CV Meds: Cardiac Glycosides

Question 1

Cardiac glycosides are used for treatment of pts who have…

Answer 1

cardiac failure OR ineffective pumping mechanism of the heart

Question 2

What are the two actions of Cardiac glycosides?

Answer 2

1. Increases force and velocity of myocardial contractions to improve stroke volume and cardiac output
2. Slows the conduction rate and allows for increase of ventricular filling

Question 3

To put it simple, the point of cardiac glycosides is to improve.. (2)

Answer 3

1. Stroke volume
2. Cardiac output

Question 4

Example of Cardiac glycosides:

Answer 4

Digoxin

Question 5

What diseases are Cardiac glycosides used for? (2)

Answer 5

1. Heart failure
2. A-fib

Question 6

Paired with what other medications will increase risk of hypokalemia and precipitate digoxin toxicity?

Answer 6

Thiazide or loop diuretics

Question 7

When paired with thiazide or loop diuretics, digoxin has an increased risk of what? (2)

Answer 7

1. Hypokalemia
2. Digoxin toxicity

Question 8

When digoxin is paired with ___s and ____s, risk of hyperkalemia is increased

Answer 8

ACEs and ARBs
(Angiotensin-Converting Enzymes) & (Angiotensin II Receptor Blockers)

Question 9

What OTHER medication increases risk of digoxin toxicity?

Answer 9

Verapamil

Question 10

Sooo which meds increases risk of digoxin toxicity?

Answer 10

1. Thiazide diuretics
2. Loop diuretics
3. Verapamil

Question 11

What are the s/s of digoxin toxicity? (GI and CNS)

Answer 11

GI effects: anorexia, N/V, abdominal pain
CNS effects: fatigue, weakness, diplopia, blurred vision, *yellow-green or white halos around objects

Question 12

What do you assess prior to administering digoxin?

Answer 12

• assess apical pulse for one whole minute
• notify provider if HR <60 (adult); <70 (child); <90 (infant)

Question 13

What s/s should you monitor for when administering digoxin? (3)

Answer 13

1. Digoxin toxicity
2. Hypokalemia
3. Hypomagnesemia

Question 14

When giving digoxin, when should you notify the provider?

Answer 14

• if HR <60 (adult); <70 (child); <90 (infant)
• if any sudden increases in HR occurs that was previously normal or low

Question 15

What is the therapeutic levels for digoxin?

Answer 15

0.8-2.0 ng/mL

Question 16

What is the toxicity level of digoxin?

Answer 16

> 2.4 ng/mL

Question 17

How do you manage digoxin toxicity?

Answer 17

• d/c digoxin and K+ wasting meds
• treat dysrhythmias with phenytoin (or lidocaine)
• treat bradycardia with atropine
• for excess overdose- administer digoxin immune FAB to prevent absorption

Question 18

Digoxin toxicity: treat dysrhythmias with what?

Answer 18

Phenytoin or lidocaine

Question 19

Digoxin toxicity: treat bradycardia with what?

Answer 19

Atropine

Question 20

Digoxin toxicity: administer what when excess overdose?

Answer 20

Digoxin immune FAB