Coreg, dig, bradycardia

  1. Home pt: on coreg BID, digoxin daily. pulse ranging 42 resting-46 walking after taking both meds. Advised pt to check pulse regularly before meds, and if under 60 to hold and call cardiologist immediately.

    After a week pt stated, he was taking am dig (pulse over 60) then 1 hour later not taking am coreg b/c pulse was 55-58. Although he was taking pm dose of coreg (pulse over 60).

    Should pt take both am dose of dig & coreg if pulse is 60 or over? or should he be separating his morning dose by 1 hour or two? (Ex: 7am dig; then 9am ck pulse & if 60 take coreg?)

    I will be contacting his dr. shortly.
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    About jbhetman

    Joined: Jul '13; Posts: 2


  3. by   classicdame
    that is probably a doctor question.
  4. by   psu_213
    Quote from classicdame
    that is probably a doctor question.
    Just for clarity: is this a hospitalized pt who takes both dig and coreg at home?

    Perhaps the pt takes his pulse in the AM and takes both at the same time at home. Now, for whatever reason, the med times has been separated by the hospital so that it appears you have the give the dig, recheck pulse in a hour and then do the coreg. (This is just theory.)

    Whatever the case, as the doctor--see if he wants both and once or he wants you to continue doing it as above.
  5. by   VANurse2010
    What's the BP? Is the patient mentating alright? Symptomatic? A pulse in the 40s, while probably too low, is not per se a reason to DC a medication. Sounds like the doctor will be tinkering with dosages.
  6. by   Biffbradford
    Bingo. What's the blood pressure? (which is what the doc will ask)
  7. by   MunoRN
    The standard titration guidelines for coreg is to titrate to a HR of 55+, so he should still take it at 58 bpm.

    Typically, coreg is the first line med, so if the patient is only taking one, it should be the coreg, not the dig. In general though, if the patient is tolerating this OK it's better that he be on it than off, but these are all better answered by the Doc.
  8. by   Anna Flaxis
    I would want to know how long the patient has been taking these, and why the patient is taking them.
  9. by   Esme12
    There are many reasons for different heart really need to check with the patients PCP or cardiologist. As per the Terms of Service....we cannot give medical advice.

    Thread closed.
  10. by   surferbettycrocker
    would wonder if the doctor wants to check blood levelsof digoxin? sounds like you work as a VNA unlessyou are a lurker wanting medical advice
    Last edit by surferbettycrocker on Jul 23, '13 : Reason: .