Digoxin Explained Clearly - Exam Practice Question
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- Опубліковано 25 чер 2024
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Dr. Roger Seheult reviews key features of digoxin and how it relates to exam questions and clinical practice. Includes discussion on the digoxin mechanism of action and narrow therapeutic window, how antacids affect digoxin, and digoxin side effects and toxicity. This question is from the BoardVitals NAPLEX Question Bank.
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Speaker: Roger Seheult, MD
Co-Founder of MedCram.com (www.medcram.com/?Y...)
Clinical and Exam Preparation Instructor
Board Certified in Internal Medicine, Pulmonary Disease, Critical Care, and Sleep Medicine.
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There is an error in your explanation of the Ca/Na pump.
The Calcium-Sodium exhanger pumps calcium OUT of the cell and sodium pumped IN to the cell. This pump is activated by low intracellular sodium. When Digoxin allosterically binds to the Na/K ATPase, it causes an increase in intracellular sodium levels (this part we agree on). This then would mean the Ca/Na exchanger would have to pump sodium against gradient from extracellular into the intracellular space that already has a high sodium content. This removes the driving force necessary for the Ca/Na pump to work and thus Calcium is not pumped out of the cell. This leaves more calcium available to increase contractility (useful in myocardium). Its nice to note also, Digitoxin while indicated for CHF really works for left ventricular failure and has minimal effect in the right.
Yea you are correct based on my notes
I was so confused, thank you so much for clearing this up !! :)
this is true
Luu it is correct. Low Na+/K+ pump activity equals to increased intracellular Na+, low Na+/Ca++ exchange and thus higher intracellular Ca++ . This higher Intracellular Ca++ concentration will increase heart contractility and stroke volume
Luu thanks alot @luu
There's an error... The Na-Ca Xchanger works in the opposite direction than in the video. Basically Na-K ATPase is knocked out, building the Na intracellularly, which reduces the gradient for the Na-Ca Xchanger as Na moves inside the cell and Ca moves outside the cell. So there is a build up of intracellular sodium and Calcium, which is why you have Delayed afterdepolarizations, because the phase 4 of a myocardial cell starts behaving like the phase 4 of an automatic cell, triggering spontaneous depolarization after a normal depolarization due to fluctuation from the electro positivity of the Na and Ca retention, similar to the leaky Na and Ca current in a phase 4 of an SA nodal cell.
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By the way you are the best!!! that is the best video/explanation on digoxin that I've ever seen/listened to
I'm a pharmacy student and this video helped me a lot on understanding the mechanism of Dig .
Thank you 😊
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Wrong explanation of digoxin mechanism.please refer any pharmacology text
MedCram is right up there along with Khan Academy! Excellent initiative
We appreciate the feedback, thank you!
most straight to the point videos on youtube!
After watching several of your videos I have concluded it would be more efficient to just download from your knowledge; when completed the processes-there is your next million! How lucky students are to have this access - I can't thank you enough!!!
your videos r the best videos, I have known so far. thank you so much doc! :)
Thanks for the feedback!
This video was so so so helpful and it’s so easy to understand, thank you!
Thank you so much for this video MedCram. There is just enough biochem so I understand Dig works along with why patient's have the side effects they do without confusing me. All of this had alluded me prior to viewing this video. Please continue the great work and any additional meds would be greatly appreciated!
This video is something i will have to revisit again, but never the less it is still good!
Thank you! I needed clarification on digoxin hypokalemia and hyperkalemia.
Fantastic vids. Thank you
Simple and easy. Than you.
Nice and easy! Great job
Wonderful simply Wonderful contribution to Humanity, Time out is a wonderful gift & treatment, Wings to fly Susan Boyle Team,
ur lectures are so clear.... than q for ur explanation
If you haven't watched this video with the provided subtitles, I'd suggest it. "The Jocks Sin'" was a personal favorite for the talk to text translation of digoxin. It worked some, but things like "inotrophy" become "in a trophy." These are great videos and this is in no way meant as negative criticism. I just thought I'd point out a funny to those that might like to watch and read at the same time.
Wonderful thank you 🙏🏻
THANK YOU SOOOO MUCH AA LIFESAVER
D should also be correct as digoxin binds to where K binds in the NaK ATPase protein, if you have hypokalemia it is VERY EASY to overdose on digoxin. .
Super helpful!
Thank you
Absolutely clear, thank you very much!
Good to hear, thanks!
Love your videos!! I make my med videos on keynote... but I’m wondering what you use for your videos??
Hello Profesor . I have a good understand of digoxine now
Thank you sir 😭🙏
Just yesterday I was thinking why are there no new videos from your channel and that's when I found this. Your videos are the best I have come across. Please complete the series on antibiotics. And also if you can include the dosing in the treatment. Thanks a million!
Thanks for your comment, we'll keep the new videos coming.
Actually, the whole series of antibiotics videos is at www.medcram.com
(We strive to keep well over half of our videos free, but we do charge for some courses, including this one... to pay the bills and free us up to make more videos. Thanks again for your support!)
@@Medcram I would like to give you the comment that I have provided further information on the dangers of Digoxin with Atrial Fibrillation Patients:
Digoxin kills Atrial Fibrillation Patients at 71%. Many studies indicate Digoxin should not ever be prescribed for Atrial Fibrillation. Here's a few for you:
1. www.ahajournals.org/doi/full/10.1161/CIRCEP.114.002292
2. www.ncbi.nlm.nih.gov/pubmed/19753533
3. www.ahajournals.org/doi/10.1161/JAHA.117.006035
4. www.karger.com/Article/FullText/444078
In an MD Edge Article on 3-28-13: This is a statement from Kaiser Research Div.-Dr. James Freeman states, "This is a very big deal. We will tell Kaiser physicians not to prescribe digoxin to patients with atrial fibrillation...". Yet Kaiser continued to prescribe for AFib Patients. How many deaths have happened because of this? If you know of anyone taking Digoxin for Atrial Fibrillation, please share this information with them, it will save their life.
Website link:
www.mdedge.com/cardiology/article/58199/cardiology/digoxin-linked-doubled-mortality-atrial-fib
Digoxin is an "All-Mortem Death" drug. This means no matter what the person dies from, Digoxin if taken for periods of time, will be also a cause of death overriding anything else. Please be aware, alert about this and further warnings about Digoxin. There's extensive studies, articles, and information available regarding the AFib & Digoxin dangers.
I'm a bit worried about education like this: not keeping updated on Medical Studies could potentially kill your Patients. Please pay attention to all Past & Present studies into medications, prescribing, and care.
A final note: I put a thumbs down to raise awareness to this for your "MedCram" study videos & others. I hope I have clarified that Digoxin in AFib Patients is a Medical "No-No". And there's hundreds of drugs, herbs, vitamins, foods that are associated with warnings regarding Digoxin. It's too high a risk, and as the studies indicate over & over there's so many other choices in drugs than to just prescribe something that's been around for a few hundred years. Digoxin is very dangerous. Please pay attention to this and other warnings for medications, and alter this video to indicate the Digoxin & AFib combination is at 71% death. Thank you.
Wonderful
Very nice video ..,👍🏻when can we expect the videos on anti arrhythmic drugs ...
AMAZING
thank you
You're welcome!
Dr Seheult could you recommend me a PANRE physician assistant study review course?
Sir i have understood all those concepts very easily thank you so much..
But i have doubt to which patient should we need to prescribe digoxin as it works as increase in contractility and pumping and also as to slow down conduction?
Vagal nerve has inhibitory effect on cardiomyocontractiliy, right?
Please make video on nitroglycerin
thank you sir digo facts simlified
very clear.. thanks
Thanks again Dr. for video on Digoxin. Ur so SMART. You helped explain how it works, cause i take Digoxin(0.125mg) for my Heart Failure too. I'd learn alot.
His explanation was wrong ,that is not the way digoxin work. Please refer any pharmacology text
anyone else that hates the pharmacology of the cardiovascular system? no? just me? okay
(this video is amazing btw and very very helpful I just happened to watch it at my weekly monent of med school regret)
But the digitalis produce to a hypoK+ or hyperK+ on the blood ? I don't understand. Thanks you
Any updates as to when the EKG content will be released?
We're about 90% finished. Currently having some of our colleagues in cardiology review each video for possible additions. Thanks for your patience
If the question is asked again, then E would be wrong. The therapeutic window for fib is 0.8-2 mcg/L for afib, it is still the same in the video for heart failure. I think that is what they were trying to see.
Is there any subscription for Pharmacy questions like this one?
especially for PEBC/Naplex ?
Thanks for the question. We are covering questions like this one by one, but for a complete question bank, we've partnered with BoardVitals who does a great job with Naplex specific questions: www.boardvitals.com/medcram
Thanks I just subscribed for the qbank :-)
*other brand names of this heart medication?*
Digoxin causes inverted T wave which means delayed regional repolarization...but it also causes shortened QT intervel as mentioned in mini katzung..and i think shortened QT intervel and inverted T wave are 2 diff things....if anyone have concept of this plz help me plz...I'll be very thankful..plz
I understand why the HR is decreased as a result of the vagus nerve stimulation but wouldn't you think increase calcium = increased contractility which would increase the heart rate? Is it that the effect of the vagus nerve stimulation outweighs that of the increased contractility?
What happens if pt is Hyperkalemia? K+ Level 6mmol.
If the point is bringing calcium in, why not just increase plasma calcium levels ie eat calc/phosph/mag/silica etc. It has been shown that calcium levels in the cell are proportional to extracellular levels
Terapotik aralık 0.5 - 0.9 ng/mL
wow
Does digoxin cause potassium level low?
This video was great, I was reading a question about a guy who wakes up from a 9 year coma and needs a little digoxin so he can escape a burning building with a guy named Ishmael.... Think his name was; Ahab or something.
I feel like the A should be correct because they are usually given 1 to 2 loading dose or goal HR is achieved and E should not be correct due to Digoxin goal in AFib is 1.5 - 2.0 ng/mL and (0.5 -0.9 ng/mL is for Chronic Heart Failure patient). Could you please clarify? Thank you!
Digoxin kills Atrial Fibrillation Patients at 71%. Many studies indicate Digoxin should not ever be prescribed for Atrial Fibrillation. Here's a few for you:
1. www.ahajournals.org/doi/full/10.1161/CIRCEP.114.002292
2. www.ncbi.nlm.nih.gov/pubmed/19753533
3. www.ahajournals.org/doi/10.1161/JAHA.117.006035
4. www.karger.com/Article/FullText/444078
In an MD Edge Article on 3-28-13: This is a statement from Kaiser Research Div.-Dr. James Freeman states, "This is a very big deal. We will tell Kaiser physicians not to prescribe digoxin to patients with atrial fibrillation...". Yet Kaiser continued to prescribe for AFib Patients. How many deaths have happened because of this? If you know of anyone taking Digoxin for Atrial Fibrillation, please share this information with them, it will save their life.
Website link:
www.mdedge.com/cardiology/article/58199/cardiology/digoxin-linked-doubled-mortality-atrial-fib
Digoxin is an "All-Mortem Death" drug. This means no matter what the person dies from, Digoxin if taken for periods of time, will be also a cause of death overriding anything else. Please be aware, alert about this and further warnings about Digoxin. There's extensive studies, articles, and information available regarding the AFib & Digoxin dangers.
I'm a bit worried about education like this: not keeping updated on Medical Studies could potentially kill your Patients. Please pay attention to all Past & Present studies into medications, prescribing, and care.
A final note to J G: I put a thumbs down to raise awareness to this for you and others. I hope I have clarified that Digoxin in AFib Patients is a Medical "No-No". And there's hundreds of drugs, herbs, vitamins, foods that are associated with warnings regarding Digoxin. It's too high a risk, and as the studies indicate over & over there's so many other choices in drugs than to just prescribe something that's been around for a few hundred years. Digoxin is very dangerous. Please pay attention to this and other warnings for medications. Thank you.
*other brand names of this heart medication*
Could you explain how you say Digoxin increases vagal activity? My understanding was digoxin increases phase 4 of the cardiac AP which shortens the AP. This decreases conduction velocity through the AV node and prolongs the AV nodal refractory period. This will help control the ventricular rate, especially useful in A-fib patients. I did not think that Digoxin had any direct effect on decreasing parasympathetic stimulation on the heart directly. Thanks.
+Edward Herrera The mechanism of this beneficial effect of digoxin is its ability to activate vagal efferent nerves to the heart (parasympathomimetic effect). Vagal activation can reduce the conduction of electrical impulses within the atrioventricular node to the point where some of the impulses will be blocked.
www.cvpharmacology.com/cardiostimulatory/digitalis
Digoxin kills Atrial Fibrillation Patients at 71%. Many studies indicate Digoxin should not ever be prescribed for Atrial Fibrillation. Here's a few for you:
1. www.ahajournals.org/doi/full/10.1161/CIRCEP.114.002292
2. www.ncbi.nlm.nih.gov/pubmed/19753533
3. www.ahajournals.org/doi/10.1161/JAHA.117.006035
4. www.karger.com/Article/FullText/444078
In an MD Edge Article on 3-28-13: This is a statement from Kaiser Research Div.-Dr. James Freeman states, "This is a very big deal. We will tell Kaiser physicians not to prescribe digoxin to patients with atrial fibrillation...". Yet Kaiser continued to prescribe for AFib Patients. How many deaths have happened because of this? If you know of anyone taking Digoxin for Atrial Fibrillation, please share this information with them, it will save their life.
Website link:
www.mdedge.com/cardiology/article/58199/cardiology/digoxin-linked-doubled-mortality-atrial-fib
Digoxin is an "All-Mortem Death" drug. This means no matter what the person dies from, Digoxin if taken for periods of time, will be also a cause of death overriding anything else. Please be aware, alert about this and further warnings about Digoxin. There's extensive studies, articles, and information available regarding the AFib & Digoxin dangers.
I'm a bit worried about education like this: not keeping updated on Medical Studies could potentially kill your Patients. Please pay attention to all Past & Present studies into medications, prescribing, and care.
A final note to Edward Herrera: I put a thumbs down to raise awareness to this for you and others. I hope I have clarified that Digoxin in AFib Patients is a Medical "No-No". And there's hundreds of drugs, herbs, vitamins, foods that are associated with warnings regarding Digoxin. It's too high a risk, and as the studies indicate over & over there's so many other choices in drugs than to just prescribe something that's been around for a few hundred years. Digoxin is very dangerous. Please pay attention to this and other warnings for medications. Thank you.
Can some one tell me the steps to manage a patient experiencing digoxin toxicity ?
Treat the electrolyte imbalance, e.g hypokalemia. Give anti-arrythmic drugs- Lidocaine. Can also give Digibind ( Digoxin Immune Fab) which binds digoxin and other cardiac glycosides to inactivate them.
Does digoxin increase cardiac output?
Digoxin kills Atrial Fibrillation Patients at 71%. Many studies indicate Digoxin should not ever be prescribed for Atrial Fibrillation. Here's a few for you:
1. www.ahajournals.org/doi/full/10.1161/CIRCEP.114.002292
2. www.ncbi.nlm.nih.gov/pubmed/19753533
3. www.ahajournals.org/doi/10.1161/JAHA.117.006035
4. www.karger.com/Article/FullText/444078
In an MD Edge Article on 3-28-13: This is a statement from Kaiser Research Div.-Dr. James Freeman states, "This is a very big deal. We will tell Kaiser physicians not to prescribe digoxin to patients with atrial fibrillation...". Yet Kaiser continued to prescribe for AFib Patients. How many deaths have happened because of this? If you know of anyone taking Digoxin for Atrial Fibrillation, please share this information with them, it will save their life.
Website link:
www.mdedge.com/cardiology/article/58199/cardiology/digoxin-linked-doubled-mortality-atrial-fib
Digoxin is an "All-Mortem Death" drug. This means no matter what the person dies from, Digoxin if taken for periods of time, will be also a cause of death overriding anything else. Please be aware, alert about this and further warnings about Digoxin. There's extensive studies, articles, and information available regarding the AFib & Digoxin dangers.
I'm a bit worried about education like this: not keeping updated on Medical Studies could potentially kill your Patients. Please pay attention to all Past & Present studies into medications, prescribing, and care.
All Current & Future Doctors: I hope I have clarified that Digoxin in AFib Patients is a Medical "No-No". And there's hundreds of drugs, herbs, vitamins, foods that are associated with warnings regarding Digoxin. It's too high a risk, and as the studies indicate over & over there's so many other choices in drugs than to just prescribe something that's been around for a few hundred years. Digoxin is very dangerous. Please pay attention to this and other warnings for medications. Thank you.
error in na ca exchange...n explaination is very superficial...not expected...
this is wrong
Thank you