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INTRODUCTION

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disopyramide (dye-soe-peer-a-mide)

Norpace, Norpace CR, Image not available.Rythmodan, Rythmodan-LA

Classification

Therapeutic: antiarrhythmics (class I)

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Indications
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Suppression/prevention of unifocal and multifocal premature ventricular contractions (PVCs), paired PVCs, and ventricular tachycardia. Unlabeled Use: Treatment/prevention of supraventricular tachyarrhythmias.

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Action
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Decreases myocardial excitability and conduction velocity. Has anticholinergic properties. Little effect on heart rate but has a direct negative inotropic effect. Therapeutic Effects: Suppression of ventricular arrhythmias.

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Adverse Reactions/Side Effects
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CNS: dizziness, fatigue, headache. EENT: blurred vision, dry eyes, dry throat. CV: CHF, arrhythmias, AV block, dyspnea, edema, hypotension. GI: constipation, dry mouth, abdominal pain, flatulence, nausea. GU: urinary hesitancy, urinary retention. Endo: hypoglycemia. Misc: impaired temperature regulation.

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PHYSICAL THERAPY IMPLICATIONS

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Examination and Evaluation
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  • Watch for signs of congestive heart failure (CHF), including dyspnea, rales/crackles, peripheral edema, jugular venous distention, and exercise intolerance. Report these signs to the physician immediately.

  • Assess heart rate, ECG, and heart sounds, especially during exercise (See Appendices G, H). Although intended to treat certain arrhythmias, this drug can unmask or precipitate new arrhythmias (proarrhythmic effect). Report any rhythm disturbances or symptoms of increased arrhythmias, including palpitations, chest pain, shortness of breath, fainting, and fatigue/weakness.

  • Assess blood pressure periodically and compare to normal values (See Appendix F). Report low blood pressure (hypotension), especially if patient experiences dizziness or syncope.

  • Assess peripheral edema using girth measurements, volume displacement, and measurement of pitting edema (See Appendix N). Report increased swelling in feet and ankles or a sudden increase in body weight due to fluid retention.

  • Monitor signs of hypoglycemia, especially during and after exercise. Common neuromuscular symptoms include anxiety, restlessness, tingling in hands/feet/lips/tongue, chills, cold sweats, confusion, difficulty in concentration, drowsiness, nightmares or trouble sleeping, excessive hunger, headache, irritability, nervousness, tremor, weakness, and unsteady gait. Report persistent or repeated episodes of hypoglycemia to the physician.

  • Assess dizziness and fatigue that might affect gait, balance, and other functional activities (See Appendix C). Report balance problems and functional limitations to the physician, and caution the patient and family/caregivers to guard against falls and trauma.

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Interventions
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  • Because of the risk of CHF and arrhythmias, use extreme caution during aerobic exercise and other forms of therapeutic exercise. Assess exercise tolerance frequently (blood pressure, heart rate, fatigue levels), and terminate exercise immediately if any untoward responses occur (See Appendix L).

  • This drug impairs temperature regulation; use caution during aerobic exercise, especially in hot environments.

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Patient/Client-Related Instruction
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  • Advise patient and family or caregivers about the signs of arrhythmias and CHF (see above under Examination and Evaluation), and to seek immediate medical assistance if these signs develop.

  • Instruct patient and family/caregivers to report other side effects such as severe or prolonged headache, vision problems, ...

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