Drug Study Digoxin (Lanoxin)

With cardiac disease being the number one cause of death worldwide, many people are using drugs like Digoxin (lanoxin) to improve the pumping ability of their hearts.

Generic Name: Digoxin
Brand Name: Lanoxin
Classification: Cardiac glycoside

Uses:

1. Treatment of congestive heart failure
2. Control of rapid ventricular contractions in clients with atrial fibrillation/flutter
3. Slow the heart rate in sinus tachycardia
4. Treatment of SVT
5. Treatment of cardiogenic shock
6. Prophylaxis and treatment of recurrent paroxysmal atrial tachycardia with paroxysmal AV junctional rhythm

Actions:

1. Increases the force and velocity of myocardial contraction by increasing the refractory period of the AV node and increasing total peripheral resistance
2. Inhibits sodium/potassium-ATPase resulting in increased calcium influx and increased release of free calcium ions within the myocardial cells, which potentiates the contractility of cardiac muscle fibers
3. Decreases the rate of conduction thereby decreasing heart rate

Contraindications:

1. Ventricular fibrillation
2. Ventricular tachycardia
3. Presence of digoxin toxicity
4. Hypersensitivity
5. Beriberi heart disease
6. Hypersensitive carotid sinus syndrome

Special Concerns:

1. Use caution in clients with ischemic heart disease, acute myocarditis, hypertropic subaortic stenosis, hypoxic states, cyanotic heart and lung diseases
2. Use caution in clients with viral myocarditis or rheumatic fever

Side-Effects:

1. Tachycardia
2. Headache
3. Dizziness
4. Mental disturbances
5. N&V
6. Diarrhea
7. Anorexia
8. Blurred vision
9. Death from ventricular fibrillation
10. Acute hemorrhage
11. Convulsions
12. Visual disturbances
13. Angioneurotic edema

Dosage:

Per Orem: 0.4-0.6 mg initially, followed by 0.1-0.3mg q6h or q8h
IV: 0.125-0.5mg/day

Nursing Considerations

1. Assess cardiac function
2. Measure liquids precisely
3. Assess for signs of toxicity, especially in children and the elderly
4. Give IV slowly over 5 minutes
5. Note possible drug interactions
6. Assess for hyperthyroidism or hypothyroidism
7. Obtain ECG
8. Monitor CBC, serum electrolytes, calcium, MG, renal and liver function tests
9. Obtain written heart rate parameters for drug administration as drug may cause extreme bradycardia
10. Do not administer if HR is <50. Hold if HR is 90-110 bpm in children
11. Obtain pulse deficit of apical and radial pulse
12. Monitor weight and I&o
13. Use antacid if gastric distress occurs
14. Use caution during withdrawal
15. Do not take with grapefruit juice
16. Take after meals to lessen gastric irritation
17. Maintain a sodium-restricted diet
18. Do not take OTC drugs