antiarrhythmic – a. n. 抗心律不齐的（药）
adenosine – n. 腺苷
propranolol – n. 普萘洛尔
procainamide – n. 普鲁卡因胺
supraventricular – a.
supraventricular arrhythmias – 室上性心律失常
verapamil – n. 维拉帕米
ablation – n. 消融
Wolff–Parkinson–White – WPW综合症
proarrhythmia – n. 致心律失常
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Antiarrhythmic Agents 抗心律不齐药
Children 小儿
Antiarrhythmic agents are not used as often in children as they are in adults. Children who do require these drugs, after cardiac surgery or because of congenital heart problems, need to be monitored very closely to deal with the related adverse effects that can occur with these drugs.
小儿使用抗心律不齐药不如成人经常。确实需要这些药物的小儿，在心脏手术后或由于先天性心脏问题，必须密切监护，处理好这些药物可能出现的相关不良效应。
Digoxin is approved for use in children to treat arrhythmias and has an established recommended dose. If other antiarrhythmics are used the dose should be carefully calculated using weight and age and should be double-checked by another nurse before administration.
地高辛获准用于小儿治疗心律不齐，且已有确立的推荐剂量。如果还用了其他抗心律不齐药，剂量必须根据体重、年龄仔细计算，并在用药前由另一名护士复查核对。
Adenosine, propranolol, procainamide, and digoxin have been successfully used to treat supraventricular arrhythmias, with propranolol and digoxin being the drugs of choice for long-term management. Verapamil should be avoided in children.
腺苷、普萘洛尔、普鲁卡因胺和地高辛已经成功用于治疗室上性心律失常，普萘洛尔和地高辛是长期管理的首选药物。维拉帕米应避免用于小儿。
Many arrhythmias in children are now treated by ablation techniques to destroy the arrhythmia-producing cells. This has been very successful in treating Wolff–Parkinson–White and related syndromes in children. If lidocaine is used for ventricular arrhythmias related to cardiac surgery or digoxin toxicity, serum levels should be monitored regularly to determine the appropriate dose and to avoid the potential for serious proarrhythmias and other adverse effects. The child should receive continuous cardiac monitoring.
Adults receive these drugs most often as emergency measures. Patient monitoring and careful evaluation of the total drug regimen should be a routine procedure to ensure the most effective treatment with the least chance of adverse effects. Frequent monitoring and medical follow-up is very important for these patients.
成人使用这些药物多数是作为应急措施使用。患者监护和所有药物方案的仔细评价应成为常规操作程序，以确保获得最大治疗效果，将不良效应减至最小。经常监测和医疗随访对这些患者非常重要。
The safety for the use of these drugs during pregnancy has not been established. They should not be used in pregnancy unless the benefit to the mother clearly outweighs the potential risk to the fetus. The drugs enter breast milk, and some have been associated with adverse effects on the neonate. Class I, III, and IV agents should not be used during lactation; if they are needed, another method of feeding the baby should be used.
妊娠期间药物使用的安全性尚未确立。妊娠期间不应使用，除非母体好处明显大于胎儿潜在风险。药物进入母乳，有些则与新生儿不良效应存在相关性。哺乳期不应使用I、III和IV类药；如果必需使用，应采用其他方式喂哺婴儿。
Older Adults 老人
Older adults frequently are prescribed one of these drugs. Older adults are more likely to develop adverse effects associated with the use of these drugs, including arrhythmias, hypotension, and congestive heart failure. They are also more likely to have renal and/or hepatic impairment related to underlying medical conditions, which could interfere with the metabolism and excretion of these drugs.
老人经常会开其中一种药物。老人更容易出现与这些药物相关的不良效应，包括心律不齐、低血压和充血性心力衰竭。老人也更容易出现与基础疾病相关的肾和/或肝损害，这些可能影响这些药物的代谢和排泄。
The dose for older adults should be started at a lower level than that recommended for other adults. The patient should be monitored very closely and the dose adjusted based on patient response. If other drugs are added to or removed from the drug regimen, appropriate dose adjustments may need to be made.
开始用药时，老人药物剂量应小于其他成人的推荐水平。应密切监护患者，并根据患者反应调整剂量。如果在药物方案中添加其他药物或减少药物，就必须适当调整剂量。
————Video ————
Antiarrhythmic Drugs
———— Tests ————
1. When administering an antiarrhythmic agent, which of the following assessment parameters is the most important for the nurse to evaluate?
A. ECG.
B. Pulse rate.
C. Respiratory rate.
D. Blood pressure. 2. Which of the following blood tests will tell the nurse that an adequate amount of drug is present in the blood to prevent arrhythmias?
A. Serum chemistries.
B. Complete blood counts.
C. Drug levels.
D. None of the above.
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答案Answer
1. A. ECG. Rationale: The ECG is the most important parameter to assess. Vital signs such as RR, PR, and BP need to be monitored, but the ECG is the most important. The benefit of the classification is in the primary mechanism of action, and the broad, predictable side effects brought about by the primary mechanism. An example would include the class III K+ channel blockers or “repolarization” blockers producing a prolonged phase 3 of the action potential and, by definition, also leading to a prolonged QT interval on the corresponding ECG. 2. C. Drug levels. Rationale: Knowing drug levels (peak and trough) is the only way to ensure there is enough drug in the body to work. Other choices do not demonstrate drug effect. Screening may have an important role in the epidemiological assessment of poisoning as it is a common finding that more substances are detected in urine than are recorded from history. Specific qualitative tests (e.g. amatoxins, paraquat) may be of clinical assistance in determining evidence of exposure. Clinicians are better served by relying on a careful interpretation of the history and clinical examination in conjunction with readily accessible investigations such as ECG, electrolytes and acid-base analysis.
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