Digoxin Flashcards

1
Q

What is digoxin?

A

a cardiac glycoside used to support CO in late stage CHF

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2
Q

What are the symptoms of Stage I CHF?

A

none

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3
Q

What is the clinical presentation of Stage I CHF?

A

low ejection fraction (less than 50%)

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4
Q

What is the preferred treatment for Stage I CHF?

A

ACEI or ARB, BB

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5
Q

What are the symptoms of Stage II CHF?

A

moderate exertion

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6
Q

What is the clinical presentation of Stage II CHF?

A

dyspnea on exertion, edema

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7
Q

What is the preferred treatment for Stage II CHF?

A

diuretic, ACEI or ARB, BB

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8
Q

What are the symptoms of Stage III CHF?

A

minimal exertion

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9
Q

What is the clinical presentation of Stage III CHF?

A

dyspnea, orthopnea, PND, edema

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10
Q

What is the preferred treatment for Stage III CHF?

A

Digoxin, diuretic, ACEI or ARB, BB, spirolactone

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11
Q

What are the symptoms of Stage IV CHF?

A

at rest

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12
Q

What is the clinical presentation of Stage IV CHF?

A

refractory edema

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13
Q

What is the preferred treatment for Stage IV CHF?

A

Above plus combo diuretics, IV vasodilators, transplant/assistance devices

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14
Q

How is digoxin an inotrope?

A

because it increases the intracellular availability of calcium, thus increasing the force of contraction

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15
Q

Where does digoxin bind in a cell?

A

the Na/K pump on the myocyte surface that pumps 3Na+ out for every 2K+ in using ATP. This pump is BLOCKED by digoxin, leading o a greater intracellular level of sodium. The increase in sodium then drives the increase of calcium in the cell via Na/Ca2+ exchange pumps

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16
Q

Interpose such as digoxin acting alone really only function to increase what?

A

SV, and thus CO, BUT congestive symptoms still exist

17
Q

What is the effect of digoxin when added to a diuretic or vasodilator?

A

shift down of the frank-sterling curve and relieve congestive symptoms

18
Q

How is digoxin given?

A

two preparations;Lanoxin- tabletsLanoxicaps- capsules

19
Q

How well is digoxin absorbed?

A

55-60% PO (tablets) and 100% capsule absorption

20
Q

How is digoxin excreted?

A

unchanged in urine (reduce in renal disease)

21
Q

What are some of the side effects of digoxin?

A

-atrial/vent arryhthmias-visual changes (blurring, yellow-green halo)-headache,fatigue, drowsiness-seizures

22
Q

How can digoxin ‘toxicity’ be neutralized?

A

digibind, an Ab to digoxin

23
Q

What does quinidine do to digoxin levels?

A

increases by decreases elimination or by increasing Gi absorption (Amiodarone has the same effect)

24
Q

What does verapamil do to digoxin levels?

A

can cause slowing of HR and increase digoxin toxicity

25
Q

T or F. Digoxin has a VERY small therapeutic window

A

T. Levels vary greatly from people to people for therapeutic response

26
Q

What patients benefit most from digoxin?

A

those with an ejection fraction less than 25% or with cardiac enlargement- late stage failure patients (class III or IV)