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What important teaching points need to be included for a patient receiving digoxin?

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Digoxin (Lanoxin®)

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Class:
  • Cardiac glycoside
Actions:
  • Increases force of myocardial contraction (positive inotropic)
  • Decreased sympathetic tone
  • Increased urine production
  • Decreased renin release
  • Slows conduction through the AV node
  • Decreases automaticity in the SA node (negative chronotropic)
Indications:
  • Heart failure (left-sided or right-sided)
  • Atrial fibrillation or Atrial flutter (to decrease ventricular rate)
  • Supraventricular tachycardia
Pharmacokinetics:
  • Onset: 5-30 minutes (IV); 30 minutes – 2 hours (PO)
  • Peak:  1-4 hours (IV); 4-6 hours (PO)
  • Half-Life: 1.5 days
Adverse Effects:
  • Nausea, vomiting, anorexia, diarrhea
  • Fatigue, visual disturbances (e.g., blurred vision, yellow tinge to vision, halos around lights)
  • Prolonged PR interval, increased AV blocks
  • Confusion, drowsiness, dizziness, insomnia, nightmares
Signs of Toxicity:
  • Prolonged PR interval (1st degree AV block)
  • Signs of ventricular ectopy
  • Complaints of visual disturbances
  • (higher risk if patient has hypokalemia–low serum potassium)
Contraindications:
  • Digitalis hypersensitivity
  • Ventricular fibrillation
  • Ventricular tachycardia
  • Safety during pregnancy, lactation (Category A).
Dosages & Routes:
  • PO: (loading dose) 10-15 mcg/kg in divided doses over 24 – 48 hours
  • IV bolus:  (loading dose) 10-15 mcg/kg (1 mg) in divided doses over 24 hours
  • Maintenance Dose (IV or PO): 0.1 – 0.375 mg/day
Nursing Implications:
  • Drug Interactions:  1) Thiazide diuretics and loop diuretics promote dig-induced dysrhythmias by depleting potassium; 2) With digoxin, beta blockers and calcium channel blockers decrease contractility and heart rate; 3) Sympathomimetics (beta-adrenergic agonists) enhance heart rate and contractility; 4) Serum digoxin levels from oral doses are decreased by cholestyramine, kaolin-pectin, Neomycin, or sulfasalazine; 5) Serum digoxin levels are increased by aminoglycosides, colestipol, azithromycin, clarithromycin, erythromycin, omeprazole, tetracycline, alprazolam, amiodarone, captopril, diltiazem, nifedipine, nitrendipine, propafenone, quinidine, verapamil.
  • Drug IV Incompatibilities:  dobutamine, doxapram, amiodarone
  • Monitor blood pressure and apical pulse prior to administration.
  • Cardiac monitor should be used on patients receiving digoxin, especially loading doses.
  • Monitor serum digoxin levels closely, especially if receiving antibiotic therapy.
  • Monitor serum electrolytes, especially potassium.
  • Check for toxicity if visual or GI disturbances occur.
  • If DIGOXIN TOXICITY occurs with DYSRHYTHMIAS, 1) Discontinue any digitalis medications and any potassium depleting diuretics.  2) Check serum potassium level.  3) Phenytoin or lidocaine can be used as antidysrhythmic medications [Do Not Use Quinidine or Amiodarone.].  4) Atropine can be used for bradycardias or AV blocks.  5) Fab antibody agents (Digibind®) can be administered carefully intravenously.
  • Avoid electrical cardioversion if patient is receiving digoxin unless condition is life-threatening.  Then use lower doses (10-20 joules).
  • Emphasize to patient the importance of taking digoxin as prescribed at regular intervals and not missing doses.
  • Do not breast feed while taking digoxin.

References:

American Heart Association. (2006). Handbook of Emergency Cardiac Care (p. 49). Salem, MA: AHA.

Dirks, J.L. (2010) Cardiovascular therapeutic management.  In L.D. Urden, K.M. Stacy, & M.E. Lough's (Eds.) Critical care nursing: Diagnosis and management (6th ed., pp. 544-545).  St. Louis: Mosby Elsevier.

Lehne, R.A. (2010). Pharmacology for nursing care (7th ed., pp. 522-527, 548-549).  St. Louis: Saunders Elsevier.

Wilson, B.A., Shannon, M.T., Shields, K.M., & Stang, C.L. (2007).  Prentice Hall Nurse's Drug Guide 2007 (pp. 513-516).  Upper Saddle River, NJ: Pearson Prentice Hall.

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What advice can be given for a patient taking digoxin?

Do not increase or decrease the dosage without his or her advice. Your doctor may advise you to record your heart rate and blood pressure daily while taking digoxin. Some doctors may initiate digoxin dosing with a loading dose (a higher than normal dose) followed by a smaller, regular maintenance dose.

What is the most important health teaching to client taking digoxin?

Take your digoxin regularly even when you are feeling well. Maintain adequate hydration. Toxicity is more likely when dehydrated. This is especially important if you are also taking diuretic medications.

Which is important to monitor in patients taking digoxin?

Digoxin toxicity can be aggravated by potassium and magnesium levels, so a healthcare provider may monitor electrolytes and magnesium levels.

What is the most important to check when administering digoxin?

A nurse should assess the apical pulse for a full minute before administering digoxin due to its positive inotropic action (it increases contractility, stroke volume, and, thus, cardiac output), negative chronotropic action (it decreases heart rate), and negative dromotropic action (it decreases electrical conduction ...

important teaching points included patient receiving digoxin Digoxin Nursing considerations Digoxin patient education Digoxin effectiveness Digoxin administration instructions

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