A primary care NP is preparing to order digoxin for an ...

[Bob-Dole]

A primary care NP is preparing to order digoxin for an 80-year-old patient who has systolic heart failure. The NP obtains renal function tests, which are normal. The NP should:
 
  a. prescribe a digoxin 0.125 mg tablet once daily.
  b. give an initial dose of 0.5 mg digoxin tablet and then 0.125 mg every 6 hours 4.
  c. administer a digoxin 0.6 mg capsule once and then 0.3 mg every 8 hours 3.
  d. administer a loading dose of intravenous digoxin in the clinic and then give 0.125 mg once daily.

Question 2

The primary care NP is prescribing a medication for an off-label use. To help prevent a medication error, the NP should:
 
  a. write off-label use on the prescription and provide a rationale.
  b. call the pharmacist to explain why the instructions deviate from common use.
  c. write the alternative drug regimen on the prescription and send it to the pharmacy.
  d. tell the patient to ignore the label directions and follow the verbal instructions given in the clinic.

[Anna]

Answer to Question 1

A
In primary care settings, slow digitalization rather than a loading dose is generally recommended because of the risk of toxicity. Digitalization may be achieved within 1 week with the use of small daily maintenance doses.

Answer to Question 2

A
When prescribing a drug for an off-label use, the provider should specify this on the written prescription and should provide a rationale so that the pharmacist understands why the prescription is different from the normal use. Calling the pharmacist would not provide written documentation. Merely writing the different instructions can lead to errors if the pharmacist changes the label to conform to usual standards. The patient may forget verbal instructions and follow the usual regimen instead.