Digoxin should not be administered if heart rate?

Question

Question

This question was previously asked in

SGPGI Staff Nurse Official Paper (Held On: 28 Feb, 2024 Shift 1)

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Answer 1

Correct Answer: Less than 60 bpm

Rationale:

Digoxin is a cardiac glycoside used to manage certain heart conditions such as atrial fibrillation, atrial flutter, and heart failure. It works by increasing the force of cardiac contractions (positive inotropic effect) and slowing the heart rate (negative chronotropic effect).
Before administering digoxin, it is crucial to assess the patient's heart rate, as the drug can further slow the heart rate and potentially cause bradycardia. The standard guideline is that digoxin should not be administered if the heart rate is less than 60 beats per minute (bpm) in adults. This is to prevent the risk of bradycardia, which can lead to complications like dizziness, fainting, or cardiac arrest.
Healthcare providers are advised to manually check the apical pulse for one full minute before administering digoxin. If the pulse is less than 60 bpm, the medication should be withheld, and the healthcare provider should be notified.
It is also important to monitor serum digoxin levels to avoid toxicity, as digoxin has a narrow therapeutic index. Symptoms of toxicity include nausea, vomiting, visual disturbances, and arrhythmias.

Explanation of Other Options:

More than 60 bpm

Rationale: Administering digoxin when the heart rate is more than 60 bpm is typically safe, provided there are no other contraindications. However, this is not a condition where digoxin administration should be withheld. The correct threshold for withholding digoxin is a heart rate less than 60 bpm.

Less than 80 bpm

Rationale: While a heart rate less than 80 bpm may seem low, it is still within the normal range for many adults, especially for those who are physically fit or taking medications that lower heart rate. Withholding digoxin for a heart rate less than 80 bpm would be overly cautious and is not supported by clinical guidelines.

More than 80 bpm

Rationale: A heart rate more than 80 bpm does not pose a contraindication for digoxin administration. In fact, digoxin may be prescribed to reduce an elevated heart rate in conditions such as atrial fibrillation. This option is incorrect as it does not align with the recommendation to withhold digoxin if the heart rate is less than 60 bpm.

Conclusion:

Digoxin should not be administered if the heart rate is less than 60 bpm, as this poses a risk of exacerbating bradycardia. Proper assessment of the apical pulse and monitoring for signs of digoxin toxicity are essential for safe administration of the medication.