A man asks a nurse why he cannot use digoxin (Lanoxin) for his ...

[jeatrice]

A man asks a nurse why he cannot use digoxin (Lanoxin) for his heart failure, because both of his parents used it for HF. The nurse will explain that digoxin is not first-line therapy for which reason?
 
  a. It causes tachycardia and increases the cardiac workload.
  b. It does not correct the underlying pathology of heart failure.
  c. It has a wide therapeutic range that makes dosing difficult.
  d. It may actually shorten the patient's life expectancy.

Question 2

A patient with heart failure who takes a thiazide diuretic and digoxin (Lanoxin) is admitted for shortness of breath. The patient's heart rate is 66 beats per minute, and the blood pressure is 130/88 mm Hg.
 
  The serum potassium level is 3.8 mEq/L, and the digoxin level is 0.8 ng/mL. The nurse admitting this patient understands that the patient:
  a. has digoxin toxicity.
  b. is showing signs of renal failure.
  c. is experiencing worsening of the disease.
  d. needs a potassium-sparing diuretic.

[14vl19]

Answer to Question 1

ANS: B
Digoxin improves cardiac output, alters electrical effects, and helps to decrease sympathetic outflow from the central nervous system (CNS) through its neurohormonal effects; however, it does not alter the underlying pathology of heart failure or prevent cardiac remodeling. Digoxin causes bradycardia and increases the cardiac workload by increasing contractility. It has a narrow therapeutic range and many adverse effects. Digoxin does not improve life expectancy; in women it may actually shorten life expectancy.

Answer to Question 2

ANS: C
This patient has a normal serum potassium level, and the digoxin level is normal. The patient is showing signs of pulmonary edema, which indicates progression of heart failure. The digoxin level is within normal limits, and the heart rate is above 60 beats per minute, so digoxin toxicity is not likely. There is no sign of renal failure. A potassium-sparing diuretic is not indicated.

[jeatrice]

Excellent

[nguyenhoanhat]

Gracias!