Digoxin Toxicity Management Quiz

______ 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 protects ______ during certain atrial arrhythmias.

Digitalis lanata (______) is a poisonous plant and its toxic effects have been known for a long time.

It is estimated that 20-30% of patients taking a digitalis preparation will experience ______ because the drugs have an extremely narrow therapeutic index.

______ are used for treating chronic toxicity in patients with renal failure.

Induced emesis with ______ is not recommended due to increased vagal effect.

______ is not recommended as it does not increase renal excretion and can worsen electrolyte abnormalities.

Use ______ to treat hyperkalemia in chronic toxicity.

______ increasing the risk of toxicity include concurrent diuretic use and presence of Eubacterium lentum in the colon.

Early ______ of digoxin intoxication involve the gastrointestinal tract in about 50% of cases.

Supportive care includes IV fluid hydration, oxygenation, ventilatory support, drug discontinuation, and correction of electrolyte imbalances

______ and vomiting result from direct drug action on the chemoreceptor trigger zone (CTZ).

Digoxin intoxication can provoke , such as brady or tachy______.

Activated charcoal is most effective if given within 6-8 hours after ingestion to reduce absorption and interrupt enterohepatic circulation

Assessing etiology, age, medical history, chronicity, existing heart disease, renal insufficiency, and ECG changes is essential for treatment

Management of Digitalis Toxicity

Administering half doses is the best ______ in patients with chronic toxicity, avoiding completely reversing the clinical effects of digoxin

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

The affinity for ______ is 10 times less than for digoxin, indicating a lower binding capacity

The use of digoxin Fab fragments in the ______ of digoxin toxicity is supported by clinical evidence and case series, particularly in pediatric patients

Digoxin immune Fab (______) is the first-line treatment for significant dysrhythmias due to digitalis toxicity

Hypomagnesemia can lead to ______ hypokalemia

A loading dose of Fab followed by a ______ infusion optimizes binding to Fab

Magnesium can act as a ______ antiarrhythmic agent until Fab fragments are available

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.

Premature ventricular contractions (PVCs) may require only observation unless the patient is hemodynamically unstable, in which case ______ may be effective.

Ventricular tachycardia responds best to digoxin immune therapy, but phenytoin and ______ are useful if immune therapy is ineffective or unavailable.

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.