Antiarrhythmics

Arrhythmias:
• Arrhythmias are disruptions in the normal rate or rhythm of the heart.
They can be caused by changes in rate (tachycardia or bradycardia);
by stimulation from an ectopic focus, such as premature atrial
contractions (PACs) or premature ventricular contractions (PVCs),
atrial flutter, atrial fibrillation (AF), or ventricular fibrillation; or by
alterations in conduction through the muscle, such as heart blocks
and bundle-branch blocks.
Class I Antiarrhythmics- Sodium channel
blockers
• Action: block sodium channels and slow conduction of electrical impulses
• Nursing Considerations: monitor hypotension, heart failure or new dysrhythmia
• Class IA-Procainamide
(indication: Tx of life-threatening ventricular arrhythmias; favourable drug with which to start
treatment because it is available in IM, IV, and oral forms)
• Class IB-Lidocaine
(indication: Tx of life-threatening ventricular arrhythmias during myocardial infarction or
cardiac surgery; also used as bolus injection in emergencies when monitoring is not available
to document exact arrhythmia)
• Class IC-Flecainide
(indication: Tx of life-threatening ventricular arrhythmias in adults; prevention of paroxysmal
atrial tachycardia (PAT) in symptomatic patients with no structural heart defect)
Class II Antiarrhythmics- Beta adrenergic
antagonists
• Action: The class II antiarrhythmics block beta receptor sites in the heart and kidneys. The
result is a decrease in heart rate, cardiac excitability, and cardiac output, a slowing of
conduction through the AV node, and a decrease in the release of renin. These effects
stabilize excitable cardiac tissue and decrease blood pressure, Which decreases the heart’s
workload.
• Nursing considerations: s/sx of fluid retention, discontinue gradually, safety precautions
• Acebutolol (indication: Mgt of premature ventricular contractions in adults; intraoperative
and postoperative tachycardia; also used as an antihypertensive).
• esmolol (indication: Short-term management of supraventricular tachycardia (SVT) in adults
and tachycardia that is not responding to other measures).
• Propranolol (indication: Tx of supraventricular tachycardias caused by digoxin or
catecholamines in adults; also used as an antihypertensive, antianginal, and antimigraine
headache drug).
Class III Antiarrhythmics- Potassium channel
blockers
• Action: Class III antiarrhythmics block potassium channels and prolong the
action potential.
• Nursing considerations: w/amiodarone-baseline pulmonary, thyroid and
neuro function. Monitor EKG, change in rhythm, hypotension.
• Amiodarone: Treatment of adults with life-threatening ventricular
arrhythmias not responding to any other drug
• Ibutilide, sotalol.
• All of these drugs are proarrhythmic and have the potential of inducing
arrhythmias. Amiodarone is the drug recommended for use during life
support measures. It is associated with serious to potentially fatal
hepatotoxicity.
Class IV Antiarrythmics-Calcium channel
blockers
• Action: The class IV antiarrhythmics block the movement of calcium
ions across the cell membrane, depressing the generation of action
potentials and delaying phases 1 and 2 of repolarization, which slows
automaticity and conduction.
• Medication: verapamil, Diltiazem (indication: IV to treat paroxysmal
supraventricular tachycardia)
• Nursing considerations: dysrhythmias, hyper/hypotension, muscle
weakness
Other Antiarrhythmics
• Adenosine: (Treatment of supraventricular tachycardias), This drug slows
conduction through the AV node, prolongs the refractory period, and decreases
automaticity in the AV node.
• Digoxin (Treatment of atrial flutter, Atrial fibrillation, paroxysmal atrial
tachycardia), This drug slows calcium from leaving the cell, prolonging the action
potential and slowing conduction and heart rate.
• Dronedarone has properties of all four classes of antiarrhythmics, and the
mechanism by which it helps suppress atrial arrhythmias is not fully understood.
It is used to reduce the risk of hospitalization in patients with paroxysmal or
persistent AF of flutter who have risk factors for cardiovascular disease and who
are in sinus rhythm or are scheduled to be converted to sinus rhythm.