Cardiac Glycosides

Question 1

Cardiac Glycosides Drug Names

Answer 1

Digoxin

Positive inotrope. Negative chronotrope.

Question 2

Cardiac Glycosides Therapeutic Action

Answer 2

• 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
• Decreases HR

Question 3

Cardiac Glycosides Indications

Answer 3

• Treatment of HF, atrial fibrillation

Question 4

Cardiac Glycosides Contraindications and Cautions

Answer 4

Contraindication:
• Allergy
• Ventricular tachycardia or fibrillation, heart block, or sick sinus syndrome
• Idiopathic hypertrophic subaortic stenosis
• Acute MI, renal insufficiency, and electrolyte abnormalities
- Increase calcium
- Decreased potassium
- Decreased magnesium
Caution:
• Pregnancy and lactation
• Pediatric and geriatric patients

Question 5

Cardiac Glycosides DDI

Answer 5

DDI:
• Verapril, amiodarone, quinidine, erythromycin, tetracycline or cyclosporine
• Potassium loosing diuretics
• Cholestyramine, charcoal, colestipol, bleomycin, cyclophosphamide, or methotrexate

Question 6

Cardiac Glycosides Adverse Effects

Answer 6

• Headache, weakness, drowsiness
• Vision changes (yellow halo)
• GI upset and anorexia
• Arrhythmia development

Question 7

Cardiac Glycosides:

Assessment

Answer 7

Assess:
Hx: allergy, impaired kidney functions, ventricular tachycardia, heart block, sick sinus syndrome, or IHSS
Physical: vital signs, weight, heart & lung sounds, skin, perfusion(pulses), mucus membrane, orientation, reflexes (baseline)
Labs: LS (crackles), renal functions, abdomen, urinary output (natria), electrolytes

Question 8

Cardiac Glycosides:

Diagnosis

Answer 8

Dx:
- 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 change in cardiac output
- Deficient knowledge

Question 9

Cardiac Glycosides:

Implementation

Answer 9

Implementation:
• Monitor apical pulse for 1 min before administering drug <60 bpm hold
• Monitor the pulse for any change in quality or rhythm
• Administer IV doses slowly over at least 5 min
• Avoid IM administration
• Arrange patient to be weighed ever day (same time and clothes)
• Avoid administering oral drug with food or antacids
• Maintain on standby: potassium salts, Lidocaine(arrhythmia), phenytoin (seizures), atropine (increased HR)
• Therapeutic Digoxin level (0.5-2 ng/mL)
• Provide thorough patient teaching

Question 10

Cardiac Glycosides:

Evaluation

Answer 10

Eval:
Response to the drug
Adverse effects 
Effectiveness of comfort measures Compliance with the regimen
Effectiveness of the teaching plan