digoxin

Question 1

use

Answer 1

• second-line Tx for
  
  • HF
  • dysrhythmias (a-fib and flutter)
  • paroxysmal SVT

Question 2

inotropy

Answer 2

force of muscle contraction

Question 3

+ inotropic effect

Answer 3

• ↑ force of myocardial contraction
• improves SV

Question 4

chronotropy

Answer 4

affecting a time or rate, as in HR

Question 5

– chronotropic effect

Answer 5

• ↓ HR
• slows rates of
  
  • SA node depolarization
  • impulses through heart’s conduction system

Question 6

What is the overall effect of dig?

Answer 6

gives ventricles more time to fill → ↑ SV and CO

Question 7

dig complications

Answer 7

• dysrhythmias
• cardiotoxicity
• toxicity

Question 8

dig-induced cardiotoxicity →

Answer 8

bradycardia

Question 9

conditions that ↑ risk of digoxin-induced dysrhythmias

Answer 9

• hypokalemia
• ↑ serum digoxin
• heart dz
• older age

Question 10

first sign of dig toxicity

Answer 10

GI effects

Question 11

S/Sx of dig toxicity

Answer 11

• GI effects
  
  • anorexia
  • N&V
  • abd pain
• CNS effects
  
  • fatigue
  • weakness
  • vision changes
    
    • diplopia
    • blurred vision
    • yellow-gree or white halos

Question 12

GI effects of dig toxicity

Answer 12

• anorexia
• N&V
• abd pain

Question 13

CNS effects of dig toxicity

Answer 13

• fatigue
• weakness
• vision changes

Question 14

vision changes r/t dig toxicity

Answer 14

• diplopia
• blurred vision
• yellow-green or white halos

Question 15

baseline/periodic labs for dig therapy

Answer 15

• dig level (0.5–2.0 ng/mL)
• serum K+ (3.5–5.0 mEq/L)

Question 16

therapeutic dig level

Answer 16

0.5–2.0 ng/mL

Question 17

K+ serum level reference range

Answer 17

3.5–5.0 mEq/L

Question 18

What do you check before administering dig?

Answer 18

HR and rhythm

Question 19

What HRs warrant holding/notifying provider before giving dig?

Answer 19

• adult: < 60
• child: < 70
• infant: < 90

Question 20

Dig dosage is based on what two factors?

Answer 20

• serum level
• pt response

Question 21

When should dig be administered?

Answer 21

at the same time daily

Question 22

What two drugs may be prescribed along with dig?

Answer 22

• K+ supplement
• diuretic

Question 23

IV dig admin

Answer 23

• infuse over at least 5 min
• monitor for dysrhythmias

Question 24

What information should you gather before contacting the provider about dig administration?

Answer 24

VS

Question 25

evaluation for dig therapy

Answer 25

* control of HF * absence of dysrhythmias

Question 26

missed dose

Answer 26

**do not double** next dose

Question 27

toxicity Sx for pt to report

Answer 27

* fatigue * weakness * vision changes * **GI effects**

Question 28

diet changes for dig therapy

Answer 28

* high-K+ foods * green leafy veggies * bananas * potatoes

Question 29

hypokalemia Sx for pt to report

Answer 29

* N&V * general weakness

Question 30

pt ed: taking dig

Answer 30

* monitor pulse before taking * hold med report changes to provider * irregular rate with early or extra beats * \< 60 bpm or \> 100 bpm * take at same time daily

Question 31

What should pts avoid while taking dig?

Answer 31

* OTC meds * prevent AE and interactions * talk to provider before taking

Question 32

contraindications

Answer 32

* disturbances in ventricular rhythm * v-fib * ventricular tachycardia * 2nd- and 3rd-degree heart block

Question 33

precautions

Answer 33

* hypokalemia * partial AV block * advanced HF * renal insufficiency

Question 34

thiazide or loop diuretics + dig =

Answer 34

* hypokalemia (monitor levels) * ↑ risk of dysrhythmias

Question 35

ACE inhibitors or ARBs + dig =

Answer 35

* ↑ risk of hyperkalemia → ↓ effects of digoxin * use cautiously with K+ or K+-sparing diuretics * monitor K+

Question 36

sympathomimetics + dig =

Answer 36

* complement inotropic action, ↑ rate and force of heart muscle contraction * may be beneficial, but also may ↑ risk of dysrhythmias * monitor ECG * pt ed: report palpitations

Question 37

quinidine + dig =

Answer 37

* ↑ risk of dig toxicity * avoid concurrent use

Question 38

verapamil + dig =

Answer 38

* ↑ plasma levels of dig * ↓ dig dose * usually avoided because verapamil (cardiosuppressive) can counteract dig

Question 39

antacids + dig =

Answer 39

* ↓ dig absorption and effect * talk to provider before taking

Question 40

What drugs should be stopped if dig toxicity occurs?

Answer 40

* dig * K+-wasting meds

Question 41

What drugs can treat dysrhythmias in dig toxicity?

Answer 41

* lidocaine * phenytoin

Question 42

Treat bradycardia r/t dig toxicity with \_\_\_\_\_\_.

Answer 42

atropine

Question 43

interventions for excessive dig overdose

Answer 43

* to bind in GI tract * activated charcoal * cholestyramine * ​​to bind in blood * **Digibind**

Question 44

class

Answer 44

* cardiac glycoside * antiarrhythmic * inotropic

Question 45

trade name

Answer 45

Lanoxin

Question 46

dig effects

Answer 46

* ↓ electrical conduction through AV node * ↑ myocardial contraction * ↑ SV * ↑ CO