cards

Question 1

causes of chronic digoxin toxicity

Answer 1

Chronic overmedication
CKD
Electrolyte abnormalities
Drug interactions: verapamil, diltiazem, amiodarone, ketoconazole, quinidine, clarithromycin, erythromycin

Question 2

What electrolyte derrangements potentiate digoxin toxicity

Answer 2

hypokalemia, hypomagnesimeia, hypercalcemia

Question 3

Clin F of digoxin toxicity

Answer 3

Constitutional symptoms such as fatigue, malaise, headache and generalised weakness are common.

Systemic manifestations may include:2, 13, 16

Cardiac: palpitations, syncope, chest pain, dysrhythmias, hypotension, bradycardia
Gastrointestinal: anorexia, nausea, vomiting, diarrhoea, abdominal pain
Neurological: confusion, delirium, weakness, CNS depression
Ocular: xanthopsia, blurred vision, diplopia, photophobia, photopsia

Question 4

ECG findings in digoxin toxicity

Answer 4

SVT with slow ventricular response
PVC
Acute–> bradycardia

Question 5

Normal ECG change with long term digoxin use

Answer 5

Digitalis effect
Mild PR interval prolongation
ST depression in a downsloping reverse tick pattern
Flattened, inverted or biphasic T waves
QT interval shortening

Question 6

Management of digoxin toxicity

Answer 6

Charcoal withing 2 hours
W/h digoxin and potentiating meds
Cardiac telemetry
Anti emetics
IVF
Correct electrolyte disturbances
Digoxin binder- fab fragments

Question 7

outline STEMI and NSTEMI management

Question 8

management of SVT

Answer 8

Vagal manoeuvers
IV adenosine - rapid IV bolus of 6mg->12mg->18mg. COntraindicated in asthmatics: verapamil
Electrical CV

Question 9

For an SVT, if adenosine cannot be given (e.g. due to asthma) then

Answer 9

give verapamil

Question 10

tx of otitis externa in diabetics

Answer 10

Ciprofloxacin to cover pseudomonas