Description of Cardiac Glycosides – PST04211 Basic Pharmacology

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NTA Level 4 • Semester 2 • PST04211

Description of Cardiac Glycosides

Basic Pharmacology • Source Session/Topic 30
Full source-text version: all educational wording from the extracted learning source is retained; only presenter/tutor metadata and web-layout noise are removed, while formatting is improved for readability.

Session 30: Description of Cardiac Glycosides

Total Session Time: 60 minutes

Prerequisites

• None

Learning Tasks

By the end of this session students are expected to be able to:

• List indications of cardiac glycosides
• List Contraindication of cardiac glycosides
• Describe dose, dosage and course of cardiac glycosides
• List side effects and adverse effects of cardiac glycosides
• Describe interaction and precaution of cardiac glycosides

Resources Needed:

• Flip charts, marker pens, and masking tape
• Black/white board and chalk/whiteboard markers
• Overhead projector and computer

SESSION OVERVIEW

Activity/

Step Time Content

Method

1 05 minutes Presentation Introduction, Learning tasks

Presentation/

2 05 minutes Indications of Cardiac Glycosides

Buzzing

Presentation/

3 10 minutes Contraindications of Cardiac Glycosides

Brainstorming

Dose, Dosage and Course of Cardiac

4 10 minutes Presentation

Glycosides

Presentation/ Side Effects and Adverse Effects of Cardiac

5 10 minutes

Brainstorming Glycosides

Interactions and Precautions of Cardiac

6 10 minutes Presentation

Glycosides

7 05 minutes Presentation Key Points

8 05 minutes Presentation Evaluation

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SESSION CONTENTS

STEP 1: Presentation of Session Title and Learning tasks (5 minutes)

READ or ASK students to read the learning tasks and clarify

ASK students if they have any questions before continuing.

STEP 2: Indications of Cardiac Glycosides (5minutes)

Activity: Buzzing (5 minutes)

ASK students to pair up and buzz on the following question for 2 minutes

• list glycosides that are used in clinical practice
• What are indications of cardiac glycoside drugs?

ALLOW few pairs to respond and let other pairs to add on points not mentioned

WRITE their response on the flip chart/board

CLARIFY and SUMMARIZE by using the content below

• The common cardiac glycosides drugs are digoxin and digitoxin
• Cardiac glycosides are also called cardiotonics or digitalis glycosides
• Cardiac glycosides are indicated in patients with:

o Heart failure

o Atrial fibrillation

o Dilated heart cardiomyopathies

• Digoxin is the commonly used cardiac glycosides
• Digoxin is used for acute and chronic conditions while digitoxin is used for maintenance

PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide

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STEP 3: Contraindications of Cardiac Glycosides (10 minutes)

Activity: Brainstorming (5 minutes)

Ask students to brainstorm on the following question:

What are contraindications of cardiac glycosides?

ALLOW few students to respond

WRITE their responses on the flip chart/ board

CLARIFY and SUMMARISE by using the content below

• Cardiac glycosides are contraindicated in patients with :

o Known hypersensitivity

o Ventricular failure

o Ventricular tachycardia

o Digitalis toxicity

STEP 4: Dose, Dosage and Course of Cardiac Glycosides (15 minutes)

• When symptoms are mild, slow loading (digitalization) with 0.125-0.25 mg per day is
safer than and just as effective as the rapid method 0.5-0.75 mg every 8 hours for 3 doses,
followed by 0.125-0.25 mg per day
• It is usually given only if diuretics and ACE inhibitors have failed to control symptoms
• Digoxin is rapidly absorbed after oral administration
• Cardiac glycosides are widely distributed to tissues, including the CNS

STEP 5: Side Effects and Adverse Effects of Cardiac Glycosides (10

minutes)

Activity: Brainstorming (5 minutes)

Ask students to brainstorm on the following question:

What are the side effects and adverse effects of cardiac glycosides?

ALLOW few students to respond

WRITE their responses on the flip chart/ board

CLARIFY and SUMMARISE by using the content below

PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide

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• The major signs of digitalis toxicity are arrhythmias, nausea, vomiting, and diarrhea
• This toxicity may be partially caused by direct effects on the gastrointestinal tract but is

also the result of central nervous system actions

• Central nervous system effects include disorientation and hallucinations especially in the

elderly and visual disturbances are noted

• Gynecomastia is a rare effect reported in men taking digitalis

STEP 6: Interactions and Precautions of Cardiac Glycosides Drug (15

minutes)

Precaution

• Caution should be taken when giving cardiac glycosides to patient with:

o Electrolyte imbalance(especially hypokalaemia and hypomagnesemia)

o Severe carditis

o Heart block

o Acute glomerulonephritis

o Pregnancy

Interaction

• Cardiac glycosides react with different drugs
• Drugs that increases the plasma level of digitalis are:

o Benzodiazepines

o Nifedipine

o Captopril

o Verapamil

• Drugs that Decreases the Plasma Level of Cardiac Glycosides

o Antihistamine

o Barbiturates

o Thyroid hormones

PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide

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Step 7: Key Points (5minutes)

• Cardiac glycosides are indicated in patients with:

o Heart failure

o Atrial fibrillation

o Dilated heart cardiomyopathies

• Cardiac glycosides are contraindicated in patients with :

o Known hypersensitivity

o Ventricular failure

o Ventricular tachycardia

o Digitalis toxicity

• Loading (digitalization) with 0.125-0.25 mg per day is safer than and just as effective as
the rapid method 0.5-0.75 mg every 8 hours for 3 doses, followed by 0.125-0.25 mg per

day

• The major signs of digitalis toxicity are arrhythmias, nausea, vomiting, and diarrhea
• Caution should be taken to patient with electrolyte imbalance

STEP 8: Evaluation (5minutes)

• What glycosides are used in clinical practice?
• What are indications of cardiac glycosides drugs?
• What are the contraindications of cardiac glycosides drugs?
• What are the dose, dosage and course of cardiac glycosides drugs?
• What are the side effects and adverse effects of cardiac glycosides drugs?
• What are the interaction and precaution of cardiac glycosides drug?

PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide

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References

Ministry Of Health and Social Welfare. (2013). Standard Treatment Guidelines &

National Essential Medicines List Tanzania Mainland (4th ed.). Dar es salaam,

Tanzania government printers.

Robert, L. T., Gary, C.Y., Gary, R.M, Barbara, G.W., Michael, L. (2014).

Pharmacotherapy: A Pathophysiologic Approach (9th ed.). New York,

McGraw-Hill Education.

Sally S.R, & Jeanne C.S. (2000). Introductory Clinical Pharmacology (6th ed)

New York, Lippincott Williams and Wilkins.

School of Pharmaceutical sciences. (2011). Tanzania Pharmaceutical Handbook

(2nd ed.). Dar es Salaam, ARDHI University press.

The Royal Pharmaceutical Society of Great Britain. (2007). Martindale: The

Extra Pharmacopoeia (5TH ed). London, pharmaceutical press.

PST 04211 Basic Pharmacology NTA Level 4 Semester 2 Facilitator Guide

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