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Cardiac glycosides

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