1.

Lanoxin
Mode of Action
It works by affecting certain minerals (sodium and potassium) inside heart cells. This reduces strain on the
heart and helps it maintain a normal, steady, and strong heartbeat.
Uses/Indications
LANOXIN is indicated for the treatment of mild to moderate heart failure. LANOXIN increases left
ventricular ejection fraction and improves heart failure symptoms as evidenced by exercise capacity
and heart failure-related hospitalizations and emergency care, while having no effect on mortality.
Common Side Effect
 Nausea or vomiting
 headache
 dizziness
 loss of appetite
 diarrhea 

Usual Dosage

Table 1. Recommended LANOXIN Injection Loading Dose

mcg = microgram
Age Total IV Loading Dose (mcg/kg)
Administer half the total loading dose initially,
then ¼ the loading dose every 6-8 hours twice
Premature 15-25
Full-Term 20-30
1-24 Months 30-50
2-5 Years 25-35
5-10 Years 15-30
Adults and pediatric patients over 10 years 8-12

Maintenance Dosing in Adults and Pediatric Patients Over 10 Years Old

The maintenance dose is based on lean body weight, renal function, age, and concomitant products [see
Clinical Pharmacology (12.3)].

The recommended starting maintenance doses in adults and pediatric patients over 10 years old with
normal renal function are given in Table 2. Doses may be increased every 2 weeks according to clinical
response, serum drug levels, and toxicity.

Table 2. Recommended Starting LANOXIN Injection Maintenance Dosage in Adults and

Pediatric Patients Over 10 Years Old

mcg = microgram
Age Total Intravenous Maintenance Dose,
 mcg/kg/day
(given once daily)
Adults and pediatric patients over 10 years 2.4-3.6

 Creatinine Clearance (mL/min)  Dose

 10–25  0.125 mg/day

 26–49  0.1875 mg/day

 50–79  0.25 mg/day

ASSESSMENT

 Monitor apical pulse for 1 full min before administering. Withhold dose and notify health care
professional if pulse rate is <60 bpm in an adult, <70 bpm in a child, or <90 bpm in an infant. Notify
health care professional promptly of any significant changes in rate, rhythm, or quality of pulse.
 Pedi:  Heart rate varies in children depending on age, ask health care professional to specify at what
heart rates digoxin should be withheld.
 Monitor BP periodically in patients receiving IV digoxin.
 Monitor ECG during IV administration and 6 hr after each dose. Notify health care professional if
bradycardia or new arrhythmias occur.
 Observe IV site for redness or infiltration; extravasation can lead to tissue irritation and sloughing.
 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 digoxin in the
preceding 2–3 wk.
DIAGNOSIS
 Tissue Perfusion, Ineffective, related to impaired cardiac status
 Decreased Cardiac Output
 Excess Fluid Volume
 Knowledge Deficit related to drug therapy
PLANNING
The client will:
 Report decreased symptoms of cardiac decompensation related to fluid overload.
 Exhibit evidence of improved organ perfusion, including kidney, heart, and brain. Demonstrate an
understanding of the drug’s action by accurately describing drug side effects and precautions.
 Immediately report side effects such as nausea, vomiting, diarrhea, heart rate below 60 beats per
minute, and vision changes.
INTERVENTION
 Monitor ECG for rate and rhythm changes during initial digitalization therapy. (Digoxin has a strong
positive inotropic effect.)
  Observe for side effects such as nausea, vomiting, diarrhea, anorexia, shortness of breath, vision
changes, and leg muscle cramps. (These are signs of toxicity.)
 Weigh client daily. (Weight gain could indicate worsening of heart failure.)
 Administer precise ordered dose at same time each day. (Overdose may cause serious toxicity.) Monitor
serum drug level and report level greater than 1.8 ng/ml. (Serum drug levels help determine therapeutic
concentration and toxicity.)
 Monitor levels of potassium, magnesium, calcium, BUN, and creatinine. (Hypokalemia predisposes the
client to digoxin toxicity.)
 Monitor for signs and symptoms of digoxin toxicity. (Early assessment may help prevent severe
toxicity.)
EVALUATION
 Decrease in severity of HF.
 Increase in cardiac output.
 Decrease in ventricular response in atrial tachyarrhythmias.
 Termination of paroxysmal atrial tachycardia.

2. Digitoxin
Mode of Action
Digitoxin 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).
Uses/Indications
 Congestive heart failure, atrial fibrillation, atrial flutter. Paroxysmal atrial tachycardia (PAT)
Cardiogenic shock.
 Digitoxin is used for chronic cardiac insufficiency, tachyarrhythmia form of atrial fibrillation,
paroxysmal ciliary arrhythmia, and paroxysmal supraventricular tachycardia.
Common Side Effect

 Nausea
 vomiting
 anorexia
 diarrhoea
 abdominal pain
 headache
 facial pain
 fatigue
 weakness
 dizziness
 drowsiness
 disorientation
 mental confusion
 bad dreams
 delirium
 acute psychoses
 hallucinations
 convulsions
  blurred vision
 color vision may be affected
 gynecomastia
 vasoconstriction
 and transient hypotension (rapid IV inj)
 local irritation (SC/IM)
 hypersensitivity reactions
 thrombocytopenia.
Potentially Fatal: Heart failure, supraventricular or ventricular arrhythmias, conduction
defects.

Usual Dosage

Administered orally (tablet)

Adult: Loading dose PO (rapid) 0.6mg, followed by 0.4mg, then 0.2mg at every 4-6 hour intervals; (slow)
0.2mg 2 times daily for 4 days; maintenance dose PO 0.05-0.3mg daily.  Dosage reduction not needed in
renal function impairment

Child: Loading dose PO <1 year 0.045 mg/kg, 1-2 years 0.04 mg/kg, >2 years 0.03 mg/kg divided into 3, 4,
or more portions with >6 hours between doses; maintenance dose PO 1/10 loading dose

ASSESSMENT

Monitor apical pulse for 1 full min before administering. Pedi: Heart rate varies in children depending on
age, ask health care professional to specify at what heart rates digoxin should be withheld. Monitor BP
periodically in patients

DIAGNOSIS

 Risk for Decreased Cardiac Output

PLANNING

 Maintain/achieve adequate cardiac output as evidenced by BP/pulse within normal range, adequate
urinary output, palpable pulses of equal quality, usual level of mentation.
 Display reduced frequency/absence of dysrhythmia(s).
 Participate in activities that reduce myocardial workload.
INTERVENTION

 Palpate pulses (radial, carotid, femoral, dorsalis pedis), noting rate, regularity, amplitude
(full or thready), and symmetry. Document presence of pulsus alternans, bigeminal pulse,
or pulse deficit.
 Auscultate heart sounds, noting rate, rhythm, presence of extra heartbeats, dropped beats.
 Monitor vital signs. Assess adequacy of cardiac output and tissue perfusion, noting
significant variations in BP/pulse rate equality, respirations, changes in skin color,
temperature, level of consciousness, sensorium, and urine output during episodes of
dysrhythmias.
 Determine type of dysrhythmia and document with rhythm strip (if cardiac/telemetry
monitoring is available):
 Provide quiet and calm environment. Review reasons for limitation of activities during
acute phase.
 Demonstrate and encourage use of stress management behaviors,: relaxation techniques,
guided imagery, slow/deep breathing.
 Demonstrate and encourage use of stress management behaviors,: relaxation techniques,
guided imagery, slow/deep breathing.
 Be prepared to initiate cardio-pulmonary resuscitation (CPR) as indicated.
 Monitor laboratory studies:
 Administer supplemental oxygen as indicated.

EVALUATION
Evaluate the effectiveness of drug therapy by confirming that the patient goals and expected outcomes
have been me