Digoxin

Mechanism(s) of Action

Blocks sodium potassium pump increasing calcium levels which strengthens heart contractions and slows electrical conduction through the av node

Clinically digoxin is used in

supraventricular arrhythmias
heart failure

Drug dosing weight

Ideal body weight

Calculated dosing regimens need to be adjusted for the

presence of

renal dysfunction

Goals of Therapy

management of a supraventricular tachyarrhythmia
management of heart failure

Loading doses are only used if indication is

atrial fibrillation/ flutter

Patients with Heart Failure have increased/reduced clearance

reduced

Steady state level should be obtained within

7-14 days on initiating therapy

Once stable on dose, periodic monitoring for clinical efficacy/lack of clinical efficacy

should be done

at least every 6 months

T/F: you cannot use serum drug level as the sole

indicator of toxicity

True

Signs and Symptoms of Digoxin Toxicity

Bradycardia

ECG changes

Arrhythmias

Anorexia

Nausea/vomiting

Diarrhea

Visual disturbances

Dosage forms of Digoxin

tablet
oral solution

IV

A patient is hospitalized for dyspnea and is being seen by the pulmonary consult team and the cardiology consult team.  The patient has been taking digoxin 0.25mg PO daily for his atrial fibrillation for the past 3 years.  The cardiology resident orders a digoxin level which results at 1530 as 1.7ng/mL.  What is the most appropriate next step?  

Check the medication administration record to see what time the morning dose was given