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Therapeutic Drug Monitoring > Digoxin > Flashcards

Digoxin Flashcards

1
Q

MOA Digoxin

A

Inhibition of Na+/K+ ATPase pump – highly expressed in cardiac and skeletal muscle

Calcium no longer kicked out of the cell – Build up of calcium in the cell; sarcoplasm release more calcium increasing in contractility.

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2
Q

Digoxin First-pass Aborption

A

Passive, non-saturable process
Food has minimal effect

No significant first-pass effect
GI metabolism due to hydrolysis or reduction (~10% population) – decrease F

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3
Q

Absorption interactions DIgoxin

A
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4
Q

Digoxin Compartment

A

Described by 2-compartment kinetics

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5
Q

Distribution Phase Digoxin

A

Distribution phase lasts 6 – 8 h

Obese: IBW

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6
Q

Tissue Distribution Digoxin

A

Skeletal and cardiac muscle:
Significant due to high levels of N+/K+ ATPase

Adipose:
Vd not influenced by obesity

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7
Q

Factors affecting Digoxin Vd

A
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8
Q

Digoxin Elimination: Main

A
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9
Q

Digoxin Toixicty

A
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10
Q

Digoxin Response Effected by…. (PD)

A
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11
Q

Factors influencing digoxin Cls

A
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12
Q

Drug Interactions DIgoxin and SOlution

A
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13
Q

Drug Interactions with Cls

A
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14
Q

Analysis of Digoxin

A
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15
Q

What are DLIS? When is it dtected>

A

Digoxin-Like Immunoreactive Substances (DLIS)

Not well understood
Endogenous substances

  • Phospholipids, steroids, bile acids

Digoxin-free patients with detectable levels:
Renal failure, hepatic failure, low renin hypertension, pregnant women (3rd trimester), neonates, infants

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16
Q

Problems with Digoxin PK Monitoring

A
17
Q

Pediatric Dosing Digoxin

A
18
Q

Digoxin Dosing Flow Chart

A
19
Q

First part of digoxin dosing

A
20
Q

When is a loading dose for digoxin given?

A

Usually not necessary to load in CHF (chronic – do not treat acutely)
Load for atrial fibrillation patients
Use IBW (limited fat distribution) if obese

21
Q

How is a loading dose given with digoxin?

A
22
Q

Cls of Digoxin

A

Systemic Clearance (ClS) Calculation

Digoxin ClS changes in proportion to ClCr

Estimate of digoxin ClS based upon an empirical linear relationship with ClCr

23
Q

When is digoxin steady state?

A

Css,min occurs after 3-5 half-lifes

Long t1/2 - steady state in 5-7 days

Css,min taken 1 hour prior to next dose

24
Q

When to get anothe rblood sample?

A

No further sampling if renal function OK and desired clinical effect achieved

Unstable patients: repeat every 5-7 days, OR as dictated by clinical state

25
Q

Indications for Monitorin g (Full List)

A
26
Q

Digoxin Monitoring Other factors

A
27
Q

When is digoxin withheld?

A
28
Q

Antidotes Digoxin

A
29
Q

Indications for DIgoxin Antidote

A
30
Q

Digibind Dosing

A
31
Q

ANtidote Monitoring

A

Allergic reactions may occur including anaphylactic shock. Therefore monitor:

Therapeutic Drug Monitoring (4 decks)

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