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Updated: Feb 25 2015

Digoxin

Cardiovascular Drug Introduction
  • Cardiovascular medications can be broken down into the following categories
    • Antiarrhythmics
    • Antihypertensives
    • Inotropes
    • Vasodilators
    • Diuretics
    • Antihyperlipidemics
    • Anti-plateletes
    • Thrombolytics
 
Overview
  • Clinical use
    • CHF → ↑ contractility
    • atrial fibrillation → ↓ conduction at AV node via ↑ in parasympathetic tone 
  • Mechanism
    • direct inhibition of Na+/K+ ATPase
      • ↓ Na+ gradient results in indirect inhibition of Na+/Ca2+ exchanger/antiport
    • ↑ [Ca2+]i → positive inotropy  
  • Toxicity
    • blurry yellow vision 
    • cholinergic
      • nausea, vomiting, diarrhea
    • life-threatening arrhythmias
      • ↑ PR, ↓ QT, T-wave inversion
    • may ↑ increase K+ serum levels
    • renal insufficiency ↑ digoxin toxicity 
    • hypokalemia ↑ digoxin toxicity
      • without K+, digoxin can bind to Na+/K+ ATPase
      • digoxin competes for excretion and competes for tissue-binding sites
  • Antidote "KLAM"
    • slowly normalize K
    • Lidocaine
    • digoxin Antibodies (anti-dig Fab fragments)
    • Mg2+
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