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Questions and Answers
______ glycosides are life-saving drugs when used in therapeutic doses in the treatment of congestive heart failure (CHF), & for management of certain supraventricular arrhythmia.
______ glycosides are life-saving drugs when used in therapeutic doses in the treatment of congestive heart failure (CHF), & for management of certain supraventricular arrhythmia.
Digitalis
Digitalis protects ______ during certain atrial arrhythmias.
Digitalis protects ______ during certain atrial arrhythmias.
ventricles
Digitalis lanata (______) is a poisonous plant and its toxic effects have been known for a long time.
Digitalis lanata (______) is a poisonous plant and its toxic effects have been known for a long time.
foxglove
It is estimated that 20-30% of patients taking a digitalis preparation will experience ______ because the drugs have an extremely narrow therapeutic index.
It is estimated that 20-30% of patients taking a digitalis preparation will experience ______ because the drugs have an extremely narrow therapeutic index.
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______ are used for treating chronic toxicity in patients with renal failure.
______ are used for treating chronic toxicity in patients with renal failure.
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Induced emesis with ______ is not recommended due to increased vagal effect.
Induced emesis with ______ is not recommended due to increased vagal effect.
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______ is not recommended as it does not increase renal excretion and can worsen electrolyte abnormalities.
______ is not recommended as it does not increase renal excretion and can worsen electrolyte abnormalities.
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Use ______ to treat hyperkalemia in chronic toxicity.
Use ______ to treat hyperkalemia in chronic toxicity.
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______ increasing the risk of toxicity include concurrent diuretic use and presence of Eubacterium lentum in the colon.
______ increasing the risk of toxicity include concurrent diuretic use and presence of Eubacterium lentum in the colon.
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Early ______ of digoxin intoxication involve the gastrointestinal tract in about 50% of cases.
Early ______ of digoxin intoxication involve the gastrointestinal tract in about 50% of cases.
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Supportive care includes IV fluid hydration, oxygenation, ventilatory support, drug discontinuation, and correction of electrolyte imbalances
Supportive care includes IV fluid hydration, oxygenation, ventilatory support, drug discontinuation, and correction of electrolyte imbalances
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______ and vomiting result from direct drug action on the chemoreceptor trigger zone (CTZ).
______ and vomiting result from direct drug action on the chemoreceptor trigger zone (CTZ).
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Digoxin intoxication can provoke , such as brady or tachy______.
Digoxin intoxication can provoke , such as brady or tachy______.
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Activated charcoal is most effective if given within 6-8 hours after ingestion to reduce absorption and interrupt enterohepatic circulation
Activated charcoal is most effective if given within 6-8 hours after ingestion to reduce absorption and interrupt enterohepatic circulation
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Assessing etiology, age, medical history, chronicity, existing heart disease, renal insufficiency, and ECG changes is essential for treatment
Assessing etiology, age, medical history, chronicity, existing heart disease, renal insufficiency, and ECG changes is essential for treatment
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Management of Digitalis Toxicity
Management of Digitalis Toxicity
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Administering half doses is the best ______ in patients with chronic toxicity, avoiding completely reversing the clinical effects of digoxin
Administering half doses is the best ______ in patients with chronic toxicity, avoiding completely reversing the clinical effects of digoxin
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Hemodynamically stable patients with ______ and supraventricular arrhythmias may be treated with observation and supportive care, discontinuation of the drug, proper hydration, and GI binding agents
Hemodynamically stable patients with ______ and supraventricular arrhythmias may be treated with observation and supportive care, discontinuation of the drug, proper hydration, and GI binding agents
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The affinity for ______ is 10 times less than for digoxin, indicating a lower binding capacity
The affinity for ______ is 10 times less than for digoxin, indicating a lower binding capacity
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The use of digoxin Fab fragments in the ______ of digoxin toxicity is supported by clinical evidence and case series, particularly in pediatric patients
The use of digoxin Fab fragments in the ______ of digoxin toxicity is supported by clinical evidence and case series, particularly in pediatric patients
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Digoxin immune Fab (______) is the first-line treatment for significant dysrhythmias due to digitalis toxicity
Digoxin immune Fab (______) is the first-line treatment for significant dysrhythmias due to digitalis toxicity
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Hypomagnesemia can lead to ______ hypokalemia
Hypomagnesemia can lead to ______ hypokalemia
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A loading dose of Fab followed by a ______ infusion optimizes binding to Fab
A loading dose of Fab followed by a ______ infusion optimizes binding to Fab
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Magnesium can act as a ______ antiarrhythmic agent until Fab fragments are available
Magnesium can act as a ______ antiarrhythmic agent until Fab fragments are available
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Short-acting beta blockers, such as esmolol, can be used for supraventricular tachyarrhythmias with rapid ventricular rates, but they may precipitate advanced or complete atrioventricular block in patients with ______ or AV node depression.
Short-acting beta blockers, such as esmolol, can be used for supraventricular tachyarrhythmias with rapid ventricular rates, but they may precipitate advanced or complete atrioventricular block in patients with ______ or AV node depression.
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Premature ventricular contractions (PVCs) may require only observation unless the patient is hemodynamically unstable, in which case ______ may be effective.
Premature ventricular contractions (PVCs) may require only observation unless the patient is hemodynamically unstable, in which case ______ may be effective.
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Ventricular tachycardia responds best to digoxin immune therapy, but phenytoin and ______ are useful if immune therapy is ineffective or unavailable.
Ventricular tachycardia responds best to digoxin immune therapy, but phenytoin and ______ are useful if immune therapy is ineffective or unavailable.
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Lidocaine may be given in boluses of 100 mg according to advanced cardiac life support (ACLS) guidelines, followed by a maintenance infusion at 1-4 mg/min if successful.
Lidocaine may be given in boluses of 100 mg according to advanced cardiac life support (ACLS) guidelines, followed by a maintenance infusion at 1-4 mg/min if successful.
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Phenytoin has been administered in boluses of 100 mg every 5-10 minutes, up to a loading dose of 15 mg/kg.
Phenytoin has been administered in boluses of 100 mg every 5-10 minutes, up to a loading dose of 15 mg/kg.
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Atropine may be useful in reversing severe sinus bradycardia induced by digoxin and in blocking its effects on the sinoatrial and AV nodes.
Atropine may be useful in reversing severe sinus bradycardia induced by digoxin and in blocking its effects on the sinoatrial and AV nodes.
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Magnesium sulfate, given intravenously, has been shown to terminate dysrhythmias in digoxin-toxic patients with and without overt cardiac disease, with a therapeutic goal of a magnesium level between 4 and 5 mEq/L.
Magnesium sulfate, given intravenously, has been shown to terminate dysrhythmias in digoxin-toxic patients with and without overt cardiac disease, with a therapeutic goal of a magnesium level between 4 and 5 mEq/L.
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Study Notes
Management of Digoxin Toxicity
- Short-acting beta blockers, such as esmolol, can be used for supraventricular tachyarrhythmias with rapid ventricular rates, but they may precipitate advanced or complete atrioventricular block in patients with sinoatrial or AV node depression.
- Calcium channel blockers are contraindicated in digoxin toxicity as they may increase digoxin levels.
- Premature ventricular contractions (PVCs) may require only observation unless the patient is hemodynamically unstable, in which case lidocaine may be effective.
- Ventricular tachycardia responds best to digoxin immune therapy, but phenytoin and lidocaine are useful if immune therapy is ineffective or unavailable.
- Phenytoin can dissociate the inotropic and dysrhythmic action of digitalis, suppressing digitalis-induced tachydysrhythmias without diminishing the contractile effects.
- Lidocaine may be given in boluses of 100 mg according to advanced cardiac life support (ACLS) guidelines, followed by a maintenance infusion at 1-4 mg/min if successful.
- Phenytoin has been administered in boluses of 100 mg every 5-10 minutes, up to a loading dose of 15 mg/kg.
- Atropine may be useful in reversing severe sinus bradycardia induced by digoxin and in blocking its effects on the sinoatrial and AV nodes.
- Magnesium sulfate, given intravenously, has been shown to terminate dysrhythmias in digoxin-toxic patients with and without overt cardiac disease, with a therapeutic goal of a magnesium level between 4 and 5 mEq/L.
- Quinidine and procainamide are contraindicated in the management of digoxin toxicity.
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Description
Test your knowledge of the management of digoxin toxicity with this quiz. Explore the appropriate use of medications such as beta blockers, calcium channel blockers, lidocaine, phenytoin, atropine, and magnesium sulfate in treating various cardiac manifestations of digoxin toxicity.
