Cardiac Glycosides

Prototype: Digoxin (Lanoxin)

Actions/Indications

• Treatment of heart failure
• Increased myocardial contraction
• Slows AV conduction
• Positive inotropic effect
• Narrow margin of safety

Cardiac Glycosides

Prototype: Digoxin (Lanoxin)  

Contraindications:

• Allergy
• Acute MI
• Atrial fibrillation, heart block, ventricular arrhythmias
• Renal insufficiency
• Pregnancy and lactation

Cardiac Glycosides

Prototype:Digoxin (Lanoxin)

Adverse Effects

• GI upset & anorexia most commonly occur.
• CNS-- yellow halo around objects
• CV--Ventricular arrhythmias

Cardiac Glycoside

Prototype: Digoxin (Lanoxin)

Drug Drug Interaction

• Multiple drugs
• Avoid herbal—ginseng & licorice (Increases digoxin toxicity)

Cardiac Glycosides

Prototype: Digoxin (Lanoxin)

Asessment

• Assess for allergy or contraindications
• Assess baseline status, vital signs, weight
• Assess cardiac and respiratory status closely
• CNS assessment
• Obtain ECG prior to initiation of drugs
• Monitor renal function and electrolytes

Cardiac Glycosides

Prototype: Digoxin (Lanoxin)

Implementation

• Before administering glycosides, take apical pulse for one full minute
• Monitor vital signs frequently
• Administer digoxin on empty stomach
• Check dose and preparation carefully
• Monitor daily weights
• Monitor digoxin levels, renal function, electrolytes

Cardiac Glycosides

Prototype: Digoxin (Lanoxin)

Evaluation

• Monitor response to drug
• Monitor for any adverse effects
• Evaluate effectiveness of teaching plan

Phosphodiesterase Inhibitors

Prototype:

Phosphodiesterase Inhibitors

• Short term treatment for HF
• Increased contraction, HR, B/P
• IV use ONLY
• Metabolized in liver
• Excreted in urine

Phosphodiesterase Inhibitors

• Allergy
• Acute MI
• Heart valve disease
• Ventricular arrhythmias
• Use with caution in the elderly
• Pregnancy
• Lactation