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Here are the medications most commonly monitored for their therapeutic dosage.
Just like the Magicians, Nurses too can pull out the prescription drugs out of our
magic nurse's caps to remind us to use the "Magic 2's" as a way to remember the
TOXICITY LEVEL of some commonly used medications.

Magic 2’s of DRUG TOXICITY MONITORING

(Remember DLADA)

Drug Normal range Toxicity Classification Indication

D – digoxin .5 – 1.5 meq/L 2 cardiac glycosides CHF

L - lithium .6 – 1.2 meq/L 2 antimanic bipolar
A – aminophylline 10 – 19 mg/100ml 20 bronchodilator COPD
D – Dilantin 10 -19 mg/100 ml 20 anticonvulsant seizures
A – acetaminophen 10 – 30 mg/100ml 200 narcotic analgesic osteoarthritis

D - DIGOXIN (LANOXIN)
Action: increases force of myocardial contraction and slows heart rate by stimulating
the vagus nerve and blocking the AV
node
increase force of myocardial contraction = increase CO

Nursing Considerations:
1. Check apical pulse for 1 full minute before administering
* If heart rate is below 60bpm, DON’T give Digoxin!
Notify physician if AP
<60 (adult)
<90-110 (infants and young children)
<70 (older children)
2. Watch out for Digitalis toxicity
antidote - Digibind
a. Anorexia - initial symptom of digitalis toxicity.
b. n/v GIT
c. Diarrhea
d. Confusion
e. Photophobia
f. Changes in color perception – yellow spots

* Okey to give to patients with renal failure.

Digoxin is metabolized in liver not in kidney.
* Risk of digitalis toxicity increases if patient is hypokalemic.
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...cont. DIGITALIS

Herbal interactions:
Licorice can potentiate action of digoxin by promoting potassium loss
Hawthorn may increase effects of digoxin
Ginseng may falsely elevate digoxin levels
Ma-huang (ephedra) increases risk of digitalis toxicity

L – LITHIUM (LITHANE)
L – lithium (lithane) decrease levels of norepinephrine, serotonin, acetylcholine
- antimanic agent

Lithium toxicity s/sx:

a.) Anorexia
b.) n/s
c.) Diarrhea
d.) Dehydration – force fluid, maintain Na intake 4 – 10g daily
e.) Hypothyroidism
(CRETINISM– the only endocrine disorder that can lead to mental retardation)

A – AMINOPHYLLINE (THEOPHYLLINE)
A – aminophyline (theophylline) – dilates bronchioles.

Nursing Consideration:
Take BP before giving aminophylline.

s/sx of Aminophylline toxicity:

1. Tachycardia
2. Hyperactivity – restlessness, agitation, tremors
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D – Dilatin (Phenytoin)
D – Dilatin (Phenytoin) – anti-convulsant/ anti-seizure

Nursing Mgt:
1. Mixed with plain NSS or .9 NaCl to prevent formation of crystals or precipitate
- Do sandwich method
- Give NSS then Dilantin, then NSS!
2. Instruct the patient to avoid alcohol --- alcohol + dilantin can lead to severe CNS
depression

Dilantin toxicity s/sx:

G – gingival hyperplasia – swollen gums
i. Oral hygiene – use soft toothbrush
ii. Massage gums
H – hairy tongue
A - ataxia
N – nystagmus – abnormal movement of eyeballs
A – acetaminophen / Tylenol – non-opoid analgesic & antipyretic – febrile patients

Acetaminophen
Acetaminophen toxicity:
1. Hepatotoxicity
2. Monitor liver enzymes
SGPT (ALT) – Serum Glutamic Piruvate Tyranase
SGOT- Serum Glutamic Acetate Tyranase
3. Monitor BUN (10 – 20)
Crea (.8-1)

Acetaminophen toxicity can lead to hypoglycemia

T – tremors, Tachycardia
I – irritability
R – restlessness
E – extreme fatigue
D – depression (nightmares) , Diaphoresis

Antidote for acetaminophen toxicity – Acetylcesteine

= causes outpouring of secretions. Suction!
Prepare suction apparatus.

Question: The following are symptoms of hypoglycemia except:

a. Nightmares
b. Extreme thirst (R: hyperglycemic symptom)
c. Weakness
d. Diaphoresis