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Case Study: Grace Markham is a 63 year old widow who lives alone. She has a history of rheumatic heart disease manifested by moderate mitral valve...
Case Study:
Grace Markham is a 63 year old widow who lives alone. She has a history of rheumatic heart disease manifested by moderate mitral valve stenosis with slight mitral insufficiency. She has been maintained on digoxin, 0.25 mg PO daily, for several years, with few adverse effects. Compliance with therapy has generally been excellent. She understands the drug therapy and her 3-g sodium diet.
She was admitted to the hospital complaining of dyspnea on exertion, ankle edema, mild chest pain on exertion, and fatigue. The ECG showed no signs of infraction but showed atrial fibrillation, with ventricular response of 124 beats/min. Her serum digoxin level was 0.9 ng/mL. a repeat cardiac catherization showed no changes in the mitral valve but did indicate some early coronary artery narrowing. While she was in the hospital, the following medications were ordered for Ms Markham:
Digoxin 0.25 mg PO daily
Lasix 20mg PO twice daily
K-Dur 20mEq PO daily
verapamil SR, 240 mg PO daily
Isordil, 10 mg PO three times daily
- Describe the relationship among digoxin,lasix, and k-dur in the management of Mrs. Markhams symptoms?
