Toxicity Flashcards
Digoxin toxicity investigations
Digoxin level
ECG - reverse tick (down sloping ST segment)
U&Es
Digoxin toxicity presentation
Generally unwell - lethargy, nausea & vomiting, anorexia, confusion
Yellow-green vision
Arrhythmias- AV block, bradycardia
Gynaecomastia
Digoxin toxicity precipitants
Hypokalaemia
Increasing age
Renal failure
MI
Hypomagnesaemia, hypercalcaemia, hypernatraemia, acidosis
Hypoalbuminaemia
Hypothermia
Hypothyroidism
Drugs - amiodarone, quinidine, verapamil, dilitiazem, spironolactone, ciclosporin, drugs causing hypokalaemia (thiazide and loop diretics)
Digoxin toxicity management
Digibind, correct arrhythmias, monitor potsassium
Medications to avoid in pregnancy
ABX - tetracyclines, aminoglycosides, sulphonamides, thrimethoprim, quinolones
ACE inhibitors and ARBs
Statins
Warfarin
Sulphoylureas
Retinoids
Cytotoxic agents
Anto-epileptics (have to work out risk v benefit)
Drugs to avoid in renal failure
Abx - tetracyclines, nitrofurantoin
NSAIDs
Lithium
Metformin
Drugs likely to accumulate in CKD
Most abx - penicillins, cephalosporins, vancomycin, gentamicin, streptomycin
Digoxin
Atenolol
Methotrexate
Sulphonylureas
Furosemide
Opioids
Drugs exacerbating heart failure
Thiazolinediones - pioglitazone
Verapamil
NSAIDs/glucocorticoids
Class I antiarrhthymics - flecanide
Lithium monitoring
6 months u&e and TFTs
Bacterial meningitis antibiotics
IV cefotaxime or ceftriaxone
Drugs to avoid in breast feeding mothers
Abx - ciprofloxacin, tetracycline, chloramphenicol, sulphonamides
Aspirin
Psychiatric drugs - lithium, benzos
Carbimazole
Methotrexate
Sulfonylureas
Cytotoxic drugs
Amiodarone
antipsychotic starting investigations
FBC, U&Es, LFTs, lipids, weight, fasting blood glucose, prolactin
Dihydropyridine (nifedipine, amlodipine, felodine) adverse effects
Flushing, headache, ankle swelling
Diltiazem adverse effects
Hypotension, bradycardia, heart failure, ankle swelling
Verapamil adverse effects
Heart failure, constipation, hypotension, bradycardia, flushing
