DIGOXIN 1. Name & class of drug – generic and trade name.

GENERIC NAME: Digoxin BRAND NAME: Lanoxicaps, Lanoxin CLASSIFICATION: CV agent, cardiac glysoside, antiarrhythmic 2. Dose range and routes for adult & geriatric client. PREPARATIONS: PO/IV – (0.05, 0.1, 0.2) mg capsules, (0.125, 0.25, 0.5) mg tablets, 0.05 mg/ml elixir, (0.25, 0.1) mg/ml injection DOSING: Digitalizing dose – (PO) - 10 – 15 mcg/kg (1 mg) in divided doses over 24 – 48 h (IV) - 10 – 15 mcg/kg (1 mg) in divided doses over 24 h Maintenance dose - (PO/IV) 0.1 – 0.375 mg/d 3. Purpose prescribed. Underline reason your client is prescribed drug. THERAPEUTIC EFFECTS: increases the contractility of the heart muscle (positive inotropic effect) USES: rapid digitalization and for maintenance therapy in CHF, atrial fibrillation, atrial flutter, paroxysmal atrial tachycardia 4. Major side effects & drug interactions. DRUG INTERACTIONS: antacids, cholestyramine, colestipol decrease digoxin absorption; diuretics, corticosteroids, amphotericin B, laxatives, sodium polystyrene sulfonate may cause hypokalemia, increasing the risk of digoxin toxicity; camcium IV may increase risk of arrhythmias if administered together with digoxin; quinidine, verapamil, amiodarone, flecainide significantly increase digoxin levels, and digoxin dose should be decrease by 50%; erythromycin may increase digoxin levels; succinycholine may potentiate arrhythmogenic effects, nefazodone may increase digoxin levels HERBAL INTERACTIONS: Ginseng increase digoxin toxicity; ma-huang, ephedra may induce arrhythmias

SIDE EFFECTS: nausea, fatigue, muscle weakness, headache, facial neuralgia, mental depression, hallucinations, confusion, drowsiness, agitation, arrhythmias, hypotension

5. Nursing Implications & teaching. IMPLICATIONS: • Be familiar with pt’s baseline data as a foundation for making assessments • Baseline lab tests, draw blood samples for determining plasma digoxin levels at least 6h after daily dose preferably just before next scheduled daily dose. Therapeutic range of serum digoxin is 0.8 – 2 ng/ml, toxic levels are > 2ng/ml • Take apical pulse for 1 full min noting rate, rhythm, and quality before administering. If changes are noted, withhold digoxin. • Withhold med if pulse falls below ordered parameters • Monitor for S&S of drug toxicity • Monitor I&O ratio during digitalization, particularly in pts with impaired renal function. Monitor for edema daily and auscultate chest for rales • Monitor serum digoxin levels closely during concurrent antibiotic-digoxin therapy, which can precipitate toxicity because of altered intestinal flora • Observe pts closely when being transferred from one prep to another; when table is replaced by elixir, potential for toxicity increases since >=30% of drug is absorbed TEACHING: • Report to Dr if pulse falls below 60 or rises above 110 or if you detect skipped beats or other changes in rhythm • Report to Dr if there is anorexia, N/V, diarrhea, or visual disturbances • Weigh each day, report weight gain >1kg d • Take precisely as prescribed, do not skip or double a dose or change dose intervals, and take at same time each day • Do not take OTC meds especially those for coughs, colds, allergy, without prior approval of Dr • Continue with brand originally prescribed unless directed by physician