Heart Failure and Digoxin

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Author:
jaime.davenport
ID:
240241
Filename:
Heart Failure and Digoxin
Updated:
2013-10-13 17:51:48
Tags:
Heart failure digoxin
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Description:
Pharm midterm 2013
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  1. Digoxin is used with _______ heart failure, not _______ heart failure
    • systolic
    • dialstolic- do not give in diastolic heart failure!!
  2. First line treatment for Heart Failure
    2nd
    3rd
    4th
    • 1st-Loop diuretics-for fluid retention.
    • 2nd- ACEI and ARB's
    • 3rd- BB
    • 4th-Digoxin
  3. True or False:
    Digoxin decreases mortality rate?
    • False
    • Dig does not decrease mortality rate.
  4. Dig is only given to patients with _______ and _______?
    heart failure and afib/flutter (antiarrhythmic properties)
  5. Do not use dig with patients with......
    • SSS
    • Heart block
    • permanent pacemaker
    • if taking BB or amiodarone
  6. Dig class is
    glycoside
  7. Dig MOA
    • 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.
  8. Dig dosage

    Therapeutic dosage
    0.25 mg every day, if there is no renal dysfunction.

    Levels 0.9-1.2 mg/ml are therapeutic
  9. What type of dietary recommendations with Digoxin?
    Do not use salt substitutes, they are full of potassium and can lead to hyperkalemia.
  10. What do you use in diastolic heart failure
    NOT DIG!!!

    BB ARE USED
  11. 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.
  12. What can verapamil and Cardizem do in SHF??
    What effect do they have?
    • They can worsen SHF
    • Have a negative inotropic effect on heart.
  13. Treatment principle of Dig
    Start low and go slow!!!
  14. 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.
  15. Once dig is started it is a ______ drug?
    • life time drug
    • You can never go off of it
  16. 1/2 life of Dig
    How long to reach steady state
    • 36 hours
    • takes about 5 days to reach steady state.
  17. Creatinine clearance of 10-50 ml/min
    How much would you decrease the dose?
    • 25-75%
    • REMEBER TO JUST GIVE ABOUT HALF THE DOSE.
  18. 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.
  19. Dig toxicity symptoms
    Visual disturbances, and sensitivity to light,  yellow halo and blurry vision

    • anorexia
    • headache
    • fatigue
    • malaise
    • disorientation
    • delirium
    • confusion
    • seizures
  20. 18% of dig toxic patients die from_____?
    arrhythmias
  21. 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
  22. 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)

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