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Digoxin | NCLEX

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Hi ninja nerds in this video we’re going to talk about digoxin that big nclex hitter so if you like this video make sure to give it a thumbs up comment down below and subscribe and don’t forget to check out where you can get the notes and the whiteboard lecture drawings all on our website let’s get started so digoxin is one of those big hitters on

The nclex and we’re going to talk about this medication what’s going on with it so also known as lanoxin but usually it’s called digoxin or dig and it is in a class of cardiac glycoside what does that mean so digoxin isn’t a medication that we give for the blood pressure it’s a medication that we give for other problems with the heart like our contractility or our

Problems filling or even with our arrhythmias so the indication for digoxin is someone with a mild usually systolic heart failure somebody who has a problem with their contractility and we might want to increase it and someone who has some type of arrhythmia like afib or a flutter so typically what we’re talking about here is someone who has a problem with either

Pumping or emptying through the heart so we’re looking at someone that might need a heart rate that’s too high or stroke volume that’s too low and we might have to increase that stroke volume or decrease that heart rate and how do we do that how does digoxin do that we’re going to talk about that through the mechanism of action here so we’re looking at this right

Here is a myocardium cell and we know that on all of our cells on our myocardium we have a sodium potassium atpase right we have this exchange of sodium and potassium and in the myocardium what happens is we have potassium that gets pumped into the cell and sodium that gets pumped out of the cell and that works normally just how it works every day it’s pumping

Out sodium pumping in potassium and what happens is digoxin comes along and it inhibits this atpase and it doesn’t necessarily turn it off all the way but it slows it down significantly when it slows that down the sodium in the cell is going to increase so let’s remember let’s back it up but now that we’re turning this off we’re turning off this sodium potassium

Or we’re slowing it down significantly to the point where sodium inside the cell is now getting really really high and potassium outside this cell is getting really really high because of this sodium getting high we have this calcium sodium or sodium calcium exchanger that normally wants to bring in sodium because sodium is getting pumped out here so it wants to

Bring in regulation get sodium back in because the sodium now in the cell is high it’s not going to bring it in as often if it’s not going to bring it in as often it’s going to keep this calcium in the cell so calcium in the cell is now going to increase as well and we can now have an increase of sodium and calcium within the cell so now our intracellular sodium

And our intracellular calcium is increased intracellular great okay so let’s run through this again really quickly we have intracellular sodium and calcium that is now increased digoxin comes in and it inhibits our sodium potassium atpase it directly does this it goes in and says we’re going to slow this down because of that it indirectly affects our sodium

Calcium exchanger right let’s think about this again potassium’s getting pumped in sodium is getting pumped out potassium’s getting pumped in sodium is getting pumped out digoxin comes in and says no no no i’m going to stop that because of that our sodium inside the cell is now increasing because it’s high sodium is not going to be getting exchanged in for calcium

To go out on our exchanger so since that sodium is high enough sodium is not coming in therefore calcium is not going out as often and that results in a higher sodium and calcium in the cell okay so intracellular calcium will then increase and because of this we have an increase in our contractility so that is the main mechanism of action of digoxin it also

Can affect the vagus nerve which we’re going to talk about in a second so we have this mechanism of action we have a positive ionotropic we have an increase in that squeeze that contractility right that’s what this means we also have a negative chronotropic which means it’s going to slow the heart rate and we also have a negative dromotropic which means it’s

Going to slow down the conduction between the heart so from our sa to our av node and that is all with that effect of the vagus nerve with all this we do have an increase in our stroke volume which is great because when we increase our stroke volume if you remember our cardiac output video we can increase our cardiac output because we know that cardiac output

Is heart rate times stroke volume and that’s really important with our patients with afib or having trouble with heart failure because we’re not pumping we’re not emptying as often or as emptying as effectively as we need to so we need to increase that cardiac output so we talked about the mechanism of action we talked about how dioxin works in the body let’s talk

About now how it affects the body all right ninja nerds now we’re going to give our patient digoxin and when we give them digoxin what we’re going to be looking at are some of the side effects typically that could lead to toxicity or the things that we’ve been looking for especially in the nclex questions they might say this patient might be in a toxic range of digoxin

So those side effects that we’re going to be looking for are gi issues like nausea vomiting anorexia or any type of belly pain abdominal pain remy looking at neuro particularly the fatigue or the confusion something like altered mental status or anything that would indicate to them that maybe they’re they’re a little more tired than normal could be an indication

That there’s a neuro effect we’re going to be looking also at their visual so when you talk to your patient or assess your patient or you’re reading the questions for the nclex you’re looking at things like blurry division fuzzy vision uh yellow green halos that they’re seeing or they’re having trouble reading like they didn’t before this could be an indication

That there’s a visual side effect and the last is a cardiac like an arrhythmia so if they’re on their telemetry and there’s an arrhythmia there that wasn’t there before all of these affect all these side effects here could indicate to us that our patient is in a toxic or in a toxicity of digoxin and the patients that are most at risk for this are typically the

Ones with renal failure or patients that are on diuretics what we’re looking at here is a patient that’s on a loop diuretic like furosemide is going to have a low potassium and when they have a low potassium or hypokalemia they are at a risk for toxicity and we want to make sure we keep an eye on these patients because if they have that lower potassium they have

An increased risk for toxicity this does not digoxin does not cause low potassium digoxin is not working on the potassium mechanism it’s working on our sodium remember our sodium and our calcium but patients that are on diuretics that have a lower potassium are at a higher risk for that toxicity and that has to do with the free amount of digoxin that’s floating

Around because potassium and digoxin can bind to a similar site and if there’s lower potassium not fighting over digoxin to get into those spots then digoxin levels are going to rise a lot quicker and a lot higher so what we’re looking at here are patients that are most at risk for toxic or what you’re looking at in the questions or who’s going to be toxic the

Fastest are the ones that are going to be low potassium which is a potassium of lower 3.5 a high calcium which is going to be over 10.2 or low magnesium which is our 1.5 and you also want to just keep in mind that creatinine level that’s going to be telling us about our kidney function what’s going on is if it’s greater than 1.3 or higher so what does all this

Mean and how do we know our patient is toxic so you’re looking at this question or you have a patient that you know is on diuretics and you’re thinking to yourself how do i know this patient is toxic or they’re in a toxic level and i need to let my doctor know what we’re looking at is our blood test there’s a toxicity range of 0.5 to 2 nanograms per milliliter and

What this means is if they’re over that if they’re over two then they are in that toxicity and this is the range that the nclex uses there’s other ranges as well that can be patient-based uh with whatever type of underlying conditions they have so just keep in mind that this is for the test but their your facility that you work at or any other patient it might be a

Different range for them but anything over two is we’re looking at toxicity and what happens our patient is in digoxin toxicity we’re like oh no they’re having some halos or they’re having some confusion we are going to one hold the dose don’t give the patient the next dose two notify their doctor their health care provider let them know hey i think this patient’s

Digoxin level is a little too high and make sure you assess your patient any fur further check their arrhythmias you might be looking for another ekg you might be listening to the lungs in their heart sounds and you’re going to possibly give or hopefully give the antidote digi bind which means that it’s going to bind to digoxin and not allow it to bind to our our

Sites in our body and eliminate that free floating digoxin and hopefully bring that level back down to a safe level toxicity is not something we want to mess around with we want to correct it immediately with that being said we want to make sure that when we put our patients on digoxin and when we are monitoring our patients we are teaching them and doing our

Interventions and what do those things look like the first thing is to assess our patient’s apical pulse we want to make sure especially on the nclex it’s going to be one full minute so we’re going to be listening to the heart for 60 seconds and we’re going to make sure that we’re going to hold it if it’s lower than 60 beats per minute in an adult lower than 70

Beats per minute in a child and for an infant lower than 90 to 110 beats per minute so you’re going to hold that medication and not give it to them and what is the apical pulse what does that mean the apical pulse remember is our fifth intercostal space mid-clavicular line that’s listening at the apex of the heart that’s where we can hear all of our valves opening

And closing so we get a nice sound of our heart and we’re getting it for a full minute because there could be arrhythmias underlying you only listen for 10 seconds you might miss that pvc or the extra beat or anything like that so make sure you’re listening for that full minute our patient also is going to get blood draws typically when they’re put on it put on

Medication it does take a couple days or so almost a week for it to get to a therapeutic level but we’re going to be checking those blood draws specifically specifically we’re going to be checking that potassium level we’re going to be checking their kidney function function the bun and creatinine remember that specifically if it’s greater than 1.3 creatinine if

It’s too high then we’re going to have some issues and remember that is a sign for toxicity or a indication that they could be going toxic soon and then our digoxin levels anything greater than two nanograms per milliliter is also an indication of toxicity if our patient misses a dose they’re not going to take an extra dose they’re not going to say oh i forgot

My morning digoxins i’ll double down on two tonight that’s a no no just take the dose as scheduled and go on to the next one tomorrow and teach them their signs of toxicity what are those signs again that alter mental status the change in the vision any type of yellow green halos or any type of chest pain arrhythmias things like that you want to make sure that

They’re notifying their doctor and getting those blood levels drawn okay engineers in this video we talked about digoxin i hope it made sense and make sure you check out our website where you can find this and many other notes for all of our lectures here on youtube and as always until next time you

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Digoxin | NCLEX By Ninja Nerd