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