Cardiac glycosides

Question 1

Digoxin indications

Answer 1

~ controlling ventricular response in persistent & permanent AF &atrial flutter & heart failure

Question 2

digoxin MOA

Answer 2

increases force of myocardial contraction & reduces conductivity within atrioventricular (AV) node

Question 3

Digoxin interaction

Answer 3

Manufacturer advises reduce dose by half with concurrent use of amiodarone, dronedarone and quinine.

Question 4

Digoxin IV to oral switch

Answer 4

increase dose by 20–33% to maintain same plasma-digoxin concentration.

Question 5

SE of digoxin

Answer 5

~ Arrhythmias; cardiac conduction disorder; cerebral impairment; dizziness; eosinophilia; skin reactions; vision disorders
~ N, V,D

Question 6

digoxin monitoring ~ TDM

Answer 6

Bloods taken at least 6 hours after a dose

Question 7

Digoxin monitoring ~ paracmeters

Answer 7

~ Electrolytes
~ Renal function

Question 8

Digoxin IV use

Answer 8

~ Avoid rapid IV administration (risk of hypertension + reduced coronary flow).

~ IV infusion (Lanoxin®), give intermittently in Glucose 5% or Sodium chloride 0.9%; dilute to concentration of not more than 62.5 micrograms/mL
~ given over at least 2 hours.