Question

ACTIVE LEARNING TEMPLATE: Medication STUDENT NAME MEDICATION CATEGORY CLASS Manifestation of digoxin toxicity REVIEW MODULE CHAPTER PURPOSE OF MEDICATION Expected Pharmacological Action Therapeutic Use Complications Medication Administration Contraindications/Precautions Nursing Interventions Interactions Client Education Evaluation of Medication Effectiveness ACTIVE LEARNING TEMPLATES THERAPEUTIC PROCEDURE AZ

Answer 1

Pharmacological Action: Positive inotrope; ↑AV node refractory period

Therapeutic uses:Congestive Heart Failure,atrial fibrillation,Paroxysmal atrial tachycardia.

Complications:

CNS: fatigue, headache, weakness.

CV: ARRHYTHMIAS, bradycardia, ECG changes, AV block, SA block

EENT: blurred vision, yellow or green vision

GI: anorexia, nausea, vomiting, diarrhea

Hemat: thrombocytopenia

Metabolic: electrolyte imbalances with acute digoxin toxicity

Medication Administration:

For Adults:

Oral solution

• 0.05mg/mL

Injectable solution(intramuscular route)

• 0.1mg/mL
• 0.25mg/mL

Tablet

• 0.0625mg (Lanoxin only)
• 0.125mg
• 0.1875mg (Lanoxin only)
• 0.25mg

Pediatric

Oral solution

• 0.05mg/mL

Injectable solution

• 0.1mg/mL
• 0.25mg/mL

Tablet

• 0.125mg
• 0.25mg

Contraindications/Precautions:

Digoxin has a narrow therapeutic index.

Acute myocardial infarction

Adams-Stokes syndrome

AV block, bradycardia,

cardiomyopathy

Cor pulmonale

Hyperthyroidism

Hypothyroidism,

Hpoxemia

Myocarditis

Myxedema

Pulmonary disease

Sick sinus syndrome

Carotid sinus hypersensitivity

Ventricular arrhythmias

Ventricular fibrillation

Ventricular tachycardia

Wolff-Parkinson-White syndrome

Interactions:

• Contraindicated :squill

• Serious:55 drugs:aluminum hydroxide,amiodarone,amphotericin B deoxycholate,atenolol,azithromycin,betaxolol,bisoprolol,bremelanotide,bretylium,calcium carbonate,clarithromycin,colchicine,cyclosporine,dexlansoprazole,dofetilide,dronedarone,eluxadoline,erdafitinib,erythromycin base,erythromycin ethylsuccinate,erythromycin lactobionate,erythromycin stearate,esmolol,esomeprazole,famotidine,flecainide,human parathyroid hormone, recombinant,hydroxychloroquine sulfate,ibuprofen/famotidine,lansoprazole,lasmiditan,levobunolol,lily ofthevalley,metoprolol,nadolol,nebivolol,nizatidine,omeprazole,pantoprazole,procainamide,propafenone,propranolol,quinidine,rabeprazole,siponimod,roxithromycin,sodium bicarbonate,sodium citrate/citric acid,sotalol,sucralfate,telaprevir,timolol,vandetanib,venetoclax,verapamil

• Monitor Closely: 293 drugs

• Minor :38 drugs

Evaluvation of medication effectiveness:

• Decrease in severity of HF.
• Increase in cardiac output.
• Decrease in ventricular response in atrial tachyarrhythmias.
• Termination of paroxysmal atrial tachycardia.

Nursing interventions:

1.Digoxin preparations must be stored in tightly covered, light resistant containers at room temp.

2.FOLLOW CLOSELY (especially in patients receiving diuretics or amphotericin) for decreased serum potassium (K), magnesium (Mg), or thyroxine (T4) along with increased calcium (Ca) will increase digoxin toxicity at a given level. Initial hyperkalemia results from release of intracellular K and indicates serious acute toxicity.

3. Follow HR and rhythm closely

4. Take apical-radial pulse before giving Digoxin; determine whether bradycardia exists individualized to patient; if so, notify H.O., check last level result and hold medication.

5. Monitor for dysrhythmias; respiratory congestion; peripheral edema

6. Monitor daily weights and perform accurate I & O

7. Order must be taken off by two RNs 8. Obtain periodic EKGs to assess both desired effects and signs of toxicity

Client Education:

Before taking medication check the if pulse rate is <60 or >100.

Do not double doses

Take missed doses within 12 hr of scheduled dose or omit

Do not discontinue medication

Aware about digitalis toxicity.Advise patient to notify if any kind of toxicity