Unformatted text preview: ACTIVE LEARNING TEMPLATE: Medication MARIN MCBRIDE
MEDICATION___________________________________________________________________________ REVIEW MODULE CHAPTER__20
_____________________________________________________________________ PURPOSE OF MEDICATION Expected Pharmacological Action
●Positive inotropic effect: increased force of myocardial
●Negative chronotropic effect: decreased heart rate Therapeutic Use
●As a second‑line medication
-Dysrhythmias (atrial fibrillation)
-Can reduce manifestations, but does not prolong life Complications
● Dysrhythmias (caused by interfering with the electrical conduction in the
● Cardiotoxicity leading to bradycardia
● GI effects (anorexia [usually first sign], nausea, vomiting, abdominal pain)
● CNS effects (fatigue, weakness, vision changes [diplopia, blurred vision,
yellow-green or white halos around objects]) Contraindications/Precautions
●Pregnancy Risk Category C
● Disturbances in ventricular rhythm (ventricular fibrillation, ventricular tachycardia,
second‑ and third‑degree heart block) are contraindications for receiving digoxin.
● Clients who have hypokalemia, partial AV block, advanced heart failure, or
impaired kidney function require caution with digoxin therapy. Interactions
● Thiazide diuretics (such as hydrochlorothiazide) and loop diuretics (such as furosemide) can lead to hypokalemia, which
increases the risk for developing dysrhythmias.
● ACE inhibitors and ARBs increase the risk of hyperkalemia, which can reduce the therapeutic effects of digoxin.
● Sympathomimetic medications such as dopamine complement the inotropic action of digoxin and increase the rate and
force of heart muscle contraction. Thesemedications can increase the risk of tachydysrhythmias.
● Quinidine increases the risk of digoxin toxicity by displacing digoxin from its binding site and reducing kidney excretion.
● Verapamil increases plasma levels of digoxin. Providers prescribe a lower dosage for clients who also take verapamil, but
generally avoid concurrent use because verapamil’s cardiosuppressive action counteracts digoxin’s therapeutic effects.
● Antacids decrease the absorption of digoxin and can decrease its effectiveness. Evaluation of Medication Effectiveness ● Control of heart failure
● Absence of cardiac dysrhythmias ACTIVE LEARNING TEMPLATES Medication Administration
●Check pulse rate and rhythm before administering
digoxin and document it. Notify the provider if the heart
rate is less than 60/min in adults, 70/min in children, or
90/min in infants.
● Administer digoxin at the same time each day.
● Monitor digoxin levels periodically during treatment and
make sure therapeutic levels are between 0.5 and 0.8
ng/mL to prevent digoxin toxicity.
● Advise clients against taking over-the-counter
medications to prevent adverse effects and medication
● When caring for clients who receive IV digoxin, monitor
for dysrhythmias. Nursing Interventions
● Monitor digoxin levels
periodically during treatment.
The expected reference
range is 0.5 to 0.8 ng/mL.
● Monitor serum potassium levels
because hypokalemia can cause cardiac
dysrhythmias, especially in older adult
clients. Monitoring the ECG to check for
dysrhythmias. Client Education
●Take digoxin at the same time each day.
The client should not skip a dose or take
more than the dose the prescribed each
● Monitor for manifestations of toxicity.
● Report any new prescriptions and contact
the provider before taking over-thecounter
medications, because digoxin interacts with
many other substances Therapeutic Procedure A7 ...
View Full Document