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14 Cards in this Set
- Front
- Back
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Normal digoxin range
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0-2ng/mL
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toxic effects of digoxin? acute v chronic?
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1st: GI sxs (flu-like: NVD, abdominal pain, fatigue, anorexia, visual changes)
2)arrythmias 3)acute OD = hyperkalemia chronic OD = hypokalemia |
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significance of elevated serum potassium? mechanism?
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-degree of K+ helps determine severity of an ACUTE OD
-digoxin inhibits Na+/K+ ATPase pump |
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when and how should hyperkalemia be treaded in a digoxin toxic patient?
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increase K+ PLUS EKG evidence of increased K+ (peaked T-waves)
1)NaHCO3 IVP 2)Glucose/Insulin IV 3)Kayexelate |
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when and how should hypokalemia be treated in a digoxin toxic patient?
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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 |
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what types of arrhythmias can digoxin induce?
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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 |
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indications for atropine in digoxin toxic patient
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1)symptomatic bradycardia or AV blockade
2)0.5mg IVP (<0.5mg results in paradoxical slowing of HR) |
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indications for isoproterenol in digoxin toxic patient
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1)avoid-may worsen VT/FV
2)increase sensitivity to catecholamines |
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indications for phenytoin and/or lidocaine in digoxin toxic patient
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1) For VT
-suppress myocardial excitability w/o slowing AVN conduction -phenytoin may improve AVN conduction |
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indications for class Ia antiarrhythmics (quinidine, PCA, disopyramide) in digoxin toxic patient
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Contraindicated - worsens conduction
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indications for direct current cardioversion (DCC) in digoxin toxic patient
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avoid unless all else fails
1)secondary increased VT/VF (digoxin lowers fibrillatory threshold) |
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indications for digibind in digoxin toxic patient
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1)K+>5.5
2)VT/VF 3)progressing AVN block (2-3) |
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indications and efficacy of MAC for enhanced elimination in digoxin toxicity
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may have some benefit, not a dramatic effect
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indications and efficacy of HD/HP for enhanced elimination in digoxin toxicity
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-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 |
