Nokea
Quinidine is prescribed to a client with cardiac arrhythmia. When documenting the client's drug history, the nurse inquires about the concomitant use of any other drug. Which of the following drugs when given concomitantly may cause an increase in serum quinidine levels?
- A. Cimetidine
- B. Rifampin
- C. Hydantoins
- D. Nifedipine
Correct Answer: A
Rationale: Cimetidine, when given concurrently with quinidine, may cause an increase in serum quinidine levels. Hydantoins and nifedipine cause a decrease in serum quinidine levels. Rifampin does not interact with quinidine.
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A nurse is preparing to administer an antiarrhythmic and identifies the drug as a class III potassium channel blocker. Which drug would the nurse be most likely to administer?
- A. Amiodarone
- B. Flecainide
- C. Mexiletine
- D. Propafenone
Correct Answer: A
Rationale: Amiodarone is a class III potassium channel blocker. Flecainide, mexiletine, and propafenone are class I sodium channel blockers.
When explaining how verapamil (Calan) produces its effects on the cardiovascular system, which of the following would the nurse integrate into the explanation? Select all that apply.
- A. Reduction in the release of renin
- B. Dilation of coronary arteries
- C. Dilation of peripheral arteries
- D. Slowed conduction through the SA and AV nodes
- E. Membrane-stabilizing effects
Correct Answer: B,C,D
Rationale: Verapamil (Calan) is a calcium channel blocker. These drugs inhibit the movement of calcium through channels across the myocardial cell membranes and vascular smooth muscle. Cardiac and vascular smooth muscle depends on the movement of calcium ions into the muscle cells through specific ion channels. When this movement is inhibited, the coronary and peripheral arteries dilate, thereby decreasing the force of cardiac contraction. This drug also reduces heart rate by slowing conduction through the SA and AV nodes.
Which of the following should be included in the nurse's ongoing assessment of a client receiving flecainide (Tambocor)? Select all that apply.
- A. Response to therapy
- B. Signs of heart failure
- C. Development of new cardiac arrhythmias
- D. Worsening of arrhythmia being treated
- E. Monitoring of serum flecainide levels
Correct Answer: A,B,C,D,E
Rationale: The nurse should closely monitor the client for a response to drug therapy, signs of heart failure, the development of new arrhythmias, worsening of the arrhythmia being treated, and serum flecainide levels.
A nurse is reviewing a journal article about class IA antiarrhythmics. The article describes a drug that decreases depolarization and prolongs the refractory period. The nurse is most likely reading an article about which drug?
- A. Quinidine
- B. Lidocaine
- C. Disopyramide
- D. Flecainide
Correct Answer: C
Rationale: Disopyramide (Norpace) decreases depolarization of myocardial fibers, prolongs the refractory period, and increases the action potential duration of cardiac cells. Lidocaine (Xylocaine) decreases diastolic depolarization, decreases automaticity of ventricular cells, and raises the threshold of the ventricular myocardium. Quinidine depresses myocardial excitability or the ability of the myocardium to respond to an electrical stimulus. Flecainide (Tambocor) depresses fast sodium channels, decreases the height and rate of rise of action potentials, and slows conduction of all areas of the heart.
Administration with which of the following would increase serum concentrations of disopyramide? Select all that apply.
- A. Amiodarone
- B. Quinidine
- C. Rifampin
- D. Cimetidine
- E. Erythromycin
Correct Answer: B,E
Rationale: Increased serum disopyramide levels occur when quinidine or erythromycin is given with disopyramide. Amiodarone and cimetidine increase serum flecainide levels. Rifampin decreases serum disopyramide levels.