Apical pulse 61; gave metoprolol and held Digoxin

knotizer12 said:

I have a resident who gets, among other things, scheduled digoxin and metoprolol during his 0800 med pass. Both meds have a parameter on them to hold if AP is less than 60. His Apical was 61; I gave his metoprolol and held his digoxin.

My rationale is that both drugs slow the HR. This resident has higher than average blood pressure usually so I gave his metoprolol because it would lower his blood pressure.

I'm always open to learning how (and if) I screwed up, so what do y'all think?

I'll typically give one, then go recheck in an hour and decide on the other.

Digoxin has a long half life, up to 2 days, so once they reach a steady state metabolism there won't be much if any of a peak in effect. Each dose just continues the HR lowering effect that you are seeing when checking before giving a dose, it doesn't really increase the HR lowering effect any.

The same basic premise goes for the metoprolol, if this is their first dose of both medications then it may be worth giving one then rechecking relevant vitals, but if it's just a continuing dose of metoprolol that they've already been on, then you don't need to assume it will further drop the HR significantly since you are already seeing the effect of metoprolol on their HR from their previous dose.