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Generic Name: Digoxin

Brand Name: Lanoxin

Stock Dosage:

Oral solution: 0.05 mg/mL

Injectable solution: 0.1 mg/mL, 0.25 mg/mL

Tablet: 0.0625 mg (adult only), 0.125 mg, 0.1875 mg (adult only), 0.25 mg

Classification:

Pharmacologic class: Cardiac glycoside

Therapeutic class: Antiarrhythmic, cardiotonic

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Generic Name: Clopidogrel bisulfate

Brand Name: Plavix

Stock Dosage:

Tablet: 75 mg, 300 mg

Classification:

Pharmacologic class: P2Y12 platelet inhibitor

Therapeutic class: Platelet aggregation inhibitor

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Mechanism of Action: Binds to adenosine diphosphate (ADP) receptors on the surface of activated platelets. This action blocks ADP, which deactivates nearby glycoprotein IIb/IIIa receptors and prevents fibrinogen from attaching to receptors. Without fibrinogen, platelets can’t aggregate and form thrombi.

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Indication/s: To reduce the rate of CVA and MI in patient with established peripheral arterial disease or a history of recent MI

Contraindications: Active pathological bleeding, including intracranial hemorrhage and peptic ulcer; hypersensitivity to clopidogrel or its components

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Side Effects and Adverse Effects:

CNS: Confusion, depression, dizziness, fatal intracranial bleeding, fatigue, fever, hallucinations, headache

CV: Chest pain, edema, hypercholesterolemia, hypertension, hypotension, vasculitis

EENT: Altered or loss of taste; conjunctival, ocular, or retinal bleeding; epistaxis; rhinitis; stomatitis; taste disorders

ENDO: Insulin autoimmune syndrome, severe hypoglycemia

GI: Abdominal pain; acute liver failure; colitis; diarrhea; duodenal, gastric, or peptic ulcer; elevated liver enzymes; gastritis; gastrointestinal and retroperitoneal hemorrhage; indigestion; nausea; noninfectious hepatitis, pancreatitis

GU: Elevated serum creatinine level, glomerulopathy, UTI

HEME: Acquired hemophilia A, agranulocytosis, aplastic anemia, neutropenia, pancytopenia, prolonged bleeding time, thrombocytopenic purpura, thrombotic thrombocytopenic purpura, unusual bleeding or bruising

MS: Arthralgia, back pain, musculoskeletal bleeding, myalgia

RESP: Bronchitis, bronchospasm, cough, dyspnea, eczema, eosinophilic pneumonia, interstitial pneumonitis, respiratory tract bleeding, upper respiratory tract infection

SKIN: Acute generalized exanthematous pustulosis, bullous dermatitis, erythema multiforme, exfoliative dermatitis, lichen planus, pruritus, skin bleeding, Stevens–Johnson syndrome, toxic epidermal necrolysis, urticaria

Other: Anaphylaxis, angioedema, drug reaction with eosinophilia and systemic symptoms (DRESS), flu-like symptoms, serum sickness

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Nursing Responsibilities:

o   Use clopidogrel cautiously in patients with severe hepatic or renal disease, risk of bleeding from surgery or trauma, or conditions that predispose to bleeding (such as peptic ulcer disease or thrombotic thrombocytopenic purpura).

o   Be aware that clopidogrel prolongs bleeding time; expect to stop it 5 days before elective surgery.

o   Obtain blood cell count, as ordered, whenever signs and symptoms suggest a hematologic problem.

o   Monitor patient who takes aspirin closely because risk of bleeding is increased.

o   Discourage use of NSAIDs, including OTC preparations, during clopidogrel therapy because of potential for bleeding.

o   Caution patient that bleeding may continue longer than usual. Instruct him to report unusual bleeding or bruising.

o   Advise patient to notify prescriber promptly if he experiences extreme skin paleness, fever, neurologic changes, purple skin patches, weakness, or yellowing of his skin or eyes.

o   Instruct patient not to discontinue clopidogrel abruptly or without first consulting prescriber.

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Mechanism of Action: Increases the force and velocity of myocardial contraction, resulting in positive inotropic effects. Digoxin produces antiarrhythmic effects by decreasing the conduction rate and increasing the effective refractory period of the AV node.

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Indication/s: To treat mild to moderate heart failure with rapid digitalization

Contraindications: Hypersensitivity to digoxin or its components, presence of digitalis toxicity, ventricular fibrillation ventricular tachycardia unless heart failure occurs unrelated to digoxin therapy

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Side Effects and Adverse Effects:

CNS: Confusion, depression, drowsiness, extreme weakness, headache, syncope

CV: Arrhythmias, heart block

EENT: Blurred vision, colored halos around objects

GI: Abdominal discomfort or pain, anorexia, diarrhea, nausea, vomiting

Other: Electrolyte imbalances

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1. Aminocaproic acid
2. Amlodipine
3. Aspirin
4. Atenolol
5. Atorvastatin
6. Captopril
7. Clopidogrel
8. Digoxin
9. Diltiazem
10. Dobutamine
11. Dopamine
12. Heparin sodium
13. Isorbidide Dinitrate
14. Losartan potassium
15. Metoprolol
16. Morphine Sulfate
17. Naloxone hydrochloride
18. Norepinephrine hydrochloride
19. Nitroglycerin
20. Propanolol hydrochloride
21. Protamine Sulfate
22. Simvastatin
23. Streptokinase
24. Ticlopidine
25. Tissue Plasminogen Activator
26. Warfarin sodium

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Nursing Responsibilities:

o   Take patient’s apical pulse before giving each dose and notify prescriber if it’s below 60 beats/minute (or other specified level).

o   Monitor patient closely for signs of digitalis toxicity, such as altered mental status, arrhythmias, heart block, nausea, vision disturbances, and vomiting. If they appear, notify prescriber, check serum digoxin level as ordered, and expect to withhold drug until level is known. Monitor ECG tracing continuously.

o   Monitor patient’s serum potassium level regularly because hypokalemia predisposes to digitalis toxicity and serious arrhythmias. Also monitor potassium level often when giving potassium salts because hyperkalemia in patients receiving digoxin can be fatal.

o   Emphasize importance of taking digoxin exactly as prescribed. Warn about possible toxicity from taking too much and decreased effectiveness from taking too little.

o   Instruct patient to take digoxin at same time each day to help increase compliance.

o   Teach patient how to take her pulse, and instruct her to do so before each dose. Urge her to notify prescriber if pulse falls below 60 beats/minute or suddenly increases.

o   Instruct patient to take a missed dose as soon as she remembers if within 12 hours of scheduled dose. If not, urge her to notify prescriber immediately.

o   Urge patient to notify prescriber if she experiences adverse reactions, such as GI distress or pulse changes.

o   Advise patient to consult prescriber before using other drugs, including OTC products.