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Digoxin is one of the high yield drugs for testing what are the brand names of digoxin in the u.s the three are digitech digox and lanoxin what are the pharmacologic categories of digoxin digoxin is an anti-arrhythmic agent and a cardiac glycoside what are the uses of digoxin digoxin is used primarily for heart failure in patients who have a reduced ejection
Fraction it is appropriate for the treatment of mild to moderate heart failure in adults to increase myocardial contractility it can also be used pediatric patients with heart failure the other important use jackson he is in atrial fibrillation atrial flutter for rate control this allows for the vitricular rate or the heart rate to be controlled in patients with
Chronic atrial fibrillation there are additional uses of digoxin referred to as off-label uses this includes fetal supraventricular tachycardia and supravatricular tachycardia or rate control in adults what is the mechanism of action of digoxin digoxin improves heart failure by inhibiting the sodium potassium atpase pump in myocardial cells this ultimately results
In an influx of calcium into the myocardial cell and increases contractility digoxin toxicity in adults and in pediatric patients can occur with digoxin levels greater than two nanograms per ml however due to the narrow therapeutic window of digoxin toxicity may result even at therapeutic levels hypokalemia may be a significant factor the symptoms of digoxin
Toxicity or nausea vomiting visual disturbances which may include halos or yellow vision or blurred vision lethargy may be a side effect of the johnson toxicity as well as life-threatening arrhythmias what arrhythmias do we see with digoxin toxicity well they include atrial tachycardia av block of all types first degree second degree and complete heart block we
May even see premature ventricular contractions in severe cases we may see matricular tachycardia or ventricular fibrillation is digoxin toxicity reversible the answer is yes digoxin toxicity is reversible when the drug is discontinued and with the administration of digoxin immune fab we associate a number of risk factors with digoxin toxicity and they included
Digoxin concentration greater than two nanograms per mil risk factors include age including older adults chronic obstructive pulmonary disease or copd hypothyroidism electrolyte disturbances hypokalemia hypomagnesemia dehydration and low body weight there are some medications that may affect digoxin and increase the concentration resulting in an increased risk
Of toxicity these medications include verapamil quinitine amiodarone and erythromycin to name a few what are the additional adverse reactions reaction that we may be they include prolonged pr interval and ekg and premature ventricular contractions rashes including maculopapular and papular rashes gynecomastia we already have discussed the abdominal pain this
Includes anorexia and diarrhea and vomiting thrombocytopenia altered mental status including confusion delirium depression and hallucinations headaches and lethargy may occur as well neuromuscular or skeletal adverse effects include estonia contraindications include any hypersensitivity to digoxin or any component of the formulation an additional contraindication
Is documented ventricular fibrillation what are the drug interactions the drug interactions of digoxin are many and they should be considered before prescribing what are digoxin considerations in pregnancy or breastfeeding it is important to remember that digoxin does cross the placenta and digoxin is found in the breast milk what are the dietary considerations of
Digoxin primarily the dietary consideration includes encouraging patients to consume diets with adequate amounts of potassium to decrease the risk of hypokalemia hypokalemia is a well-documented cause that increases the risk of digoxin toxicity what are the monitoring parameters of digoxin we monitor heart rate and rhythm in addition periodic ekg should be done to
Assess the effects of toxicity baseline and periodic labs including creatinine serum potassium magnesium and calcium especially on patients who are taking diuretics patients should be observed for non-cardiac signs of toxicity including confusion and depression when should we draw digoxin levels digoxin levels should be drawn because digoxin has a narrow therapeutic
Range digoxin serum concentrations should be drawn optimally at 12 to 24 hours after each dose but they should at least be drawn six to eight hours after the last dose other factors that affect serum digoxin concentration is exercise so a period of rest at least two to three hours after exercise should be allowed before drawing serum digoxin levels what is the
Reference range of digoxin the digoxin therapeutic serum concentration level antidote is 0.822 nanograms per meal question instructions for adherence of a two year johnson after cardiac surgery what information is important to relay select all that apply a mix the medication with orange juice b give a second dose one time if a child vomits c if the medication at
The same time every day d notify the health care provider if the child has persistent vomiting e administer a missed dose as soon as possible f notify the health care provider if more than one dose is missed for any reason the correct answer is c and d explanation digoxin should be given at the same time every day usually every 12 hours gastrointestinal upset
Nausea and vomiting may be signs of toxicity the healthcare provider should be notified of more than two missed doses this may affect therapeutic levels digoxin should not be crushed or mixed with other fluids question is a patient who has been taking heart failure what lab finding may cause a significant risk of digoxin toxicity to the patient if left untreated
A hyperkalemia b hypokalemia c hyponatremia d hypernatremia the correct answer is b b hypokalemia explanation hypokalemia is a common cause of digoxin toxicity potassium levels must be monitored in patients taking digoxin to avoid toxicity serum sodium levels are not a significant cause of digoxin toxicity question the health care provider prescribed warfarin
In a patient with deep vein thrombosis the nurse instructs a client to avoid using which over-the-counter medication while taking warfarin a aspirin b digoxin furosemide d guaifenesin the correct answer is a aspirin explanation aspirin is an anti-platelet medication that is contraindicated while taking warfarin because it will increase the drug’s anticoagulant
Effects digoxin furosemide and guaifenesin do not affect blood coagulation digoxin and furosemide are not over-the-counter medications these medications require a prescription question a patient with atrial fibrillation is being discharged on digoxin what statements by the patient indicate the patient understands the teaching a i may experience rash over the
Palms and soles of my feet b increased appetite is a sign of digoxin toxicity c i will contact the health care provider if i have visual disturbances such as seeing yellow halos d i will contact the healthcare provider if i have diarrhea the correct answer is c i will contact the health care provider if i have visual disturbances such as seeing yellow halos and
D i will contact the healthcare provider if i have diarrhea explanation visual disturbances such as blurred vision and yellow halos are symptoms of digoxin toxicity are there symptoms of digoxin toxicity include abdominal pain diarrhea and vomiting patients may experience bradycardia and other arrhythmias the type of rash described in a and increased appetite
Would not be expected with digoxin toxicity question an outpatient receiving digoxin and hydrochlorothiazide was recently started on two new medications enalapril and vicodin postoperatively the patient calls saying he is experiencing mild tightness in his throat what is the appropriate action for the nurse to take at this time a check at digoxin level to assess
For toxicity b record the information in the medical record tell the patient to rest for one hour and call back in two hours c ask the client to discontinue the hydrochlorothiazide immediately d tell the patient that he should be evaluated immediately in the emergency department and notify the health care provider the correct answer is d tell the patient that
He should be evaluated immediately in the emergency department and notify the health care provider explanation the nurse should recognize the tightness in the throat as a possible adverse reaction to enalopril an ace inhibitor this is not a symptom of digoxin toxicity angioedema from enalapril may be life-threatening and lead to airway obstruction
Transcribed from video
DIGOXIN Nursing Pharmacology, HEART FAILURE, EKG, CHF, Hypokalemia, AND NCLEX Questions and Answers By QBankpro Academy
