Presentation is loading. Please wait.

Presentation is loading. Please wait.

LOVE AND OTHER DRUGS DIGOXIN FOR HEART FAILURE!. DRUG CLASS AND MECHANISM: DIGOXIN INCREASES THE STRENGTH AND VIGOR OF HEART CONTRACTIONS, AND IS USEFUL.

Similar presentations


Presentation on theme: "LOVE AND OTHER DRUGS DIGOXIN FOR HEART FAILURE!. DRUG CLASS AND MECHANISM: DIGOXIN INCREASES THE STRENGTH AND VIGOR OF HEART CONTRACTIONS, AND IS USEFUL."— Presentation transcript:

1 LOVE AND OTHER DRUGS DIGOXIN FOR HEART FAILURE!

2 DRUG CLASS AND MECHANISM: DIGOXIN INCREASES THE STRENGTH AND VIGOR OF HEART CONTRACTIONS, AND IS USEFUL IN THE TREATMENT OF HEART FAILURE. IT IS EXTRACTED FROM THE LEAVES OF A PLANT CALLED DIGITALIS LANATA. DIGOXIN INCREASES THE FORCE OF CONTRACTION OF THE MUSCLE OF THE HEART BY INHIBITING THE ACTIVITY OF AN ENZYME (ATPASE) THAT CONTROLS MOVEMENT OF CALCIUM, SODIUM ANDPOTASSIUM INTO HEART MUSCLE. CALCIUM CONTROLS THE FORCE OF CONTRACTION. INHIBITING ATPASE INCREASES CALCIUM IN HEART MUSCLE AND THEREFORE INCREASES THE FORCE OF HEART CONTRACTIONSHEART FAILUREENZYMECALCIUMSODIUMPOTASSIUMHEART MUSCLE

3 DRUG CLASS AND MECHANISM:. DIGOXIN ALSO SLOWS ELECTRICAL CONDUCTION BETWEEN THE ATRIA AND THE VENTRICLES OF THE HEART AND IS USEFUL IN TREATING ABNORMALLY RAPID ATRIAL RHYTHMS SUCH AS ATRIAL FIBRILLATION, ATRIAL FLUTTER, AND ATRIAL TACHYCARDIA. (ABNORMALLY RAPID ATRIAL RHYTHMS CAN BE CAUSED BY HEART ATTACKS, EXCESSIVE THYROID HORMONES, ALCOHOLISM, INFECTIONS, AND MANY OTHER CONDITIONS.) DURING RAPID ATRIAL RHYTHMS, ELECTRICAL SIGNALS FROM THE ATRIA CAUSE RAPID CONTRACTIONS OF THE VENTRICLES.ABNORMALLY RAPID ATRIAL RHYTHMSHEART ATTACKSTHYROID HORMONESALCOHOLISM

4 DRUG CLASS AND MECHANISM: RAPID VENTRICULAR CONTRACTIONS ARE INEFFICIENT IN PUMPING BLOOD CONTAINING OXYGEN AND NUTRIENTS TO THE BODY, CAUSING SYMPTOMS OF WEAKNESS, SHORTNESS OF BREATH, DIZZINESS, AND EVEN CHEST PAIN. DIGOXIN ALLEVIATES THESE SYMPTOMS BY BLOCKING THE ELECTRICAL CONDUCTION BETWEEN THE ATRIA AND VENTRICLES, THUS SLOWING VENTRICULAR CONTRACTIONS. THE FDA APPROVED DIGOXIN IN 1975WEAKNESSCHEST PAIN

5 PRESCRIBED FOR: DIGOXIN IS USED FOR MILD TO MODERATE CONGESTIVE HEART FAILURE AND FOR TREATING AN ABNORMAL HEART RHYTHM CALLED ATRIAL FIBRILLATION.CONGESTIVE HEART FAILUREABNORMAL HEART RHYTHMATRIAL FIBRILLATION

6 DOSING: DIGOXIN MAY BE TAKEN WITH OR WITHOUT FOOD. DIGOXIN IS PRIMARILY ELIMINATED BY THE KIDNEYS; THEREFORE, THE DOSE OF DIGOXIN SHOULD BE REDUCED IN PATIENTS WITH KIDNEY DYSFUNCTION. DIGOXIN BLOOD LEVELS ARE USED FOR ADJUSTING DOSES IN ORDER TO AVOID TOXICITY. THE USUAL STARTING DOSE IS MG DAILY DEPENDING ON AGE AND KIDNEY FUNCTION. THE DOSE MAY BE INCREASED EVERY TWO WEEKS TO ACHIEVE THE DESIRED RESPONSE.

7 DRUG INTERACTIONS: DRUGS SUCH AS VERAPAMIL (CALAN, VERELAN, VERELAN PM, ISOPTIN, ISOPTIN SR, COVERA-HS), QUINIDINE (QUINAGLUTE, QUINIDE),AMIODARONE (CORDARONE), INDOMETHACIN (INDOCIN, INDOCIN-SR), ALPRAZOLAM(XANAX, XANAX XR, NIRAVAM), SPIRONOLACTONE (ALDACTONE), AND ITRACONAZOLE(SPORANOX) CAN INCREASE DIGOXIN LEVELS AND THE RISK OF TOXICITY. THE CO-ADMINISTRATION OF DIGOXIN AND BETA-BLOCKERS [FOR EXAMPLE PROPRANOLOL(INDERAL, INDERAL LA) OR CALCIUM CHANNEL BLOCKERS (FOR EXAMPLE, VERAPAMIL), WHICH ALSO REDUCES HEART RATE, CAN CAUSE SERIOUS SLOWING OF THE HEART RATEVERAPAMILQUINIDINEAMIODARONEINDOMETHACINALPRAZOLAMSPIRONOLACTONEITRACONAZOLEPROPRANOLOLCALCIUM CHANNEL BLOCKERSHEART RATE

8

9 GGS BLOOD PRESSURE IS 145/90. ACCORDING TO THE GUIDELINES FOR DETERMINING HYPERTENSION, STAGE OF HER BP IS: NORMAL PREHYPERTENSION STAGE 1 HYPERTENSION STAGE 2 HYPERTENSION

10 THE FIRST-LINE DRUG FOR TREATING GGS BLOOD PRESSURE MIGHT BE: DIURETICS ALPHA BLOCKERS ACE INHIBITORS ALPHA/BETA BLOCKERS

11 SIX MONTHS LATER, GGS BLOOD PRESSURE WAS 168/86. HER HYPERTENSION WOULD BE CLASSIFIED AS: STAGE 1 STAGE 1 ISH STAGE 2 STAGE 2 ISH

12 THE GROUP(S) OF ANTIHYPERTENSIVE DRUGS THAT ARE LESS EFFECTIVE IN AFRICAN-AMERICAN CLIENTS IS/ARE: DIURETICS CALCIUM-CHANNEL BLOCKERS AND VASODILATORS BETA BLOCKERS AND ACE INHIBITORS ALPHA BLOCKERS

13 THE MOST FREQUENT DIURETIC THAT IS COMBINED WITH AN ANTI-HYPERTENSIVE DRUG IS: CHLORTHALIDONE HYDROCHLOROTHIAZIDE BENDROFLUMETHIAZIDE POTASSIUM-SPARING DIURETIC

14 THE PREFERRED BETA BLOCKER CATEGORY FOR TREATING HYPERTENSION IS: BETA1 BLOCKER BETA2 BLOCKER BETA1 AND BETA2 BLOCKER BETA2 AND BETA3 BLOCKER

15 A COMMON SIDE EFFECT OF ACE INHIBITOR NAUSEA AND VOMITING DIZZINESS AND HEADACHE UPSET STOMACH CONSTANT IRRITATED COUGH

16 ANGIOTENSIN II RECEPTOR BLOCKERS(ARBS) ACT BY: INHIBITING ANGIOTENSIN-CONVERTING ENZYME BLOCKING ANGIOTENSIN II FROM AT1 RECEPTORS PREVENTING THE RELEASE OF ANGIOTENSIN I PROMOTING THE RELEASE OF ALDOSTERONE

17 JR HAS A SERUM CHOLESTEROL LEVEL OF 265 MG/DL, TRIGLYCERIDES 235MG/DL, AND LDL 180MG/DL. THESE SERUM LEVELS INDICATE: HYPOLIPIDEMIA NORMOLIPIDEMIA HYPERLIPIDEMIA ALIPIDEMIA

18 THE CLIENTS CHOLESTEROL LEVEL SHOULD BE: 150 TO 200 MG/DL 200 TO 225 MG/DL 225 TO 250 MG/DL GREATER THAN 250 MG/DL

19 DEMIS HIGH DENSITY LIPOPROTEIN IS 60MG/DL. THIS IS: LOWER THAN THE DESIRED LEVEL OF HDL DESIRED LEVEL OF HDL HIGH THAN THE DESIRED LEVEL FOR HDL VERY LOW HDL LEVEL THAN DESIRED

20 THE LABORATORY TESTS ORDERED TO DETERMINE THE PRESENCE OF AMINO ACID THAT CAN CONTRIBUTE TO CARDIOVASCULAR DISEASE OR STROKE IS ANTIDIURETIC HORMONE HOMOCYSTEINE CERULOPLASMIN CRYOGLOBULIN

21 WHICH SERUM LEVELS SHOULD BE MONITORED WHEN THE CLIENT IS TAKING A STATIN DRUG? BLOOD UREA NITROGEN COMPLETE BLOOD COUNT CARDIAC ENZYMES LIVER ENZYMES

22 WHAT SEVERE SKELETAL MUSCLE ADVERSE REACTION COULD OCCUR WHILE TAKING STATINS? MYASTHENIA GRAVIS RHABDOMYOLYSIS DYSKINESIA AGRANULOCYTOSIS

23 A CLIENT IS DIAGNOSED WITH PERIPHERAL ARTERIAL DISEASE (PAD). HE IS PRESCRIBED ISOXUPRINE HCL. THE ACTION OF ISOXUPRINE HCL IS TO: RELAX THE ARTERIAL WALLS WITHIN THE SKELETAL MUSCLES INCREASE TISSUE OXYGEN IN THE VESSELS INCREASE THE RIGID ARTERIOSCLEROTIC BLOOD VESSELS INCREASE INTERMITTENT CLAUDICATION

24 CLIENT IS DIAGNOSED WITH PEPTIC ULCER DISEASE. THE NURSE REALIZES THAT PREDISPOSING FACTORS FOR THIS CONDITION INCLUDE: HELICOBACTER PYLORI HYPOSECRETION OF PEPSIN DECREASE HYDROCHLORIC ACID DECREASED NUMBER OF PARIETAL CELLS

25 WHEN A CLIENT IS GIVEN SUCRALFATE (CARAFATE), THE NURSE KNOWS THAT ITS MODE OF ACTION IS TO: NEUTRALIZE GASTRIC ACIDITY INHIBIT GASTRIC SECRETION BY INHIBITING HISTAMINE 2 RECEPTORS IN PARIETAL CELLS SUPPRESS GASTRIC ACID SECRETION BY INHIBITING THE HYDROGEN/ POTASSIUM ATPASE ENZYME COMBINE WITH PROTEIN TO FORM A VISCOUS SUBSTANCE THAT FORMS A PROTECTIVE COVERING OF ULCER

26 THE TEACHING FOR CLIENT TAKING RANITIDINE INCLUDES: DRUG-INDUCED IMPOTENCE IS IRREVERSIBLE ADMINISTER DRUG 30 MEALS BEFORE MEALS SEPARATE FROM AN ANTACID BY AT LEAST ONE HOUR ALWAYS ADMINISTER WITH A MAGNESIUM HYDROXIDE

27 A CLIENT IS TAKING FAMOTIDINE TO INHIBIT GASTRIC ACID SECRETIONS. THE SIDE EFFECTS OF FAMOTIDINE MAY INCLUDE: DIARRHEA DIZZINESS DRY MOUTH BLURRED VISION

28 KRISHA HAS A HEART FAILURE AND IS PRESCRIBED LASIX. WHAT TYPE OF DIURETIC IS FUROSEMIDE (LASIX) THIAZIDE DIURETIC OSMOTIC DIURETIC HIGH-CEILING (LOOP) DIURETIC POTASSIUM-SPARING DIURETIC

29 WHAT TYPE OF ELECTROLYTE IMBALANCE COULD OCCUR WHEN TAKING FUROSEMIDE? HYPOKALEMIA HYPERKALEMIA HYPOGLYCAEMIA HYPERMAGNESEMIA

30 WHY WOULD A DIURETIC COMBINATION SUCH AS TRIAMTERENE AND HYDROCHOLOROTHIAZIDE BE PRESCRIBED? TO DECREASE SERUM POTASSIUM LEVEL TO INCREASE SERUM POTASSIUM LEVEL TO DECREASE THE GLUCOSE LEVEL TO INCREASE THE GLUCOSE LEVEL

31 THALIA IS TAKING HYDROCHLOROTHIAZIDE 50MG/DAILY AND DIGOXIN 0.25MG DAILY. WHAT TYPE OF ELECTROLYTE IMBALANCE CAN OCCUR? HYPOCALCEMIA HYPOKALEMIA HYPERKALEMIA HYPERMAGNESEMIA

32 THALIAS ELECTROLYTE IMBALANCE WOULD BE BECAUSE OF: HIGH DOSE OF DIGOXIN DIGOXIN TAKEN DAILY HYDROCHLOROTHIAZIDE LOW DOSE OF HYDROCHLOROTHIAZIDE

33 MR HAS DIABETES MELLITUS AND IS TAKING HYDROCHLOROTHIAZIDE, 50MG. CONCERNING THE HYDROCHLOROTHIAZIDE, CLIENT TEACHING SHOULD INCLUDE MONITORING: HAEMOGLOBIN AND HAEMATOCRIT SERUM BLOOD UREA NITROGEN (BUN) BLOOD GASES SERUM GLUCOSE (SUGAR) LEVELS

34 MRS. DEMI JONAS TAKES DIGOXIN 0.25MG PER DAY. WHAT IS THE SERUM THERAPEUTIC RANGE FOR DIGOXIN? 0.1 TO 1.5NG/ML 0.5 TO 2.0NG/ML 1.0 TO 2.5NG/ML 2.0 TO 4.0NG/ML

35 YOU ARE ASSESSING MRS. LOVATO FOR POSSIBLE DIGITALIS TOXICITY. SIGN AND SYMPTOMS OF DIGITALIS TOXICITY INCLUDE: FAST PULSE RATE OF 100 BPM PULSE OF 72 WITH AN IRREGULAR RATE PULSE GREATER THAN 60BPM AND IRREGULAR RATE PULSE BELOW 60 BPM

36 SELENA GOMEZ, A PATIENT WITH RIGHT-SIDED HEART FAILURE IS TAKING LOOP DIURETICS, FUROSEMIDE (LASIX) 40 MG TABLET. WHAT DO YOU THINK IS THE REASON WHY SHE IS TAKING DIURETICS? FOR FEVER AND DIARRHEA FOR FEVER, ASTHMA AND DIARRHEA FOR EDEMA AND HYPERTENSION FOR INCREASED INTRA-CRANIAL PRESSURE AND CEREBRAL EDEMA

37 THE NURSE PROVIDES NUTRITIONAL TEACHING FOR A CLIENT RECEIVING LEVODOPA. THE CLIENT SHOULD BE ENCOURAGED TO: LOWER THE INTAKE OF SIMPLE CARBOHYDRATES INCREASE VITAMIN B6 INTAKE AVOID FOODS SUCH AS HAM, SWEET POTATOES AND OATMEAL DECREASE INTAKE OF DAILY PRODUCTS

38 WHEN A CLIENT FIRST TAKES NITRATE, A COMMON SYMPTOM THAT OFTEN OCCURS IS: NAUSEA AND VOMITING HEADACHES STOMACH CRAMPS IRREGULAR PULSE RATE

39 YOU ARE ASSESSING MRS. LOVATO FOR POSSIBLE DIGITALIS TOXICITY. SIGN AND SYMPTOMS OF DIGITALIS TOXICITY INCLUDE: FAST PULSE RATE OF 100 BPM PULSE OF 72 WITH AN IRREGULAR RATE PULSE GREATER THAN 60BPM AND IRREGULAR RATE PULSE BELOW 60 BPM

40 WHEN A CLIENT FIRST TAKES NITRATE, A COMMON SYMPTOM THAT OFTEN OCCURS IS: NAUSEA AND VOMITING HEADACHES STOMACH CRAMPS IRREGULAR PULSE RATE

41 NORMAL VALUES FOR MAGNESIUM MG/DL MG/DL MG/DL ALL OF THE ABOVE EXCEPT C

42 NORMAL VALUES FOR SODIUM MG/DL MG/DL MG/DL ALL OF THE ABOVE EXCEPT C

43 NORMAL VALUES FOR POTASSIUM MEQ/ML 4-5MEQ/ML MEQ/ML ALL OF THE ABOVE

44 NORMAL VALUES FOR CALCIUM 8-10MG/DL 9-15MG/DL 12-20MG/DL 15-20MG/DL

45 D5LRS 1LITER, TO CONSUME FOR 24. DROP FACTOR IS GTTS/MIN 13-14GTTS/MIN 41-42GTTS/MIN ALL OF THE ABOVE EXCEPT C

46 D5LRS 1LITER, TO CONSUME FOR 24. DROP FACTOR IS GTTS/MIN 13-14GTTS/MIN 41-42GTTS/MIN ALL OF THE ABOVE EXCEPT C

47 NA LEVEL OF 137MG/DL HYPERNATREMIA HYPONATREMIA ABNORMAL NORMAL

48 K LEVEL OF2.5 MEQ/ML HYPOKALEMIA HYPERKALEMIA ABNORMAL NORMAL

49 MG LEVEL OF 1.1 MG/DL HYPOMAGNESEMIA HYPERMAGNESEMIA ABNORMAL NORMAL

50 MRS. LOVATO IS ALSO TAKING DIURETIC THAT DECREASES HER POTASSIUM LEVEL. A LOW POTASSIUM LEVEL (HYPOKALEMIA) COULD HAVE WHAT EFFECT ON DIGOXIN. INCREASES THE SERUM DIGOXIN SENSITIVITY LEVEL DECREASES SERUM DIGOXIN LEVEL DOES NOT HAVE ANY EFFECT ON THE SERUM DIGOXIN SENSITIVITY LEVEL CAUSES A LOW AVERAGE SERUM DIGOXIN SENSITIVITY LEVEL

51 BETA-BLOCKERS ARE EFFECTIVE AS ANTI-ANGINALS BECAUSE THEY: INCREASE OXYGEN TO SYSTEMIC CIRCULATION MAINTAIN HEART RATE AND BLOOD PRESSURE DECREASE HEART RATE AND DECREASE MYOCARDIAL CONTRACTION DECREASE HEART RATE AND INCREASE MYOCARDIAL CONTRACTION

52 WHAT INSTRUCTION SHOULD THE CLIENT RECEIVE WHEN DISCONTINUING A BETA BLOCKER? THE BETA-BLOCKER SHOULD BE ABRUPTLY STOPPED WHEN ANOTHER CARDIAC DRUG S PRESCRIBED THE BETA-BLOCKER SHOULD NOT BE ABRUPTLY STOPPED; THE DOSE SHOULD BE TAPERED DOWN THE BETA-BLOCKER SHOULD BE MAINTAINED WHILE TAKING ANOTHER ANTI-ANGINAL DRUG HALF THE BETA-BLOCKER DOSE SHOULD BE TAKEN FOR THE NEXT SEVERAL WEEKS

53 THE BETA-BLOCKER ACETABULOL (SECTRAL) IS PRESCRIBED TO DYSRHYTHMIAS. THE PRIMARY PURPOSE OF THE DRUG IS TO: INCREASE THE BETA1 AND BETA2 RECEPTORS IN THE CARDIAC TISSUES INCREASE THE FLOW OF OXYGEN TO THE CARDIAC TISSUES BLOCK THE BETA 1 ADRENERGIC RECEPTORS IN THE CARDIAC TISSUES BLOCK THE BETA 2 ADRENERGIC RECEPTORS IN THE CARDIAC TISSUES

54 A CLIENT IS SUFFERING FROM FEVER. WHAT MEDICATION SHOULD YOU ADMINISTER? ACETAMINOPHEN (TYLENOL) CLOPIDOGREL (PLAVIX) FUROSEMIDE (LASIX) PREDNISONE

55 A CLIENT IN ER COMPLAINED FROM CHEST PAIN. HIS MEDICATION IS NITROSTAT, WHAT DO YOU CALL IN MEDICAL TERMS IS THAT CHEST PAIN? VAGINA ANGINA PECTORIS PECTORIS PRECTORIS ALL OF THE ABOVE EXCEPT A


Download ppt "LOVE AND OTHER DRUGS DIGOXIN FOR HEART FAILURE!. DRUG CLASS AND MECHANISM: DIGOXIN INCREASES THE STRENGTH AND VIGOR OF HEART CONTRACTIONS, AND IS USEFUL."

Similar presentations


Ads by Google