Toxicity from which of the following medications may cause a client to see a green-yellow halo around lights?
A. digoxin (Lanoxin)
B. furosemide (Lasix)
C. metoprolol (Lopressor)
D. enalapril (Vasotec)
Correct Answer: A. digoxin (Lanoxin)
One of the most common signs of digoxin toxicity is the visual disturbance known as the “green-yellow halo sign.” Digoxin’s therapeutic half-life is between 30 to 40 hours, but this may change in overdose. Digoxin excretion is primarily renal, and for this reason, patients with poor or worsening renal function, such as patients who are elderly or have CKD, are more likely to develop toxicity. The other medications aren’t associated with such an effect.
Option B: Toxicity with furosemide manifests as extensions of its diuretic activity. Signs and symptoms of overdose or toxicity include dehydration, reduced blood volume, and electrolyte imbalances. Risk of hypokalemia increases with the use of a high dose of furosemide, decreased oral intake of potassium, in patients with hyperaldosteronism states (liver abnormalities or licorice ingestion) or concomitant use of corticosteroid, ACTH, and laxatives.
Option C: The primary adverse effects of metoprolol include heart failure exacerbation, fatigue, depression, bradycardia or heart block, hypotension, bronchospasm, cold extremities, dizziness, decreased libido, diarrhea, tinnitus, decreased exercise tolerance, glucose intolerance, and may mask hypoglycemia.
Option D: The side effect most commonly encountered with the use of ACE inhibitors is cough. The cough is characteristically non-productive and stops with the discontinuation of the drug. Other adverse effects of enalapril are hypotension, hyperkalemia, angioedema, cholestatic jaundice, and hypersensitivity reaction. Vasodilation caused by enalapril to reduce the afterload of heart and decrease the total peripheral resistance is also responsible for hypotension.
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