Pharmacological Therapies: High-Alert Medications & Safety
A 72-year-old male with a history of chronic heart failure and atrial fibrillation is admitted for an exacerbation of dyspnea and peripheral edema. He is currently prescribed digoxin 0.25 mg daily and warfarin 5 mg daily. Assessment reveals bilateral 2+ pitting edema, crackles in the lung bases, and a heart rate of 52 beats/min. The client reports seeing 'yellow halos' around the lights and experiencing nausea for the past 24 hours. The provider orders a Stat BMP, Digoxin level, and a 2-unit transfusion of packed red blood cells (PRBCs) due to a hemoglobin of 6.8 g/dL.
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High-Alert Medications: Digoxin Safety
Digoxin is a cardiac glycoside with a narrow therapeutic index (0.5–2.0 ng/mL). Toxicity is often precipitated by hypokalemia and presents with neurological and gastrointestinal symptoms.
- Assess apical pulse for 60 seconds; hold if < 60 bpm in adults.
- Early signs of toxicity include anorexia, nausea, and vomiting.
- Visual disturbances (yellow-green halos) are late signs of toxicity.
- Hypokalemia increases the risk of digoxin toxicity even at therapeutic levels.