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ANTIARRHYTHMICS, PART 1 | ||
DRUG NAME | quinidine, procainamide, lidocaine, mexiletine, flecainide, propafenone *High Alert Medications* | propranolol, esmolol, sotalol, acebutolol *High Alert Medications* |
CLASS | Class I (sodium channel blockers) | Class II (beta blockers) |
MECHANISM OF ACTION | Block sodium influx, affect conduction and / or repolarization | Block catecholamines → decreased heart contractility |
INDICATIONS | Arrhythmias (e.g., supraventricular tachycardias, paroxysmal atrial tachycardia, atrial flutter, atrial fibrillation, ventricular tachycardia and ventricular fibrillation) | |
ROUTE(S) OF ADMINISTRATION |
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SIDE EFFECTS |
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CONTRAINDICATIONS AND CAUTIONS |
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ANTIARRHYTHMICS, PART 2 | ||
DRUG NAME | amiodarone *High Alert Medications* | verapamil, diltiazem *High Alert Medications* |
CLASS | Class III (potassium channel blockers) | Class IV (calcium channel blockers) |
MECHANISM OF ACTION | Block potassium efflux, prolong repolarization, action potential duration | Block calcium influx, slow conduction velocity, decrease heart contractility |
INDICATIONS | Arrhythmias (e.g., supraventricular tachycardias, paroxysmal atrial tachycardia, atrial flutter, atrial fibrillation, ventricular tachycardia and ventricular fibrillation) | |
ROUTE(S) OF ADMINISTRATION |
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SIDE EFFECTS |
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CONTRAINDICATIONS AND CAUTIONS |
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NURSING CONSIDERATIONS: ANTIARRHYTHMICS | ||||
CLASS | Classes I & II | Classes III & IV | ||
ASSESSMENT AND MONITORING | Assessment
Monitor
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Assessment: amiodarone
IV administration: amiodarone
Monitor
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CLIENT EDUCATION | Quinidine
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Antiarrhythmics, also called antidysrhythmics, are a class of medications that help control arrhythmias or abnormal heartbeats, such as supraventricular tachycardia, ventricular tachycardia and ventricular fibrillation.
In general, antiarrhythmics act by altering electrical conduction pathways through the heart, and can be administered orally, intravenously, or intramuscularly. Now, based on their mechanism of action, they can be divided into four main classes.
Class I antiarrhythmics are sodium channel blockers that inhibit sodium influx into cardiac cells, and can be further subdivided into three groups depending on how they affect conduction and repolarization. Class IA antiarrhythmics, such as quinidine and procainamide, act by slowing conduction and prolonging repolarization. Class IB, like lidocaine and mexiletine, also act by slowing conduction, but they shorten repolarization. And class IC, such as flecainide and propafenone, prolong conduction but have no effect on repolarization.
Next, class II antiarrhythmics are beta-blocker medications, and include propranolol, esmolol, sotalol, and acebutolol. These medications act by preventing the catecholamines norepinephrine and epinephrine from binding and activating them; ultimately decreasing heart contractility and slowing the conduction through the atrioventricular or AV node.
Antiarrhythmic drugs are used to prevent and treat abnormal and irregular heart rhythms (arrhythmias). These drugs are classified into four major classes based on their physiological effect on the heart muscle.
First, there is Class I antiarrhythmics, which are sodium channel blockers. It includes drugs like quinidine and procainamide. Class I antiarrhythmics are subdivided into three smaller groups: class 1A, class 1B, and class 1C. Next comes class II antiarrhythmics which are beta-blockers. They include drugs like propranolol and esmolol. Class III antiarrhythmics consist of potassium channel blockers like amiodarone; and class IV antiarrhythmics which are calcium channel blockers, consisting of drugs like verapamil and diltiazem.
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