Page 364 - Cardiac Nursing

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Patient must be on telemetry during initi- ation of therapy or with increase in dosage (recommendation is for 3 days Monitor QT interval every 2–3 hours: if 15% or if QTc is dose. If 500 milliseconds, reduce QTc after second dose is 500 millisec- onds, drug should be discontinued Drugs that increase dofetilide levels include verapamil, ke- toconazole, cimetidine, macrolide an- tibiotics, ritonavir, prochlorperazine, levels and Mg 2
Has potential to cause arrhythmias when given with digoxin, othe
Comments monitoring) QTc increases Drug Interactions: megestrol Maintain normal K
Drug Interactions: agents solutions Drug interactions: level BP , and c blockers, digoxin recent MI rhythmia (TdP) Monitor for HF
TdP (up to 3% incidence), usually occurs within 3 days after initiating therapy Has no negative inotropic effects and does CV: tachycardia, hypertension, arrhyth- CNS: restlessness, headache, tremor, urine output, transient T Hypotension, dizziness, diaphoresis, CV: marked proarrhythmia, marked nega- tive inotropic effects (HF), bradycardia, CNS: blurred vision, dizziness, flushing, ringing ears, drowsiness, headache. Other: bad taste, constipation, edema,
Side Effects not lower BP mias, angina stroke Other: nausea, tachypnea nausea heart block abdominal pain
(continued) Dose based on creatinine clearance: if normal renal function, 500 mcg b.i.d. If abnormal renal function, 250 mcg Do not give if creatinine clearance 9.5 hours 1 mg IV bolus every 3–5 minutes during May be given by way of ET tube if IV ac- cess not available: use 2–2.5 mg May be infused at 2–10 mcg/min to maintain BP during symptomatic Loading infusion: 500 mcg/kg/min for Use dosing chart that comes with drug. 9 minutes 0.2–1 mcg/mL (Plasma levels do not correlate with ef- ficacy, but inc
Dose/Administration Therapeutic Level/Half-Life b.i.d. 20 mL/min Half-life resuscitation efforts bradycardia 1 minute Maintenance infusion: 50–100 mcg/kg/min -Blocking plasma concentration 0.15–1 mcg/mL Half-life 100–200 mg PO q 12 hours Therapeutic level greater when levels Half-life
DRUGS USED FOR HEART RATE AND RHYTHM CONTROL
Conversion of atrial fibrillation or flutter to NSR and maintenance of NSR after Treatment of any cardiac arrest situation requiring CPR: VF, pulseless VT, asys- Rapid control of ventricular rate in atrial In absence of structural heart disease: Conversion of atrial fib to sinus rhythm and maintenance of NSR Treatment of SVT: AVNRT, CMT Slow conduction through accessory path- ways in atrial fib or CMT Life-threatening ventricular arrhythmias

Indication conversion tole, PEA fib/flutter (sustained VT)

Table 16-2 ■ Drug (Class) Dofetilide (Tikosyn) (Class III antiarrhythmic) Epinephrine (Adrenalin) Esmolol (Brevibloc) -blocker) (Cardioselective Flecainide (Tambocor) (Class IC antiarrhythmic)

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