NUR266 MEDS Ch 45: Antiarrhythmic Agents. -Arnold wk 6
A client diagnosed with heart disease is prescribed an antiarrhythmic drug. Further teaching is needed when the client makes which statement? "I need to call my primary care provider before taking any herbal supplements." "I will take my medication at the prescribed time." "I know I must take my medication every day for my heartbeat to be fixed." "I can check the drug label about taking the medicine with food."
"I know I must take my medication every day for my heartbeat to be fixed." Antiarrhythmic drugs do not cure disease. Along with lifestyle changes, they can improve the quality of life. Adherence to the drug regimen is important. Following the directions on drug labels is also important. The client should check with the primary care provider before taking any nonprescription drug, supplement, or herbal preparation.
A client experiencing a ventricular arrhythmia has received a bolus of lidocaine. What is the recommended rate for continuous infusion of lidocaine IV now prescribed for this client? 1 to 4 mg/min 10 to 20 mg/min 6 to 8 mg/min 0.25 to 0.75 mg/min
1 to 4 mg/min A continuous infusion of lidocaine IV after a bolus is 1 to 4 mg/min. The administration of 0.25 to 0.75 mg/min would be too small of a dosage. The administration of 10 to 20 or 6 to 8 mg/min would be too large.
A patient receives lidocaine IV. The nurse would expect the drug to exert its effects for how long? 60 to 90 minutes 90 to 120 minutes 10 to 20 minutes 30 to 40 minutes
10 to 20 minutes Lidocaine when given IV has a duration of action of 10 to 20 minutes.
The primary health care provider prescribes sotalol (Betapace) 80 mg BID orally. The drug is available in 40 mg tablets. The nurse will administer how many tablets in 24 hours?
4 tablets
When educating a group of nursing students on the mechanism of the action of various anti-arrhythmic drugs, the nurse identifies which drugs as inhibiting the beta-adrenergic receptors of the heart and the kidney? Amiodarone Disopyramide Propafenone Acebutolol
Acebutolol The nurse should inform the nursing students that acebutolol acts by inhibiting the beta-adrenergic receptors of the heart and the kidney. Propafenone and amiodarone appear to act directly on the cardiac cell membrane, and on the beta-adrenergic receptors of the heart and the kidney. Disopyramide acts by decreasing the depolarization of the myocardial fibers, and not the beta-adrenergic receptors of the heart and the kidney.
After reviewing antiarrhythmic drugs, a group of nursing students demonstrate understanding of the drugs when they identify which as a class II antiarrhythmic? Select all that apply. Ibutilide Acebutolol Amiodarone Propranolol Verapamil
Acebutolol Propranolol Acebutolol and propranolol are class II antiarrhythmics. Amiodarone and ibutilide are class III antiarrhythmic drugs. Verapamil is a calcium channel blocker.
In some cases, low-dose amiodarone may be used to prevent recurrence of what cardiac disorder? Mitral valve regurgitation Angina pectoris Ventricular hypertrophy Atrial fibrillation
Atrial fibrillation Low-dose amiodarone may be a pharmacologic choice for preventing recurrent atrial fibrillation after electrical or pharmacologic conversion. Potassium channel blockers such as amiodarone prolong duration of the action potential, slow repolarization, and prolong the refractory period in both the atria and ventricles. Potassium channel blockers are not effective in preventing valvular disorders, ventricular hypertrophy, or angina.
Which statement would be true about the mechanism of action of class II antiarrhythmic agents? Block the influx of sodium into the cells Stimulate the uptake of potassium in the tissues Block the stimulation of the adrenergic receptors Cause depression in phase 2 of repolarization
Block the stimulation of the adrenergic receptors Class II antiarrhythmic drugs block adrenergic receptors (beta-blockers), producing antisympathetic effects that slow the heart rate, lengthen the time needed for conduction, and increase the force of contraction. The effect seen with class II antiarrhythmic drugs is depression of phase 4 of depolarization.
A breast-feeding woman is prescribed a Class 3 antiarrhythmic. What information should the nurse provide to the client regarding the safety of the breast-feeding while taking this medication? The safety of this class of antiarrhythmic medications has not been established. Breast-feeding must be discontinued and other forms of feeding should be introduced. The medication doesn't pass into the breast milk. The decision to continue breast-feeding should be based on the stress is creates for the woman
Breast-feeding must be discontinued and other forms of feeding should be introduced. The safety for the use of antiarrhythmic drugs during pregnancy has not been established. They should not be used in pregnancy unless the benefit to the mother clearly outweighs the potential risk to the fetus. The drugs enter breast milk, and some have been associated with adverse effects on the neonate. Class I, III, and IV agents should not be used during lactation; if they are needed, another method of feeding the baby should be used.
Lidocaine is the prototype of class IB antiarrhythmics used for treating serious ventricular arrhythmias associated with what conditions? (Select all that apply.) Digitalis-induced ventricular arrhythmias Cardiac surgery Cardiac arrest Atrial arrhythmia caused by diuretics Cardiac catheterization
Cardiac catheterization Cardiac surgery Digitalis-induced ventricular arrhythmias Lidocaine is the prototype of class IB antiarrhythmics used for treating serious ventricular arrhythmias associated with acute myocardial infarction, cardiac catheterization, or cardiac surgery and digitalis-induced ventricular arrhythmias. It is not intended for use with clients experiencing cardiac arrest.
The nurse is preparing discharge teaching for a client prescribed chronic antiarrhythmic medication therapy. Which signs/symptoms should be reported to the health care provider immediately? (Select all that apply.) Diarrhea Heart palpations Chest pain Nausea Dyspnea
Chest pain Dyspnea Heart palpations Report any of the following to your health care provider: chest pain, difficulty breathing, palpitations, numbness, or tingling. The other options present the seriousness of the correct options.
The health care provider has prescribed a class IV calcium channel blocker for a client diagnosed with acute supraventricular tachycardia. Which drug does this nurse expect to be prescribed? Bethanechol chloride Midazolam hydrochloride Chlorambucil Diltiazem
Diltiazem Calcium channel blockers obstruct the movement of calcium into conductive and contractile myocardial cells by inhibiting the influx of calcium through its channels, causing a slower conduction through the SA and AV nodes. Diltiazem is administered intravenously to treat acute supraventricular tachycardia. Bethanechol is used to treat neurogenic bladder. Chlorambucil is an antineoplastic agent used to treat chronic lymphocytic leukemia. Midazolam hydrochloride is administered to reduce anxiety.
A client is prescribed propranolol (Inderal). Which condition in the client's history may affect the treatment regimen? Dizziness Diarrhea Elevated glucose Nausea
Elevated glucose The client with diabetes may experience elevated glucose levels while taking propranolol, and the insulin or oral hypoglycemic drug dosages may need to be adjusted. Nausea, diarrhea, and dizziness are all adverse reactions to propranolol
There are four primary classes of antidysrhythmic drugs. What class consists primarily of potassium channel blockers? IV I II III
III The class III antiarrhythmics are primarily potassium channel blockers. Class I drugs are sodium channel blockers; class II drugs are beta-adrenergic blockers; and class IV drugs are calcium channel blockers.
A client has been prescribed IV amiodarone for emergency treatment of a serious ventricular arrhythmia. The nurse monitors the client's ECG anticipating a noted change how long after the medication is delivered? 10 minutes 2-3 days 90 minutes Immediately
Immediately The onset of IV amiodarone is immediate with the peak occurring in 20 minutes and a duration of 6-8 hours.
A client is administered diltiazem IV, followed by propranolol IV. The nurse should assess for what potential side effect of this medication combination? Hypertensive crisis Impaired myocardial contractility Valve regurgitation Anaphylaxis
Impaired myocardial contractility If diltiazem is used with propranolol or digoxin, it is necessary to exercise caution to avoid further impairment of myocardial contractility. The administration of IV diltiazem and propranolol will not produce hypertensive crisis, anaphylaxis, or valve regurgitation.
An ED patient presents with dyspnea, tachycardia, and chest pain. The patient has a history of cardiomyopathy. The nursing assessment reveals hypotension with an apical pulse of 134 bpm. What would the nurse conclude might be causing the symptoms? Inadequate cardiac output Hypokalemia Asthma attack Adequate cardiac output
Inadequate cardiac output Symptoms presenting suggest a cardiac condition. A diseased heart may not be able to maintain an adequate cardiac output with heart rates below 60 bpm above 120 bpm.
Lidocaine (Xylocaine) is available in a variety of dosage forms. How should a nurse administer lidocaine to a client with a ventricular arrhythmia? Intramuscularly Orally Topically Intravenously
Intravenously The nurse should administer lidocaine intravenously for the treatment of ventricular arrhythmias.
The nurse is caring for a client who has been prescribed quinidine. The nurse should advocate for a lower-than-normal dose if the client has a history of what medical diagnosis? Chronic obstructive pulmonary disease Primary hypertension Type 1 or type 2 diabetes Liver disease
Liver disease Hepatic impairment increases the plasma half-life of several antidysrhythmic drugs, including quinidine, and clients with hepatic impairment usually receive a reduced dosage. The pathophysiologies of the other conditions would not affect the half-life of quinidine since they do not affect drug metabolism.
Which is part of the nurse's evaluation of anti-arrhythmic drug therapy? (Select all that apply.) No evidence of injury seen. No evidence of infection is seen. Patient is free of nausea. Patient urinates adequately. Oral mucous membranes are intact and moist.
No evidence of injury seen. No evidence of infection is seen. Patient is free of nausea. Patient urinates adequately. Oral mucous membranes are intact and moist. Most of these are part of the nurse's evaluation of anti-arrhythmic drug therapy. Therapeutic response, identification of adverse reactions, and demonstration of client and family's understanding are also included in the nurse's evaluation of anti-arrhythmic drug therapy.
A patient with cardiac arrhythmia is prescribed verapamil. Which of the following possible adverse effects should the nurse inform the patient about? Hypertension Hyperactivity Peripheral edema Diarrhea
Peripheral edema The nurse should inform the patient that peripheral edema could be an adverse effect to verapamil therapy. Diarrhea, hyperactivity, and hypertension are not adverse effects associated with verapamil therapy. Other adverse effects associated with verapamil are constipation, mental depression, and hypotension.
A patient is admitted to the cardiology unit of a health care facility for ventricular arrhythmia. In which condition can an anti-arrhythmic drug be safely administered? Severe congestive heart failure Aortic stenosis Premature ventricular contraction Third-degree heart block
Premature ventricular contraction The patient can be safely administered an anti-arrhythmic drug if the patient has premature ventricular contractions. Aortic stenosis, third-degree heart block, and severe congestive heart failure are contraindications for the use of anti-arrhythmic drugs.
Intravenous verapamil has been ordered immediately in the treatment of a client experiencing supraventricular tachycardia. In order to ensure client safety, the nurse should be aware that concurrent use of which medication is absolutely contraindicated? Propranolol Lidocaine Sodium bicarbonate Diltiazem
Propranolol Use of IV verapamil with IV propranolol should not take place; it may result in potentially fatal bradycardia and hypotension. None of the other medications would result in these adverse reactions if used concurrently with verapamil.
A patient, admitted to a health care facility with cardiac arrhythmia, is prescribed propranolol. Which factor should the nurse closely monitor as a part of the ongoing assessment during the therapy? Tendon reflexes Hydration Pulse rate Visual acuity
Pulse rate During anti-arrhythmic drug therapy, the nurse should closely monitor the patient's pulse rate. A change in the pulse rate and rhythm will help assess a response to drug therapy, the development of signs of CHF, the development of a new cardiac arrhythmia, or worsening of the arrhythmia being treated. It is not necessary to monitor the tendon reflexes, hydration or visual acuity when administering an anti-arrhythmic drug to the patient.
Which factor would necessitate a reduction in the dosage of disopyramide? Chronic diarrhea Renal impairment Hypertension Immobility
Renal impairment As a general rule, dosage of several antidysrhythmic drugs, including disopyramide, should be reduced in clients with significant impairment of renal function to avoid toxicity.
A client has been prescribed disopyramide (Norpace) to treat a tachyarrhythmia. Which factor would necessitate that the dose be reduced? Immobility Renal impairment Hypertension Chronic diarrhea
Renal impairment Disopyramide is excreted in the kidneys and the liver in almost equal proportions. The dose must be reduced in renal insufficiency based on creatinine clearance. The dose does not need to be reduced in immobility, hypertension, or chronic diarrhea.
A client has a complex cardiac history that includes recurrent ventricular fibrillation. After the failure of more conservative treatments, the care team has introduced oral amiodarone. What assessments should be prioritized by the nurse who is providing care for this client? Respiratory assessment Neurological assessment Orientation and cognition Active and passive range of motion
Respiratory assessment Amiodarone has several adverse effects that are potentially fatal. Pulmonary toxicity is the most important of these serious adverse effects. Consequently, the nurse should prioritize respiratory assessments over musculoskeletal or neurological assessments.
What should be included in the nurse's ongoing assessment of a client receiving flecainide (Tambocor)? (Select all that apply.) Signs of heart failure Monitoring of serum flecainide levels Development of new cardiac arrhythmias Response to therapy Worsening of arrhythmia being treated
Response to therapy Signs of heart failure Development of new cardiac arrhythmias Worsening of arrhythmia being treated Monitoring of serum flecainide levels The nurse should closely monitor the client for a response to drug therapy, signs of heart failure, the development of new arrhythmias, the worsening of arrhythmia being treated, and serum flecainide levels.
A client diagnosed with a dysrhythmia has not responded appreciably to treatment with oral propranolol. When the medication is discontinued, what instruction should the nurse provide the client to maximize safety? Gradually replace the propranolol with newly prescribed metoprolol. Monitor cardiac status at regularly after taking the final dose of propranolol. Be prepared to substitute an intramuscular propranolol for several months. Taper down the propranolol dose over a period of 2 weeks.
Taper down the propranolol dose over a period of 2 weeks. It is essential that propranolol not be discontinued abruptly after long-term therapy; a hypersensitivity to catecholamines may have developed, exacerbating ventricular dysrhythmia. Gradual tapering over a 2-week period, with client monitoring, is necessary. Replacement with a different beta-blocker is not necessarily indicated. Propranolol is not administered by the IM route. Monitoring alone is not sufficient treatment in this situation.
A nurse is assigned to care for a client who has to be administered an antiarrhythmic drug. Under what conditions would its use be contraindicated? Select all that apply. The client has renal or hepatic disease. The client has aortic stenosis. The client has electrolyte disturbances. The client has hypotension. The client has cardiogenic shock.
The client has hypotension. The client has aortic stenosis. The client has cardiogenic shock. The nurse knows that antiarrhythmic drugs are contraindicated in clients with hypotension, aortic stenosis, and cardiogenic disturbances. Arrhythmic drugs are used cautiously and not contraindicated in clients with electrolyte disturbances and renal or hepatic disease.
A nurse is the cardiac care unit is preparing to hang an intravenous dose of dofetilide (Tikosyn) for a client who has just been admitted. What is the most likely goal of this intervention? To convert the client's atrial fibrillation to normal sinus rhythm To resolve the client's uncompensated heart failure To treat sinus bradycardia accompanied by hypotension To treat the client's ventricular tachycardia
To convert the client's atrial fibrillation to normal sinus rhythm Dofetilide is used to convert clients in atrial fibrillation to normal sinus rhythm and maintain them in sinus rhythm. This drug is not used in the treatment of bradycardia, heart failure, or ventricular arrhythmias
The teaching plan for a client taking amiodarone should include which instruction? Drowsiness is common but will not interfere with any of your usual activities. Take this medication with grapefruit juice for optimal absorption. Urinary retention is common and no need for concern. Use a reliable form of birth control while taking this medication.
Use a reliable form of birth control while taking this medication. Amiodarone is a pregnancy category D drug. Because of a specific enzyme reaction, grapefruit or its juice should not be taken with amiodarone or calcium channel blockers. Urinary retention is an adverse reaction and should be reported to the health care provider. Drowsiness may occur, and the client should be instructed not to drive and to avoid hazardous tasks if drowsy.
A female patient diagnosed with chronic atrial flutter has been prescribed verapamil in conjunction with digoxin to control ventricular rate. To enhance the therapeutic effect of the drug, the nurse will instruct the patient to: avoid grapefruit and grapefruit juice. take an aspirin every day. take the medication with meals. avoid fresh fruit.
avoid grapefruit and grapefruit juice. The patient should be instructed to avoid grapefruit and grapefruit juice because they may increase the verapamil level. The patient should also abstain from using alcohol and aspirin while taking this medication. Encouraging the patient to increase her fluid intake and include fresh fruit and fiber in her diet can help prevent constipation. Taking the medication with meals would not enhance its effect.
The nurse notes that a client's current medications include both diltiazem for a dysrhythmia and atazanavir. The nurse should recognize the need to closely monitor which client assessment datum? peripheral pulses blood pressure level of consciousness oxygen saturation levels
blood pressure When caring for clients who are receiving diltiazem, the nurse monitors carefully for changes in blood pressure and cardiac rhythm as well as output. Checking the blood pressure is especially important if the client is taking atazanavir concurrently since the combination tends to produce hypotension. There is no need for increased monitoring of oxygenation, peripheral pulse, or level of consciousness.
The nurse notes that a client's current medications include both diltiazem for a dysrhythmia and atazanavir. The nurse should recognize the need to closely monitor which client assessment datum? peripheral pulses oxygen saturation levels level of consciousness blood pressure
blood pressure When caring for clients who are receiving diltiazem, the nurse monitors carefully for changes in blood pressure and cardiac rhythm as well as output. Checking the blood pressure is especially important if the client is taking atazanavir concurrently since the combination tends to produce hypotension. There is no need for increased monitoring of oxygenation, peripheral pulse, or level of consciousness.
When describing the drugs classified as class IV antiarrhythmics, the nurse would identify these as: cardiac glycosides. beta blockers. vasodilators. calcium channel blockers.
calcium channel blockers. Class IV antiarrhythmics include calcium channel blockers. Beta blockers are class II antiarrhythmics. Cardiac glycosides, such as digoxin may be used as an antiarrhythmic, but are not classified as class I, II, III, or IV. Vasodilators are not used as antiarrhythmics.
The nurse teaches the client receiving propranolol at home for management of a ventricular arrhythmia to monitor what parameter? daily blood pressure weekly weight daily fluid intake weekly pulse
daily blood pressure Hypotension can occur with propranolol, which is a beta-blocker, so clients should check their blood pressure and pulse every day. Propranolol does not require that fluid intake be measured. Propranolol also will not require daily weight taking, but it may be necessary with a diagnosis of propranolol.
Propranolol is ordered for a client who has a cardiac arrhythmia. It will be important for the nurse to determine if the person has a history of: hypersensitivity to beta blockers. idiosyncratic reaction to cinchona derivatives. hypersensitivity to sulfonylureas. chronic heart failure secondary to a tachyarrhythmia.
hypersensitivity to beta blockers. Propranolol would be contraindicated in a patient with hypersensitivity to beta blockers since it blocks the beta-adrenergic receptor sites. For the same reason, it would not be contraindicated in chronic heart failure secondary to a tachyarrhythmia, treatable with beta blockers. It would also not be contraindicated in a client with an idiosyncratic reaction to cinchona derivatives or in a client with hypersensitivity to sulfonylureas because it is not a cinchona derivative and does not contain sulfonylurea.
Propranolol is ordered for a client who has a cardiac arrhythmia. It will be important for the nurse to determine if the person has a history of: hypersensitivity to sulfonylureas. hypersensitivity to beta blockers. chronic heart failure secondary to a tachyarrhythmia. idiosyncratic reaction to cinchona derivatives.
hypersensitivity to beta blockers. Propranolol would be contraindicated in a patient with hypersensitivity to beta blockers since it blocks the beta-adrenergic receptor sites. For the same reason, it would not be contraindicated in chronic heart failure secondary to a tachyarrhythmia, treatable with beta blockers. It would also not be contraindicated in a client with an idiosyncratic reaction to cinchona derivatives or in a client with hypersensitivity to sulfonylureas because it is not a cinchona derivative and does not contain sulfonylurea.
A 70-year-old woman with a history of atrial fibrillation takes digoxin and verapamil to control her health problem. Verapamil achieves a therapeutic effect by: decreasing sodium and potassium conduction. inhibiting the movement of calcium ions across the cardiac muscle cell membrane. blocking adrenergic receptors and producing antisympathetic effects. weakening diastolic depolarization and the action potential duration.
inhibiting the movement of calcium ions across the cardiac muscle cell membrane. Verapamil acts by inhibiting the movement of calcium ions across the cardiac and arterial muscle cell membrane. It works preferentially in "slow response" myocardial tissue, such as the SA and AV nodes. Beta blockers inhibit adrenergic receptors and Class IB antiarrhythmics are among the drugs that decrease sodium and potassium conduction. Lidocaine weakens phase 4 diastolic depolarization and decreases the action potential duration and the effective refractory period of Purkinje fibers and ventricular muscle.
The primary health care provider prescribes a class I sodium channel blocker to be given intravenously. Which drug would the nurse most likely administer? mexiletine disopyramide flecainide lidocaine
lidocaine The nurse should administer lidocaine intravenously; disopyramide, flecainide, and mexiletine are administered orally.
What is the primary goal of antidysrhythmic drug therapy for a client who has been successfully cardioverted? proof of increased cardiac contractility increase in blood pressure maintenance of normal sinus rhythm (NSR) suppression of original dysrhythmia
maintenance of normal sinus rhythm (NSR) Maintaining NSR after conversion from atrial fibrillation or atrial flutter is one of the indications for antidysrhythmic drug therapy. This is not achieved solely by increasing contractility. Increased tissue perfusion is a valid goal, but increased blood pressure may or may not be desirable. Clinicians use drugs not just to suppress dysrhythmia but to prevent or relieve symptoms or prolong survival.
Initiation of the heart's electrical impulses depends predominantly on what electrolyte movement? Select all that apply. calcium ions into a myocardial cell potassium ions out of a myocardial cell sodium and calcium ions out of a myocardial cell potassium ions into a myocardial cell sodium ions into a myocardial cell
potassium ions out of a myocardial cell sodium ions into a myocardial cell calcium ions into a myocardial cell Initiation of an electrical impulse depends predominately on the movement of sodium and calcium ions into a myocardial cell and movement of potassium ions out of the cell.
