Digoxin

Pharmacology / Cardio & Renal / Heart Failure Drugs

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Digoxin is an antiarrhythmic cardiac glycoside used for the symptomatic treatment of heart failure (HF) and certain arrhythmias. Its mechanism of action involves the reversible inhibition of Na+/K+ ATPase, which increases intracellular sodium, preventing calcium efflux at the Na+/Ca2+ exchanger. This results in increased cardiac contractility due to higher sarcoplasmic calcium stores. Digoxin's direct stimulation of the vagus nerve enables it to treat certain arrhythmias. However, it can cause side effects such as hyperkalemia, bradycardia, heart block, and gastrointestinal issues. Additionally, it may induce various arrhythmias and is contraindicated in heart block without a pacemaker. Monitoring potassium and heart rate is crucial during digoxin therapy. Hypokalemia exacerbates digitalis toxicity, while renal insufficiency and some antiarrhythmics increase susceptibility to toxicity by prolonging digoxin's serum half-life or inhibiting its renal clearance. In cases of digoxin toxicity, digoxin immune Fab can be used for reversal, with dosing based on the quantity of digoxin ingested or administered.

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1. DJ Foxglove - digoxin (Lanoxin, Digitek, Digox), a cardiac glycoside → antiarrhythmic and symptomatic treatment of HF
2. Knocked over banana vending machine - reversible inhibition of Na+/K+ ATPase
3. Three P batteries - ATPase
4. Obstructed salty sodium peanuts - increased intracellular sodium as a result of Na+/K+ ATPase inhibition
5. Salty peanuts preventing calci-yum from leaving - ↑ intracellular sodium prevents calcium efflux at the Na+/Ca2+ exchanger
6. Flexed arm - ↑ cardiac contractility due to ↑ sarcoplasmic calcium stores
7. Deflated heart balloon - symptomatic treatment of chronic systolic heart failure
8. Las Vegas - direct stimulation of the vagus nerve allows treatment of certain arrhythmias
9. Rhythm-inducing record - antiarrhythmic
10. Tall pile of bananas - side effect of hyperkalemia; monitor K+
11. Various dances on the heart shaped dancefloor - digoxin is proarrhythmic and may induce various arrhythmias; these chronic ECG changes don’t necessarily indicate toxicity or myocardial ischemia
12. taSTy scoop - chronic digoxin use may cause “scooped” concave ST segments on ECG
13. Dangling heart watch - side effect of bradycardia; monitor HR
14. SA music note - side effect of bradycardia due to parasympathetic activity at SA node
15. Heart shield - side effect heart block
16. AV music note - side effect of heart block due to parasympathetic activity at AV node
17. Remain unblocked - digoxin is contraindicated in heart block (without a pacemaker)
18. Sick dancer - GI side effects include nausea, vomiting, abdominal pain
19. Yellow spotlight - side effect of xanthopsia (objects appear yellow)
20. Kid inside banana depleted vending machine - hypokalemia exacerbates digitalis toxicity
21. Long tapering decay flag on cracked kidney - renal insufficiency ↑ the serum half-life of digoxin, susceptibility to toxicity
22. Records in kidney jukebox - many antiarrhythmics inhibit renal clearance of digoxin, increasing susceptibility to toxicity
23. Fabulous - digoxin immune Fab reverses digoxin toxicity; dose based on quantity of digoxin ingested/administered