There of ventricular tachycardia or treatment/prevention of supraventricular tachyarrhythmias

There are many
different classes of drugs that can be used to treat arrhythmia and have a different
mechanism of action.  Each category of
drug is specific to a certain type of arrhythmia. Therefore, it is important to
know the classification of each drug and the basic mechanism of action
associated with each class. 

In the course of
my previous clinicals, I have had multiple patients with dysrhythmia as well as
patients with a history of MI and angina. Some were taking medications as
on-going treatment, and some were taking medications for preventative purposes.
Regardless of the reason, as a nurse it is important to assess blood pressure,
pulse, also in some cases their EKG. Also, re-assessing patients after
medication administration, observing for side/adverse effects, and patient’s
renal/hepatic function is important. Lastly, safety precautions are essential
with patients who are taking antiarrhythmic due to its vasodilation effects. Nurses
must make sure the bed alarm is on, the patient knows how to use the call
light, perform hourly rounding, and if necessary having the patient close to
the nursing station.

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My personal
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The
class I drugs (sodium-channel blockade)  are the membrane-stabilizing agents works
directly on sodium channel to decrease the automaticity of cardiac muscle. It
is subdivided into A, B, C.

Type
1A:
Disopyramide Phosphate PO 100-200 mg Q6hr

Indication

Action

Side effects

Nursing Implication

Pt & family education

Treatment
of ventricular tachycardia or treatment/prevention of supraventricular
tachyarrhythmias

It
works by decreasing myocardial excitability and conduction velocity.

hypotension,
dyspnea, AV blocks, edema, headache, urinary retention

–         
Monitor BP, pulse, and EKG
–         
Strictly checking I and daily weight
 

–         
Advise the pt to take the medication as directed
–         
Inform the pt about side effect and safety
–         
Instruct the pt to change position slowly to prevent
orthostatic hypotension

Type
1B
Lidocaine IV 1-1.5mg/kg IV Bolus

Indication

Action

Side effects

Nursing Implication

Pt & family education

Treatment
of ventricular arrhythmia

Suppresses
automaticity & spontaneous depolarization

Confusion,
paresthesia, drowsiness, slurring speech, seizure activity

–         
Monitor EKG, BP, and respiratory status
–         
Monitor serum electrolyte levels
 

–         
Inform the pt about side effect and safety
–         
Instruct the pt to change position slowly to prevent
orthostatic hypotension

Type
1C:
 Flecainide acete 100mg PO twice daily
maximum of 400mg daily

Indication

Action

Side effects

Nursing Implication

Pt & family education

Used
to treat ventricular arrhythmias (SVT, PSVT)

Slows
conduction in cardiac tissue by interfering with transport of ions across
cell membranes

Dizziness,
visual disturbances, paresthesia, tremors

–         
Monitor I and EKG
–         
Evaluate renal, hepatic, pulmonary function
 

–         
Inform the pt about side effect and safety
–         
Advise the pt to take the medication as directed
 

 

Class
II drugs:
Beta-blockers

Propranolol

Indication

Action

Side effects

Nursing Implication

Pt & family education

Use
to treat HTN, angina, arrhythmias, and it can also be used for prevention/management
of MI

Inhibit
stimulation of beta1& beta2 adrenergic receptor sites

SOB,
wheezing, insomnia, fatigue, dizziness, hypotension

–         
Monitor BP, pulse
–         
Check renal and hepatic toxicity
 

–         
Inform the pt about side effect and safety
–         
Advise the pt to take the medication as directed
(Abrupt withdrawal of the medication can cause life-threatening arrhythmias, hypertension,
and MI)
–         
Educate the pt how to check pulse/ bp
–         
Instruct the pt to change position slowly to prevent
orthostatic hypotension
 

 

Class
III drug:
delay repolarization and prolong action potential duration ( K+ cannel blockade)

Amiodarone 800-1600 mg PO daily

Indication

Action

Side effects

Nursing Implication

Pt & family education

Life-threatening
ventricular arrhythmias unresponsive to less toxic agents

Extends
action potential and cause vasodilation

SOB,
wheezing, insomnia, fatigue, dizziness, hypotension

–         
Monitor BP, pulse
–         
Check renal and hepatic toxicity
 

–         
Inform the pt about side effect and safety
–         
Advise the pt to take the medication as directed
–         
Teach pt & family how to check pulse/BP
–         
Instruct the pt to change position slowly to prevent
orthostatic hypotension
 

 

Class
IV drugs:
calcium-channel blockade

Verapamil hydrochloride 2.5-5mg IV over
1-2 min for narrow complex SVT or PSVT

Indication

Action

Side effects

Nursing Implication

Pt & family education

Used
in management of hypertension, angina, SVT, AND atrial flutter or
fibrillation

Inhibits
the transport of calcium into muscle resulting in inhibition of excitation

SOB,
distended neck vein, dizziness, hypotension, confusion

–         
Pt should remain laying down for at least 1 hr after
IV administration to prevent hypotension
–         
Monitor BP, pulse
–         
Check renal and hepatic toxicity
–         
Monitor serum potassium periodically

–         
Inform the pt about side effect and safety
–         
Advise the pt to take the medication as directed
–         
Educate the patient & family how to take
pulse/blood pressure
–         
Educate the pt to change position slowly to prevent
orthostatic hypotension