Posted: November 29th, 2014

Half-life and drug dosing Gayle

Gayle Herbert is 80 years old and has a history of renal insufficiency and congestive failure. She is receiving DIGOXIN, a drug that strengthens the force of the heart’s contraction, for congestive heart failure. The dose of DIGOXIN is to be increased starting today. The half-life of digoxin is 30 to 40 hours.
If the new dose of digoxin were given orally:
• How long would it take for the drug to reach steady state?
• Will the renal insufficiency affect the time to reach steady state?
• What DRUGS will interact with digoxin?
• Will these drugs affect digoxin? Why?

This is a case study. First and foremost, answer the questions. They help you identify what the problem is. You need to consider what are the most likely causes for the current issue (including drug) and understand why this might happen in Gayle. I.e. what predispose this patient to the event/or risk factors?Then consider if you were the nurse prescriber present having to deal with this. Now that you have identified the problem, what are you going to do about it. Again the broad categories are:
Info gathering/identification and prioritisation of the problem(s) – include what other clincial data/signs/symptoms you may need and explain why you want what you want. (i.e. what’s the rationale for the tests that you are wanting – what might it tell you – or what are you suspecting so that the tests you are getting can help you confirm)
Treatment options – i.e. consider what drug/non-drug therapies are available to you, what drug therapies have you considered but deliberately excluded (i.e. still relevant to the case at hand) because they may not be suitable in the context of this patient – so here this is a more generic discussion on drugs and disease (a mini review of the disease/condition you are treating and the treatment options available generically)
Individualised plan – so out of the treatment options, what is the best option for this patient – how do you plan to dose, monitor, etc (i.e. make it specific for your patient at hand)
Monitoring advice – if you had to talk to the patient, what are the things you might want to advise

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