Heart Failure Medications Flashcards
1
Q
digoxin (Lanoxin) therapeutic use
A
- Cardiac Glycosides/inotropic
- Second-line drug for HF
- Treats some cardiac dysrhythmias
- Atrial fibrillation
- Atrial flutter
- Paroxysmal atrial tachycardia
2
Q
digoxin adverse reactions
A
- Cardiac dysrhythmias, especially likely with digoxin toxicity
- Any dysrhythmia may occur, with AV block being most common
- GI symptoms – early signs of toxicity
- Nausea, vomiting, anorexia
- CNS symptoms
- Fatigue, visual disturbances, such as yellow vision and blurred vision
- Increased mortality in women
3
Q
digoxin contraindications and precautions
A
Contraindications:
* Uncontrolled Ventricular dysrhythmias
* AV block or severe heart disease
* Digoxin toxicity
Precautions:
* Hypokalemia, hypercalcemia
* Concurrent use of diuretics
* Impaired kidney function
* Infants, children and older adults
4
Q
digoxin interactions
A
- Erythromycin and some other antibiotics increase digoxin levels
- Other antidysrhythmics (verapamil, quinidine, amiodarone, flecainide)
increase digoxin levels; decrease digoxin dosage for concurrent
administration - Diuretics increase risk for digoxin toxicity by decreasing potassium
levels - Herbal ginseng increases risk of digoxin toxicity; St. John’s wort
decreases digoxin levels - Note that the above interactions do not comprise a complete list. It’s
important to check for interactions when other drugs are given along
with digoxin
5
Q
digoxin administration
A
- Available as oral tablets, capsules, and elixir, as well as for IV use
- Give oral form with or without food
- Tablets may be crushed and mixed with food if necessary
- IV form may be administered directly over at least 5 min; monitor site
carefully for infiltration, which can cause tissue damage
6
Q
digoxin nursing interventions
A
- Recognize that vomiting can cause hypokalemia, which increases risk
for digoxin toxicity - Monitor for and report GI symptoms
- Monitor for and report CNS effects
- Take apical pulse for 1 full minute before administering digoxin;
withhold drug if pulse falls below prescribed parameters (such as 60/
min in adults) - Monitor digoxin levels frequently
- Monitor serum potassium levels; administer potassium for low or
borderline low values - Monitor cardiac rhythm and treat dysrhythmias per protocol
- For severe digoxin toxicity, digoxin immune FAB (Digibind) is
administered IV as an antidote to neutralize digoxin
7
Q
digoxin client educations
A
- Report nausea, loss of appetite, or vomiting to provider
- Report headache, visual disturbances to provider
- Report heart palpitations to provider
- Learn to monitor pulse rate and report decrease or increase beyond
prescribed parameters - To decrease risk of toxicity or low serum levels, take digoxin at the
same time each day; do not skip or double a dose - Report signs of hypokalemia, such as muscle weakness
- High risk of toxicity
8
Q
hydrochlorothiazide (Microzide, Oretic) therapeutic use
A
- Thiazide diuretics
- Used with other drugs, treats heart failure
- Treats cirrhosis of the liver and renal failure
- Treats hypertension
9
Q
hydrochlorothiazide adverse reactions
A
- Electrolyte imbalance: hyponatremia, hypochloremia, severe fluid loss
(dehydration), and hypokalemia (most common) - Hyperglycemia (especially in clients who are diabetic)
- Increased uric acid levels (hyperuricemia) with possible gouty arthritis
in susceptible clients
10
Q
hydrochlorothiazide nursing interventions
A
- Monitor serum electrolyte levels periodically; notify provider for
abnormal levels - Monitor carefully for signs of electrolyte imbalance
- If hypokalemia occurs, monitor for dysrhythmias
- If hypokalemia is a risk (e.g. client also taking digoxin)
hydrochlorothiazide may be combined with a potassium supplement or
potassium-sparing diuretic - Monitor blood glucose periodically in all clients
- Monitor blood glucose more frequently in clients who have diabetes
mellitus; insulin or oral antidiabetic drug dosage may need to be
increased - Monitor uric acid levels periodically
11
Q
hydrochlorothiazide medication administration
A
- Available orally alone and in fixed-dose combination with multiple other
drugs, such as potassium-sparing diuretics, ACE inhibitors, ARBs, beta
blockers and other antihypertensive drugs - Chlorothiazide is available in IV form
- Give with food to minimize GI effects
- Give last dose of day by 3 p.m. to prevent nocturia and sleep loss
12
Q
hydrochlorothiazide client education
A
- Eat foods rich in potassium (if indicated) such as citrus fruits, potatoes,
bananas - Report signs of electrolyte imbalance, such as confusion, muscle
twitching or weakness, irregular pulse, nausea, and others - Clients who have diabetes mellitus need to carefully monitor blood
glucose levels and notify provider for persistent hyperglycemia - Be aware that this effect may occur; usually without symptoms
- Clients with history of gout need to report symptom onset to provider
13
Q
hydrochlorothiazide contraindications and precautions
A
Contraindications:
* Allergy to thiazides or sulfonamides
* Greatly decreased urine output (anuria)
* Electrolyte imbalance
Precautions:
* Renal or hepatic disorders
* Older adults
* Pregnancy/lactation
14
Q
hydrochlorothiazide interactions
A
- Lithium toxicity may occur
- Increased risk of digoxin toxicity with potassium or magnesium
deficiency - Corticosteroids and amphotericin B increase risk for hypokalemia
- Decreased absorption with cholestyramine (Questran) or colestipol
(Colestid) - NSAIDS can reduce effectiveness
15
Q
furosemide (Lasix) therapeutic use
A
- Loop diuretic
- Treats pulmonary edema in heart failure
- Treats edema caused by renal, hepatic or cardiac failure not affected by
other diuretics - Treats hypertension not controlled by other diuretics
