Cardiac Glycosides Flashcards
Cardiac Glycosides
Digoxin
Uses:
- HF
- A-Fib
Precautinos/Interactions:
- Thiazide or loop diuretics increase risk of hypokalemia & precipitate digoxinn toxicity
- Ace and ARBs increase risk of hyperkalemia
- Verapamil increases risk of toxicity
Side/Adverse Effects:
-digoxin toxicity: GI effects (anorexia, nausea, vomiting, abdominal pain); CNS effects (fatigue, weaness, diplopia, blurred vision, yellow-green or white halos arouond objects)
Nursing Interventions/Education:
- Assess apical pulse for 1 min before administration
- Notify provider if HR is <60 (adult), <70 (child), <90 (infant)
- Monitor for signs of digoin toxicity, hypokalemia, and hypomagnesemia
- Notify provider of any sudden increase in pulse rate that previously had been normal or low.
- maintain therapeutic digoxin level
Management of digoxin toxicity:
- D/C digoxin and ptassium-wasting medications
- treat dysrthmyias with phenytoin (or lidocaine)
- treat bradycardia with atropine
- for excessive overdose, administer digoxin immune FAB to prevent absorption (antidote)
Antianginal Medications
Nitroglycerin, Nitrostat/Nitrolingual, Nitro-Bid (topical ointment), Nitro-Dur (Transderm patch)
Available sublingual tab, sustained-release tab, transdermal oitment transderm patch
Uses:
- Acute angina attack
- Prophylaxis of chronic stable or variant angina
Precautions/Interactions
- Contraindicated in clients with head injury
- Hypotensive risk with antihypertensive medications
- Contraindicated if taking erectile dysfunction meds, can cause life-thretening HTN
Side/Adverse effects:
- Headache
- Orthostatic hypotension
- Reflex tachycardia
- Tolerance
Nursing Interventions/Education:
- Nitrostat/nitrolingual
- Administer sublingual, rest for 5 mins, if pain not relieved by 1 tab, call 911 then take second tab.
- May use up to three tabs taken 5 mins apart; keep nitrostat in original dark container.
- May be used prophylactically 5 to 10 mins before exercise.
- Do not shake nitrolingual canister (causes bubbles)
- Replace NTG tabs every 6 months
- Wear medical alert identification - Nitro-Bid (topical)
- Wear gloves for admin
- Do not massage or rub area
- Apply to area without hair
- Cover the area where the patch is placed with a clear plastic wrap and tape in place
- Gradually reduce the dose and frequency of application over 4-6 weeks - Nitro-Dur (transderm patch)
- Skin irritation may alter medication absorption
- Optimal locations are upper chest or side; pelvis; and inner, upper arm
- Rotate skin sites, usually worn for 12-14 hr.
Antidysrhythmic
Adenosine, amiodarone, atropine
Uses
- Adenosine: slows conduction time through the AV node, interrupts AV node pathways to restore NSR
- Converts SVT to NSR - Amiodarone: prolongs repolarization, relaxes smooth muscles, decreases vascular resistance
- Used for V-fib, unstable V-tach - Atropine: increases the heart rate by couonteracting the muscarine-like actions of acetycholine and other choline esters
- Used for brdycardia, known exposure to chemical nerve agent, reduces secretions
Precautions/Interactions:
- Toxicity is major concern d/t additive effects
- Caution needed when used with AV block
- Caution is needed when using anticholinergic medications
Side/adverse effects:
- Adenosine:
- flushing nausea, bronchospasm, prolonged asystole
- Amiodarone:
- bradycardia, cardiogenic shock, pulmonary disorders
- Atropine:
- When used for life-thretening emergencies, has no contraidications
Nursing interventions/Education:
- Adenosine:
- Rapid IV push (1-2 seconds)
- Flush immediately with normal saline
- Amiodarone:
- Incompatible with heparin
- May be given PO maintenance dose
- Monitor for respiratory complications
- Atropine:
- Monitor for dry mouth, blurred vision, photophobia, urinary retention, and constipation
Antilipemic Medications
-Statin
atorvastatin, simvastatin, lovastatin, pravastatin sodium, rosuvastatin, fluvastatin
Uses:
- Primary hypercholesterolemia
- Prevention of coronary events
- protection against MI nd stroke in clients who have DM
Prevention/interactions:
- should be d/c’d during pregnancy
- use with caution in renal dysfunction
- can cause prolonged bleeding in pt taking warfarin
- Drug interactions with
- digoxin
- warfarin
- thyroid hormones
- thiazide diuretics
- phenobarbital
- NSAIDs
- tetracycline
- beta-blocking agents
- gemfibrozil
- glipizide
- glyburide
- oral contraceptives
- phenytoin
Side/Adverse effects:
- muscle aches
- hepatotoxicity
- Rhabdomyolysis
- peripheral neuropathy
Nursing interventions/education:
- Take in evening (cholesterol sythesis increases
- Monitor liver & renal function labs
- Low-fat/high-fiber diet
- Note dietary precautions with specific classes
- do not administer with grapefruit juice
Cholesterol Absorption Inhibitor
Ezetimibe
Used in combination with antilipidemic meds to prevent cholesterol absorption
Nursing interventions/education:
- Take 2 hours before or 4 hours after other atilipemics
- risk of liver damge increased when combined with statins
