Clinical Medications Worksheets

Generic Name Trade Name Classification Dose Route Time/frequency

digoxin Lanoxin antiarrhythmics, inotropics
Peak Onset Duration
2-8 hr 30-120 min 2-4 days
Why is your patient getting this medication
Treatment of CHF
Mechanism of action and indications
Increases the force of myocardial contraction. Prolongs
refractory period of the AV node. Decreases conduction
through the SA and AV nodes. Digoxin inhibits the Na-K-
ATPase membrane pump, resulting in an increase in
intracellular sodium and calcium concentrations. Increased
intracellular concentrations of calcium may promote activation
of contractile proteins (e.g., actin, myosin). Digoxin also acts
on the electrical activity of the heart, increasing the slope of
phase 4 depolarization, shortening the action potential duration,
and decreasing the maximal diastolic potential.
0.25mg PO Q Sun., Tue., Thurs.
0.125mg PO Q Mon., Wed., Fri., Sat.
Normal dosage range
Digitalizing dose--0.75-1.5 mg given as 50% of the dose initially and
one quarter of the initial dose in each of 2 subsequent doses at 6-12 hr
intervals. Maintenance dose--0.125-0.5 mg/day as tablets or 0.350-0.5
mg/day as gelatin capsules, depending on patient's lean body weight,
renal function, and serum level.
(Geriatric Patients): Daily dosage should not exceed 0.125 mg except
when treating atrial fibrillation.
Digoxin has a narrow therapeutic range (0.5-2 ng/ml). Have second
practitioner independently check original order and dose calculations.
Monitor therapeutic drug levels.
For IV meds, compatibility with IV drips and/or solutions
N/A
Nursing Implications (what to focus on)
Contraindications/warnings/interactions
Hypersensitivity, uncontrolled ventricular arrhythmias, AV block,
Idiopathic hypertophic subaortic stenosis, constrictive pericarditis. Use
cautiously in: electrolyte abnormalities (hypokalemia, hypercalcemia,
and hypomagnesemia may predispose toxicity), hypothyroidism,
geriatric patients (very sensitive to toxic effects, dose adjustments
required for age-related decrease in renal function and body weight),
MI, renal impairment, obesity (dose should be based on ideal body
weight).
Common side effects
Fatigue, ARRYTHMIAS, bradycardia, anorexia, nausea, vomiting.

Lanoxin (digoxin)
Interactions with other patient drugs, OTC or herbal Lab value alterations caused by medicine
medicines (ask patient specifically) Evaluate serum electrolyte levels (especially potassium, magnesium,
Demadex: Although diuretics and digitalis glycosides are and calcium) and renal and hepatic functions periodically during
frequently and appropriately used together, diuretic-induced therapy. Notify physician or other health care professional before
hypokalemia and hypomagnesemia may predispose patients on giving dose if patient is hypokalemic. Hypokalemia, hypomagnesemia,
digitalis to arrhythmias. or hypercalcemia may make the patient more susceptible to digitalis
Fludrocortisone, hydrocortisone: Systemically administered toxicity. Older adults may be toxic even when serum concentrations
corticosteroids may induce hypokalemia and possibly increase are within normal range; assess for clinical symptoms of toxicity even
the risk of digoxin toxicity. In addition, corticosteroid-induced when serum levels are normal.
sodium and water retention can result in edema leading to heart Be sure to teach the patient the following about this medication
failure. These effects may be more common with the natural Instruct patient to take medication as directed, at the same time each
corticosteroids (cortisone, hydrocortisone) which have greater day. Missed doses should be taken within 12 hr of scheduled dose or
mineralocorticoid activity. not taken at all. Do not double doses. Consult health care professional
Synthroid: The clearance of or sensitivity to digitalis if doses for 2 or more days are missed. Do not discontinue medication
glycosides may be increased in previously hypothyroid patients without consulting health care professional. Teach patient to take pulse
when a euthyroid state is achieved after the addition of thyroid and to contact health care professional before taking medication if
hormones. pulse rate is <60 or >100. Review signs and symptoms of digitalis
Coreg: Concomitant use of digitalis glycosides and beta- toxicity with patient and family. Advise patient to notify health care
blockers including carvedilol may increase the risk of professional immediately if these or symptoms of CHF occur. Inform
bradycardia. These agents slow atrioventricular conduction and patient that these symptoms may be mistaken for those of colds or flu.
decrease heart rate, hence they may have additive cardiac Instruct patient to keep digoxin tablets in their original container and
effects during coadministration. Pharmacokinetically, not to mix in pill boxes with other medications; they may look similar
carvedilol has been shown to modestly increase the systemic to and may be mistaken for other medications. Advise patient that
bioavailability of digoxin. The mechanism may involve sharing of this medication can be dangerous. Caution patient to avoid
enhanced absorption as well as reduced renal excretion of concurrent use of OTC and herbal products without consulting health
digoxin due to inhibition of intestinal and renal P-glycoprotein care professional. Advise patient to avoid taking antacids or
efflux transporter by carvedilol. antidiarrheals within 2 hr of digoxin. Advise patient to notify health
ASA: Nonsteroidal anti-inflammatory drugs (NSAIDs) may care professional of this medication regimen before treatment. Patients
increase plasma digoxin concentrations and half-life. The exact taking digoxin should carry identification describing disease process
mechanism is unknown, but may be related to reduced renal and medication regimen at all times. Review fall prevention strategies
clearance of digoxin. Data have been conflicting. The with older adults and their families. Emphasize the importance of
interaction has been reported with indomethacin and ibuprofen, routine follow-up exams to determine effectiveness and to monitor for
but data for other NSAIDs are not available. toxicity.
Reglan: Digoxin serum concentrations may be reduced during
concomitant therapy with metoclopramide. The proposed
mechanism is metoclopramide-induced stimulation of gastric
motility, which may decrease digoxin absorption. Rapidly
dissolving preparations such as digoxin solution in capsules do
not appear to be affected. Patients should be advised to notify
their physicians if they experience worsening of their heart
symptoms.
Proventil, Xopenex: Administration of a single oral dose of
albuterol has resulted in a 22% decrease in serum digoxin
levels and a 14% decrease in serum potassium. The mechanism
is unknown. Serum digoxin levels and clinical response should
be monitored during concurrent administration with albuterol.
Dosages should be adjusted as necessary.
Protonix: Proton pump inhibitors may increase the
bioavailability of digoxin. The proposed mechanism is a pH-
dependent increase in gastrointestinal absorption of digoxin.
The clinical significance of this effect is unknown. In patients
treated with proton pump inhibitors, the possibility of an
enhanced pharmacologic response to digoxin should be
considered. Patients should be closely monitored for
development of toxicity, particularly those with digoxin levels
in the upper range of normal. Patients should be be advised to
notify their physician if they experience nausea, anorexia,
Lanoxin (digoxin)
Nursing Process- Assessment
(Pre-administration assessment)
Monitor apical pulse for 1 full min before
administering. Monitor intake and output ratios
and daily weights. Assess for peripheral edema,
and auscultate lungs for rales/crackles throughout
therapy. Before administering initial loading dose,
determine whether patient has taken any digitalis
preparations in the preceding 2-3 wk. Digoxin use
has been associated with an increased risk of falls
in the elderly. Assess for falls risk and implement
prevention strategies per facility protocol.
Lanoxin (digoxin)
Assessment Evaluation
Why would you hold or not give this med? Check after giving
S/S of toxicity: abdominal pain, anorexia, Decrease in severity of CHF.
nausea, vomiting, visual disturbances, Increase in cardiac output.
bradycardia, and other arrhythmias. Pulse rate
is <60 bpm.
Withhold drug and notify physician or health
care professional immediately.