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Digoxin PK

Pharmacokinetics of Digoxin for final exam

QuestionAnswer
Therapeutic range 0.7-2 ng/mL (narrow!)
How long does it generally take for VENTRICULAR RATE CONTROL? Usually achieved by 24 hours
How is loading dose given & why? Loading dose is DIVIDED due to a LONG DISTRIBUTION T1/2
___( Higher / Lower )___ doses are used in the ACUTE SETTING to control rate (>2ng/mL) HIGHER
(T/F) Dose is proportional to [serum] as well as many disease states FALSE! Dose & [serum] are POORLY CORRELATED (as well as renal impairment, drug intxns, age, thyroid DZ, & hypokalemia)
(T/F) Levels are determined by clinically measurable endpoints FALSE! There are no readily measurable clinical endpoints for dig
Name 3 DZ-states that might cause std doses to produce toxic fx. Renal insufficiency, hypokalemia, hyper/hypothyroidism
What Sx might a patient show that would cause you to suspect toxicity (6)? * Anorexia - N/V - Confusion - visual disturbances - arrhythmia - confusion in elderly
What is the Volume of distribution for dig in normal patients vs patients with renal dysfxn? Normal = ~7 L/kg (range: 5-10) Renal Dysfxn =(decreased ) 4-5 L/kg
What factors would caused the volume of distribution to decrease? (3) Renal insufficiency, age, exercise
V & CL are calculated based on ____________________. Renal function
How much is renally excreted in urine (unchanged)? 60-80%
Name 8 important drug interactions with dig. - Spironolactone - Amiloride - Nifedipine - Verapamil - Rifampin - Quinidine - Diazepam - Amiodarone
Which drugs increase dig levels (6) & by what mechanism? Primarily by MDR1 aka PgP/ABCB1 inhibition: - amiodarone, quinidine, ditiazem, nifedipine, verapamil, & spiro
Created by: myassen
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