Digoxin
- Description – (cardiac glycosides)
- Mode of action – inhibits enzyme sodium-potassium ATPase -» promotes ca accumulation -» causes the heart muscle fibers to contract efficiently.
- Therapeutic effects – increases force of contractions, slows the HR, slows conduction -» increases CO, decreases edema, and increases fluid excretion.
- Therapeutic range – 0.5 to 2ng/mL ( > 2ng/mL is toxic)
- Antidote – Digoxin immune Fab (Digibind) -» used in extreme toxicity
- Indications – CHF, cardiogenic shock, atrial dysrhythmias
- Contraindications – ventricular dysrhythmias and 2nd/3rdº heart block
- Side effects/toxicity – anorexia, n/v, diarrhea, HA, visual disturbances (yellow-green halos), bradycardia
- Early s/s present as GI manifestations (anorexia, n/v, diarrhea); then HR abnormalities, and visual disturbances.
- Interventions
- Monitor for toxicity
- Monitor serum digoxin levels
- Potassium levels
- Monitor the client taking a potassium-losing diuretic or corticosteroid closely for hypokalemia -» hypokalemia can cause digoxin toxicity
- Note that older clients are more sensitive to digoxin toxicity
- Monitor apical pulse for 1 full minute -» hold med and notify MD if HR < 60 bpm
- Teach pt. s/s of toxicity, to avoid OTC meds
- Advise pt. to eat foods high in potassium (dried/fresh fruits, fruit juices, vegetables, and potatoes)
antidote list
- alteplase/activase – aminocaproic acid -» only used in acute, life-threatening conditions
- ferrous sulfate (PO) – defuroxamine -» absorbs iron
- digoxin/lanoxin (PO) – digoxin immune fab/digibind
- heparin (IV/SQ) – protamine sulfate (IV)
- iron dextran (IV/IM) – defuroxamine -» absorbs iron
- enoxaparin/lovenox (SubQ) – protamine sulfate (IV)
- magnesium (IV/IM) – calcium gluconate (IV)
- reteplase/retavase – aminocaproic acid -» only used in acute, life-threatening conditions
- tenecteplase/TNKase – aminocaproic acid -» only used in acute, life-threatening conditions
- warfarin/coumadin (PO) – vitamin K (IV/IM)
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