Digoxin calculator

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OverviewIt is important for healthcare professionals including doctors, nurses, pharmacists, and pharmacy technicians to know which medications to prescribe and at what dose to prescribe them.Dose calculations should be performed before a medication is prescribed so that it is not wasted.A dosage calculator should be used if there is any concern about the correct dose.Common means of administering a medication:Volume infusion: medication given over a set period of timeBolus: medication administered quickly or in a short burstContinuous infusion: medication administered continuously over an extended period of timeDosage regimen is a plan for the administration of a drug for a given time period to achieve the desired physiological and pharmacological effects.Loading dose is a specific dose of the medication given, usually when initiating therapy, to achieve the desired plasma Plasma The residual portion of blood that is left after removal of blood cells by centrifugation without prior blood coagulation. Transfusion Products drug concentration rapidly.Maintenance dose is the amount of medication given, usually repeatedly and at set intervals, to maintain a specific plasma Plasma The residual portion of blood that is left after removal of blood cells by centrifugation without prior blood coagulation. Transfusion Products drug concentration over a given time period.Related videosTherapeutic WindowDefinitionTherapeutic window is the dosage range within which the drug is effective (i.e., the dose at which the drug produces the desired effect) without causing toxicity.Minimum effective concentration is the minimum drug level in the blood required to achieve the desired effect.Minimum toxic concentration is the minimum drug level in the blood at which toxic side effects occur.Therapeutic indexTherapeutic index is a measure similar to therapeutic window and is used for:Measurement of the relative safety of a medicationComparison between the dose needed for therapeutic effect and the dose that causes toxicityTherapeutic index is calculated by dividing the toxic dose for 50% of the population by the minimum effective dose for 50% of the population.$$Therapeutic~index=\frac{TD_{50}}{ED_{50}}$$TD50 = toxic dose for 50% of the populationED50 = effective dose for 50% of the populationExampleThe therapeutic window for digoxin Digoxin A cardiotonic glycoside obtained mainly from digitalis lanata; it consists of three sugars and the aglycone digoxigenin. Digoxin has positive inotropic and negative chronotropic activity. It is used to control ventricular rate in atrial fibrillation and in the management of congestive heart failure with atrial fibrillation. Its use in congestive heart failure and sinus rhythm is less certain. The margin between toxic and therapeutic

Creatinine is normal. Digoxin requirements in older adult may change and a formerly therapeutic dose can become toxic.Observe for signs and symptoms of toxicity. In adults and older children, first symptoms of toxicity usually include abdominal pain, anorexia, nausea, vomiting, visual disturbances, bradycardia, and other arrhythmias. In infants and small children, first signs of overdose are usually cardiac arrhythmias. If these appear, withhold drug and notify health care professional immediately.If signs of toxicity occur and are not severe, discontinuation of digoxin may be all that is required.Correct electrolyte abnormalities, thyroid dysfunction, and concomitant medications. Administer potassium to maintain serum potassium between 4.0 and 5.5 mEq/L. Monitor ECG for evidence of potassium toxicity (peaked T waves).Treatment of life-threatening arrhythmias may include administration of digoxin immune Fab (Digibind) , which binds to the digitalis glycoside molecule in the blood and is excreted by the kidneys.ImplementationDo not confuse Lanoxin with levothyroxine or naloxone.High Alert: Digoxin has a narrow therapeutic range. Medication errors associated with digoxin include miscalculation of pediatric doses and insufficient monitoring of digoxin levels.For rapid digitalization, initial dose is higher than maintenance dose; 50% of total digitalizing dose is given initially. Administer remainder of dose in 25% increments at 4–8 hr intervals.When changing from parenteral to oral dose forms, dose adjustments may be necessary because of pharmacokinetic variations in percentage of digoxin absorbed: 100 mcg (0.1 mg) digoxin injection = 125 mcg (0.125 mg) tablet or 125 mcg (0.125 mg) of elixir.PO Administer oral preparations consistently with regard to meals. Tablets can be crushed and administered with food or fluids if patient has difficulty swallowing. Use calibrated measuring device for elixir; calibrated dropper is not accurate for doses of less than 0.2 mL or 10 mcg.IM Administer deep into gluteal muscle and massage well to reduce painful local reactions. Do not administer more than 2 mL of digoxin in each IM site. IM administration is not generally recommended.IV AdministrationIV Push: Dilution: May be administered undiluted. May also dilute 1 mL of digoxin in 4 mL of sterile water for injection, D5W, or 0.9% NaCl. Less diluent will cause precipitation. Use diluted solution immediately.Rate: Administer over at least 5 min.Y-Site Compatibility: acycloviralemtuzumabamikacinMORE...aminocaproic acidaminophyllineamphotericin B lipid complexanidulafunginargatrobanarsenic trioxideascorbic acidatracuriumatropineazathioprineazithromycinaztreonambenztropinebivalirudinbleomycinbumetanidebuprenorphinebutorphanolcalcium chloridecalcium gluconatecangrelorcarboplatincarmustinecefazolincefotaximecefotetancefoxitinceftarolineceftazidimeceftobiproleceftolozane/tazobactamceftriaxonecefuroximechloramphenicolchlorothiazidechlorpromazineciprofloxacincisatracuriumcisplatinclindamycincyanocobalamincyclophosphamidecyclosporinecytarabinedacarbazinedactinomycindaptomycindaunorubicindexamethasonedexmedetomidinedexrazoxanediltiazemdimenhydrinatediphenhydraminedobutaminedocetaxeldopaminedoxorubicin liposomaldoxycyclineenalaprilatephedrineepinephrineepirubicinepoetin alfaeptifibatideertapenemerythromycinesmololetoposideetoposide phosphatefamotidinefentanylfludarabinefluorouracilfolic acidfosphenytoinfurosemideganciclovirgemcitabinegentamicinglycopyrrolategranisetronheparinhetastarchhydrocortisonehydromorphoneifosfamideimipenem/cilastatinimipenem/cilastatin/relebactamindomethacinirinotecanisavuconazoniumisoproterenolketamineketorolaclabetalolLRleucovorin calciumlevofloxacinlidocainelinezolidlorazepammagnesium sulfatemannitolmeperidinemeropenemmeropenem/vaborbactammesnamethadonemethohexitalmethotrexatemethylprednisolonemetoclopramidemetoprololmetronidazolemidazolammilrinonemitomycinmorphinemoxifloxacinmultivitaminsmycophenolatenafcillinnalbuphinenaloxonenicardipinenitroglycerinnitroprussidenorepinephrineoctreotideondansetronoxacillinoxaliplatinoxytocinpalonosetronpamidronatepantoprazolepapaverinepemetrexedpenicillin Gpentobarbitalphenobarbitalphentolaminephenylephrinephytonadionepiperacillin/tazobactamplazomicinpotassium acetatepotassium chlorideprocainamideprochlorperazinepromethazinepropranololprotaminepyridoxineremifentanilrituximabrocuroniumsodium acetatesodium bicarbonatestreptomycinsuccinylcholinesufentanilsulbactam/durlobactamtacrolimustedizolidtheophyllinethiaminethiotepatigecyclinetirofibantobramycintrastuzumabvancomycinvasopressinvecuroniumverapamilvinblastinevincristinevinorelbinevoriconazolezoledronic acidY-Site Incompatibility: amiodaroneamphotericin B deoxycholateamphotericin B liposomalMORE...caspofungindantrolenediazepamdoxorubicin hydrochloridefoscarnetgemtuzumab ozogamicinidarubicinminocyclinemitoxantronepaclitaxelpentamidinephenytoinpropofoltelavancintopotecantrimethoprim/sulfamethoxazolePatient/Family TeachingInstruct patient to take medication as directed, at same time each day. Teach parents or caregivers of infants and children how to accurately measure medication. Take missed doses within 12 hr of scheduled dose or omit. Do not double doses. Consult health care professional if doses for 2 or more days are missed. Do not discontinue medication without consulting health care professional.Teach