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Drug Class MOA and other information S/Es and A/Es Nursing Implications & Client Teachings
I: Na Channel Blocker
A – Depress myocardial excitability – SLE-like syndrome (fever, chills, – For emergency situations only!
procainamide (Procanbid) – Indication: A-fib, PACs, PVCs, V-tach joint pain, swelling, skin rash)
B – Depress myocardial ventricular excitability – ↑ incidence of CNS effects, GI,
lidocaine (Xylocaine) – Indication: ventricular dysrhythmias (PVCs, V-tachs, fever
V-fib)
II: β Blocker – ↓ AV node activity → ↓ ventricular contraction rate, ↓ HR, – bradycardia, hypotension – X: P < 60
esmolol (Brevibloc) ↓ CO, ↓ BP, ↓ O2 consumption – nonselective β blocker: Pt. w/ lung dz → respiratory depression
propranolol (Inderal) – Indication: SVT and ventricular dysrhythmias bronchospasm
III: K Channel Blocker – ↓ AV node conduction, ↓ adrenergic stimulation – Pulmonary fibrosis – Better than Lidocaine in emergency cases
amiodarone (Cordarone) – Indication: A-fib, V-fib, V-tach – HA, heart block, bradycardia,
hypotension, tremor, ataxia
IV: Ca2+ Channel Blocker – ↓ SA & AV nodes conduction → ↓ HR – Hypotension, peripheral edema, –
verapamil (Calan) – Indication: For A-fib/A-flutter, SVT; angina, HTN contribute to CHF
diltiazem (Cardizem)
Cardiac glycoside – Inhibits Na+/K+ ATPase Pump – Toxic effects: – Take apical P for 1 full minute → HOLD if P < 60
digoxin (Lanoxin) – Cardiotonic; (-) dromotropic → ↓HR & automaticity – Anorexia, n/v – Long half-life: monitor digoxin serum levels
– (+) inotropic → more Ca2+ available → ↑ stroke volume – CNS effects: weakness, – Monitor serum K+ level for hypokalemia
– Indication: A-fib; CHF (promotes coronary circulation → fatigue, visual disturbances, – Digoxin toxicity antidote: Digoxin immune Fab
improves diuresis) rebound v-fib – May need Mg2+ supplement
Unclassified – Indication: SVT – –
adenosine (Adenocard)
CCBs – (-) dromotropic, (-) inotropic, relax arterial smooth – Hypotension → palpitations, reflex – Causes heart block if used w/ β-1 blocker
verapamil (Calan) muscle → ↓ PVR tachycardia – Can contribute to CHF
– Indication: HTN w/ DM, COPD, angina px, arrhythmias – GI: constipation, nausea, – Beneficial to African-Americans
nifedipine (Procardia)
(not very effective) – Bradycardia – Interaction w/ grapefruit (↑ GI absorption)
– Other: peripheral edema, rash,
flushing, dermatitis
Renin inhibitor – ↓ plasma renin activity & inhibits angiotensinogen – – Diarrhea, cough, edema –
propanolol (Inderal) angiotensin I conversion
– May be combined w/ other HTN agents
Carbonic anhydrase inhibitors – Adjunct w/ other diuretics for intense diuresis – Hypokalemia – hyperuricemia
acetazolamind (Diamox) – Na+ reabsorption in the collecting duct & tubule
– Indication: glaucoma & epilepsy