Pharmacology, part 9: Cardiovascular Medications - Atropine & Antidysrhythmic Classes III & IV

by Cathy Parkes

In this video

Class 3 antidysrhythmic medications - potassium channel blockers (amiodarone)

  • What is it used for?
  • Side effects
  • Back box warning
  • Easy tip to remember
  • Patient teaching
  • A note about sotalol

Class 4 antidysrhythmic medications - calcium channel blockers (verapamil, diltiazem)

  • What is it used for?
  • Side effects
  • Nursing Care

Class 5 antidysrhythmic (adenosine, digoxin, magnesium)

  • What is it used for?
  • Easy tip to remember
  • Side effects
  • Nursing Care
  • Patient teaching

Anticholinergic or antimuscarinic medications (atropine)

  • What is it used for?
  • Easy tip to remember
  • Mode of action
  • Side effects of atropine
  • Nursing Care

Full transcript

Okay! In this video, we are going to be talking about antidysrhythmic medications, class III, IV, and V, as well as an anticholinergic, antimuscarinic medication that is also used for dysrhythmias.

So let's talk about class III antidysrhythmic medications. These are potassium channel blockers, and the key medication to know within this class is amiodarone.

You would use amiodarone for severe dysrhythmias such as ventricular fibrillation and ventricular tachycardia.

So this medication carries many serious side effects, including hypotension, bradycardia, pulmonary toxicity, liver toxicity, and thyroid dysfunction.

It does carry a black box warning because of the cardiac toxicity, the liver toxicity, and the pulmonary toxicity.

So the way I remember this medication, my little hint here that's on my card, is that Amy owes me $100, but she's in the hospital with v-fib on an amiodarone drip, so it's probably not a good time to collect. So again, Amy owes me $100, so amiodarone. And just think about her in the hospital on amiodarone drip, and that's why you can't get your $100 back.

So I'm amused by this. I don't know if you are. I like the cool chicken hint, too, that's one of my favorites, but this one's definitely top five for me.

Other key points about amiodarone is that your patient should not consume grapefruit juice while they're taking this medication.

Also, keep in mind that sotalol, is another medication that is officially within this class, Class 3 antidysrhythmic, but it is a nonselective beta blocker, so I don't know why they stuck it here and not into Class 2, but officially, sotalol is a Class 3 antidysrhythmic. But again, I would really focus your attention on amiodarone.

Now, let's briefly talk about Class 4 antidysrhythmic medications, which are calcium channel blockers.

This class includes medications such as verapamil and diltiazem which, if you recall, we talked about when we covered medications for hypertension and angina. So calcium channel blockers, like I said, are Class 4 antidysrhythmics.

They can treat atrial fibrillation, atrial flutter, as well as supraventricular tachycardia.

So side effects with calcium channel blockers include hypotension, peripheral edema, bradycardia, headache, and constipation.

And if your patient is going to be on a calcium channel blocker, you're going to want to monitor their EKGs and their vital signs, and then teach them to change positions slowly due to the side effect of hypotension.

Okay. So our Class 5 antidysrhythmic is adenosine.

Adenosine is used to treat supraventricular tachycardia.

And the way I remember this one, this is also my top five of hints here, is let's say you have some shady business going on in your bedroom and your mom walks in on your den of sin, right, adenosine, she walks in on your den of sin and it gives her tachycardia because she's seeing something, whatever you got going on in there. And so she ends up needing adenosine to slow her rhythm down. So that's my little hint for adenosine.

Side effects with adenosine include arrhythmias as well as shortness of breath and hypotension.

Other Class 5 antiarrhythmics include digoxin as well as magnesium sulfate.

If your patient is taking this medication, you'll need to monitor their EKG rhythm and then also teach them to change positions slowly.

Okay. Lastly, here with the antidysrhythmics, I want to talk about an anticholinergic or antimuscarinic medication that is used for arrhythmias, and that is atropine.

Atropine is a really important medicine to know.

It is used for sinus bradycardia. It can also be used for heart block, and it can also be used to help decrease secretions during surgery.

So the tip I want to offer here is one that was sent in by a member of our Level Up crew, and they said that atropine is the trampoline to help get your heart rate up. So I love it. That's an amazing hint.

So the mode of action of atropine is that it inhibits acetylcholine sites in the smooth muscles as well as the secretory glands and the central nervous system. So it decreases vagal stimulation of the heart, which allows for an increase in the heart rate.

However, the side effects of atropine are anticholinergic side effects, and you remember my little PG-13 hint for anticholinergic side effects, which is can't pee, can't see, can't spit, and can't poop, right? So we're going to have blurred vision, dry mouth, urinary retention, constipation, and possibly tachycardia as well.

So when your patient is on atropine, you're going to want to monitor for urinary retention, because we definitely don't want that. We're going to want to increase their fiber and fluid intake in order to prevent that constipation as well.

So that is it for our antidysrhythmic medications. I hope this video has been helpful, and I will pick it up with more videos soon. Thanks for watching!

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