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Y3R2 - Toxicology ☠️ > L11: Digitalis & Theophylline > Flashcards

L11: Digitalis & Theophylline Flashcards

1
Q

Source of Digitalis

A

The roots, leaves and seeds of “Digitalis Purpurea” contain several poisonous glycosides.

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2
Q

Toxic Action of Digitalis

A
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3
Q

Risk factors for Digitalis Toxicity

A
  • Age
  • Renal functions
  • Electrolyte indisturbances
  • Drug Interactions
  • Natural products
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4
Q

Age Risk Factors for Digotalis Toxicity

A

Adyanced age (>80 y) is associated with increased morbidity and mortality.

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5
Q

Renal Function Risk Factors for Digotalis Toxicity

A

Deteriorating renal function, dehydration, electrolyte disturbances or drug interactions, usually precipitates chronic toxicity.

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6
Q

Electrolyte Disturbances Risk Factors for Digotalis Toxicity

A
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7
Q

Drug Interactions Risk Factors for Digotalis Toxicity

A
  • Drug interactions are one of the most common causes of digoxin Toxicity

(e.g., Beta-blockers, Calcium channel blockers, Quinidine, loop diuretics)

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8
Q

Natural Products Risk Factors for Digotalis Toxicity

A

Natural licorice should be avoided as it causes
- Sodium and water retention
- Increases potassium loss.

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9
Q

CP of Digitalis Toxicity

A
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10
Q

what causes yellow-green visual changes with digitalis toxicity?

A

due toxic effects on retinal con than rod cell.

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11
Q

Types of Digitalis Toxicity

A
  • Acute overdose toxicity.
  • Acute versus chronic use toxicity (more common).
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12
Q

Investigations in Digitalis Toxicity

A
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13
Q

TTT of Digitalis Toxicity

A
  • Emergency TTT & Supportive
  • Decontamination
  • Antidote
  • Enhanced Elimination
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14
Q

Emergency TTT of Digitalis Toxicity

A
  • ABC and assist ventilation if necessary.
  • Continuous cardiac monitoring for at least 12-24 hours after significant ingestion due to delayed tissue distribution
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15
Q

Continuous cardiac monitoring for at least 12-24 hours after significant ingestion of digitalis due to ……..

A

due to delayed tissue distribution

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16
Q

Aspects of Emergency TTT in Digitalis Toxicity

A
  • Bradycardia or Heart block
  • Ventricular Arrhythmias
  • Hyperkalemia
  • Hypokalemia
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17
Q

Emergenct TTT of bradycardia & Heart Block in Digitalis Toxicity

A
  • Give atropine 0.5-2mg l.V.
  • Temporary transvenous cardiac pacemaker may be needed
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18
Q

Emergency TTT of Ventricular Arrythmia in Digitalis Toxicity

A
  • Fab is the preferred treatment for life-threatening arrhythmias.
  • Lidocaine is the antiarrhythmic drug of choice.
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19
Q

Emergency TTT of hyperkalemia in Digitalis Toxicity

(VIP)

A
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20
Q

when does hyperkalemia of Digitalis Toxicity need TTT?

A

Needs treatment especially if associated with ECG changes

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21
Q

what to do in a case of Hyperkalemia due to digitalis if no FAB is available?

A

Give triad of
- Sodium bicarbonate (1 mEq/kg)

  • Glucose (0.5 g/kg IV)
  • Given simultaneously with Insulin (0.1 U/kg IV)

or Sodium Polystyrene Sulfonate (Kayexalate, 0.5 g/kg PO)

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21
Q

Types of TTT of Hyperkalemia associated with Digitalis Toxicity

A

Moderate elevation of serum k (>5.5 mEq/L):
- Fab Fragment: It rapidly reverses it

Progressive elevation of serum k (k > 6-7 mEq/ L):
- Bi-Carbonate/Glucose/Insulin

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21
Q

why shouldn’t calcium be used in hyperkalemia of Digitalis Toxicity?

A

may worsen ventricular arrhythmias.

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21
Q

Emergency TTT of hypokalemia of Digitalis Toxicity

22
why shouldn't digoxin-specific Fab administration be used in hypokalemia of **Digitalis Toxicity** until hypokalemia is corrected?
Because reinstitution of Na+-K+-ATPase function may cause profound hypokalemia.
23
Deconatmination in ****Digitalis Toxicity****
24
Antidote of **Digitalis Toxicity**
Fab Fragments
25
Indications of **Fab fragments**
26
MOA of **Fab fragments**
It is low molecular weight immunoglobulin fragments that bind to digitalis forming complex, which is cleared by the kidney and reticuloendothelial system.
27
Encanced Elimination in **Digitalis Toxicity**
28
is Digoxin hemodialyzable?
not dialyzable due to large volume of distribution
29
is Digitoxin Hemodialyzable?
dialyzable and can be eliminated by repeated-dose charcoal - due to its enterohepatic circulation
30
Therapeutic index of theophylline
Theophylline has an extremely narrow therapeutic index
31
Intro to **Theophylline toxicity**
32
Toxic Action in **Theophylline toxicity**
33
Onset of **Acute Theophylline toxicity**
Manifestations of severe toxicity may be delayed 12-16 hours with sustained-release preparations
34
CP of **Acute Theophylline toxicity**
35
Causes of **Chronic Theophylline toxicity**
- when excessive doses are administered repeatedly over 24 hours or longer - when intercurrent illness or an interacting drug interferes (Eg, erythromycin, cimetidine) with hepatic metabolism of theophylline.
36
Incidence of **Chronic Theophylline toxicity**
- The usual victims are very young infants and elderly patients, especially those with chronic obstructive lung disease.
37
Differences between **Acute & Chronic Theophylline toxicity**
In chronic toxicity: - Vomiting and hypotension are less common than acute. - Metabolic effects as hypokalemia and hyperglycemia are not present - On the other houd, arrythmia and seizures are common at lower level.
38
Investigations in **Theophylline toxicity**
- Serum Theophylline Level - Other Lab Studies
39
Seum Theophylline level
40
Other lab studies in **Theophylline toxicity**
Arterial blood gases (ABG), electrolytes, glucose, creatinine, hepatic function tests and ECG.
41
TTT aspects in **Theophylline toxicity**
- Emergency & supportive treatment - Antidotes - Decontamination - Enhanced Elimination
42
Emergency & Supportive TTT in **Theophylline toxicity**
43
Is there an antidote for **Theophylline toxicity**?
no
44
Decontamination options in **Theophylline toxicity**
- Gastric Lavage - Activated Charcoal - Catharitic - WBI
45
Gastic lavage in **Theophylline toxicity**
If no vomiting can be done even 4 hs after ingestion.
46
AC in **Theophylline toxicity**
- It is important to control nausea and vomiting first. - "Ondansteron" is the drug of choice to control emesis in theophylline toxicity.
47
Catharitcs in **Theophylline toxicity**
Sorbitol is used with the activated charcoal.
48
WBI in **Theophylline toxicity**
With sustained-release preparations.
49
Enhanced Elimination options in **Theophylline toxicity**
- Hemodialysis - MDAC - Hemoperfusion
50
what is teh definitive Life-Saving Intervention in severe **Theophylline toxicity**?
Hemodialysis
51
Introducation to the use of hemodialysis in **Theophylline toxicity**
- It is the definitive life-saving intervention in severe theophylline poisoning - Highly effective in achieving good clinical outcome if commenced early. - Arrangements for urgent hemodialysis are made as soon as potentially life-threatening theophylline toxicity is anticipated.
52
Indications of the use of hemodialysis in **Theophylline toxicity**
53
what is the corner stone in TTT of **Theophylline toxicity**?
Multiple dose activated charcoal
54
uses of MDAC in **Theophylline toxicity**
- Used for stable patients with levels below 100 mg/L in acute toxicity. - It enhances the elimination of theophylline - but use of this modality delays effective treatment with hemodialysis in severe cases.
55
what is more effective in **Theophylline toxicity**, Hemodialysis or Hemoperfusion?
Hemoperfusion
56
Indications of Hemoperfusion in **Theophylline toxicity**?
Done in the presence of life-threatening toxicity. - Persistent seizures - persistent hypotension - ventricular dysrhythmias - If the serum level is greater than 100 mg/L in acute toxicity (If available).

Y3R2 - Toxicology ☠️ (15 decks)

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