Quinidine: Do most nurses measure QRS interval before giving drug?

[RealNurseMom, BSN]

Hi, I'm currently taking an online course on pharmacology and am learning about the Quinidine drug. I understand that to prevent Quinidine Syncope nurses should measure QRS and QT interval. An increase of 25% could mean that the patient is at risk for Ventricular Tachycardia. As a nurse, when patients are on Quinidine how often is the QRS interval measured? Is it before each dose? Thanks!

[Reno1978, BSN, RN]

Where I've worked, patients in critical care, or telemetry floors have ECG strips printed and interpreted every shift.

To determine if cardiac measurements are becoming prolonged, you compare your strip with prior strips.

I've never heard of measuring cardiac intervals prior to a scheduled medication dose.

[Quaffetti]

I've worked cardiac tele for 8 years and I don't think I've ever given that drug. The only drug we commonly give where we watch the QT is sotalol.

[AntFlip7395]

Tikosyn, particularly when it is first initiated, you must watch the QT interval, it is known for potentiating torsades de pointes.

It's been a long time since I've given quinidine. I think most physicians have stopped prescribing it because there are less dangerous drugs available to treat atrial fib/flutter. Quinidine can potentiate ventricular arrhythmias as well as interference with the P450 cytochrome system, which affects the actions of other drugs. Also, it causes GI disturbances, hence the "code brown" you may have to clean up after giving it.

[oramar]

It was used a lot 20-30 years ago but I haven't seen it in clinical situation or known anyone on it for a long time. Do you know that years ago docs used to start people on it even when they were on med/surg floor with no monitoring. I don't think we knew the problems it could cause back then. I do remember a few people having the kinds of problems the nurses here are describing and then the drug kinda went away.

[GN Dave]

Working in a CCU, we check the strips every shift, sooner if we anticipate a problem. Watch your strips carefully when using ANY IV anti-arrhythmic, amiodarone or such... you can catch the QT getting wider and wider, head off trouble before it starts...

Hope that helps...

[WalkieTalkie, RN]

Yeah, that's old school. I work in a CVICU, and I've only ever seen it given once.

[RealNurseMom, BSN]

Wow, I'm new to this forum and pleasently surprized how quick I got anwers! thanks for all the responses! We actually learnt that even though newer drugs replaced Quinidine as time went on, recently this drug has been reintroduced in the treatment of etopic venticular rythms and V-Tach.

[Spatialized]

Never given it, but we do have a doc that has used it when other meds haven't worked for resistant ventricular arrhythmias (nothing like slow VT to make your night exciting!). I'm on a tele/step-down floor and measure intervals at least q-shift, but not necessarily prior to giving a medication, although I usuaslly do get to it before I do my med pass. The only time we do is for sotalol (mentioned above) or tikosyn, both known to prolong the QT interval.

Tom

[WalkieTalkie, RN]

Never given it, but we do have a doc that has used it when other meds haven't worked for resistant ventricular arrhythmias

Yep, that's exactly why I gave it. We had a patient who was in VT for about a week before his family withdrew care on him. Amiodarone and lidocane gtts didn't convert him either. His BP was 90s from what I recall, awake/alert but not doing well, but it was certainly shocking to see someone in VT like that. It took us about an hour to figure out how to make the monitor shut up about his constant VT!