You are a nurse working in a cardiologist’s office. Design teaching points broch
ID: 138025 • Letter: Y
Question
You are a nurse working in a cardiologist’s office. Design teaching points brochure that can be given to older adult patients starting on an antiarrhythmic medication. Focus on the prototype medications lidocaine, propranolol, amiodarone, and diltiazem. Conduct an Internet search to help develop the brochure. You are a nurse working in a cardiologist’s office. Design teaching points brochure that can be given to older adult patients starting on an antiarrhythmic medication. Focus on the prototype medications lidocaine, propranolol, amiodarone, and diltiazem. Conduct an Internet search to help develop the brochure.Explanation / Answer
Human aging is a global issue with important implications for current and future incidence and prevalence of health conditions and disability. Cardiac arrhythmias, including atrial fibrillation, sudden cardiac death, and bradycardia requiring pacemaker placement, all increase exponentially after the age of 60. It is important to distinguish between the normal, physiological consequences of aging on cardiac electrophysiology and the abnormal, pathological alterations. The age-related cardiac changes include ventricular hypertrophy, senile amyloidosis, cardiac valvular degenerative changes and annular calcification, fibrous infiltration of the conduction system, and loss of natural pacemaker cells and these changes could have a profound effect on the development of arrhythmias. The age-related cardiac electrophysiological changes include up- and down-regulation of specific ion channel expression and intracellular Ca2+ overload which promote the development of cardiac arrhythmias. As ion channels are the substrates of antiarrhythmic drugs, it follows that the pharmacokinetics and pharmacodynamics of these drugs will also change with age. Aging alters the absorption, distribution, metabolism, and elimination of antiarrhythmic drugs, so liver and kidney function must be monitored to avoid potential adverse drug effects, and antiarrhythmic dosing may need to be adjusted for age. Elderly patients are also more susceptible to the side effects of many antiarrhythmics, including bradycardia, orthostatic hypotension, urinary retention, and falls. Moreover, the choice of antiarrhythmic drugs in the elderly patient is frequently complicated by the presence of co-morbid conditions and by polypharmacy, and the astute physician must pay careful attention to potential drug-drug interactions. Finally, it is important to remember that the use of antiarrhythmic drugs in elderly patients must be individualized and tailored to each patient's physiology, disease processes, and medication regimen.
This trend applies to both male and females, in developing countries as well as in developed countries. In fact, the large population in the developing world contributes significantly to the transformation in demographics. These trends in the global patterns of aging have important implications for the current and future incidence and prevalence of many health conditions. With the advance in overall age comes an increase in the incidence of cardiovascular diseases, including cardiac arrhythmias. Global aging has important implications for health care delivery, as age-related physiological changes are frequently overlooked when treatment options are considered and may result in unnecessary adverse outcomes.
The prevalence of cardiac diseases, including cardiac arrhythmias, increases with age. Increased frequencies of supraventricular and ventricular ectopies have been reported in elderly patients. Additionally, elderly patients have a heightened propensity to develop certain arrhythmias, including atrial fibrillation, sudden cardiac death, and bradyarrhythmias requiring pacemaker placement.
Basic Facts
An arrhythmia is a change in the heart's normal rate or rhythm. Arrhythmias are classified by their location in the heart and by their speed or rhythm. An atrial or supraventricular arrhythmia is a rhythm abnormality that occurs in one of the two upper chambers of the heart, the left or right atrium. Ventricular arrhythmias originate in the ventricles and can interfere with the heart's ability to pump blood to the body. They are potentially dangerous arrhythmias, but in some circumstances, especially in the absence of structural heart disease, they can be benign.
When an arrhythmia occurs repeatedly over time or causes symptoms such as palpitations, lightheadedness, fainting (syncope), shortness of breath, or chest pain, it may require treatment.
WHAT TO EXPECT
Once the physician has recorded an arrhythmia and established its location in the heart, he or she can decide if treatment is necessary, and, if so, which treatment option is most appropriate. When treating arrhythmias, physicians consider if an underlying heart problem such as heart disease, past heart attack, or valve disease is contributing to an arrhythmia. Physicians also evaluate conditions such as ischemia (lack of oxygen to the heart) or electrolyte or metabolic abnormalities, which may affect any underlying heart problem, and determine if the patient prefers drug therapy or other treatment approaches.
For purposes of treatment, physicians use two classifications of arrhythmias: ambient, or triggering, arrhythmias, and sustained arrhythmias.
Triggering arrhythmias include premature atrial contractions (PACs) and premature ventricular complexes (PVCs).
Sustained arrhythmias include:
The goals of antiarrhythmic treatment are to prevent or suppress arrhythmias by treating the underlying cause of arrhythmias. Physicians also seek to prevent conditions that contribute to arrhythmias, such as ischemia and metabolic imbalances in the heart muscle, and to manage serious symptoms such as lightheadedness, shortness of breath, fatigue, and chest pain.
When medical treatment is required to suppress an atrial arrhythmia, physicians decide which drugs to use based on the risks and quality-of-life effects of the arrhythmia, the presence of any underlying disease, the severity of a person's symptoms, and the risk of side effects. Common medications include a category of drugs referred to as antiarrhythmic agents, beta-blockers, calcium channel blockers, and digitalis.
Antiarrhythmic agents: These drugs affect the electrical activity of the heart rate by slowing the conduction of impulses through heart tissue or blocking electrical impulses. Certain antiarrhythmic agents are not used in people who have congestive heart failure.
Beta-blockers: Beta-blockers block the effect of adrenaline and are effective in slowing and regularizing the heart rate.
Side effects of beta-blockers include:
Calcium channel blockers: Calcium channel blockers prevent calcium atoms from penetrating heart muscle tissue. This forces muscles to contract less vigorously by making them less responsive to the electrical signals that cause muscle contraction. This action also dilates (widens) blood vessels and lowers blood pressure. Calcium channel blockers also slow conduction through the atrioventricular node (A-V node), making them useful for certain types of arrhythmias.
Side effects of calcium channel blockers include:
Digitalis: Digitalis regulates the heart's rate and rhythm by slowing the transmission of electrical impulses from the atria to the ventricles. The drug also strengthens the force of heart contractions, which can improve circulation.
Some antiarrhythmic medications may be harmful to patients who have an implanted pacemaker, or who had or are having surgery, including dental surgery. People should also be aware that caffeine can decrease the effectiveness of antiarrhythmic medications.
In some cases, such as with arrhythmias that cannot be treated with medication, physicians may use interventional or surgical procedures to control the arrhythmia. These procedures may include:
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