Inotrope
Treats
     ONLY used to treat ATRIAL arrhythmias
     Used for rate control in hemodynamically stable atrial fibrillation
Precipitants of toxicity
     Verapamil use
          Verapamil decreases the renal clearance of digoxin
Toxicity
     Digoxin is renally cleared with a narrow therapeutic index
     An inciting event, such as a viral illness or excessive diuretic use, can lead to volume depletion or renal injury that acutely elevates the digoxin level. This leads to symptoms of toxicity in patients chronically taking digoxin.
     Hypokalemia, often associated with loop diuretic use, increases the patient's susceptibility to the toxic effects of digoxin.
     Sx
          Anorexia
          Nausea/vomiting/diarrhea
          Confusion
          Weakness
          Fatigue
          AV block
          Ventricular and supraventricular arrhythmias
          Visual disturbances
               Yellow/green halos around objects (CLASSIC)
               Scotoma
               Blurry vision
               Blindness
     Dx
          A serum digoxin level can rule out toxicity
          EKG to rule out life-threatening arrhythmias
          INR to ascertain low oral intake
Caution
     Increases myocardial oxygen demand by increasing inotropy

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The Compendium platform was created by David Kwinter, MD, CCFP(EM).