Cardiac Glycosides

Question 1

How is digoxin used?

Answer 1

To slow down the heart rate whilst increasing the force of heart contraction.

Question 2

Is a loading dose of digoxin required?

Answer 2

Sometimes.

Question 3

What is the therapeutic range of digoxin?

Answer 3

1-2mcg.

Question 4

What is the bioavailability of IV digoxin?

Answer 4

100%.

Question 5

What is the bioavailability of digoxin tablets?

Answer 5

50-90%.

Question 6

What is the bioavailability of digoxin elixir?

Answer 6

75%.

Question 7

What cardiac side effects should patients and HCPs be aware of when using digoxin?

Answer 7

Arrhythmias and heart block.

Question 8

What neurological side effects should patients and HCP be aware of when using digoxin?

Answer 8

Weakness, lethargy, dizziness, headache, mental confusion, psychosis.

Question 9

What GI side effects should patients and HCPs be aware of when using digoxin?

Answer 9

Anorexia, nausea, vomiting, diarrhoea, abdominal pain.

Question 10

How can GI side effects be avoided when using digoxin?

Answer 10

Giving large doses in divided doses.

Question 11

What visual side effects should patient’s and HCPs be aware of when using digoxin?

Answer 11

Blurred and/or yellow vision.

Question 12

If a patient is suspected to be suffering from digoxin toxicity, what plasma concentration is likely to be seen?

Answer 12

1.5-3mcg/L.

Question 13

What monitoring is required when using digoxin?

Answer 13

Serum electrolytes, renal function, plasma-digoxin, heart rate.

Question 14

When should plasma digoxin levels be taken?

Answer 14

AT least 6 hours after dose.

Question 15

At what rate should heart rate be maintained when using digoxin?

Answer 15

Above 60 bpm.

Question 16

Why should digoxin doses be reduced in renal impairment?

Answer 16

To reduce the accumulation of metabolite.

Question 17

An increase in the plasma concentration of digoxin is seen when used with which drugs?

Answer 17

Alprazolam, amiodarone, ciclosporin, diltiazem, itraconazole, lercanidipine, macrolides, mirabegron, nicardipine, nifedipine, quinine, spironolactone, verapamil.

Question 18

A reduced plasma concentration of digoxin is seen when used with which drug?

Answer 18

St. John’s wort.

Question 19

Use of digoxin with which drugs can lead to hypokalaemia and subsequent increased risk of cardiac and digoxin toxicity?

Answer 19

Acetazolamide, amphotericin, loop diuretics, thiazide like diuretics.