TABLE 27-1 Summary of Antiarrhythmic Medications* Class IA Action Moderate depression of depolarization; prolongs repolarization Treats and prevents

atrial and ventricular dysrhythmias Drugs: Generic (Trade) Names quinidine (Quinaglute, Quinidex, Cardioquin) procainamide (Pronestyl) disopyramide (Norpace) Side Effects Nursing Interventions

Decreased cardiac Observe for HF contractility Monitor BP with IV Prolonged QRS, QT administration Proarrhythmic Monitor QRS duration for Hypotension with IV increase >50% from baseline administration Monitor for prolonged QT Lupus-like syndrome with Monitor N-acetyl procainamide Pronestyl (NAPA) laboratory values Anticholinergic effects: during procainamide therapy dry mouth, decreased urine output CNS changes (eg, confusion, lethargy) Discuss with physician decreasing the dose in elderly patients and patients with cardiac/liver dysfunction Discuss patient's left ventricular function with physician

IB

Minimal depression of lidocaine (Xylocaine) depolarization; shortened mexiletine (Mexitil) repolarization tocainide (Tonocard) Treats ventricular dysrhythmias Marked depression of depolarization; little effect on repolarization Treats atrial and ventricular dysrhythmias Decreases automaticity and conduction flecainide (Tambocor) propafenone (Rythmol)

IC

Proarrhythmic HF Bradycardia AV blocks

II

atenolol (Tenormin) Bradycardia, AV block bisoprolol/HCTZ(Ziac, Zebeta) Decreased contractility

Monitor heart rate, PR interval, signs and symptoms of HF

Treats atrial and ventricular dysrhythmias

esmolol (Brevibloc) labetalol (Trandate) metoprolol (Lopressor, Toprol) propranolol (Inderal, Innopran) sotalol (Betapace; Sorine; also has class III actions) amiodarone (Cordarone, Pacerone) dofetilide (Tikosyn) ibutilide (Corvert)

Bronchospasm Monitor blood glucose level in Hypotension with IV patients with type 2 diabetes administration mellitus Masks hypoglycemia and thyrotoxicosis CNS disturbances Pulmonary toxicity Make sure patient is sent for (amiodarone) baseline pulmonary function Corneal microdeposits tests (amiodarone) (amiodarone) Closely monitor patient Photosensitivity (amiodarone) Hypotension with IV administration Polymorphic ventricular dysrhythmias Nausea and vomiting See beta-blockers (sotalol) Bradycardia, AV blocks Hypotension with IV administration HF, peripheral edema Monitor heart rate, PR interval Monitor blood pressure closely with IV administration Monitor for signs and symptoms of HF

III

Prolongs repolarization Treats and prevents ventricular and atrial dysrhythmias, especially in patients with ventricular dysfunction

IV

Blocks calcium channel Treats atrial dysrhythmias

verapamil (Calan, Isoptin) diltiazem (Cardizem, Dilacor, Tiazac, Diltia, Cartia) bepridil (Vascor)

*Based on Vaughn-Williams classification. AV, atrioventricular; BP, blood pressure; CNS, central nervous system; HF, heart failure; IV, intravenous.