Week 2 Cardiac Glycosides

Question 1

What are the three common Cardiac Glycosides?

Answer 1

Digoxin
Digitoxin
Ouabain

Question 2

What are the three main indications for cardiac glycosides?

Answer 2

• Heart failure
• A-fib
• A-flutter

Question 3

Cardiac Glycosides are positive ____

Answer 3

inotropes

Question 4

Cardiac Glycosides are negative ___

Answer 4

Chronotropes

Question 5

What are the 4 main results from Cardiac Glycosides being positive Inotropes

Answer 5

Increased CO
Increased Renal perfusion
Increased urinary output
Decreased renin release

Question 6

Decreased renin release leads to what two things?

Answer 6

Decreased blood volume and decreased vasoconstriction

Question 7

What is the MOA of Cardiac Glycosides?

Answer 7

1. Inhibition of the Sodium-Potassium pump

2. Increased Vagal activity to the heart

Question 8

What occurs in the cardiac cell when the sodium-potassium pump is inhibited from Cardiac Glycosides?

Answer 8

This increases the concentration of Na and Ca++ in the cell. This increased the force and speed of contractions.
Higher availability of Ca++ leads to increased binding with troponin

Question 9

What occurs with increased vagal stimulation to the heart from Cardiac Glycosides?

Answer 9

Increased parasympathetic NS activity leading to a decreased rate of contractions. (SA node in innervated by the vagus nerve)

Question 10

How do Cardiac Glycosides increase cardiac output?

Answer 10

Through increased force of contractions and increased diastolic filling time related to decreased rate of contractions.

Question 11

Why do Cardiac Glycosides have a narrow therapeutic index?

Answer 11

Because the t1/2 is 36-40 hours and drug levels are highly influenced by potassium

Question 12

if a patient is taking Cardiac Glycosides and has hypokalemia, what will occur?

Answer 12

with decreased levels of potassium, there will be less of exchange at the sodium/potassium pumps. This will allow for increased binding of digoxin and an increased effect of the drug. Leading to toxicity.

Excessive lowering of HR, cardiac muscle exhaustion

Question 13

If a patient has hyperkalemia and is taking a Cardiac Glycosides, what will occur?

Answer 13

More potassium will compete with the drug, leading to decreased binding and will decrease the effects of the drug.

Question 14

If a patient has hypercalcemia and is taking a Cardiac Glycosides, what will occur?

Answer 14

This enhances inotropy leading to a possible Ca++ overload and increased chance of arrhythmias induced by Cardiac Glycosides

Question 15

if a patient has hypomagnesemia and is taking Cardiac Glycosides, what will occur?

Answer 15

This can sensitize the heart to arrhythmias induced by Cardiac Glycosides

Question 16

What are the first two signs of digitalis toxicity?

Answer 16

blurred vision/visual Halos

loss of appetite

Question 17

What are the main side effects of Cardiac Glycosides?
8
NAHABCHB

Answer 17

N/V/D
Anorexia
Headache
Anxiety
blurred vision
confusion
Hallucinations
Bradycardia

Question 18

What are the 5 main contraindications of Cardiac Glycosides?

Answer 18

Hypokalemia
hyperkalemia
AV blocks
Wolff-Parkinson-White syndrome (WPW)
Impaired renal function

Question 19

What are the three main expected outcomes for clients taking Cardiac Glycosides?

Answer 19

• Report decreased cardiac decompensation r/t fluid overload
• Exhibit evidence of understanding of the action of the drug by accurately describing side effects and precautions
• immediately reporting side effects

Question 20

What needs to be checked prior to administering Cardiac Glycosides?

Answer 20

Apical Heart rate (at or above 60)

drug levels

Question 21

What is the tx range of digoxin?

Answer 21

0.5-2ng/ml