CHF: Medications

CHF: Medical Management

Medications may be necessary to manage the effects of CHF. Children may be maintained on several medications for extended periods of time. Two common medications are:

DIGOXIN (LANOXIN)

Digoxin is an inotropic medication. That means it works directly on the heart to increase the velocity of contraction and the force of the contraction. In addition, it slows conduction through the AV node, slowing the heart rate and suppressing dysrhythmias.

Initial doses are given parenterally; these are the loading or digitalizing doses. Maintenance doses are given once daily, or divided into 2 doses 12 hours apart.

The goal of therapy is to reduce the heart rate and venous pressure. Diuresis will begin and edema lessen. When digitilization has taken place, an ECG will show a lengthened PR interval and depression of the ST segment.

Symptoms of digitalis toxicity include: anorexia, nausea and vomiting, dizziness, diarrhea, headache and arrhythmia. The child's apical pulse rate should be above 100 beats per minute in infants and above 70 bpm in older children before medicating. The physician should be notified if the child vomits more than once each day, as vomiting is a sign of digitalis toxicity. Any arrhythmia or alteration in cardiac conduction that develops in a child taking digoxin should be assumed to be caused by digoxin, until further evaluation proves otherwise.

Dosage: Full term neonates: (follow facility protocols)

IV loading dose is 20 to 30 mcg/kg in 3 or more divided doses, with 1st dose equal to 50% total dose. Subsequent doses given q 6 to 8 hours.
Oral loading dose 25 to 35 mcg/kg in 3 divided doses q 6 to 8 hours.
Oral maintenance dose is 6 to 10 mcg/kg/day orally, in two divided doses.

Dosage: Infants 1 month to 24 months: (follow facility protocols)

IV loading dose 30 to 50 mcg/kg in 3 or more divided doses, with 1st dose equal to 50% total dose. Subsequent doses given q 6 to 8 hours.
Oral loading dose 35 to 60 mcg/kg in 3 divided doses q 6 to 8 hours.
Oral Maintenance dose 10 to 15 mcg/kg/day in 2 divided doses.

Dosage: Children 2 to 5 years: (follow facility protocols)

IV loading dose 25 to 35 mcg/kg in 3 or more divided doses, with 1st dose equal to 50% total dose. Subsequent doses given q 6 to 8 hours.
Oral loading dose 30 to 40 mcg/kg in 3 divided doses q 6 to 8 hours.
Oral maintenance dose is 7.5 to 10 mcg/kg/day in 2 divided doses.

FUROSEMIDE (LASIX)

Diuretics like Lasix remove edema and act to lower blood pressure. This helps reduce the extra load on the pulmonary system.

The excretion of sodium is promoted by inhibiting it's reabsorption in the kidney's ascending loop of Henle. Chloride, water and potassium are also excreted in higher amounts.

Electrolytes should be monitored with regular blood draws and analysis. The child should ingest a diet high in potassium, or take oral potassium supplements.

Daily weights should be monitored, and the child should be watched to be sure he/she is voiding. Normal urine output for an neonates and infant is 1 to 2 ml/kg/hour. Normal adult urine output declines to 0.5 ml/kg/hr.

Dosage: children: (follow facility protocol)

IV Initial dose 1 mg/kg increase, 1 mg/kg q 2 hours to desired effect, not to exceed 6 mg/kg per day.
PO initial dose 2 mg/kg increase, 1-2 mg/kg q 6 - 8 hours to desired effect, not to exceed 6 mg/kg per day.