Digoxin Diltiazem Acebutolol Amiodarone
Classification Cardiac glycoside. Inhibits Non-dihydropyridine calcium- Beta1-selective blocker (with Class III antiarrhythmic;
Action Na+/K+-ATPase -> channel blocker. Blocks L- intrinsic sympathomimetic mainly blocks K+ channels,
increases intracellular Ca2+ type Ca2+ channels -> slows activity). Decreases HR, prolonging
(positive inotrope); slows SA/AV conduction and contractility and renin repolarization/action
AV conduction/HR. causes vasodilation. release. potential; also Na+, Ca2+
and beta-blocking effects.
Uses Heart failure symptom Hypertension, angina; rate Hypertension; ventricular Serious ventricular
control; ventricular rate control in atrial arrhythmias. arrhythmias; atrial
control in atrial fibrillation/flutter; some SVTs. arrhythmias when
fibrillation/flutter. appropriate.
Interactions/ Contra: ventricular Contra/caution: severe Contra/caution: severe Contra: severe sinus-node
contraindications fibrillation. Interactions: hypotension, sick bradycardia, >1st-degree dysfunction/bradycardia,
amiodarone, verapamil, sinus/2nd-3rd degree AV heart block, cardiogenic 2nd/3rd-degree AV block
macrolides may raise block without pacemaker, shock/decompensated HF. without pacemaker. Many
digoxin; loop/thiazide HFrEF. Additive bradycardia Caution asthma/COPD, interactions: warfarin,
diuretics -> low K+ with beta blockers/digoxin; diabetes. Additive digoxin; QT-prolonging
increases toxicity. CYP3A4 interactions. bradycardia with drugs. Grapefruit can
diltiazem/verapamil. increase level.
Side effects/Adverse N/V, anorexia, fatigue, Bradycardia, hypotension, Bradycardia, hypotension, Pulmonary toxicity,
reactions – How to bradycardia, dysrhythmias; dizziness, edema, headache; fatigue, dizziness; may mask hepatotoxicity, thyroid
recognize – how to visual halos/yellow-green may worsen HF. Prevent hypoglycemia; bronchospasm dysfunction,
prevent vision = toxicity. Prevent by falls; monitor HR/BP. possible. Do not stop bradycardia/QT
monitoring level, K+, renal abruptly. prolongation, corneal
function. deposits,
photosensitivity/blue-gray
skin. Monitor lungs, LFTs,
thyroid, ECG.
Pre-assessment Apical pulse for 1 full min; Check BP, apical Check BP and apical pulse; Baseline ECG, HR/BP;
What do I need to hold/notify per ordered pulse/rhythm, edema/HF assess HF, respiratory status, K+/Mg2+; LFTs, TSH;
know before I give parameters (commonly HR signs; ECG for IV therapy. glucose in diabetes. pulmonary
it? <60 adult). Check K+, assessment/chest imaging
Mg2+, creatinine and as ordered; medication
digoxin level if ordered. interaction review.
Take same time daily; do Rise slowly; monitor Take consistently; rise slowly. Report cough/dyspnea,
not double missed dose. pulse/BP. Do not crush ER Check pulse/BP. Do not jaundice, syncope, vision
Interventions
Report N/V, vision changes, products. Report fainting, abruptly stop (rebound changes. Use sunscreen.
including teaching
palpitations. Avoid dyspnea, edema. Avoid angina/MI risk). Report Avoid grapefruit. Keep
OTC/herbals without grapefruit if instructed for wheezing, fainting, edema. thyroid/liver/lung/eye
checking. Digoxin immune product/interactions. follow-up.
Fab treats severe toxicity.
Therapeutic Improved HF Lower BP; fewer angina Lower BP/HR; fewer Fewer/suppressed
response symptoms/exercise episodes; controlled ventricular ectopic beats. dysrhythmias; stable
tolerance; controlled ventricular rate. rhythm/ventricular rate.
ventricular rate.
Created by T. Campos, MSN, RN, CNE 1/2019– ; Revised 8/12/2024
Classification Cardiac glycoside. Inhibits Non-dihydropyridine calcium- Beta1-selective blocker (with Class III antiarrhythmic;
Action Na+/K+-ATPase -> channel blocker. Blocks L- intrinsic sympathomimetic mainly blocks K+ channels,
increases intracellular Ca2+ type Ca2+ channels -> slows activity). Decreases HR, prolonging
(positive inotrope); slows SA/AV conduction and contractility and renin repolarization/action
AV conduction/HR. causes vasodilation. release. potential; also Na+, Ca2+
and beta-blocking effects.
Uses Heart failure symptom Hypertension, angina; rate Hypertension; ventricular Serious ventricular
control; ventricular rate control in atrial arrhythmias. arrhythmias; atrial
control in atrial fibrillation/flutter; some SVTs. arrhythmias when
fibrillation/flutter. appropriate.
Interactions/ Contra: ventricular Contra/caution: severe Contra/caution: severe Contra: severe sinus-node
contraindications fibrillation. Interactions: hypotension, sick bradycardia, >1st-degree dysfunction/bradycardia,
amiodarone, verapamil, sinus/2nd-3rd degree AV heart block, cardiogenic 2nd/3rd-degree AV block
macrolides may raise block without pacemaker, shock/decompensated HF. without pacemaker. Many
digoxin; loop/thiazide HFrEF. Additive bradycardia Caution asthma/COPD, interactions: warfarin,
diuretics -> low K+ with beta blockers/digoxin; diabetes. Additive digoxin; QT-prolonging
increases toxicity. CYP3A4 interactions. bradycardia with drugs. Grapefruit can
diltiazem/verapamil. increase level.
Side effects/Adverse N/V, anorexia, fatigue, Bradycardia, hypotension, Bradycardia, hypotension, Pulmonary toxicity,
reactions – How to bradycardia, dysrhythmias; dizziness, edema, headache; fatigue, dizziness; may mask hepatotoxicity, thyroid
recognize – how to visual halos/yellow-green may worsen HF. Prevent hypoglycemia; bronchospasm dysfunction,
prevent vision = toxicity. Prevent by falls; monitor HR/BP. possible. Do not stop bradycardia/QT
monitoring level, K+, renal abruptly. prolongation, corneal
function. deposits,
photosensitivity/blue-gray
skin. Monitor lungs, LFTs,
thyroid, ECG.
Pre-assessment Apical pulse for 1 full min; Check BP, apical Check BP and apical pulse; Baseline ECG, HR/BP;
What do I need to hold/notify per ordered pulse/rhythm, edema/HF assess HF, respiratory status, K+/Mg2+; LFTs, TSH;
know before I give parameters (commonly HR signs; ECG for IV therapy. glucose in diabetes. pulmonary
it? <60 adult). Check K+, assessment/chest imaging
Mg2+, creatinine and as ordered; medication
digoxin level if ordered. interaction review.
Take same time daily; do Rise slowly; monitor Take consistently; rise slowly. Report cough/dyspnea,
not double missed dose. pulse/BP. Do not crush ER Check pulse/BP. Do not jaundice, syncope, vision
Interventions
Report N/V, vision changes, products. Report fainting, abruptly stop (rebound changes. Use sunscreen.
including teaching
palpitations. Avoid dyspnea, edema. Avoid angina/MI risk). Report Avoid grapefruit. Keep
OTC/herbals without grapefruit if instructed for wheezing, fainting, edema. thyroid/liver/lung/eye
checking. Digoxin immune product/interactions. follow-up.
Fab treats severe toxicity.
Therapeutic Improved HF Lower BP; fewer angina Lower BP/HR; fewer Fewer/suppressed
response symptoms/exercise episodes; controlled ventricular ectopic beats. dysrhythmias; stable
tolerance; controlled ventricular rate. rhythm/ventricular rate.
ventricular rate.
Created by T. Campos, MSN, RN, CNE 1/2019– ; Revised 8/12/2024
