A nurse is preparing for the admission of a client with heart failure who is being sent directly to the hospital from the physician’s office. The nurse would plan on having which of the following medications readily available for use?
A. diltiazem (Cardizem)
B. digoxin (Lanoxin)
C. propranolol (Inderal)
D. metoprolol (Lopressor)
Correct Answer: B. digoxin (Lanoxin)
Digoxin exerts a positive inotropic effect on the heart while slowing the overall rate through a variety of mechanisms. Digoxin is the medication of choice to treat heart failure. Digoxin is beneficial in patients with systolic heart failure, better known as heart failure with reduced ejection fraction (HFrEF), with an ejection fraction below 40%. It is used for rate control in atrial fibrillation or atrial flutter when conventional therapies have not achieved goal heart rate.
Option A: Diltiazem is an oral and parenteral non-dihydropyridine calcium channel blocker. It is used in many clinical scenarios as an antihypertensive, anti-arrhythmic, and as antianginal. Diltiazem is a negative inotrope (decreased force) and negative chronotropic (decreased rate). The combination, along with coronary artery vasodilation, leads to decreased myocardial oxygen demand, decreased heart rate, and reduced blood pressure.
Option C: Propranolol can be used to ameliorate the sympathetic response in angina, tachyarrhythmias, prevention of acute ischemic attacks, migraine prophylaxis, and restless leg syndrome. Propranolol can be used in almost all cases if the desired result is to slow contractility and decrease a patient’s heart rate. It exerts its response by competitively blocking beta-1 and beta-2 adrenergic stimulation in the heart, which is typically induced by epinephrine and norepinephrine.
Option D: Metoprolol (a beta-blocker) has a negative inotropic effect and would worsen the failing heart. Metoprolol is a cardioselective beta-1-adrenergic receptor inhibitor that competitively blocks beta1-receptors with minimal or no effects on beta-2 receptors at oral doses of less than 100 mg in adults. It decreases cardiac output by negative inotropic and chronotropic effects.
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