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Dosing Exam 1 > Cardiac Glycoside and Titration > Flashcards

Cardiac Glycoside and Titration Flashcards

1
Q

Lanoxin (digoxin) Indication

A

HF (Left ventricular dysfunction)

Afib

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2
Q

Lanoxin (digoxin) MOA in HF

A

Inhibit Na/K ATPase (increase myocardial contractility-)

AKA positive inotropic

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3
Q

Lanoxin (digoxin) MOA in Afib

A

Reduce impulses to AV node and Decreased HR

AKA negative chronotropic

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4
Q

Lanoxin (digoxin) Halflife

A

Age dependent

Premature > Adults > Neonate/children/infants

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5
Q

Lanoxin (digoxin) PK

A

Linear

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6
Q

Lanoxin (digoxin) Factors to consider

A 
Renal function (clearance dependent)
Electrolytes (HypoK/Mg = enhance toxicity)
Thyroid (Hypo = higher dose, hyper = lower)
Drug interactions
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7
Q

Lanoxin (digoxin) Labs to check

A

SCr
TSH
K/Mg

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8
Q

Transitioning from PO to IV Lanoxin (digoxin)

A

Decrease dose by 20-25%

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9
Q

Lanoxin (digoxin) loading dose

A

Afib only

Initial dose is 50% of calculated LD dose + 2 additional doses of 25% separate by 6 hours

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10
Q

Lanoxin (digoxin) LD monitoring

A

Hear rate

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11
Q

Lanoxin (digoxin) Target concentration

A

HF 0.5-0.9 mcg/L

Afib 1-1.5 mcg/L

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12
Q

Indications for digoxin level measurements

A 
Altered renal function 
Suspected toxicity
Diagnosis with interacting disease state
Drug interaction
Patient compliance
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13
Q

LD concentration measurements

A

12-24 hrs after las dose

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14
Q

MD concentration measurements

A

5-7 days after initiation

24 hrs after last dose

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15
Q

Exercise + Lanoxin (digoxin)

A

Cause falsely low trough levels

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16
Q

S/Sx of Lanoxin (digoxin) toxicity

A

> 2mcg/L
CNS (visual disturbances, headache, confusion)
GI (N/V/D)
CV (bradycardia, AV blcok, arrhthmias)

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17
Q

Management of digoxin toxicity

A

Stop meds
Monitor levels until less than 2 mcg/dl
Consider digibind

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18
Q

Beta 1

A

Increased force and rate of heart contractility

Improves CO

19
Q

Alpha

A

Vasoconstriction

20
Q

Phenylephrine (Neo-synephrine)

A

ALPHA

Arrhythmia pts

21
Q

Norepinephrine (Levophed)

A

Alpha (>) and B1

Shock pts

22
Q

Epinephrine (Adrenalin)

A

alpha, B1 and B2 (B>a)

Anaphylaxis

23
Q

Low dose dopamine

A

Increase urination

24
Q

Medium dose dopamine

A

Increase cardiac contractility, HR, CO

25
Q

High dose dopamine

A

Vasoconstriction

Increased BP

26
Q

Vasopressin

A

Fixed dose of 0.03 units/min to replace vasopressin
No titration
>0.04 u/min = cornary and mesenteric ischemia

27
Q

Goal

A

Increase BP and perfuse organs

28
Q

Titrations

A

Titrate to desire effect

Indicator of adequate pressure (vasopressor target) = MAP >65

29
Q

BP monitoring

A

Invasive is preferred via MAP through a arterial line

30
Q

MAP =

A

1/3 SBP + 2/3 DBP or DBP + 0.33 (pulse pressure)

31
Q

If extravasation AE occurs:

A

titrate pressor off and administer Nitro-Bid ointment OR phentolamine (alpha 1 blocker)

32
Q

Inotropes drugs

A

Dobutrex (dobutamine) and Primacor (milrinone)

33
Q

Dobutrex AE

A

Arryhthmias

Hypotension

34
Q

Primacor AE

A

Renal adjust

HypoTN

35
Q

If PAC placed, target a CI of

A

> 2.2

36
Q

If no PAC, monitor for S/Sx of improved perfusion such as

A

Improved coloration and warmth of extremities
Increased urine output
Improved mentation
Increase in BP

37
Q

Vasodilators Drugs

A

Nitroglycerin (Tridil)

Nitroprusside (Nitropress)

38
Q

Nitroglycerin (Tridil) Monitoring

A

Contraindicated if recent PDE5 inhibitors

39
Q

Nitroprusside (Nitropress) Monitoring

A

Caution if high intracranial pressure or renal/hepatic impairment

40
Q

Nitroprusside (Nitropress) Max dose

A

10 mcg/kg/min for 10 minutes

41
Q

Anti-Hypertensive drugs

A

Nicardipine (Cardene)
Labetolol (Trandate
- used in HTN emergency

42
Q

Reduce MAP by no more than

A

25% in 1st hr

43
Q

Monitoring/titration measures

A

Titrate to desired effect using MAP or BP

Symptoms

Dosing Exam 1 (8 decks)

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