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* 基本機制 :
阻斷 Na-K ATPase... 最後增加胞內 Ca, 加強收縮力
加強副交感 : AV node 阻斷 ( 所以才會 PR prolonged, 改善 Af )
現在角色越來越少
只用在 HF 的 Af 病人拿來做 Rate control
The usual daily dose is 0.125–0.25 mg and should be decreased in patients with renal insufficiency.
Digoxin is not dialyzable, and toxicity is only treatable by the administration of digoxin immune Fab.
* Useless :
- 有些人天生效果不好
- 藥物濃度 therapeutic window 很窄
* EKG :
- PR prolonged
- STD with Spoon shaped 較緩降陡升
(Ischemia, Strain 的 STD 會比較對稱)
(Downsloping ST depression, Salvador Dali sagging)
- T flatten
- QT shorten
- U wave
- Severe bradycardia and life threatening arrhythmias, including
VT, Vf, high degrees of AV block
* Digoxin intoxication 會造成 高血鉀
低血鉀 會加強 Digoxin 效果 ( 避免會低血鉀的 diuretics : Thiazide )
高血鈣, 低血鎂, 腎衰竭都會加強 Digoxin 效果
Agents that may increase levels include erythromycin, tetracycline, quinidine, verapamil, flecainide, and amiodarone.
* 常見 Complaint : GI upset, 視野變黃 ( 梵谷 )
* 懷疑 Digoxin intoxication :
- 驗 Digoxin level
- 做 EKG
- 驗 K, Ca, Mg
Treatment : Antidigoxin Fab
If the ingested dose of digoxin is known, administer 2 vials of Fab for every milligram of digoxin ingested.
In critical cases : administer empirically 10 to 20 vials.
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