Name: _Digoxin__________________ CLASSIFICATION: Cardiac glycosides, inotropic, antidysrhythmic_____________________________________ GENERIC: digoxin (Rx)____________________________________TRADE:__Toloxin ______________________ ________________ MECHANISM of ACTION: Inhibits the sodium-potassium ATPase pump, which makes more calcium available for contractile proteins, thereby resulting in increased cardiac output (positive inotropic effect); increases force of contractions; decreases heart rate (negative chronotropic effect); decreases AV conduction speed THERAPEUTIC USES: Heart failure, atrial fibrillation SIDE EFFECTS: CNS: Headache, drowsiness, apathy, confusion, disorientation, fatigue, depression, hallucinations DOSAGE & ROUTE: IV, PO. Loading dose, IV route CV: Dysrhythmias, hypotension, bradycardia, AV block • Adult/adolescent/child >10 yr: IV 8-12 mcg/kg, divided into ≥3 doses, with the first EENT: Blurred vision, yellow-green halos, photophobia, diplopia dose equaling one-half the total, give subsequent doses every 6-8 hr. GI: Nausea, vomiting, anorexia, abdominal pain, diarrhea Loading dose, PO (tablets) • Adult/adolescent/child >10 yr: PO Total dosage of 10-15 mcg/kg in 3 divided doses, give one-half the total loading dose initially, then one-fourth the loading dose every 4-8 hr × 2 doses CONTRAINDICATIONS/INTERACTIONS: Hypersensitivity to digoxin, ventricular fibrillation, ventricular tachycardia Precautions: Pregnancy, breastfeeding, geriatric patients, renal disease, acute MI, AV block, severe respiratory disease, hypothyroidism, sinus nodal disease, hypokalemia, carotid sinus syndrome, 2nd- or 3rd-degree heart block, electrolyte disturbances, hypertension, cor pulmonale, Wolff-Parkinson-White syndrome. Increase: toxicity—azole antifungals, macrolides, tetracyclines, ritonavir; monitor for toxicity Increase: hypercalcemia, hypomagnesemia, digoxin toxicity—thiazides, parenteral calcium; monitor electrolytes Increase: hypokalemia, digoxin toxicity—diuretics, amphotericin B, carbenicillin, ticarcillin, corticosteroids Increase: digoxin levels—propantheline, quiNIDine, verapamil, amiodarone, anticholinergics, diltiaZEM, NIFEdipine, indomethacin Increase: bradycardia—β-adrenergic blockers, antidysrhythmics Increase: cardiac dysrhythmia risk—sympathomimetics Decrease: digoxin absorption—antacids, kaolin/pectin, cholestyramine, metoclopramide Decrease: digoxin level—thyroid agents, cholestyramine, colestipol, metoclopramide, aMILoride Drug/Food Decrease: digoxin effect—food, separate by ≥1 hr Decrease: GI absorption—flaxseed, psyllium Name: _Digoxin__________________ NURSING INTERVENTIONS: Assess: • Apical pulse for 1 min CLIENT TEACHING: • Not to stop product abruptly; about all aspects of before giving product; if pulse <60 in adult or <90 in infant, take product; to take exactly as ordered; how to monitor heart rate again in 1 hr; if <60 in adult, call prescriber; note rate, rhythm, • To avoid OTC medications, herbal remedies because many adverse product character; monitor ECG continuously during parenteral loading dose; interactions may occur; not to take antacid within 2 hr of this product monitor I&O, daily weight; check for edema • To notify prescriber of loss of appetite, lower stomach pain, diarrhea, weakness, Electrolytes: potassium, sodium, chloride, magnesium, calcium; renal drowsiness, headache, blurred or yellow vision, rash, depression, toxicity function studies: BUN, creatinine; blood studies: ALT, AST, • About the toxic symptoms of this product; when to notify prescriber bilirubin, Hct, Hgb before initiating treatment and periodically • To maintain a sodium-restricted diet as ordered thereafter; monitor for decrease or increase in potassium Monitor product levels; therapeutic level 0.5-2 ng/mL, draw ≥6-8 hr • To use one brand consistently, to keep in original container after last dose, optimally 12-24 hr after a dose • To notify prescriber if pregnancy is planned or suspected Beers: avoid dosage >0.125 mg/dL in atrial fibrillation, heart failure • To carry ID stating condition treated, products taken in older adults; decreased renal clearance may lead to toxicity • How to take pulse, when to notify prescriber Pregnancy/breastfeeding: no well-controlled studies; use only if clearly needed; excreted in breast milk (small amounts), may breastfeed CLASSIFICATION__________________________________________ GENERIC:_______________________________________TRADE:_____________________________________________ MECHANISM of ACTION: THERAPEUTIC USES: SIDE EFFECTS: DOSAGE & ROUTE: CONTRAINDICATIONS/INTERACTIONS: NURSING INTERVENTIONS: CLIENT TEACHING: