DOAC's, Amiodarone and Digoxin

Question 1

Direct Oral Anticoagulants (DOAC’s):

Thrombin inhibitor - one example - starts with d

Factor Xa inhibitors - 3 examples - r, a, e

Answer 1

Dabigatran

Rivaroxaban
Apixaban
Edoxaban

Question 2

Direct Oral Anticoagulants (DOAC’s)

Indications

What is one of the benefits of using DOAC’s?

Does it require monitoring?

How should treatment be altered around surgery?

What has a lower mortality rate, DOAC’s or warfarin?

Answer 2

Non-valvular AF (Warfarin used in valvular AF as research has shown that it is more effective)
DVT/PE

Does not require monitoring

Stops 2 days before and after

DOAC’s even though it has expensive reversal agents

Question 3

Amiodarone:

MOA

Side effects:

Skin:

• They get photosensitive. What colour does the skin look like?
• What may happen if you give an IV infusion of this?

What gland is affected?

They also get parkinsonism/tremor!

Answer 3

K, Na and Ca channel blocker and alpha and beta adrenergic receptor blocker
Prolongs cardiac AP’s, prolongs refractory period and slows sinus and AV nodes

Slate grey appearance

Thrombophlebitis

Thyroid dysfunction due to iodine content

Pulmonary fibrosis

Question 4

Amiodarone:

How should it be monitored? - 2

Answer 4

LFT

TFT

Question 5

Digoxin:

MOA

Answer 5

Postively inotropic (contractility) 
Lowers HR via antiadrenergic effects

Question 6

Digoxin:

Side effects:

• Symptoms of CVD
• How does it affect the eyes?
• Why does it cause gynecomastia?

Answer 6

Dizziness
Palpatations
Bradycardia

Blurred vision
Xanthopsia (yellow vision)

The mechanism of digoxin-induced gynecomastia is believed to be a direct action at estrogen receptors due to similarity in the structure of digoxin and estrogen. [6] Although furosemide is reported to cause gynecomastia, its exact mechanism is still not known.

Question 7

Digoxin:

ECG findings in normal use - LOOK AT PICS

Findings if it reaches toxic levels

Answer 7

Downsloping ST

• Scooped
• Sagging
• Hockey stick appearance

Atrial tachyarrhythmias
VT
Conduction delay including AV block

Question 8

Digoxin;

In what patients does digoxin need to be monitored?

Answer 8

Patients with renal impairment of if problem suspected

Question 9

Acute digoxin toxicity:

What 4 things need to be checked?

What is the antidote?

Answer 9

Electrolytes due to N&V
Renal function as could effect exertion of meds
Glucose
ECG

Digoxin immune fab (Digibind)