Cardiac Glycosides

Question 1

Cardiac Glycosides action

Answer 1

↑ intracellular calcium
allows more calcium to enter the myocardial cell during depolarization
positive inotropic effect
↑ renal perfusion with a diuretic effect & ↓ renin release & slowed conduction through the AV node

Question 2

Cardiac Glycosides drug names

Answer 2

Digoxin (- chronotropic) slows HR

Question 3

What is the Digoxin level we need to know

Answer 3

0.5-2 ng/mL

Question 4

Cardiac Glycosides contraindications

Answer 4

Allergy
ventricular tachycardia or fibrillation, heart block or sick sinus syndrome
Idiopathic hypertrophic
subaortic stenosis
Acute MI, renal insufficiency & electrolyte abnormalities
Emergency equipment on standby:
potassium salts, lidocaine
phenytoin (seizures) 
atropine 
cardiac monitor

Question 5

Cardiac Glycosides indications

Answer 5

Tx of Heart Failure
Atrial fibrillation (fast arrhythmia)

Question 6

Cardiac Glycosides caution

Answer 6

Pregnancy & lactation

Pediatric & geriatric patients

Question 7

Cardiac Glycosides drug-drug interactions

Answer 7

verapamil, amiodarone, quinidine, quinine, erythromycin, tetracycline or cyclosporine (↑ risk of digoxin toxicity)
Potassium losing diuretics (hypokalemia, digoxin toxicity)
Cholestyramine, charcoal, colestipol, bleomycin, cyclophophamide or methrotrexate (↓ absorption of digoxin

Question 8

Cardiac Glycosides adverse effects

Answer 8

Headache, weakness, drowsiness, vision changes
GI upset & anorexia
Arrhythmia development (lower arrhythmia)
yellow halo → sign of digoxin toxicity

Question 9

Cardiac Glycosides nursing implications

Answer 9

Oral drug on empty stomach; no antacids
Hx & physical exam
Known allergies
look for those contraindications
electrolyte abnormalities (potassium, calcium, magnesium)
Daily weights
Pulse rate, BP, listen to heart sounds
check for edema
Dehydrtaion or not
Lung sounds: rales or crackles
Abdomen: bowel sounds
urinary output
Labs: electrolytes, renal fxn
Monitor apical pulse for 1 full min before administration of meds
Hold digoxin if 60bpm & contact provider
Monitor the pulse for any changes in quality arrhythmia
If give IV give it slowly
Avoid IM administration

Question 10

Cardiac Glycosides prototype

Answer 10

Digoxin

Question 11

Digoxin prototype actions

Answer 11

Increases intracellular calcium and allows more calcium to enter the myocardial cell during depolarization; this cause a positive inotropic effect (increased force of contraction), increased renal perfusion with a diuretic effect and ↓ in renin release, a negative chronotropic effect (slower heart rate), and slowed conduction through the AV node

Question 12

Digoxin prototype indications

Answer 12

Tx of HF

Atrial fibrillation

Question 13

Digoxin adverse effects

Answer 13

Headache, weakness, drowsiness, visual disturbances, arrhythmias, GI upset