DIGOXIN Flashcards

1
Q

Drug class

A

cardiac glycoside

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2
Q

What does negatively chronotropic mean?

A

reduces heart rate

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3
Q

What does positively inotrophic mean?

A

increases contractility

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4
Q

What does digoxin do? (2)

A
  1. It is negatively chronotropic - reduces heart rate

2. and is positively inotrophic - increases contractility

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5
Q

How does digoxin work in atrial fibrillation and atrial flutter? (5)

A
  • via indirect pathway
  • increasing vagal (parasympathetic) tone
  • this reduces conduction at the AVNode
  • this prevents impulses from being transmitted to the ventricles
  • this consequently reduces ventricular rate
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6
Q

How does digoxin work in heart failure? (6)

A
  • has a direct effect on myocytes
  • by inhibiting Na/K/ATPase pumps
  • this causes Na to accumulate in the cell
  • cellular extrusion of Ca2+ required low intracellular Na+ conc
  • elevation of intracellular Na causes Ca2+ to accumulate
  • this increases contractile force
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7
Q

Indications (2)

A
  1. atrial fibrilation

2. severe heart failure - 3rd line treatment

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8
Q

Contra-indications (5)

A
  1. heart
  • second heart block
  • intermittent complete heart block
  • ventricular arrhythmias
  1. kidneys
    - renal failure

ION IMBALANCES

  1. HYPOKAELEMIA
    - digoxin competes with K in Na/K pump
  2. hypomagnaesemia
  3. hypercalcaemia
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9
Q

Side effects (4)

A
  1. heart
    - bradycardia
    - arrhythmias
  2. GI upset
  3. Skin
    - Rash
  4. Head
    - dizzy
    - visual disturbances
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10
Q

Interactions (5)

A
  1. loop diuretics
  • increases digoxin toxicity
  • due to hypokaelemia
  1. amiodarone
  2. calcium channel blockers
  3. spironolactone
  4. quinine
  • increases the plasma concentrations of digoxn
  • digoxin toxicity
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11
Q

Elimination

A

kidneys

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