Pharm 5 Cardio pt6

Question 1

List the drug interactions of Digitalis (5)

Answer 1

Quinidine 
verapamil
beta blockers 
Antacids
Thyroid Hormones

Question 2

Drug Interaction of Digitalis + Quinidine or Verapamil. Therefore, whaddya do to prevent it?

Answer 2

addition of quinidine or verapamil elevates digoxin concentration in as little as several hours
Decrease digoxin level by one-half when starting either quinidine or verapamil

Question 3

Drug interaction of Digitalis + beta-blockers

Answer 3

in patients with AV conduction abnormalities: complete heart block

Question 4

Drug interaction of Digitalis + Antacids

Whaddya do to prevent it?

Answer 4

reduce digoxin absorption; take digoxin at least 1 hour before or 4 hours after taking antacids

Question 5

Drug interaction of Digitalis + Thyroid hormones

Whaddya do when starting patients on drugs for thyroid dysfunction?

Answer 5

may decrease therapeutic effectiveness of digoxin

Digoxin dosage adjustment may be necessary when starting patients on drugs for thyroid dysfunction

Question 6

When suspicious of digitalis overdoses. Do what? (3 steps)

Answer 6

1. Stop giving digitalis -duh
2. Tx arrhytmias (hospitalized, monitored setting)
3. Digitalis FAB - antidote for digitalis overdose

Question 7

6 beneficial hemodynamic effects of Digitalis.

Buuuut….

Answer 7

Inc cardiac output
Inc LV Ejection fraction
Dec LV Diastolic Pressure
Inc Exercise tolerance
Inc Natriuresis
Dec Neurohormonal activation
Buuuut: We now know that ppl on Digitalis (with no reason for mortality) have a dramatically higher mortality.  It kills people

Question 8

42-year old African-American male with new onset hypertension without any co-morbidity.
Whaddya use? Why?
What if they fail?

Answer 8

Diuretic
If they fail: Change to or add a CCB
Diuretics work especially well in African Americans.
Some data says CCB works slightly better in African Americans.

Question 9

38-year old Caucasian male, well-controlled IDDM (insulin-dependent)
Whaddya use? Why?

Answer 9

ACE

ACE or ARB: b/c of renal protection

Question 10

52-year old African American male one-week s/p AMI

Whaddya use?

Answer 10

Beta-blocker and, possibly, an ACE

Question 11

65-year old Caucasian male with BPH

Whaddya use?

Answer 11

Alpha-adrenergic receptor antagonist

Question 12

71-year old female with isolated systolic hypertension

Whaddya use?

Answer 12

Long-acting CCB

Question 13

39-year old with prior episodes of PSVT (Paroxysmal supraventricular tachycardia)

Answer 13

Beta blocker OR CCB