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Clinical PK > Digoxin > Flashcards

Digoxin Flashcards

1
Q

What 3 formulations can be used for digoxin?

A

IV
PO
Elixir

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2
Q

IV digoxin is absorbed by how much percent?

A

100%

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3
Q

PO digoxin is absorbed by how much percent?

A

70%

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4
Q

Elixir digoxin is absorbed by how much percent?

A

80%

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5
Q

How is PO digoxin converted to IV?

A

Decrease PO dose by 25%

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6
Q

How is IV digoxin converted to PO?

A

Increase IV dose by 25%

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7
Q

In what location is digoxin mainly absorbed?

A

Small intestine

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8
Q

What 3 things can decrease the absorption for digoxin?

A
  • High fiber meals
  • Binding drugs
  • Malabsorption syndromes
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9
Q

What can increase the absorption for digoxin?

A
  • P-gp inhibitors (amiodarone, verapamil, and quinidine)
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10
Q

Where is digoxin mainly distributed?

A

Lean organ tissue - muscle, heart, kidneys, and liver

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11
Q

What should the volume of distribution (Vd) be in digoxin?

A

7 L/kg

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12
Q

Is Vd affected by obese patients?

A

NO

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13
Q

What two things can decrease the Vd?

A
  • Renal failure

- Hyperkalemia

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14
Q

What major site is digoxin metabolized?

A

GI tract-hydrolysis (stomach acid) & liver metabolism

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15
Q

What is the name of the bacteria that inactivates digoxin?

A

Eubacterium lentum

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16
Q

What two classes of drugs eradicates E. lentum causing digoxin to increase?

A

Macrolide antibiotics

Tetracycline antibiotics

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17
Q

How is digoxin excreted/eliminated?

A

75% kidneys

25% biliary/hepatic elimination

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18
Q

What is the half-life of digoxin?

A

36 hours

19
Q

What health conditions or drugs decrease the clearance of digoxin?

A
  • Heart failure (HF)
  • Hypothyroid
  • Hypokalemia
  • Amiodarone
  • Verapamil
20
Q

What health conditions or drugs increase the clearance of digoxin?

A
  • Hyperthyroid

- Digibind

21
Q

What is the loading dose (LD) of digoxin PO?

A

1 to 1.5 mg PO

22
Q

What is the LD of digoxin IV?

A

0.5 to 1 mg IV

23
Q

How is the LD of digoxin administered? (HINT = step by step process)

A
  1. 50% of dose initially
  2. 25% of dose at 6 hours
  3. 25% of dose at 12 hours
24
Q

What is the maintenance dose (MD) of digoxin?

A

0.125 to 0.5 mg daily

25
Q

What weight (IBW, Adj. BW, Act. BW) should be used to calculate the dose of digoxin?

A

IBW

26
Q

If digoxin is being used for HF, what should the therapeutic range be?

A

0.5 to 1.0 mcg/L

27
Q

If digoxin is being used for AF, what should the therapeutic range be?

A

0.8 to 2.0 mcg/L

28
Q

When should digoxin therapeutic levels be checked after LD has been administered?

A

Within 12-24 hours

29
Q

(T/F) - Checking the levels of digoxin within 12-24 hours after LD has been administered helps to determine the MDs

A

FALSE - ensures us the patient isn’t toxic

30
Q

When should digoxin therapeutic levels be checked if no LD is given?

A

wait 3-5 days before obtaining serum levels

31
Q

If IV MD digoxin is given, when should levels be checked?

A

After 6 hours from administration

32
Q

If PO MD digoxin is given, what should be done?

A

Trough concentrations should be ordered

33
Q

When would digoxin toxicities most likely occur? [HINT = at what concentration]

A

> 2.0 mcg/L

34
Q

What are some common cardiac toxicities associated with digoxin?

A
  • Proarrhythmic
  • Bradycardia
  • Atrial tachycardia w/ AV block
  • Fatal ventricular arrhythmias
35
Q

What are some common GI toxicities associated with digoxin?

A
  • Nausea
  • Vomiting
  • Diarrhea
  • Abdominal pain
36
Q

What are some common CNS toxicities associated with digoxin?

A
  • Headache
  • Fatigue
  • Vertigo
  • Confusion
37
Q

What are some common visual disturbances associated with digoxin?

A
  • Blurriness

- Yellow-green halo vision

38
Q

Can potassium affect digoxin levels or toxicities?

A

Yes - hypokalemia increases digoxin potency

39
Q

Can magnesium affect digoxin levels or toxicities?

A

Yes - hypomagnesemia increases digoxin toxicity (arrhythmias)

40
Q

Can calcium affect digoxin levels or toxicities?

A

Yes - hypercalcemia increases digoxin toxicity

41
Q

What medication is an antidote for digoxin?

A

Digibind (Digoxin immune Fab)

42
Q

How do you calculate the dose of Digibind?

A

Calculated as the # of vials

43
Q

Is the # of Digibind rounded up or down?

A

Rounded up - always

Clinical PK (11 decks)

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