Term
| For the NANDA-I nursing diagnosis label of Activity intolerance, |
|
Definition
| ambulate without shortness of breath is an expected patient outcome |
|
|
Term
|
Definition
| Chest pain, shortness of breath, and nausea could be the symptoms of a |
|
|
Term
|
Definition
| Inadequate blood pumped by the heart to meet the metabolic demands of the body |
|
|
Term
|
Definition
Defining Characteristics
- Altered HR/Rhythm
- Altered Preload
- Altered Afterload
- Altered Contractility
- Behavioral/Emotional |
|
|
Term
| Decreased cardiac output - Altered HR/Rhythm |
|
Definition
- bradycardia
- ECG change
- arrhythmia
- conduction abnormality
- ischemia |
|
|
Term
| Decreased cardiac output - Altered Preload |
|
Definition
- dec or inc CVP
- dec or inc PAWP
- edema
- fatigue
- murmur
- JVD
- wt gain |
|
|
Term
| Decreased cardiac output - Altered Afterload |
|
Definition
- abnormal skin color (pale, dusky, cyanosis)
- alteration in BP
- dec peripheral pulses
- dec or inc PVR
- dec or inc SVR
- dyspnea
- oliguria
- prolonged capillary refill |
|
|
Term
| Decreased cardiac output - Altered Contractility |
|
Definition
- adventitious breath sounds
- coughing
- dec cardiac index
- dec EF
- dec left ventricular stroke work index
- dec stroke vol index
- orthopnea
- paroxysmal nocturnal dyspnea
- presence of S3, S4 |
|
|
Term
| Decreased cardiac output - Behv/Emot |
|
Definition
|
|
Term
|
Definition
| Insufficient physiological or psychological energy to endure or complete required or desired daily activities |
|
|
Term
|
Definition
Defining Characteristics
- abnormal BP response to activity
- abnormal HR response to activity
- ECG change (arrhythmia, conduction abnormality, ischemia)
- exertional discomfort/dyspnea
- fatigue
- generalized weakness |
|
|
Term
|
Definition
Defining Characteristics
- inaccurate follow through of instruction
- inaccurate performance on a test
- inappropriate behv (hysterical, hostile, agitated, apathetic)
- insufficient knowledge |
|
|
Term
|
Definition
- Quinidine
- Procainamide
- Disopyramide |
|
|
Term
|
Definition
- Lidocaine
- Phenytoin
- Mexiletine |
|
|
Term
|
Definition
- Flecainide
- Propafenone |
|
|
Term
|
Definition
- Propranolol
- Acebutolol
- Esmolol |
|
|
Term
|
Definition
- Amiodarone
- Dronedarone
- Sotalol
- Dofetilide
- Ibutilide |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
Sodium
Beta
Potassium
Calcium |
|
|
Term
| Class IA (sodium) and Class III (potassium) |
|
Definition
|
|
Term
|
Definition
| - drug of choice for terminating SVT |
|
|
Term
|
Definition
| is used for ventricular dysrhythmias; |
|
|
Term
|
Definition
| is used for atrial and ventricular dysrhythmias; |
|
|
Term
|
Definition
| is used for digoxin-induced dysrhythmias. |
|
|
Term
| Drugs and supplements that prolong the QT interval. can intensify dronedarone-induced QT prolongation |
|
Definition
| (eg, phenothiazines, tricyclic antidepressants, amitriptyline, class I and class III antidysrhythmics) |
|
|
Term
|
Definition
| is contraindicated when the PR intervals are greater than 280 msec, the QT interval is greater than 500 msec, and the heart rate is less than 50 beats/min. |
|
|
