Digoxin Diltiazem Acebutolol Amiodarone
Classification Drug Class Drug class DRUG CLASS CLASS OF DRUG
Action Cardiac Glycosides Calcium channel Beta 1 Blocker Potassium channel blocker
ACTION blockers (diltiazem) (Antidysrhythmic drug) (Antidysrhythmic drug)
Inhibits sodium-potassium ACTION ACTION
ATPase.
Relax coronary arteries Increases refractory
Positive inotropic:
Increases myocardial
and decrease coronary (recovery) time.
contractility. artery spasm (variant Prolongs duration of action
Increases stroke volume angina)\ potential.
(increases cardiac output) Reduce cardiac
Increases blood flow. workload and oxygen
Decreases preload. demands.
Negative chronotropic:
Decreases heart rate.
Negative dromotropic:
Decreases conduction of heart
cells.
Uses USES Used for prevention of Atrial and Life threatening ventricular
Heart failure (CHF). anginal supraventricular arrythmias unresponsive ve
Atrial arrhythmias. arrhythmias to other drugs: V-tack, V-fib
Interactions/ INTERACTIONS
contraindicati
ons Diuretics
Hypokalemia
Cortisone
Sodium retention, potassium
release
Antacids
Decrease digitalis absorption.
CONTRAINDICATION
Ventricular dysrhythmias
Bradycardia
Hypokalemia
Renal disease
Side SIDE EFFECTS/ADVERSE SIDE EFFECT SIDE EFFECTS SIDE EFFECTS
effects/Advers REACTIONS Dizziness, Depression, Dizzy, headache, Fatigue
e reactions – Dizziness, weakness, fatigue, sexual flushing, edema, Confusion
How to headache dysfunction, peripheral orthostatic Dizziness
recognize – edema hypotension Gi distress
Bradycardia, cardiac
how to ADVERSE REACTION ADVERSE EFFECTS
dysrhythmias,
prevent Anorexia, nausea, vomiting,
Bronchospasms, ADVERSE REACTIONS Pulmonary toxicity, Elevated
diarrhea, bradycardia, Bradycardia, liver enzymes,
Blurred vision, yellow or green hypotension hypotension, dysrhythmias, hypotension,
halos around objects, dyspnea bradycardia, neuropathy,
Digoxin toxicity tremor, blue-gray skin
A/R – Digoxin Toxicity discoloration
Common signs of toxicity
Created by T. Campos, MSN, RN, CNE 1/2019, revised 6/2019–
, Anorexia, nausea, vomiting,
diarrhea
Blurred vision, green or yellow
halos
Bradycardia, premature
ventricular contractions,
cardiac dysrhythmias
Pre- ASSESSMENT ASSESSMENT ASSESSMENT ASSESSMENT
assessment
Obtain a baseline pulse rate Obtain baseline vital Obtain baseline vital signs
for future comparisons. Apical signs for future and ECG for future
Digoxin pulse for one minute. comparisons. comparison.
Medical/medication history.
Medication/medical Medical/medication history
Electrolytes
Signs and symptoms of history Palpitations, apical pulse
CHF/atrial Pain level for acute compared to radial pulse.
arrhythmia/edema/lung episode Cardiac enzymes – if
sounds. History of angina ordered.
Assess for evidence of digitalis attacks, frequency, and
toxicity. severity
INTERVENTION INTERVENTION
Interventions Monitor serum digoxin Monitor vital signs for
including level – 0.5-2ng mL. Toxic is hypotension and
teaching over 2.2 ng/mL. bradycardia.
Monitor serum potassium Monitor lung sounds.
level and report if If giving IVP, give slowly.
hypokalemia. Monitor ECG for abnormal
Monitor edema/signs and patterns and report findings.
symptoms of CHF, pulse. Patient should be on a
cardiac monitor.
PATIENT TEACHING TEACHING
Take drug same time every Do not stop beta TEACHING
day. blocker or calcium Monitor their blood
Take pulse and notify HCP channel abruptly- teach pressure and pulse, ECG (if
if less than 60 above 100. to monitor heart rate available on wearable
S/S to report, for example and blood pressure. electronic device).
s/s of dig toxicity. Notify HCP for Take drug as ordered – do
If taking diuretic take consistent dizziness or not stop any cardiac drug
potassium supplement as faintness. abruptly.
prescribed. Beta blockers can take 1-3
months for full effect.
Tell patient to report side
effects and adverse
reactions to a health care
provider, for example
palpitations, slow heart rate.
Teach to get up slowly.
Advise patient to avoid
alcohol, caffeine, and
Created by T. Campos, MSN, RN, CNE 1/2019, revised 6/2019–
Classification Drug Class Drug class DRUG CLASS CLASS OF DRUG
Action Cardiac Glycosides Calcium channel Beta 1 Blocker Potassium channel blocker
ACTION blockers (diltiazem) (Antidysrhythmic drug) (Antidysrhythmic drug)
Inhibits sodium-potassium ACTION ACTION
ATPase.
Relax coronary arteries Increases refractory
Positive inotropic:
Increases myocardial
and decrease coronary (recovery) time.
contractility. artery spasm (variant Prolongs duration of action
Increases stroke volume angina)\ potential.
(increases cardiac output) Reduce cardiac
Increases blood flow. workload and oxygen
Decreases preload. demands.
Negative chronotropic:
Decreases heart rate.
Negative dromotropic:
Decreases conduction of heart
cells.
Uses USES Used for prevention of Atrial and Life threatening ventricular
Heart failure (CHF). anginal supraventricular arrythmias unresponsive ve
Atrial arrhythmias. arrhythmias to other drugs: V-tack, V-fib
Interactions/ INTERACTIONS
contraindicati
ons Diuretics
Hypokalemia
Cortisone
Sodium retention, potassium
release
Antacids
Decrease digitalis absorption.
CONTRAINDICATION
Ventricular dysrhythmias
Bradycardia
Hypokalemia
Renal disease
Side SIDE EFFECTS/ADVERSE SIDE EFFECT SIDE EFFECTS SIDE EFFECTS
effects/Advers REACTIONS Dizziness, Depression, Dizzy, headache, Fatigue
e reactions – Dizziness, weakness, fatigue, sexual flushing, edema, Confusion
How to headache dysfunction, peripheral orthostatic Dizziness
recognize – edema hypotension Gi distress
Bradycardia, cardiac
how to ADVERSE REACTION ADVERSE EFFECTS
dysrhythmias,
prevent Anorexia, nausea, vomiting,
Bronchospasms, ADVERSE REACTIONS Pulmonary toxicity, Elevated
diarrhea, bradycardia, Bradycardia, liver enzymes,
Blurred vision, yellow or green hypotension hypotension, dysrhythmias, hypotension,
halos around objects, dyspnea bradycardia, neuropathy,
Digoxin toxicity tremor, blue-gray skin
A/R – Digoxin Toxicity discoloration
Common signs of toxicity
Created by T. Campos, MSN, RN, CNE 1/2019, revised 6/2019–
, Anorexia, nausea, vomiting,
diarrhea
Blurred vision, green or yellow
halos
Bradycardia, premature
ventricular contractions,
cardiac dysrhythmias
Pre- ASSESSMENT ASSESSMENT ASSESSMENT ASSESSMENT
assessment
Obtain a baseline pulse rate Obtain baseline vital Obtain baseline vital signs
for future comparisons. Apical signs for future and ECG for future
Digoxin pulse for one minute. comparisons. comparison.
Medical/medication history.
Medication/medical Medical/medication history
Electrolytes
Signs and symptoms of history Palpitations, apical pulse
CHF/atrial Pain level for acute compared to radial pulse.
arrhythmia/edema/lung episode Cardiac enzymes – if
sounds. History of angina ordered.
Assess for evidence of digitalis attacks, frequency, and
toxicity. severity
INTERVENTION INTERVENTION
Interventions Monitor serum digoxin Monitor vital signs for
including level – 0.5-2ng mL. Toxic is hypotension and
teaching over 2.2 ng/mL. bradycardia.
Monitor serum potassium Monitor lung sounds.
level and report if If giving IVP, give slowly.
hypokalemia. Monitor ECG for abnormal
Monitor edema/signs and patterns and report findings.
symptoms of CHF, pulse. Patient should be on a
cardiac monitor.
PATIENT TEACHING TEACHING
Take drug same time every Do not stop beta TEACHING
day. blocker or calcium Monitor their blood
Take pulse and notify HCP channel abruptly- teach pressure and pulse, ECG (if
if less than 60 above 100. to monitor heart rate available on wearable
S/S to report, for example and blood pressure. electronic device).
s/s of dig toxicity. Notify HCP for Take drug as ordered – do
If taking diuretic take consistent dizziness or not stop any cardiac drug
potassium supplement as faintness. abruptly.
prescribed. Beta blockers can take 1-3
months for full effect.
Tell patient to report side
effects and adverse
reactions to a health care
provider, for example
palpitations, slow heart rate.
Teach to get up slowly.
Advise patient to avoid
alcohol, caffeine, and
Created by T. Campos, MSN, RN, CNE 1/2019, revised 6/2019–
