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14 Cards in this Set

  • Front
  • Back
Normal digoxin range
toxic effects of digoxin? acute v chronic?
1st: GI sxs (flu-like: NVD, abdominal pain, fatigue, anorexia, visual changes)
3)acute OD = hyperkalemia
chronic OD = hypokalemia
significance of elevated serum potassium? mechanism?
-degree of K+ helps determine severity of an ACUTE OD
-digoxin inhibits Na+/K+ ATPase pump
when and how should hyperkalemia be treaded in a digoxin toxic patient?
increase K+ PLUS EKG evidence of increased K+ (peaked T-waves)
2)Glucose/Insulin IV
when and how should hypokalemia be treated in a digoxin toxic patient?
decreased K+ PLUS EKG evidence of decreased K+ (tachy/bradyarrhythmias)
1)conservative replacement of K+ w/ IV monitor EKG and K+ level
-NEVER give KCl by IVP
what types of arrhythmias can digoxin induce?
digoxin slows AVN and excites above and below AVN
1)AV nodal blockade secondary to increased vagal tone decreased HR
2)VT,VF,AF,Atrial flutter
3)multi-directional VT
indications for atropine in digoxin toxic patient
1)symptomatic bradycardia or AV blockade
2)0.5mg IVP (<0.5mg results in paradoxical slowing of HR)
indications for isoproterenol in digoxin toxic patient
1)avoid-may worsen VT/FV
2)increase sensitivity to catecholamines
indications for phenytoin and/or lidocaine in digoxin toxic patient
1) For VT
-suppress myocardial excitability w/o slowing AVN conduction
-phenytoin may improve AVN conduction
indications for class Ia antiarrhythmics (quinidine, PCA, disopyramide) in digoxin toxic patient
Contraindicated - worsens conduction
indications for direct current cardioversion (DCC) in digoxin toxic patient
avoid unless all else fails
1)secondary increased VT/VF (digoxin lowers fibrillatory threshold)
indications for digibind in digoxin toxic patient
3)progressing AVN block (2-3)
indications and efficacy of MAC for enhanced elimination in digoxin toxicity
may have some benefit, not a dramatic effect
indications and efficacy of HD/HP for enhanced elimination in digoxin toxicity
-no benefit for digoxin removal
-may be used to remove K+ or if the patient has renal failure and you want to remove the digoxin-Fab complex