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Digoxin is used with _______ heart failure, not _______ heart failure
- dialstolic- do not give in diastolic heart failure!!
First line treatment for Heart Failure
- 1st-Loop diuretics-for fluid retention.
- 2nd- ACEI and ARB's
- 3rd- BB
True or False:
Digoxin decreases mortality rate?
- Dig does not decrease mortality rate.
Dig is only given to patients with _______ and _______?
heart failure and afib/flutter (antiarrhythmic properties)
Do not use dig with patients with......
- Heart block
- permanent pacemaker
- if taking BB or amiodarone
- Inhibits sodium potassium adenosine triphosphate activity, which enhances calcium entry into the cell.
- Calcium increases contractility and velocity of contraction= better output b/c heart is pumping better.
- BOTTOM LINE= REDUCES WORK LOAD OF THE HEART.
0.25 mg every day, if there is no renal dysfunction.
Levels 0.9-1.2 mg/ml are therapeutic
What type of dietary recommendations with Digoxin?
Do not use salt substitutes, they are full of potassium and can lead to hyperkalemia.
What do you use in diastolic heart failure
BB ARE USED
What drugs can worsen systolic heart failure?
CCB!! (may be useful in diastolic HF)
CCB can worsen SHF especially verapamil and Cardizem!!! they have negative inotropic effect on the heart.
What can verapamil and Cardizem do in SHF??
What effect do they have?
- They can worsen SHF
- Have a negative inotropic effect on heart.
Treatment principle of Dig
Start low and go slow!!!
If you switch patient form digoxin to generic lanoxin what are you going to have to start doing again?
Going to have to start the monitoring process all over again.
Once dig is started it is a ______ drug?
- life time drug
- You can never go off of it
1/2 life of Dig
How long to reach steady state
- 36 hours
- takes about 5 days to reach steady state.
Creatinine clearance of 10-50 ml/min
How much would you decrease the dose?
- REMEBER TO JUST GIVE ABOUT HALF THE DOSE.
When to draw dig levels?
6-8 hours after last does and ideally just before the next dose. If you draw dig levels too soon they will be wrong.
Dig toxicity symptoms
Visual disturbances, and sensitivity to light, yellow halo and blurry vision
18% of dig toxic patients die from_____?
Dig should be stopped with plans to restart in 2-3 days if any of the following occur?
- elevated dig level
- substantial reduction in renal function
- symptoms of toxicity
- significant conduction abnormalities
- increase in ventricular arrhythmias
Drug interactions with Dig
BB- can result in complete heart block
Erythromycin, clarithromycin, tetracycline may increase absorption of dig and result in toxicity
Thyroid replacement drugs increase the dose of dig needed. (thyroid replacement increases metabolism, that is why it is needed)