ONE TEMPLATE ON DIGOXIN AND
ONE ON LASIX
Homework Answers
1. Medication - Digoxin
# Classification
Therapeutic: antiarrhythmics, inotropics
Pharmacologic: digitalis glycosides
# Action
Increases the force of myocardial contraction. Prolongs refractory period of the AV node. Decreases conduction through the SA and AV nodes. Therapeutic Effects: Increased cardiac output (positive inotropic effect) and slowing of the heart rate (negative chronotropic effect).
# Contraindications/Precautions Uncontrolled
ventricular arrhythmias; AV block : in absence
of pacemaker Idiopathic hypertrophic
subaortic stenosis; Constrictive pericarditis;
Hypokalemia greatly increase risk of digoxin toxicity Hypercalcemia increase risk of toxicity, especially with mild hypokalemia); Hypomagnesemia may increaserisk of digoxin toxicity
# Adverse Reactions/Side Effects: yelloow green vision-digoxin, CNS fatigue, headache, weakness. EENT: blurred vision, yellow or green vision. CV: ARRHYTHMIAS, bradycardia, ECG changes, AV block, SA block. GI: anorexia, *nausea, vomiting, diarrhea. Hemat: thrombocytopenia. Metab: electrolyte imbalances with acute digoxin toxicity.
# Interactions :
Amiodarone ,verapamil,and quinidine may increase serum digoxin concentration by 50-70% . Concurrent use of digoxin and verapamil may lead to severe heart block . Diuretics may potentiate cardiac toxicity .
# Nursing consideration:
- MONITOR APICAL PULSE FOR 1 FULL MINUTE BEFORE ADMINISTERING.
- WITHHOLD DOSE & NOTIFY HCP IF PULSE < 60.
- ALSO NOTIFY HCP PROMPTLY OF ANY SIGNIFICATION CHANGES IN RATE, RHYTHM , OR QUALITY OF PULSE
# Client teaching:
- Instruct pt to take medication as directed, at the same time each day. teach pt how to accurately measure medication . take missed dose within 12 hrs of scheduled dose or omit. do not double doses. consult HCP if doses for 2 or more days are missed. do not d/c med w/o consulting HCP
- Teach pt to take pulse & to contact HCP before taking med if pulse < 60 or > 100.
PEDs : teach parents or caregivers that changes in heart rate especially bradycardia are among first signs of digoxin toxicity in children. instruct parents in apical pulse assessment & to call HCP if pulse outside boundaries set by HCP
- Review signs and symptoms of digoxin toxicity with patient. Advise patient to call HCP immediately if theses symptoms or symptoms of CHF occur. Inform pt that these symptoms may be mistaken for cold or flu
- Instruct pt to keep in original container and not to mix with other pills
- Caution pt avoid concurrent use of RX, OTC & herbal products w/o consulting HCP
- Advise pt to avoid taking antacids or antidiarrheals within 2 hours of digoxin
- Patient should carry ID describing disease process & medication regimen at all times
2. Medication - Lasix
# Classification
Diuretic
# Action
Reduces edema and increase urinary output
# Indication
Edema due to heart failure, hepatic impairment, or renal disease; hypertension
# Side effects
Dehydration
Hypokalemia
Hypomagnisemia
Hypovolemia
Metabolic Acidosis
# Drug interactions
Corticosteroid
Antihypertensives
Alcohol
Nitrates
Digoxin
# Route/ dose
PO: 20-80mg per day;
-hypertension: 40 mg bid
-hypercalcemiq: 120mg per day in 1-3 doses
# Patient teaching
-take as directed, take missed doses as soon as possible, do not double doses
- contact doctor of more than 3 pounds are gained in one day
- change positions slowly to minimize orthostatic hypotension
- sunscreen/ protective clothing to prevent photo sensitivity reactions
-contact Hc provider if taking OTC meds or herbal products with this therapy
# Nursing implications
- Monitor blood pressure
- Assess fluid status
- Monitor input and output
- Assess for tinnitus or hearing loss
- Assess fall risks and implement fall prevention strategies
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Anti-Fungals
Azole -Fluconazole/Ketoconazole
others- Amphotericn B, Nystatin
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(Potassium Chloride) medication template
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