Hey there future nurses, it's Christine from Nurse in the Making and today we're going to talk about the medication digoxin. But before we dive in, don't forget to subscribe to my YouTube channel for weekly videos, daily nursing school questions, and all things to help you pass nursing school. Digoxin is the generic name and the trade name is linoxin, but you'll commonly hear this medication called dig. Digoxin falls under the medication class called cardiac glycosides.
These medications help the heart pump more effectively. Cardiac glycosides act by increasing the amount of sodium and calcium within our cells. What do we know about increasing the amount of sodium and calcium within amounts of calcium. Contractility increases. Remember, calcium, think contract.
But what does this have to do with blood pressure? When the heart can beat effectively and appropriately, circulation improves. and as a result we see less edema.
When our hearts are contracting correctly it doesn't need to beat as quickly. Remember digoxin helps the heart stay in control. So digoxin lowers the heart rate and blood pressure and it improves cardiac function and overall blood flow. You can think of digoxin as the controller of the heart. Now that we understand how the drug works, let's look at who it's used for.
This drug lowers blood pressure, helps the heart pump more effectively, therefore lowering the heart rate, and it will also maintain a safe heart rhythm. This medication is used for lowering blood pressure, aka managing hypertension, patients with a history of arrhythmias, most commonly atrial fibrillation, and managing the heart's workload in patients with heart failure. Remember, we are helping the heart contract with more power. This medication is contraindicated, meaning it should not be used in patients with ventricle fibrillation or an acute myocardial infarction, aka a heart attack. This is because it can alter the heart's contractions.
It can also alter blood flow and can worsen the impact of a heart attack and can even lead to death. Since the Dijoxin is so strong, there is a very small window for healthy dosing, aka the therapeutic range is narrow. Keep these values in mind. The therapeutic range for Dijoxin is 0.5 to 2 nanograms per milliliter.
Let's look at some of the most common side effects of digoxin. These are dizziness from low blood pressure and heart rate, GI upset, worsening edema. If the patient's edema is worsening, this shows a disruption in blood flow. A rash, which may indicate an allergy or toxicity.
These are very serious side effects. Since this is such a powerful drug, we take all these side effects very seriously. It might indicate that the person has too much digoxin in their bloodstream.
This is called digoxin toxicity. Digoxin toxicity is a very dangerous thing and it's very commonly seen on exams and your long-awaited NCLEX. So remember digoxin is powerful so having too much of it in your bloodstream can cause major problems.
Also remember it has a very small window for safe dosing. Do you remember that range? 0.5 to 2 nanograms per milliliter.
You need to remember these values. The NCLEX loves to ask about digoxin and its side effects. side effects, so be prepared to know this range. Any value over 2 would put a patient at risk for toxicity. The symptoms of digoxin toxicity are nausea and vomiting, their heart rate is too slow, meaning the effect of the medication was too strong.
This is considered low when it's less than 60 beats per minute in an adult, less than 70 beats per minute for a child, or less than 90 beats per minute in an infant. Any confusion, fatigue, dizziness should be reported along with the ones that the NCLEX loves to test on, which is vision changes. If a patient on this drug reports blurry vision, halos around lights, or color changes, think digoxin toxicity. There are some things that put your patient at risk for digoxin toxicity.
One of these is hypokalemia or a decrease in potassium levels. So be careful when your patient is on a potassium wasting diuretic such as lube and thiazide diuretics. Another cause of digoxin toxicity is injured kidneys or the elderly because they have a decrease in glomular filtration rate aka GFR.
This causes toxicity because digoxin is almost solely excreted by the kidneys. So if the kidneys are injured or slow, they can't do their job to filter the medication out. Therefore, the medication is staying in the bloodstream causing toxicity. And now for some nursing considerations for digoxin.
Prior to giving digoxin, you always want to assess blood pressure and heart rate. For this medication, you need to check the heart rate by listening to the apical pulse. You need to listen to the apical pulse for a full minute. You want to remember to hold a medication if the heart rate falls under 60 beats per minute for an adult, under 70 beats per minute for a child, and under 90 beats per minute for an infant. Let's talk about where the apical pulse is located.
It's located on the left side at the fifth intercostal space. It's also called the apex of the heart or the point of maximal impulse, PMI. Some other nursing considerations is you always want to know the signs of toxicity and notify the healthcare provider if any should arise.
You also want to monitor electrolyte imbalances. Remember, this drug alters sodium and calcium placement within the cells, so we monitor sodium and calcium. Remember how I said hypokalemia can cause digoxin toxicity?
So we also want to monitor potassium levels. And finally, since this is often given for our heart failure patients, we want to monitor fluid status, which includes strict intake and output levels, meaning you are very closely watching and measuring all fluids entering the body and being excreted from the body. You also want to monitor their daily weights.
A fluid restriction may also be used for your heart failure patients. We want to make sure fluid balance such as electrolytes and blood pressure is maintaining in homeostasis. It's all about balance and control. That's all for digoxin. If you want to learn more about the other types of antihypertensives, go ahead and check this video out.
Happy studying future nurses!