Question

Are there any medications you would decline to administer and discuss your reasons with the prescribing provider?

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She is to be discharged on the same medications that were administered in the office. What teaching needs to be done (include side effects) and what should be monitored?

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There is a black box warning on Atenolol, summarize what it is in 2-3 sentences.

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Answer 1

Digoxin is one drug I would decline to administer when the heart rate is lesser than 60 beats per minute in an adult and document it in the nurses record, and also inform the doctor.

The reason is that digoxin is a drug that is used in the treatment of heart failure, atrial fibrillation and atrial flutter and paroxysmal atrial tachycardia. The side effects include arrythmias,bradycardia and heart block. So before administering Digoxin it is very important to check the heart rate and hold the dose if the Heart rate is below 60 beats per minute in an adult.

When a patient is discharged home on Digoxin the following teaching should be given.

1. The patient is to be instructed to take medication at the same time each day.

2. They should be asked to check the pulse and if less than 60 beats per minute, should contact health care professional.

3. For elderly patients risk for fall should be assessed and instructions given to prevent falls.

4. Tell patient that this medicine is not to be shared.

5. Medicine should be kept in original container.

6. Instruct patient if receivingany other treatment to tell the healthcare professional that she is on digoxin.

7. Carry a card that has the heart condition details and that she is on digoxin.

The following side effects should be included in the teaching:

The common side effects are

Head ache,fatigue,weakness,blurred vision,nausea ,diarrhea,vomiting,skin rash,mental changes.

Serious side effects include:

Heart block,bradycardia,arrythmias.

The pulse rate should be monitored before taking the dose of digoxin.

ATENOLOL Black box warning

Black box warning is given by the Food and Drug Administration(FDA) regarding a drug.These are serious warnings to alert the doctor and the patient that if that drug is stopped abrubtly there can be serious effects. One such drug is Atenolol.If stopped abruptly it can cause severe chest pain and jump in blood pressure.It should be gradually stopped after consulting with healthcare professional.