Cardiac glycosides

Question 1

Heart failure results from what?

Answer 1

Inadequate pumping of the heart muscle and the heart’s inability to meet the circulation needs of the whole body

Question 2

How does a person appear with heart failure, describe the characteristics when someone has decreased tissue perfusion

Answer 2

Fatigue, shortness of breath, weakness and activity intolerance

Question 3

Heart failure causes a reduction in what?

Answer 3

Cardiac output (CO)

Question 4

Heart Failure not only causes a reduction in CO, but it also affects what else?

Answer 4

Heart rate, stroke volume (SV) preload and afterload

Question 5

What are the two types of heart failure (HF)?

Answer 5

Left and Right sided failure

Question 6

What does the left side HF affect?

Answer 6

The lungs

Question 7

What are symptoms or manifestations of L side failure? (HF)

Answer 7

Dyspnea, cough, oliguria

Question 8

What are symptoms or manifestations of R side HF?

Answer 8

Systemic congestion with peripheral edema, jugular vein distension, weight gain

Question 9

What classes of drugs are the choice treatment for HF?

Answer 9

Diuretics, ACE inhibitors, Angiotensin 11receptor blockers (ARBs), and beta adrenergic blockers

Question 10

What is the drug class is used if Diuretics, ACE inhibitors, Angiotensin 11receptor blockers (ARBs), and beta adrenergic blockers fail to control the symptoms or manifestations?

Answer 10

Cardiac glycosides

Question 11

Which class of drugs & the name of a drug where the medication increases the myocardial contraction and improves the hearts’ effectiveness as a pump, improving SV & CO?

Answer 11

The class is Cardiac glycosides- the drug in this class Digoxin

Question 12

What happens when the heart rate is decreased?

Answer 12

A decreased heart rate gives the ventricles more time to fill with blood coming from the atria, which leads to increased SV and increased CO

Question 13

When is digoxin used in females?

Answer 13

For females, use only if the client has not responded to first-line medications.

Question 14

When is digoxin used as a second-line medication ?

Answer 14

Dysrhythmias (atrial fibrillation)

Question 15

What are complications for cardiac glycosides?

Answer 15

Hypokalemia, base the dose on blood levels, dysrhythmias & cardiotoxicity

Question 16

What are manifestations of hypokalemia?

Answer 16

Nausea, vomiting, weakness,

Question 17

What is the normal potassium level?

Answer 17

3.5-5mEq/L

Question 18

Name some foods high in potassium

Answer 18

Green leafy vegetables, bananas, potatoes

Question 19

What are side effects of Digoxin?

Answer 19

Anorexia (usually the first time manifestations of toxicity), nausea, vomiting, ABD pain, - CNS effects-fatigue, weakness vision changes ( blurred vision, YELLOW-GREEN or white halos around objects

Question 20

What are the contraindications /precautions in cardiac glycosides?

Answer 20

Pregnancy risk C, contraindicated V-Tac, V-Fib, Second & Third degree heart block, also those who have impaired kidney function & hypokalemia

Question 21

What are some known drug interactions with cardiac glycosides and why ?

Answer 21

1) Thiazide & loop diuretics because these medications when taken with digoxin can lead to hypokalemia, which increases the risk of developing dysrhythmias.
2) ACE & ARBs increase the risk of hyperkalemia- which can lead to decreased therapeutic effects of digoxin 3) Dopamine can increase the heart rate which can increase the risk of tachydysthmias 4) Quinidine-avoid concurrent use with digoxin because this displaces digoxin from its bonding site and reducing kidney excretion. 5) Verapamil-increases levels of digoxin- because Verapamil cardiosupresses action counteracts the action of digoxin 6) Antacids decrease absorption of digoxin and can decrease its effectiveness

Question 22

What are important nursing administration tasks to remember with digoxin?

Answer 22

1) Check the apical pulse rate and rhythm and record before administering digoxin. If the rate is < 60/ min in adults, < 70 /min in children & < 90 /min in infants, notify the provider **** 2) Administer digoxin at the same time each day 3) Evaluate manifestations or symptoms and the clients’ digoxin level when toxicity is suspected

Question 23

If administering IV digoxin, infuse over how long?

Answer 23

Infuse over at lease 5 minutes

Question 24

For clients with pulmonary edema and administering digoxin IV, how long is the IV infusion time ?

Answer 24

10-15 minutes

Question 25

It is important to teach the client taking digoxin two things-what are they?

Answer 25

1) Monitor pulse rate and report to provider if there are changes2) Take the medications as prescribed, if a dose is missed DO NOT DOUBLE THE DOSE

Question 26

How is digoxin toxicity managed?

Answer 26

First, if the cause is hyperkalemia- correct the electrolyte with IV insulin- if the potassium is normal then the antidote is DigiFab- also when clients have severe hyperkalemia and bradycardia

Question 27

How can a nurse evaluate the medication effectiveness in HF?

Answer 27

1) Control of heart failure 2) Absence of dysrhythmias

Question 28

A nurse is evaluating a client’s latest electrolytes who are taking digoxin. Which of the following electrolyte’s values increases a client’s risk or chance for digoxin toxicity?
1. Calcium 9.2 mg/dL
2. Calcium 10.3 mg/dL
3. Potassium 3.4 mEq/L
4. Potassium 4.8 mEq/L

Answer 28

3. 3.4 When the K level is below the expected reference range, the client is at risk for digoxin toxicity. A low potassium level can cause a FATAL dysrhythmia.

Question 29

A nurse is caring for a client who has a new prescription for digoxin and takes multiple other medications. The nurse should recognize that concurrent use of which of the following medications places the client at risk for digoxin toxicity?
1. Phenytoin
2. Verapamil
3. Warfarin
Aluminum hydroxide

Answer 29

2. Verapamil a calcium channel blocker can decrease digoxin levels

Question 30

You are teaching a client about his new medication, digoxin. The nurse should instruct the client to monitor and report which of the following adverse effects that are manifestations or symptoms of digoxin toxicity? Select all that apply.
1. Fatigue
2. Constipation
3. Anorexia
4. Rash
5. Blurred vision

Answer 30

1, Fatigue, 3. Anorexia, 5. Blurred vision yellow-tinge vision

Question 31

What is the normal digoxin level?

Answer 31

0.5-2 ng/mL

Question 32

Digoxin is also called what?

Answer 32

Digitalis

Question 33

True or False, Digoxin helps an injured or weak heart pump more effectively?

Answer 33

True