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GLYCOSIDES
Explain how digoxin produces a positive inotropic
Cardiac Glycosides
Digitalis glycosides are a group of chemically
Cardiac Glycosides
This group of drugs have three
effects on heart:
Positive inotropic(increases myocardial
contraction & stroke volume)
Negative chronotropic(decreases heart
rate)
Negative dromotropic(decreases
conduction of heart cells)
Cardiac Glycosides
Mechanism of action
Cardiac Glycosides
Therapeutic uses:
Main indication:
Used in the treatment of Congestive heart failure
Treatment of Atrial dysrhythmias :like Atrial flutter,
Atrial fibrillation and paroxysmal atrial tachycardia,
supra ventricular tachycardia
contraindication:
Cardiac Glycosides
Drug drug interactions:
Many drugs interact with digoxin
Rifampin,
barbiturates,cholestyramine,antacids,kaolin,pectin,
sulfasalazine reduce therapeutic effects of digoxin
Calciumpreparations,quinidine,verapamail,cyclosporine,tert
racycline,erythromycin,spironolactone increase the risk of
digitalis toxicity
Amphotericin B, potassium wasting diuretics and steroids
taken with digoxin may cause hypokalemia and increase
the risk of digoxin toxicity. Potassium replacement must be
given.
B-blockers and calcium channel blockers cause slow heart
rate and arrhythmias
Lippincott Williams & Wilkins. Nursing Pharmacology Made Incredibly Easy!3rd Ed.Ch5. Pg.183
Cardiac Glycosides
Digitalization: the administration of a loading
Adverse Effects of
Digitalis Glycosides
Heart : Ventricular
Arrhythmias & Heart
block
CNS side-effects:
headache
weakness,seizures,dro
wsiness,
confusion, blurred
vision,
yellow vision
GI side-effects:
Anorexia,Nausea,Vomit
ing
DIGITALIS TOXICITY
Includes slow to rapid
ventricular rhythms,
nausea, vomitting,
blurred vision, anorexia,
abdominal pain, mental
K+ supplementaion to
compensate for
intracellular K.
If that doesnt work
Antidote:
Nursing implications
Administer the initial rapid digitalization and loading
dose as ordered I.V.
Take apical pulse for one whole minute before
administering the drug
If there is bradycardia
pulse less than 60 in adults
Less than 90 in infants
more than 110 in adults
Nursing implications
Check the spelling of the drug DIGOXIN is different
from DIGITOXIN
Check the dosage preparation and the level of Digitalis
in the blood
( therapeutic level is 0.5-2.0ng/ml)
Administer i.v drug VERY SLOW over 5 min to avoid
arrhythmias. DO NOT administer I.M as it can cause
severe pain.
Administer the drug without food if possible to avoid
delayed absorption
Weigh the patient daily to determine fluid retention .
Maintain emergency equipment and drugs like
potassium salts, lidocaine for arrhythmias, phenytoin for
seizures, atropine for bradycardia
Provide health teaching drug name ,action ,dosage
,side effects ,how to measure pulse and ask patient to
Nursing implications
On missed doses ,Dont play catch up. Take as
prescribed
On abnormal weight gain/loss to report:3 lbs/ day or
more
On driving: Avoid due to CNS s/e (Drowsiness)
On vision changes: These may normally exist within
the 1st 3 days of therapy
Monitor electrolytes, potassium ,sodium ,calcium
,magnesium, renal function tests including BUN
,CREATININE, blood tests including AST, ALT, Bilirubin.