Cardiac Glycosides Flashcards
DIGOXIN
Increases force of myocardial contraction, cardiac output and renal perfusion and output and decreases blood volume to slow heart rate and conduction velocity through the AV node
THERAPEUTIC ACTIONS
What does this drug do to our body?
Increases intracellular calcium, allows more calcium to enter the myocardial cell during depolarization; positive inotropic effect, increased renal perfusion with a diuretic effect and decrease in renin release, and slowed conduction through the AV node
INDICATATIONS
Why are we giving this drug?
Treatment of HF
Atrial Fibrillation
ADVERSE EFFECTS
What are we monitoring for?
Headache, weakness drowsiness vision changes GI upset and anorexia Arrhythmia development
CONTRAINDICATIONS
When NOT to give the drug
Allergy Ventricular tachycardia or fibrillation heart block, or sick sinus syndrome Idiopathic hypertrophic subaortic stenosis Acute MI renal insufficiency electrolyte abnormalities
CAUTIONS
Pregnancy and lactation
Pediatric and geriatric patients
DRUD TO DRUG INTERACTIONS
Verapamil amiodarone quinidine quinine erythromycin tetracycline, or cyclosporine Potassium losing diuretics Cholestyramine charcoal colestipol bleomycin cyclophosphamide, or methotrexate
ASSESSMENT
What we view prior to administering
History and physical Exam Known allergies Impaired kidney function ventricular tachycardia heart block sick sinus syndrome, or IHSS Electrolyte abnormalities weight cardiac status skin and mucus membranes affect orientation, and reflexes LS abdomen and urinary output appropriate lab values
NURSING D/X
.Risk for imbalanced fluid volume related to increased renal perfusion secondary to the effects of the drug
.Decreased cardiac output related to ineffective cardiac muscle function
.Ineffective tissue perfusion related to change in cardiac output
.Impaired gas exchange related to changes in cardiac output
.Deficient knowledge related to prescribed drug therapy
IMPLEMENTATIONS
Monitor apical pulse for one full minute before
administering the drug.
Monitor the pulse for any change in quality or rhythm
Administer IV doses slowly over at least five minutes
Avoid IM administration.
Arrange for the patient to be weighed at the same time each day in the same clothes.
Avoid administering the oral drug with food or antacids
Maintain emergency equipment on standby: potassium salts, lidocaine, phenytoin, atropine, and a cardiac monitor.
Obtain digoxin level as ordered; monitor the patient for therapeutic digoxin level (0.5-2 ng/ml)
EVALUATION
Monitor patient response to the drug (improvement in signs and symptoms of heart failure, resolution of atrial arrhythmias, serum digoxin level of 0.5-2 ng/ml)
Monitor for adverse effects (vision changes, arrhythmias, heart failure, headache, dizziness, drowsiness, GI upset, nausea)
Evaluate the effectiveness of the teaching plan
Monitor the compliance with the regimen
Prototype
DIGOXIN
