NCLEX Drug Toxicities Notes

Digoxin 2
Lithium 2
Aminophylline 20
Dilantin 20
Acetaminophen 200

Digoxin
Brand Name: Lanoxin
Toxicity: 2
Normal Range: 0.5-1.5 meq/L
Indication: Congestive Heart Failure
Classification: Cardiac Glycoside
Mechanism of Action:
 Increase force of Myocardial Contraction
 Increase force of Cardiac Contraction
 Increase Cardiac Output
Nursing Management:
Check Apical Pulse Rate
HR < 60bpm- Notify the Physician

S/S:
 Anorexia
 Nausea and Vomiting
 Diarrhea
 Confusion
 Photophobia
 Xantopsia

Antidote: DIGIBIND

Lithium
Brand Name: Lithane
Toxicity: 2
Normal Range: 0.6-1.2 meq/L
Indication: Bipolar Disorder (Anti-Manic)
Mechanism of Action:
 Decrease ACTH
 Decrease Norepinephrine
 Decrease Serotonin
Nursing Management:
Force Fluid (2-3 L)
Increase Sodium Intake (4-10 g/daily to prevent dehydration)

S/S:
 Anorexia
 Diarrhea
 Dehydration
 Hypothyroidism
 Fine Tremors

Aminophylline/Theophylline
Brand Names: Elixophyllin
Toxicity: 20
Normal Range: 10-19meq/100ml
Indication: COPD
Classification: Bronchodilator
Mechanism of Action:
 Bronchodilator- dilates the bronchial tree thereby allowing more air to enter the lungs.
Nursing Management:
Avoid Caffeine
S/S:
 Tachycardia
 CNS excitability
 Irritability and Agitation
 Restlessness
 Tremors

Dilantin/Phenytoin
Toxicity: 20
Normal Range: 10-19 meq/L
Classification: Anti-Convulsant
Mechanism of Action:
 Suppresses the paroxysmal electrical activity that makes up focal lesions.
 Blocks post-tetanic potentiation (PTT). PTT is an important mechanism in the development of high frequency trains of impulses in excitatory brain circuits; the spread of this activity to adjacent neurons and propagation to distant neuronal aggregates results in uncontrolled spread of excitation of the whole brain leading to a tonic-clonic seizure.
Nursing Management:
It is only mixed with 0.9 plain NSS or NaCl to prevent crystals or precipitate.
Given via: Sandwich Method
Instruct client to avoid alcohol- CNS depression, may lead to seizure.
S/S:
 Gingival Hyperplasia
 Instruct client to massage his gums
 Hairy Tongue
 Ataxia
 (+) Rhomberg’s Test
 Nystagmus
Acetaminophen
Brand Name: Tylenol
Toxicity: 200
Indication: Osteoarthritis
Classification: Anti- Narcotic Analgesic
Mechanism of Action:
 Acetaminophen is used for the relief of fever as well as aches and pains associated with many conditions.
 Relieves pain in mild arthritis but has no effect on the underlying inflammation, redness, and swelling of the joint.

S/S:

 Jaundice
 Abdominal Pain
 Vomiting

Antidote: Acetylceisteine
Nursing Management:
Prepare suction apparatus