Drug of Choice in heart failure?

Appeared in: AIIMS Delhi NO - 2017

Explanation

Digoxin is a cardiac glycoside, a class of drugs used to treat heart conditions.
It exerts a positive inotropic effect, which means it increases the force and velocity of myocardial contraction, helping the weakened heart pump more efficiently.
While no longer a first-line drug for all heart failure cases, it is a valid treatment and the only appropriate option listed, often used as an adjunct therapy for symptomatic control, especially in patients with atrial fibrillation.

Option B: ADR is an abbreviation for 'Adverse Drug Reaction'. It is a term used in pharmacology to describe unintended harmful effects of a drug, not a medication itself.
Option C: NORAD (Noradrenaline/Norepinephrine) is a potent vasopressor used to treat severe hypotension, typically in the context of shock (e.g., septic shock). Its strong vasoconstrictive effects would increase the afterload on an already failing heart, which is generally undesirable in chronic heart failure management.
Option D: KCL (Potassium Chloride) is an electrolyte supplement. It is used to treat or prevent hypokalemia (low potassium levels), not to treat heart failure directly.

Clinical Relevance

Nursing practice connection: Knowing Pharmacological management of heart failure helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
A key nursing responsibility before administering Digoxin is to check the patient's apical pulse for one full minute. The medication should be held and the provider notified if the pulse is below 60 bpm for an adult.
Nurses must educate patients on the signs of digoxin toxicity (anorexia, nausea, vomiting, visual changes, bradycardia) and the importance of reporting them immediately.
What if? If a patient on Digoxin has a lab result showing low potassium (hypokalemia), the nurse's priority action is to hold the Digoxin dose and notify the healthcare provider. Hypokalemia significantly increases the risk of life-threatening arrhythmias from digoxin toxicity.

How to Approach the Question

First, identify the core condition presented in the question, which is 'heart failure'.
Next, evaluate each option to determine its pharmacological class and primary clinical use.
Eliminate 'ADR' as it is an acronym for a concept (Adverse Drug Reaction), not a drug.
Analyze the remaining drug options. 'NORAD' is for shock, and 'KCL' is for electrolyte replacement. Neither is a primary treatment for heart failure itself.
This leaves 'Digoxin', a known cardiac glycoside used to improve contractility in heart failure. Therefore, it is the correct answer among the choices provided.

Concept Tested & Keywords

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E6 Pharmacology Nursing Lilley 11e Part 2 p. 73-75

E6 Pharmacology KD Tripathi Essentials 9e Part 2 pp. 191-193, 192-194

Practise the full AIIMS Delhi NO - 2017

Attempt every question from this paper in a timed mock, then review the full solution for each one.