Mindanao State University – Iligan Institute of Technology Student: Egao, Vanessa Jones C.

Section: Block 260

PHARMACOLOGY

DRUG STUDY

Brand Name: Lanoxin_______________________________Generic Name: Digoxin_______________________ Drug Classification: Cardiac Glycoside

Dosage, Route & Frequency Drug-Drug & Drug-Food Side Effects Adverse Reactions (By
Drug Action Indications Contraindications
Recommended Prescribed Interactions (By System) System)
Digitalizing Dose HF: Inhibits sodium/potassium ATPase DRUG: Amiodarone may Rapid digitalization Hypersensitivity to digoxin. Dizziness, headache, CNS: Fatigue, muscle weakness,
Adult: PO 10–15 mcg/kg (1 mg) in pump in myocardial cells. Promotes increase concentration/toxicity. and for maintenance Ventricular fibrillation. diarrhea, rash, visual headache, facial neuralgia,
divided doses over 24–48 h IV 10– calcium influx. Supraventricular Beta blockers (e.g., metoprolol), therapy in CHF, atrial disturbances mental depression, paresthesias,
hallucinations, confusion,
15 mcg/kg (1 mg) in divided Arrhythmias: Suppresses AV node calcium channel blockers (e.g., fibrillation, atrial flutter, Cautions: Renal
drowsiness, agitation,
doses over 24 h conduction. Therapeutic Effect: diltiaZEM) may have additive effect paroxysmal atrial impairment, sinus nodal dizziness. CV: Arrhythmias,
Child: PO/IV <2 y, 40–60 on slowing AV nodal conduction. tachycardia. disease, acute MI (within 6 hypotension, AV block. Special
mcg/kg; 2–10 y, 20–40 mcg/kg; HF: Increases contractility. Potassium-depleting diuretics (e.g., mos), second-or third- Senses: Visual
>10 y, 10–15 mcg/kg (1.5–2 mg) Supraventricular Arrhythmias: Increases furosemide) may increase toxicity degree heart block (unless disturbances. GI: Anorexia, naus
Neonate: PO/IV 30–50 mcg/kg effective refractory period/decreases due to hypokalemia. functioning pacemaker), ea, vomiting,
Premature neonate: PO/IV 20 conduction velocity, decreases heart Sympathomimetics (e.g., concurrent use of strong diarrhea. Other: Diaphoresis,
recurrent malaise, dysphagia
mcg/kg rate. norepinephrine) may increase risk of inducers or inhibitors of P-
arrhythmias. HERBAL: Ephedra may glycoprotein
Maintenance Dose Absorption: 70% PO tablets; 90% PO liquid increase risk of arrhythmias. Licorice (e.g.,cyclosporine),
Adult: PO/IV 0.1–0.375 mg/d and capsules. may cause sodium and water hyperthyroidism,
Child: PO/IV <2 y, 7.5–9 Onset: 1–2 h PO; 5–30 min IV. retention, loss of potassium. FOOD: hypothyroidism,
Peak: 6–8 h PO; 1–5 h IV.
mcg/kg/d; 2–10 y, 6–7.5 Meals with increased fiber (bran) or hypokalemia,
Duration: 3–4 d in fully digitalized patient.
mcg/kg/d; >10 y, 0.125–0.25 mg/d high in pectin may decrease hypocalcemia.
Distribution: Widely distributed; tissue
Neonate: 6–7.5 mcg/kg/d levels significantly higher than plasma absorption.
Premature neonate: 3.75 levels; crosses placenta.
mcg/kg/d Metabolism: Approximately 14% in liver.
Elimination: 80–90% excreted by kidneys;
may appear in breast milk.
Half-Life: 34–44 h.

Responsibilities in the Nursing Process (ADPIE)
Assessment & Drug Effects
 Take apical pulse for 1 full min, noting rate, rhythm, and quality before administering drug.
 Be familiar with patient's baseline data (e.g., quality of peripheral pulses, blood pressure, clinical symptoms, serum electrolytes, creatinine
clearance) as a foundation for making assessments.
 Lab tests: Baseline and periodic serum digoxin, potassium, magnesium, and calcium. Draw blood samples for determining plasma digoxin
levels at least 6 h after daily dose and preferably just before next scheduled daily dose.
 Monitor for S&S of drug toxicity: In children, cardiac arrhythmias are usually reliable signs of early toxicity. Early indicators in adults (anorexia,
nausea, vomiting, diarrhea, visual disturbances) are rarely initial signs in children.
 Monitor I&O ratio during digitalization, particularly in patients with impaired renal function. Also monitor for edema daily and auscultate
chest for rales.
 Observe patients closely when being transferred from one preparation (tablet, elixir, or parenteral) to another; when tablet is replaced by
elixir potential for toxicity increases since 30% of drug is absorbed.
Nursing Diagnosis:
 Risk for Decreased Cardiac Output
Planning:
 After 16 hours of nursing interventions, the patient will demonstrate adequate cardiac output as evidenced by vital signs within acceptable
limits, dysrhythmias absent/controlled, and no symptoms of failure (e.g., hemodynamic parameters within acceptable limits, urinary output
adequate)
Responsibilities in the Nursing Process (ADPIE)
Intervention/ Health Education
 Report to physician if pulse falls below 60 or rises above 110 or if you detect skipped beats or other changes in rhythm, when digoxin
is prescribed for atrial fibrillation.
 Suspect toxicity and report to physician if any of the following occur: Anorexia, nausea, vomiting, diarrhea, or visual disturbances.
 Weigh each day under standard conditions. Report weight gain >1 kg (2 lb)/d.
 Take digoxin PRECISELY as prescribed, do not skip or double a dose or change dose intervals, and take it at same time each day.
 Do not to take OTC medications, especially those for coughs, colds, allergy, GI upset, or obesity, without prior approval of physician.
 Continue with brand originally prescribed unless otherwise directed by physician.
 Encourage periods of rest and assist with all activities.
 Assist the patient in assuming a high Fowler’s position.
 Provide quiet environment: explain therapeutic management, help patient avoid stressful situations, listen and respond to expressions
of feelings.
Evaluation:
 After 16 hours of nursing interventions, the patient demonstrated adequate cardiac output as evidenced by vital signs within
acceptable limits, dysrhythmias absent/controlled, and no symptoms of failure (e.g., hemodynamic parameters within acceptable
limits, urinary output adequate)