A patient in heart failure shows a decrease in the glomerular filtration rate. The patient has been taking digoxin (Lanoxin) and hydrochlorothiazide (HydroDIURIL)
Considering the change in the patient's status, what change in the medication regimen would the nurse anticipate? a. A change from hydrochlorothiazide (HydroDIURIL) to furosemide (Lasix)
b. A change from hydrochlorothiazide (HydroDIURIL) to spironolactone (Aldac-tone)
c. A change from hydrochlorothiazide (HydroDIURIL) to mannitol (Osmitrol)
d. A change from digoxin (Lanoxin) to verapamil (Calan)
A
The decrease in the GFR indicates the need for a stronger diuretic to help pull volume off the patient. Furosemide is the drug of choice for diuresis. Loop diuretics are preferred to thiazides when cardiac output is greatly reduced and renal insufficiency is a factor.
Spironolactone is not as strong a diuretic as furosemide and would not facilitate the GFR as well.
Mannitol is indicated for brain injury and hydrocephalus.
Nothing indicates that digoxin should be changed to verapamil; the issue in this scenario is the low GFR and the fact that thiazide diuretics are not effective in patients with renal dysfunction.
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