QuestionSBA
QuestionChoice
Digoxin levels should be taken no earlier than 6 hours after a dose as this may lead to inaccurate dose adjustments being made from a falsely elevated level
34317
c
Blood levels at 1200 hrs
QuestionChoice
Digoxin levels should be taken no earlier than 6 hours after a dose as this may lead to inaccurate dose adjustments being made from a falsely elevated level
34316
b
Blood levels at 1000 hrs
QuestionChoice
Taking digoxin levels more than 6 hours after the initial dose may lead to inaccurate dose adjustments being made from a falsely low level
34318
d
Blood levels immediately before next dose
QuestionChoice
This is the correct time to take a digoxin level, which is 6 hours after the last dose
34315
a
Blood levels at 1400 hrs
QuestionChoice
Digoxin levels should be taken no earlier than 6 hours after a dose as this may lead to inaccurate dose adjustments being made from a falsely elevated level
34319
e
Blood levels immediately post-dose
Concept
Chapter
#### Monitoring

The BNF advises to monitor lung function (in patients with a history of obstructive airway disease).

#### Overdoses

Overdosages with beta-blockers may cause cardiac effects such as bradycardia, hypotension, syncope, conduction abnormalities, and heart failure. Bradycardia is the most common arrhythmia, but some beta-blockers may induce ventricular tachyarrhythmias secondary to prolongation of QT interval (e.g. sotalol) or QRS duration (e.g. propranolol).
Non-cardiovascular effects include central nervous system effects (including drowsiness, confusion, convulsions, hallucinations, and in severe cases coma), respiratory depression, and bronchospasm.

Management
 - Airway protection 
 - Activated charcoal within 1 hour
 - IV Fluids
 
IV glucagon is the first-line management.
 
For symptomatic bradycardia, IV atropine may be used.

2618
2806
Digoxin side effects
Topic
9
Internal Medicine
6874
Case Presentation: A 70 year old man is on the acute admissions unit being treated for exacerbation of congestive cardiac failure and new atrial fibrillation. **PMH** CCF, recurrent DVTs. **DH** lisinopril 15mg PO OD, carvedilol 25mg PO BD, spironolactone 50mg PO OD, isosorbide mononitrate 30mg PO BD, warfarin sodium 3mg PO OD. NKDA


On the morning drug round at 0800 hrs, he has been given his usual medications as well as 375 micrograms of digoxin in accordance with the rapid digitalisation protocol.

**Investigations**

U&Es: Na 144, K 3.9, Cl 99, Ur 4.2, Cr 117 (baseline 103), eGFR 52mL/min/1.73m^2

Question: Select the most appropriate monitoring option to assess the need for dose adjustments of digoxin in this patient.
a