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Digoxin - Flashcards

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1
Q

Digoxin effects on heart rate / contraction

A

Negatively chronotrophic - reduces rate

Positively inotrophic - increased force of contraction

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2
Q

How does digoxin work in AF

A

Increases Vagal parasympathetic tone

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3
Q

Digoxin effect in heart failure

A

Inhibits NaKATPase pumps -> Na accumulates in cell -> ca accumulation -> increased force

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4
Q

Digoxin adverse effects

A

Bradycardia, GI disturbance, rash, dizziness, visual disturbance

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5
Q

Important to remember about digoxin therapeutic dose

A

Close to toxic -> arrythmias

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6
Q

Who can never have digoxin

A

Second degree heart block
Intermittent complete heart block
Ventricular arrythmias

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7
Q

Which electrolyte abnormalities increase risk of digoxin toxicity

A

Hypokalaemia
Hypomagnesia
Hypercalcaemia

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8
Q

Under which circumstance should digoxin dose be reduced

A

Renal failure

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9
Q

Eg if drugs causing hypokalaemia -> increased risk of digoxin toxicity

A

Loop and thiazide diuretics

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10
Q

Need a rapid effect of digoxin - how prescribed

A

Loading dose 500micrograms

Followed by 250-500 micrograms 6 hours later

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11
Q

Usual maintenance dose of digoxin

A

125-250 micrograms

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12
Q

What is the reverse tick sign on ECG

A

St depression from therapeutic digoxin

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13
Q

Dipyridamole uses

A

first line TIA , second line ischemic stroke (if clopidogrel contraindicated)
Induce tachycardia for myocardial perfusion scan

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14
Q

What’s normally given with dipyridamole in second line ischemic stroke

A

Aspirin

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15
Q

Mechanism of dipyridamole

A

Antiplatelet and vasodilator

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16
Q

Dipyridamole adverse effects

A

Headache, flushing, dizzy, GI

Risk of bleeding, thrombocytopenia

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17
Q

Caution using dipyridamole in who

A

Ischemic heart disease, aortic stenosis, heart failure

As may exacerbate

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18
Q

Dipyridamole interactions (2 types)

A

Inhibits uptake of adenosine -> risk of cardiac arrest

Increased bleeding with other antiplatelets / anticoagulants

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19
Q

Loop diuretics egs

A

Furosemide

Bumetanide

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20
Q

Loop diuretic uses

A

Relive breathlessness in pulmonary oedema

Treatment of fluid overload eg. Heart / liver / renal failure

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21
Q

Loop diuretics mechanism (2)

A

Loop or henle - inhibit Na/K/2Cl co transporter

Dilation of capacitance veins

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22
Q

Loop diuretics adverse effects

A

Headache and dehydration.
Low electrolyte states
Hearing loss and tinnitus

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23
Q

Why do loop diuretics cause hearing problems

A

NaKCl transporter is used in regulating endolymph composition in inner ear

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24
Q

Who should never get loop diuretics

A

Hypovolemia

Dehydration

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25
Loop diuretics use in caution when
Risk of hepatic encephalopathy | Hypokalaemia , hyponatraemia and gout
26
What drugs to loop diuretics effect
Any that are excreted by the kidneys Eg Lithium levels increase due do reduced excretion Digoxin toxicity due to hypokalaemia Increase ototoxicity / nephrotoxicity of aminoglycosides
27
Eg loop diuretics prescription for acute pulmonary oedema
Furosemide IV 40mg
28
Eg of potassium sparing diuretic
Amiloride (co-amilofruse / Co-amilozide)
29
Why are potassium sparing diuretics often used with other diuretics
They are weak diuretics and used with stinger to counteract potassium loss
30
Where does amiloride act
Distal convoluted tubules
31
Who should not get potassium sparing diuretics
Renal impairment | Hyperkalaemia
32
Which drugs should not be given with potassium sparing diuretics
Potassium elevating - oral supplements / aldosterone antagonists
33
When might use amiloride over spirolactone
Hypertension due to hyperaldosteronism (conns) has amiloride directly effects ENaC channels When spirolactone adverse effects eg gynaecomastia are not acceptable
34
Thiazide like diuretic egs
Bendroflumethazide, indapamide, chlortalidone
35
Thiazide diuretics uses
Alternative first line for hypertension where CCBs otherwise used. Add on treatment for hypertension
36
When are CCBs not used in hypertension
Oedema / heart failure
37
Mechanism of thiazides
Inhibit Na/Cl co transporter in distal convoluted tubule Vasodilation
38
Thiazide diuretics adverse effects
Hyponatraemia , hypokalaemia -> arrythmias | Impotence
39
Who should never get thiazide diuretics ? | Avoid in?
Hypokalaemia | Hyponatraemia , gout
40
Bendroflumethazide prescription
2.5mg daily
41
Why are thiazides good for combo with ACEi
Thiazide -> hypokalaemia (RASS system) ACEi -> hyperkalaemia (block it ) Have a synergistic blood pressure lowering effect
42
Eg of dopaminergic drugs for Parkinson's
Levodopa as (co-careldopa, co-beneldopa), ropinirole, pramipexol
43
Which dopaminergic drugs used for early vs late Parkinson's
Early - ropinirole, pramipexol (as dopamine agonists) | Late - levodopa
44
What and where is there a deficiency of in Parkinson's
Dopamine in nigrostriatal pathway
45
Dopaminergic adverse effects
Nausea, dizzy, confusion, hallucinations, hypotension
46
Major issue with Levodopa
Wearing off effect - symptoms get worse at end of dosage interval. Increasing dose / frequency -> dyskenesias (movements) With both called on-off effect
47
Cautions with dopaminergic drugs
Existing cognitive / psychiatric disease Elderly Cardiovascular disease
48
Which drugs have opposite effect to levodopa
Antipsychotics, metoclopramide
49
Digoxin uses
AF / flutter (usually less effective than b blocker / ccb) | Heart failure
50
How do emollients work
Replace water in dry skin and have oils that prevent water loss
51
Emollients uses
Dry skin conditions eg eczema / psoriasis
52
Adverse effects of emollients
Greasy skin | Worsen acne vulgaris / folliculitis by blocking pores
53
Egs of fibrinolytic drugs
Alteplase, streptokinase
54
Fibrinolytic drug uses
Acute ischemic stroke (within 4.5 hours) Acute STEMI Pulmonary embolism with haemodynamic instability
55
What gives better results than fibrinolytic drugs for STEMIs
PCI
56
Other word for fibrinolytic drugs
Thrombolytic
57
Mechanism of thrombolytics
Dissolve fibrinous clots -> re canalise vessels
58
Fibrinolytic drugs adverse effects
Nausea vomiting bruising bleeding | Hypotension
59
What can reperfusion of brain / heart tissue ->
Cerebral oedema | Arrythmias
60
Why shouldn't streptokinase be given as a repeat prescription
Development of anti streptokinase antibodies
61
Contraindications to fibrinolytic treatment
Bleeding (disorders, recent surgery / trauma, hypertension, peptic ulcers...)
62
When using fibrinolytic treatment for stroke what must be ruled out
Intracranial haemorrhage
63
Gabapentin and pregabalin uses ? Specific use for each ?
Focal epilepsies (w or w/o 2 generalisation) Neuropathic pain Gabapentin - migraine prophylaxis Pregabalin - generalised anxiety disorder
64
Mechanism of Gabapentin
Bunds to voltage gated ca channels -> inhibits neurotransmitter release
65
Gabapentin / pregabalin side effects
Drowsy, dizzy, ataxia (usually improve after few weeks)
66
Gabapentin / pregabalin reduced dose in
Renal impairment (as eliminated )
67
Gapapentin / pregabalin interactions
Effects may be enhanced when combined with other sedating drugs eg bendodiazepines
68
Prescription of Gabapentin
Start at low dose and titrated up to mink use adverse effects
69
H2 antagonist eg
Ranitidine
70
H2 antagonist uses
Peptic ulcer disease | GORD and dyspepsia
71
What is often preferred to h2 antagonists
PPIs
72
Mechanism of h2 antagonists
Reduce gastric acid secretion
73
Warning with h2 antagonists
Can disguise symptoms of gastric cancer (remember not to just treat symptoms )
74
What is benefit of h2 antagonists over PPIs and eg?
Faster action - suppress acid secretion pre op
75
Egs of heparins
Enoxaparin, dalteparin, unfractioned heparin
76
Uses of heparins and fondaparinux
Venous thromboembolism VTE prophylaxis and treatment of DVT / PE ( LMW Heparin) Acute coronary syndrome
77
2 key components of final common coagulation pathway
Thrombin | Factor Xa
78
How does unfractioned heparin work
Activates antithrombin -> inactivates Xa and thrombin
79
Eg of LMW heparins
Dalteparin, enoxaparin
80
Fondaparinux mechanism
Inhibits Xa
81
Adverse effects of heparins and fondaparinux
Bleeding Injection site reactions Heparin induced thrombocytopenia
82
When should anticoagulants be used cautiously
Clotting disorders, severe hypertension, recent surgery / trauma, renal impairment
83
Drug for reversing anticoagulation
Protamine
84
Precribing for VTE prophylaxis
Enoxaparin 40mg sc daily / | Dalteparin 5000 units so daily
85
Where should sc drugs be given
Sub cut tissue of abdominal wall
86
What is APTR ? Usual target?
Activated partial thromboplastin ratio | 1.5-2.5
87
What is the APTR Usually measuring ? How often should it be checked
Anticoagulant effect of UFH . | 6hrly
88
How are patients diagnosed with VTE treated ? Why?
LMW heparin and warfarin Because warfarin inhibits protein C / S (anticoagulants) before inhibiting clotting factors. LMW heparin provides cover period during this time

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