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Pharmacology
Cardiac glycosides
| Question | Answer |
|---|---|
| dig is strong and highly selective inhibitor of the | sodium-potassium-adenosine triphosphatase (ATPase) system, the sodium pump |
| dig is a positive inotrope because of | sodium and calcium buildup inside the cell from inhibition of the sodium pump |
| @10% of individuals have intestinal bacteria that | inactivates dig in the gut requiring larger doses. if tx'd with antibiotics can result in toxicity |
| different bioavailability in different preparations so | best to prescribe by brand |
| dig and blood-brain barrier | crosses |
| several drugs reduce clearance of dig and can double the serum concentrations resulting in toxicity unless dose is reduced | quinidine, Norvasc, verapamil, Cardizem |
| contraindicated in | av blocks, uncontrolled ventricular arrhythmias, idiopathic hypertrophic subaortic stenosis (IHSS), |
| precautions in | renal impairment and hypothyroidism need decreased dose |
| abnormalities of certain electrolytes in the extracellular compartment may result in toxicity | potassium, calcium, magnesium |
| most common adverse reactions | gi sx: n/v, anorexia, diarrhea resulting from CNS actions; classic but rare sign is yellow vision and green halos |
| ? administration should be considered even when levels are normal unless a high grade av block is present | potassium levels should be kept up |
| potassium and dig interact by inhibiting | each other's binding to sodium-potassium-ATPase |
| hypercalcemia increases the risk of dig arrhythmias by | overloading the intracellular calcium stores |
| hypomagnesemia is a risk for | arrhythmias r/t dig |
| Afib and PSVT tx: | may be treated outpatient with or without a loading dose if hemodynamically stable; therapeutic level 1.5-2 ng/dl |
| heart failure: although not first line tx, is still indicated if ? | EF<40%, audible S3 |
| dig less effective in HF with: | EF>40% or secondary to hypertrophic cardiomyopathies |
| mild to mod HF normally treated with | ACEIs and diuretics, only dig if symptoms persist |
| therapeutic levels for HF | 0.8-1.2 ng/dl |
| steady state normally achieved in | 5-7d |
| levels should be drawn at least ? hours after the last dose | 6 hours |
Created by:
heatherbrown2020
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