Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
12 Cards in this Set
- Front
- Back
|
CARDIAC GLYCOSIDE
digoxin (Very Narrow Margin of Safety) |
Indications: treatment of acute HF, atrial fibrillation
Actions: increases intracellular calcium and allows more calcium to enter the myocardial cell during depolarization; this causes a positive inotropic effect (increased force of contraction), increased renal perfusion with a diuretic effect and decrease in renin release, negative chronotropic effect (slower HR), and slowed conduction through the AV node. Decreased blood volume. Result is decreased in cardiac workload and relief of HF. Excreted unchanged in the urine, because of this caution should be used in presence of renal impairement because decreased excretion which can lead to toxicity. |
|
|
Digoxin adverse effects
|
headache
weakness drowsiness, visual disturbances (yellow halo around objects) arrhythmias, GI upset anorexia Dig Toxicity=serious condition that can be life threatening. Includes anorexia, N/V, Malaise, depression, irregular heart rhythm. (dig. anitdote has been developed to tx. toxicity) |
|
|
Digoxin drug interactions
|
-likeliness of toxic effects increase with verapamil, amiodarone, quinidine, quinine, erythromycin, tetracycline, cyclosporine (decreased dig dose needed, however if dig. and one of these drugs have been apart of regimen and is discontinued then dig may need to be increased)
-Risk for arrhythmias if dig taken with K-losing drugs (monitor K levels frequently) -dig. may be less effective if it taken with cholestyramine, charcoal, antacids, bleomycin, methotrexate, cyclophosphamide. (if combo used take 2-4 hrs apart) -may be less effective if combined with thyroid hormones, metoclopramide, or penicillin. -do not take with st. johns wort, psyllium, decrease effectiveness; increased dig toxicity if combined with ginseng, hawthorn, and licorice |
|
|
Cardiac Glycosides Contraindications/Cautions
Digoxin |
Contraindicated/Caution:
allergy, V. tach or fib, heart block or sick sinus syndrome, idiopathic hypertrophic subaortic stenosis, acute MI, renal insufficiency, electrolyte abnormalities. Lactation. Caution=Pregnancy |
|
|
Digoxin Nsg. Implications and Teaching
|
-Consult with prescriber about need for loading dose when beginning therapy.
-Monitor apical pulse for one full min. before giving drug (hold dose if pulse is less than 60 bpm in adult of less than 90 in infant. Retake pulse in an hour. If remains low, document it, withhold drug, and notify dr.) -Administer IV doses very slowly over atleast 5 minutes and avoid IM injections -Weigh pt same time each day, with same scale and same clothes. -Do not give oral drug with food or antacids -Have standby emergency equipment; K-salts, lidocaine, phenytoin, atropine, cardiac monitor -Monitor therapeutic dig. level (0.5-2.0) -Comfort/safety measures-small frequent meals, access to bathrooms, safety precautions, adequate lighting to accomodate vision changes, positioning changes, and frequent rest periods to balance supply and demand. |
|
|
Digoxin Antidote:
Digoxin Immune Fab |
ACTION:Is an antigen-binding fragment (fab) derived from specific anti-digoxin antibodies. These antibodies bind molecules of dig., making them unavailable at their site of action.
Excreted through kidneys INDICATIONS: Life threatening dig toxicity (serum levels>10 ng/mL with serum K>5 mEq/L) |
|
|
Dig. Immune Fab Nsg. Considerations
|
-Continuous cardiac monitoring while drug is being given and for several hours after infusion is finished.
-Hypersensitivity reactions possible so provide standby life support equipment. -Serum dig levels will be very high and unreliable for about 3 days after dig. immune fab is administered because of high levels of dig. in the blood. The pt. should not be redigitalized for several days to 1 week after dig. immune fab has been used b/c potential of remaining fragments in the blood. -Comes in two preparations that have different dosings between the two (digibind and digifab). Care must be taken to check the brand name before administering the drug. |
|
|
PHOSPHODIESTERASE INHIBITORS- Use is limited due to potentially fatal V. arrhythmias. Reserved for use in severe conditions.
inamrinone milrinone |
INDICATIONS: Inamrinone=Only for use with HF pts that have not been reponsive to dig, diuretics, or vasodilators. Milrinone= short-term management of HF in adults receiving digoxin and diuretics.
ACTIONS: blocks the enzyme phophodiesterase, which leads to an increase in myocardial cell cAMP, which increases calcium levels in the cell, causing a stronger contraction and prolonged response to sympathetic stimulation which can lead to vasodilation,increased O2 consumption, and arrhythmias; directly relaxes vascular smooth muscle Excreted in urine and feces |
|
|
Phosphodiesterase Inhibitors Contrain./Cautions
|
-allergy to drug or bisulfites
-severe aortic or pulmonic valvular disease -acute MI -fluid volume deficit -ventricular arrhythmias. -Use cautiously in elderly and pregnant/lactating women |
|
|
PHOSPHODIESTERASE INHIBITORS adverse effects
|
-arrhythmias
-hypotension -GI effects=nausea,vomiting, anorexia, abdominal pain -thrombocytopenia -pericarditis -valsculitis -pleuritis -fever -chest pain -burning at injection site |
|
|
PHOSPHODIESTERASE INHIBITORS DRUG/DRUG INTERACTIONS:
|
precipitates form when given with solution containing furosemide. Use alternate lines if these drugs are given IV.
|
|
|
PHOSPHODIESTERASE INHIBITORS Nsg. Implications and Teaching
|
-Prevent drug from light to prevent drug degradation.
-Monitor IandO and record daily. Monitor platelets count before and regularly during therapy. Inspect bruising and petechiae to detect early signs of thrombocytopenia. Notify Dr. about need to decrease dose at first signs of thrombocytopenia. -monitor IV injection sites. -Provide life support on standby -Same comfort measures as dig. |
