digoxin , milirinone , nesiritide

Question 1

digoxin MOA

Answer 1

-inhibits Na+/K+ ATPase -
( “knocked over banana vending machine”)

-leads to increased intracellular Na+
(“offwhite man holding salty peanuts, salty peanuts in floor”)

-increase intracellular Na+ promotes Calcium inlfux through the Na+/Ca+2 exchanger
(“salty peanuts guy opens the door for the Calci-YUM guy”)

-results in increased contractillity
(“blue shirt guy flexes his arm “)

Question 2

what is Digoxin used for ?

Answer 2

• Anti-arrhythmic effect (“turntable”)
• symptomatic treatment of chronic systolic HF (“deflated balloon”)

-direct stimulation of the Vagal nerve can treat Atrial arrhythmias
(“las VAGas”)

Question 3

side effects of Digoxin

Answer 3

-hyperkalemia as a result of acute toxicity
(“pile of bananas”)

-induce various Arrhythmias
(“various dancers on heart shaped dancing floor”)

-chronic use of Digoxin may cause scooped concave ST segment on ECG
(scooped ice cream can says :”taSTy”)

-Bradycardia due to parasympathetic activation of SA node
(“Dangling heart watch” , “SA music note”)

• Heart block in case of toxicity (“AV music note”)
• GI symptoms (“nauseated dancer”)
• Xanthopia (“yellow spotlight”)

Question 4

Digoxin is contraindicated in …

Answer 4

-SA node heart block

(**use with caution in beta blockers**)

Question 5

what may exacerbate digoxin toxicity ?

Answer 5

Hypokalemia

• loop diuretics may cause hypokalemia , diarrhea , vomiting

Renal insufficiency
can make digoxin toxicity worse and will precipitate digoxin rise, the long flag indicates the long 1⁄2 life of digoxin, and increasing susceptibility to toxicity

• many arrhythmics inhibit renal clearance of digoxin, increasing susceptibility to toxicity

Question 6

what can reverse digoxin Toxicity ?

Answer 6

immune fab (“FAB uolous las vegas” sign)

Question 7

which drugs can treat Acute heart failure ?

Answer 7

Milirinone
(donkey sign says “hes One in a million”)

Nesiritide
(elephant sign says “necessary to turn the tide”)

Question 8

Milirinone MOA

Answer 8

-inhibits phosphodiesterase
(“don’t phoster disinterest”)

-decreases CAMP breakdown
(sign says “join the CAMPaign”)

-increases cardiac contractility
(“red donkey flexing arms”)

-causes arteriolar dilation in HF, but watch for hypotension
(“dilated red donkey ears”)

Question 9

Nesiritide MOA

Answer 9

-BNP analog that increases cGMP

-Nesiritide causes arteriolar AND venous dilation, reducing afterload and preload→natiuresis
(“elephant has dilated red ears and blue legs”)

(“BuMP the GruMP”)