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Antidysrhythmic Medications; Medications Affecting Cardiac Function (by class and action) (keep, make notes)
Class
Action
Examples
Uses
Side Effects
IA
Slow depolarization by
slowing sodium influx =
decrease myocardial
contractility and
excitability; increase
refractory time
Decreased automaticity in
Bundle of His and Purjinke
fibers
Cardioquin/quinidine
PAC, PJC ,PVC
Diarrhea, nausea,
vomiting, hypotension,
SLE syndrome, hemolytic
anemia, agranulocytosis
IB
Pronestyl/procainamide
Norpace/disopyramide
Lidocaine/xylocaine
Tonocard/tocainide
Mexitil/mexiletine
IC
II
Slow conduction by altering Tambocar/flecanide
ion transport across cell
membrane
Rhythmol/propafenone
Ethmozine/moricizine
Inderal/propranolol
Decrease automaticity,
contractility, AV conduction
and heart rate via beta
Corgard/nadolol
blockade
(Beta blockers) See also
III
RNSG 2432 • 71
Blocks sympathetic
stimulation and action
Ventricular
dysrhythmias
Atrial and ventricular
tachy dysrhythmias
SVT and atrial
dysrhythmias
CHF, angina, nausea,
vomiting, constipation,
blurred vision
CHF, angina, worsening of
asthma, COPD,
hypotension, heart blocks
Blocadren/timolol
Brevibloc/esmolol
Cordorone/amiodarone
Betapace/sotalol
Slows repolarization by
blocking potassium
channels
PVCs; 1st line drug, arrest Numbness, paresthesias,
with multifocal PVC
temors, blurred vision
(lidocaine).
convulsions, respiratory
arrest
Corvert/ibutilide
Life-threatening
Pulmonary fibrosis, blue
ventricular dysrhythmias skin, syncope, angina,
and some SVT
hypotension, nausea,
headache
72 • RNSG 2432
IV
Slow influx of calcium
across cell membrane
Cardizem/diltiazem
Calan/verapamil
(Calcium channel
blockers)
Other**
Isoptin/verapamil
Nifedipine (Adalat, Procardia)
Block vagal response;
Atropine**
increase heart rate
Potassium channel
Adenocard/adenosine
opener; acts on AV node to
slow conduction and inhibit
reentry pathways
SVT, rapid ventricular
Hypotension, CHF,
response atrial fib/flutter bradycardia, constipation,
peripheral edema,
decreased liver function
(do not give to patients
with heart failure;
decreases contractility)
Other
Decreases AV node
conduction
Digoxin/digitalis (also neg
chronotropic and positive inotropic )
Treat symptomatic
Urinary retention, acute
bradycardia!
glaucoma, agitation, flush
Treat paroxysmal
Flushing, transient
supraventricular
dysrhythmias, SOB,
tachycardia (PSVT)
angina (give over 102
associated with accessory seconds, followed by 20 ml
bypass tracts (Wolffflush of NS
Parkinson-White
syndrome) SVT, PAT
Atrial fib/flutter
N, V, D, visual changes,
dysrhythmias
Classification by
action
Action
Examples
Class
Antiarrhythmics
Promote normal sinus
rhythm
Adenocard/adenosine: IV;
Adenocard: (other);
Side Effects: QT
Betapace/sotalol: PO;
Betapace: Class III;
lengthening, arrhythimias,
Cordarone/amiodarone: PO or IV; Cordarone/amiodarone: hypotension, neuro status
changes
Corvert/ibutilide: IV;
Class III;
Lanoxin/digoxin: PO, IM, or IV;
Covert/ibutilide: Class
Pronestyl/procainamide: PO, IM, III; Lanoxin/digoxin:
*Reference specific
or IV Rythmol/propafenone: PO; other; Pronestyl: Class I class for side effect; ie,
Xylocaine/lidocaine: IM or IV;
A;
beta blockers and effect
Tikosyn: PO
Rhythmol/propafenone:Cl on pulmonary system*
ass I C; Xylocaine: Class
I B; Tikosyn: Class III
None; used for blood
Intropin/dopamine;
Arrhythmias, tachycardia,
pressure support, short
Adrenalin/epinephrine: IV
nausea, vomiting
Other
(Refer to Class IIV)
Catecholamines
Stress chemicals,
vasopressors
term perfusion to kidneys;
IV drip* ; Epinephrine
used to restored cardiac
rhythm in cardiac arrest
Side Effects
Chronotropes
Change the heart rate;
positive chronotropes
increase the heart rate;
negative chronotropes
decrease the heart rate.
Atropine IV;
Dobutrex/dobutamine: IV (mild
positive chronotrope);
Lanoxin/digoxin: PO, IM, or IV
(negative chronotrope
”Other”
Inotropes
Inotropes are drugs that
change ower (contractility);
positive inotropes increase
contractility and increase
cardiac output; negative
inotropes decrease
contractility.
Drugs that put the heart on
bedrest by decreasing heart
rate, decreasing
contractility, and decrease
blood pressure; end in “lol”
Dobutrex/dobutamine: IV (positive
inotrope); Intropin/dopamine: IV
(positive inotrope);
Lanoxin/digoxin: PO, IM, or IV
(positive inotrope);
Primacor/milrinone: IV (positive
inotrope)
Inderal/propranolol: PO or IV;
Lopressor/Toprol XL/metoprolol:
PO or IV; Coreg/carvedilol: PO;
Tenormin/atenolol: PO or IV
*Most antiarrhythmics VENTRICULAR
are negative inotropes ARRHYTHMIAS
(dobutamine; dopamine),
hypotension
Digoxin: “Other” class
Class II
bradycardia, hypotension,
CHF, pulmonary edema,
*wheezing
Drugs that put the heart on
bedrest by dilating coronary
arteries to reduce frequency
of angina, decreasing
afterload, and suppressing
arrhythmias
Drugs that relax blood
vessels throughout the
body to lower blood
pressure; decrease
afterload & inc. CO; in
CHF patients; and decrease
the development of overt
heart failure; end in “pril”
Procardia/nifedipine: PO or SL;
Calan/verapamil: PO or IV;
Cardizem/diltiazem: PO or IV;
Norvasc/ Amlodipine: PO
Class IV
bradycardia, hypotension,
CHF, arrhythmias
Capoten/captopril: PO;
Vasotec/enalapril: PO or IV;
Prinivil/Zestril/lisinopril: PO;
Accupril/quinapril: PO;
Altace/ramipril: PO
No effect on heart
rhythm
Beta blockers
(Class II anti
arrhythmia)
Calcium Channel
blockers
(Class IV anti
arrhythmia)
Ace Inhibitors
Note specific action of
each; atropine to increase
heart rate; lanoxin slow
and strengthen heart
pumping action
*danger to patients with
heart failure
*Decrease remodeling
of heart, important in
heart failure; dec. BP
hypotension, tachycardia,
cough, headache
RNSG 2432 • 73
74 • RNSG 2432
Vasodilators
Drugs that dilate blood
vessels to decrease blood
pressure; decrease
afterload; inc CO
Nitrostat/Nitro-Dur/ nitroglycerin:
SL, PO, IV, transdermal, Buccal;
Natrecor/nesiritide: IV;
Imdur/isosorbide mononitrate: PO;
Isorbid/Isordil/isosorbide dinitrate:
SL or PO; Apresoline/hydralazine:
PO, IM, or IV; Catapres/ clonidine:
PO, transdermal, epidural
No effect on heart
rhythm
Anti-Platelet
agents
Drugs that inhibit platelet
aggregation to decrease
occurrence of athersclerotic
events in patients at risk
Plavix/clopidogrel: PO; ASA/aspirin:
PO; Ticlid/ ticlopidine: PO;
Aggrastat/tirofiban: IV;
Integrilin/eptifibatide: IV;
ReoPro/abciximabL: IV
No effect on heart
bleeding (esp. GI), edema,
rhythm; preventive; IV
anemia, neutropenia
forms immediate post MI
Anti-Coagulants
Drugs that prevent
thrombus formation
Lovenox/enoxaprine: SQ; Heparin: IV No effect on heart
or SQ; Coumadin/warfarin: PO or IV; rhythm; preventive
Fragmin/dalteparin: SQ
Diuretics
enhance selective excretion
of various electrolytes and
water to decrease BP and
excess fluid
Loop diuretics
inhibit reabsoption of Na &
Cl from the loop of Henle
and distal renal tubule
Bumex/bumetanide: PO, IM, or IV;
Lasix/furosemide: PO, IM, or IV;
Demadex/ torsemide: PO or IV
No effect on heart
rhythm; preventive
No effect on heart
rhythm; preventive
Thiazide diuretics
Diuril/chlorothiazide: PO or IV;
HCTZ/hydrochlorothiazide: PO
No effect on heart
rhythm; preventive
Osmitrol/mannitol: IV
No effect on heart
rhythm; preventive
Osmotic Diuretics
Bleeding, anemia,
thrombocytopenia;
monitor PTT, PT and INR
hyper- and hypokalemia,
hyper- and hyponatremia,
hypovolemia, hypotension
Potassium-sparing Cause loss of sodium bicarb Aldactone/spironolactone: PO
diuretics
and Ca while saving K and
hydrogen ions
Inc. excretion of Na and
H2O by inhibiting Na
reabsortion in the distal
tubule
Inc. osmotic pressure of
glomerular filtrate, thus
inhibiting reabsorption of
H2O & electrolytest
hypotension, headache,
dizziness, edema, facial
flushing