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PHM 702- Toxicology > Digoxin Toxicity > Flashcards

Digoxin Toxicity Flashcards

1
Q

Onset of acute digoxin toxicity

A

Minutes to several hours

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2
Q

Symptoms of acute digoxin toxicity

A

Can be asymptomatic, but symptoms include N/V, abdominal pain, lethargy, confusion, weakness

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3
Q

Caveat about chronic digoxin toxicity

A

Can be difficult to diagnose

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4
Q

Chronic digoxin toxicity symptoms

A

Loss of appetite, weakness, anorexia, N/V, abdominal pain, weight loss, delirium, confusion, drowsiness, HA, hallucinations, visual disturbances, seizures (rarely)

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5
Q

What electrolyte abnormality should you watch out for in digoxin toxicity and why?

A

HYPERKALEMIA, because it’s an indication for DigiFab treatment!

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6
Q

Digoxin toxicity symptoms: cardiac abnormalities

A

cardiac dysrhythmias including ventricular tachydysrhythmias and bradydysrhythmias

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7
Q

The cardiac dysrhythmias are due to what?

A

Sensitized myocardium and depressed AV node

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8
Q

Examples of cardiac dysrhythmias in digoxin toxicity

A

atrial flutter, afib with AV block, non-sustained ventricular tachycardia, high-degree AV block, junctional tachycardia, sinus bradycardia

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9
Q

Diagnostic tests for digoxin toxicity

A

Digoxin serum concentrations, BMP with calcium and magnesium, blood gas, ECG, thyroid function tests, med list for DDIs

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10
Q

How long should you wait to obtain digoxin serum concentrations to ensure accuracy?

A

At least 6 hours

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11
Q

Total therapeutic range for digoxin

A

0.5-2ng/ml

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12
Q

What will give false positive results of digoxin toxicity?

A

Bilirubin and spironolactone

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13
Q

GI decontamination in digoxin toxicity: treatment

A

AC 1g/kg q2-4h up to 4 doses

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14
Q

Purpose of AC in digoxin toxicity

A

Prevents reabsorption from the GI tract and reduces half-life

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15
Q

When to use AC in digoxin toxicty

A

If definitive therapy with digoxin-specific Fab isn’t immediately available or if AKI

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16
Q

If a patient with digoxin toxicity has hypokalemia or hyperkalemia, what should you NOT administer and why?

A

Calcium, because it can exaggerate the cardiac effects and lead to the stone heart phenomenon

17
Q

What can you administer for hyperkalemia?

A

IV insulin and sodium bicarb IF DigiFab won’t be administered immediately

18
Q

What can you administer for hypomagnesemia in a patient with digoxin toxicity?

A

mag sulfate 2gm IV over 20 minutes followed by 1-2g/hr PRN

19
Q

Indications for DigiFab

A

Life-threatening dysrhythmia regardless of serum concentration

Potassium concentration >5mEq/L in digoxin toxicity

Chronic elevations of serum digoxin concentrations with dysrhythmias, GI symptoms, or AMS

Serum digoxin concentration of >15mg/ml anytime after ingestion or >10ng/ml after 6 hours

Acute ingestion of 10mg of digoxin in an adult

20
Q

MoA of DigiFab

A

free digoxin in the intravascular and interstitial space is bound by the antigen-binding fragments

21
Q

The movement of free intracellular and dissociated digoxin into the interstitial or intravascular space is due to what?

A

The concentration gradient

22
Q

What happens to the free digoxin concentrations with DigiFab?

A

It decreases

23
Q

What happens to the total serum digoxin concentrations with DigiFab?

A

It increases

24
Q

What happens to renal CL with DigiFab?

A

It increases

25
Q

What happens to serum potassium concentrations with DigiFab?

A

It decreases

26
Q

Empiric DigiFab dosing for chronic toxicity

A

3-6 vials

27
Q

Empiric DigiFab dosing for acute toxicity

A

10 vials

28
Q

DigiFab formula for known serum concentration

A

[serum digoxin concentration (ng/ml) * patient weight (kg)]/100 = # of vials

29
Q

DigiFab formula for known amount ingested

A

[amount ingested (mg) / 0.5 (mg/vial)] * 80% bioavailability = # of vials

30
Q

Other cardiac therapies for digoxin toxicity: when to use atropine

A

Early bradydysrhythmias

31
Q

Atropine dosing

A

0.5mg IV push repeated q5min

32
Q

Other cardiac therapies for digoxin toxicity: when to use phenytoin and lidocaine

A

Ventricular dysrhythmias

33
Q

Phenytoin dosing for digoxin toxicity

A

100mg (50mg/min) q5min until dysrhythmia is controlled or until 1,000mg; maintenance dose of 100mg IV q8h until digoxin toxicity has resolved

34
Q

Lidocaine dosing for digoxin toxicity

A

1-1.5mg/kg IV bolus followed by a continuous infusion of 1-4mg/min

35
Q

Other cardiac therapies (non-pharmacological) for digoxin toxicity

A

Pacemakers, cardioversion

PHM 702- Toxicology (12 decks)

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