Flashcards in Pharm 5 Cardio pt6 Deck (13)
List the drug interactions of Digitalis (5)
Drug Interaction of Digitalis + Quinidine or Verapamil. Therefore, whaddya do to prevent it?
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
Drug interaction of Digitalis + beta-blockers
in patients with AV conduction abnormalities: complete heart block
Drug interaction of Digitalis + Antacids
Whaddya do to prevent it?
reduce digoxin absorption; take digoxin at least 1 hour before or 4 hours after taking antacids
Drug interaction of Digitalis + Thyroid hormones
Whaddya do when starting patients on drugs for thyroid dysfunction?
may decrease therapeutic effectiveness of digoxin
Digoxin dosage adjustment may be necessary when starting patients on drugs for thyroid dysfunction
When suspicious of digitalis overdoses. Do what? (3 steps)
1. Stop giving digitalis -duh
2. Tx arrhytmias (hospitalized, monitored setting)
3. Digitalis FAB - antidote for digitalis overdose
6 beneficial hemodynamic effects of Digitalis.
Inc cardiac output
Inc LV Ejection fraction
Dec LV Diastolic Pressure
Inc Exercise tolerance
Dec Neurohormonal activation
Buuuut: We now know that ppl on Digitalis (with no reason for mortality) have a dramatically higher mortality. It kills people
42-year old African-American male with new onset hypertension without any co-morbidity.
Whaddya use? Why?
What if they fail?
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.
38-year old Caucasian male, well-controlled IDDM (insulin-dependent)
Whaddya use? Why?
(ACE or ARB: b/c of renal protection)
52-year old African American male one-week s/p AMI
Beta-blocker and, possibly, an ACE
65-year old Caucasian male with BPH
Alpha-adrenergic receptor antagonist
71-year old female with isolated systolic hypertension