Cardiac glycosides Flashcards
Heart failure results from what?
Inadequate pumping of the heart muscle and the heart’s inability to meet the circulation needs of the whole body
How does a person appear with heart failure, describe the characteristics when someone has decreased tissue perfusion
Fatigue, shortness of breath, weakness and activity intolerance
Heart failure causes a reduction in what?
Cardiac output (CO)
Heart Failure not only causes a reduction in CO, but it also affects what else?
Heart rate, stroke volume (SV) preload and afterload
What are the two types of heart failure (HF)?
Left and Right sided failure
What does the left side HF affect?
The lungs
What are symptoms or manifestations of L side failure? (HF)
Dyspnea, cough, oliguria
What are symptoms or manifestations of R side HF?
Systemic congestion with peripheral edema, jugular vein distension, weight gain
What classes of drugs are the choice treatment for HF?
Diuretics, ACE inhibitors, Angiotensin 11receptor blockers (ARBs), and beta adrenergic blockers
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?
Cardiac glycosides
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?
The class is Cardiac glycosides- the drug in this class Digoxin
What happens when the heart rate is decreased?
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
When is digoxin used in females?
For females, use only if the client has not responded to first-line medications.
When is digoxin used as a second-line medication ?
Dysrhythmias (atrial fibrillation)
What are complications for cardiac glycosides?
Hypokalemia, base the dose on blood levels, dysrhythmias & cardiotoxicity
What are manifestations of hypokalemia?
Nausea, vomiting, weakness,
What is the normal potassium level?
3.5-5mEq/L
Name some foods high in potassium
Green leafy vegetables, bananas, potatoes
What are side effects of Digoxin?
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
What are the contraindications /precautions in cardiac glycosides?
Pregnancy risk C, contraindicated V-Tac, V-Fib, Second & Third degree heart block, also those who have impaired kidney function & hypokalemia
What are some known drug interactions with cardiac glycosides and why ?
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
What are important nursing administration tasks to remember with digoxin?
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
If administering IV digoxin, infuse over how long?
Infuse over at lease 5 minutes
For clients with pulmonary edema and administering digoxin IV, how long is the IV infusion time ?
10-15 minutes
It is important to teach the client taking digoxin two things-what are they?
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
How is digoxin toxicity managed?
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
How can a nurse evaluate the medication effectiveness in HF?
1) Control of heart failure 2) Absence of dysrhythmias
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
- 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.
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
- Verapamil a calcium channel blocker can decrease digoxin levels
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
1, Fatigue, 3. Anorexia, 5. Blurred vision yellow-tinge vision
What is the normal digoxin level?
0.5-2 ng/mL
Digoxin is also called what?
Digitalis
True or False, Digoxin helps an injured or weak heart pump more effectively?
True
