Treatment for Digoxin Overdose

Treatment for Digoxin Overdose B. Trimble Digoxin Overdose Digoxin is derived from the leaves of a digitalis plant (foxglove). Some plants have chemicals that can cause symptoms similar to digoxin if eaten, such as lily of the valley and oleander. Digoxin is a substrate of P-glycoprotein. Drugs that induce or inhibit P-glycoprotein in the intestines or the kidneys have the potential to alter digoxin pharmacokinetics (Katzung, Mastes, Trevor, 2012). Digoxin increases the strength of heart contractions by inhibiting the activity of the enzyme ATPase. ATPase controls the movement of calcium, sodium, and potassium into the heart muscle. ATPase increases the amount of calcium in heart muscle, which increases the force of contractions. Digoxin slows the electrical conduction between the atrium and ventricles of the heart and slows ventricular contractions. Digoxin is eliminated through the kidneys and should be reduced in dosage in patients with kidney dysfunction (Katzung, Mastes, Trevor, 2012). Medications such as verapamil, quinidine, Amiodarone, indomethacin, spironolactone, Alprazolam and itraconazole can increase drug levels and the risk of toxicity of digoxin. Furosemide and other diuretics that reduce blood potassium or magnesium levels may predispose patients to drug induced abnormal heart rhythms. Saquinvard and ritonavir increase the amount of digoxin in the body and may cause toxicity (PubMed, 2013). Assessment of the severity of toxicity and etiology (accidental, unintentional, or deliberate overdose) altered drug metabolism due to decreased renal function or interaction with other drugs is necessary. Consideration of factors that influence treatment include age, medical history, chronicity of digoxin intoxication, severity of heart disease, and/or renal insufficiency and ECG changes (Katzung, Mastes, Trevor, 2012). Symptoms of digoxin toxicity include anorexia, nausea, vomiting, diarrhea, visual changes, cardiac arrhythmias (1st degree, 2nd degree â€Å"Wenckebach†, or 3rd degree heart block), atrial tachycardia with AV block, AV dissociation, accelerated junctional, unifocal or multifocal premature ventricular contractions, ventricular tachycardia, and ventricular fibrillation (Patel, 2011). Toxicity is usually associated with levels greater than 2 mg/ml. Low body weight, advanced age, impaired renal function, hyperkalemia, hyper-calcemia, or hypo-magnesium may cause d igoxin toxicity. Other symptoms may include decreased consciousness, decreased urine output, difficulty breathing, and overall swelling (Brunton, Chabner, Knollman, 2011). Treatment will consist of emergency protocol if outside the hospital; this includes calling emergency medical services and CPR. Once the patient is in medical care, the treatment will depend upon the severity of symptoms and levels of digoxin in the body. Laboratory testing will include serum electrolytes, digoxin levels, and thyroid function tests. The patient will be placed on continuous cardiac monitoring with a 12 lead ECG obtained (Brunton, Chabner, Knollman, 2011). The primary focus is to correct electrolyte levels; if hypokalemic administer potassium to reach a level of 4.0 to 5.5 mmol/L. Activated charcoal will be administered either orally or per nasogastric tube in order to bind undigested digoxin. If bradycardic and symptomatic, atropine may be given intravenously. Peak cardiac effects of digoxin occur 3 to 6 hours after ingestion. Gastrointestinal symptoms precede cardiac manifestation. Neurological symptoms like fatigue and malaise are common. Visual disturbances occur with aberration in color vision, mostly yellow-green. Activated charcoal binds to the digoxin and prevents recirculation to the enterohepatic circulation. Cholestyramine may be used for chronic toxicity in patients with renal insufficiency. Continuous hemodynamic monitoring includes the ECG and 12 lead EKG (Brunton, Chabner, Knollman, 2011). Prompt measurement of electrolyte levels (potassium, calcium, digoxin, BUN, creatinine, and CMP). Sodium bicarbonate may be administered to correct metabolic acidosis along with glucose and insulin to enhance potassium uptake by the cells (Brunton, Chabner, Knollman, 2011). Magnesium may serve as a temporary antiarrthymic until digifab is available. Hypomagnesium increases myocardial digoxin uptake and decreases cellular sodium/potassium ATPase activity. Digibind (digifab or digoxin immune Fab) is an immunoglobulin fragment that binds with digoxin. In acute intentional overdose digibind (40 mg reconstituted with 4 ml sterile water) is administ ered 4 to 6 vials as a loading dose over 30 minutes as an emergent IV bolus. The bolus is followed by 0.5 mg/minute for 8 hours and then 0.1 mg/ minute for 6 hours (Patel, 2011). For patients with chronic toxicity that are dependent on digoxin, the initial dose is twice the bolus. This avoids complete reversal of clinical effects of digoxin. Response is typically within 20 to 30 minutes after infusion, elimination half- life is around 16 hours. Digoxin levels are unreliable for one to two weeks after therapy. Complications in long-term digoxin users, who receive digibind treatment administration are that it may precipitate worsening of heart failure as reversing the beneficial inotropic agent of digoxin causes hypokalemia and atrial arrhythmias with rapid ventricular response (Katzung, Mastes, Trevor, 2012). Hypokalemia has occurred in patients treated with standard therapy as well as with Fab fragments. Clinically adverse phenomena have occurs in patients with immunotherapy. Other untoward effects of Fab include anaphylaxis and serum sickness, this is because it is a sheep protein, but this is uncommon. Recrudescence of digoxin toxicity is possible within 7 to 14 days because Fab is eliminated more rapidly than digoxin released from tissue binary sites. Plasmapheresis may be performed or the agent reinstituted in such cases (Patel, 2011). If hemodynamically stable, bradycardia and supraventricular arrhythmias may be treated with observation and supportive measures. Ensuring hydration to optimize renal clearance, administering gastrointestinal binding agents may be used. For patients with rate related ischemia or neurological unstable digiFab is the treatment of choice (PubMed, 2013). In unstable premature ventricular contractions, lidocaine may be effective. In ventricular tachycardia the best response is to digiFab, but phenytoin and lidocaine are useful if Fab is ineffective or unavailable (Brunton, Chabner, Knollman, 2011). They depress the enhanced ventricular automaticity without significant slowing of AV conduction. Phenytoin may reverse digoxin induced prolongation of AV nodal conduction. Phenytoin has been shown to dissociate the inotropic and dysrhythmia actions of digoxin, suppressing digoxin tachycardia without diminishing the contractile affect and can terminate SVT induced by digoxin. Doses for lidocaine are 100 mg bolus with an infusion of 1 to 4 mg/minute. Phenytoin dosage is 100 mg every 5 to 10 minutes up to a loading dose of 15 mg/kg. Magnesium sulfate dosage is 2 gram over 5 minutes followed by an infusion of 1 to 2 g/hour, with magnesium levels drawn every one to two hours. Atropine may be given for bradycardia to improve sinus and AV node conduction by inhibiting vagal activity (Brunton, Chabner, Knollman, 2011). Phenytoin may reverse digoxin induced prolongation of the action potential in myocardial cells and may suspend tachycardia, prolongs effective refractory period, and depresses spontaneous depolarization in ventricular tissue. Lidocaine is a class IB antiarrthymic that increases the electrical stimulation threshold of the ventricles, suppressing the automaticity of conduction through the tissue. It combines with sodium channels and inhibits recovery after repolarization, resulting in decreased myocardial excitability and conduction velocity (Brunton, Chabner, Knol lman, 2011). Magnesium sulfate possesses properties that slow the rate of sinoatrial node impulse formation and prolong conduction times (Brunton, Chabner, Knollman, 2011). Prevention of unintentional overdose (accidental overdose, interaction with other medications, or the altered metabolism due to renal insufficiency) is mostly through patient education. Instructing the patient in the correct dosage of the medication; that blood tests will be necessary to ensure appropriate dosage; suggesting daily recording of heart rate and blood pressure. Advise the patient that many drugs interact with digoxin, and to inform the physician and pharmacist of all medications, including over the counter and herbal medications, and if started on a new prescription. Advising the patient to report any sign/symptoms associated with digoxin toxicity. Review signs and symptoms of toxicity with the patient. If the overdose were intentional, the patient would need the same consults as any other patient undergoing treatment (cardiologist, nephrologist, medical toxicologist, regional poison control center) as well as psychiatric consult. Follow up appointments with the patient to monitor drug and electrolyte levels. Reference Brunton, L., Chabner, B., Knollman, B. (2011). Goodman Gilmans:The Pharmacological Basis of Therapeutics (12 ed.). McGraw-Hill. Katzung, B., Mastes, S., Trevor, A. (2012). Basic Clinical Pharmacology (12 ed.). McGraw-Hill. Patel, V. (2011). Digitalis toxicity. Retrieved from Medscape: http://www.emedicine.medscape.com/article/154336-overview PubMed. (2013, Janurary). Digitalis toxicity. Retrieved from PubMed.gov: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001218

The Birth Of An American Super Essay -- essays research papers fc

The Birth of an American Super Hero Heroes have been an important part of American history. They gave adults and especially young children something to strive for and believe in. Some heroes are real and some are imaginary. Real heroes can be presidents, soldiers, or even a parent. The imaginary hero's can be from books, comic books, or movies. One of the most popular hero's of our time is an imaginary hero created for the pages of comic books. The creation of this hero we all know as Superman took hard work, creativity, determination, and plenty of luck. Jerry Siegel and Joe Shuster were the two Jewish-American teenage boys who created Superman. Jerry Siegel was the writer and Joe Shuster was the artist. Siegel and Shuster met at the age of sixteen while working on their high school newspaper. They made a number of attempts creating the Superman character. The first attempt utilized a bald middle aged man with advanced mental abilities. The next attempt was closer to the Superman we now know. He was younger and had hair but was not an alien with super powers. 'The ultimate version of Superman was born one night in 1934, when Siegel found new ideas coming so fast that he couldn't sleep'; (Daniels 21). Seigel and Shuster collaborated on these ideas and created comic strips created for the Sunday comics. Seigel's new Superman came from a planet called Krypton. 'This was the first benevolent alien created'; (Daniels 21). He wore tights for a futuristic appearance and the cape...

Using Animals in Disease Research

Using Animals in Disease Research People all over the world have different opinions on whether animal testing is an ethical way to research drugs and treatments or not. Almost every medical advancement has involved using of animals including discovery of penicillin, organ transplantation, vaccines etc. Scientists should use animals in disease research because nowadays it is the only right way to develop drugs, treatments and cures for diseases and to be sure that new products are safe to use.The first reason why animals should be used in lab testing is that it is the best way to do the research not on human beings but on something that is very similar to humans by chemistry, cell structure and organization. Only drug testing on animals will shows maximally closest result to what will happen in the human's body. Perhaps we weren't be able to cure even very common diseases in present-day medicine without using animals in researches. The second reason why scientists should use animals i n their researches is that animal’s rights are still protected and they don't feel pain during the testing.According to Foundation for Biomedical Research, the Public Health Service Act, Federal laws, and Animal Welfare act controls the removal of pain. All animals used in procedures always relieved from pain by anesthesia. A well-treated animal provide more reliable scientific results, which is the goal of all researchers. The last reason why using animals in research is necessary is that human beings are more important than animals. Animals quickly reproduce itself and they have short life cycle that help scientists to study effects of the drugs on several generations. Also animals can be donors of organs for humans.The society knows many facts in a last few years about transplanting of animal`s organs into human body. The opponents of using animals in disease research might say that scientists could discover drugs using alternative methods such as computer models. However, scientists should see the drug action in all system of living organism to be sure how it works. Using animals in lab testing and researches is necessary because alternative methods are currently not as reliable. Testing drugs and treatments on animals will someday help scientists find the cure for diseases like Alzheimer, AIDS, and cancer.

Religion And The Establishment Clause A Look At Sex...

Religion and the Establishment Clause: A Look at Sex Education Policy Carsen Jenkins Sex education in public schools is an extremely controversial topic within the current United States climate. Many states heavily regulate the curriculum, creating restrictions on what teachers can and cannot discuss. When looking at these restrictions, specifically on teaching about sexual orientation and promoting abstinence until marriage, there seems to be connection with religious ideas of sex and sexuality. Many different religions have strong views of abstinence or chastity along with adverse opinions regarding homosexuality. Additionally, many states require the promotion of abstinence until marriage along with active criticism of homosexuality. If these requirements are indeed rooted in religious belief, it is imperative to examine the establishment clause, which prevents any state organization from promoting or establishing a religion. Previous litigations have applied the Lemon test to determine whether a law or regulation is violating the establishment clau se. To pass this test, a law must have a secular purpose, have a predominantly secular effect, and not foster excessive entanglement between government and religion. After researching the state requirements for sex education in Alabama, Texas, South Carolina, and Utah, the legislation does not have a clear secular purpose nor a primary secular effect, consequently violating the establishment clause. The first step inShow MoreRelatedThe Constitution Is The Highest Level Of Law1858 Words   |  8 PagesFirst Amendment addresses several personal freedoms. The first clause of the First Amendment, the establishment of free exercise of religion clause, was the focus on taking legal action in education. There have been many cases and disputes that argue the appropriate government relationship in relation to religion. 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