DigoxinToxicity in afya

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cardiac glycoside 
mainly used rate control in AF
sometimes used for Sx in heart failure (not change mortality - via +ve inotropic effect

''Mechanism of action''
dec AV conduction so slowing ventricular rate in AF/flutter 
inc force of  contraction by inhibition of Na/K pump (and via vagal stimuation)

''Digoxin toxicity''

Plasma concentration alone unhelpful (although likelihood inc from 1.5-3mcg/l)
''Features'' -  unwell, lethargy, nausea & vomiting, anorexia, confusion, yellow-green vision
arrhythmias (e.g. AV block, bradycardia)

''Precipitating factors''
classically - hypokalaemia 
hypo K, Mg, albumin, thermia, thyroid, acidosis 
hyper K, Na, Ca
increasing age
renal failure
myocardial ischaemia
drugs: QcVADS(TL) amiodarone, quinidine, verapamil, diltiazem, spironolactone (competes for secretion in distal convoluted tubule therefore reduce excretion), ciclosporin. Also drugs which cause hypokalaemia e.g. thiazides and loop diuretics

''Management''
Digibind
correct arrhythmias
monitor potassium

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