Heart Failure

Question 1

Digoxin derived from

Answer 1

Foxglove plants and toad skin secretions

Question 2

Kinetics of digoxin

Answer 2

Long half life, narrow therapeutic index

Renal elimination

Question 3

MOA digoxin

Answer 3

Positive inotrope
Negative chronotrope
Negative dromotrope

Question 4

ADRS for digoxin

Answer 4

Gi effects, confusion visual disturbance bradycardia arrhythmia AVA block

Question 5

DDIs of digoxin

Answer 5

CYP 3A4 substrate
Beta blockers amiodarone and cyclosporine inc digoxin effects
Antacids and cholestyramine dec digoxin levels
Diltiazem verapamil and quinidine reduce digoxin clearance

Question 6

Antidote for digoxin toxicity

Answer 6

Digibind

Question 7

IV inotropes for acute decompensated heart failure

Answer 7

Adrenergic agonist- Dobutamine-short term management only or can get renal failure
PDE 5 inhibitors-amrinone and milrinone for short term management or acute exacerbations otherwise can get thrombocytopenia or ventricular arrhythmia

Question 8

IV vasodilator for acute decompensated heart failure

Answer 8

Nesiritide-inc cGMP, for pts w/ dyspnea at rest
Nitroprusside
Nitroglycerin-can get tolerance

Question 9

4 drug combo

Answer 9

Beta blocker
ACE inhibitor
Digoxin
Diuretics