Digoxin

It's AMH Friiiiiiday.
I've decided to learn more about digoxin toonight.
it's an anti-arrhythmic for heart failure and tachy-arrhythmias (abnormal heart rate).
i dont really understand what the AMH is trying to say under MOA, but i believe it blocks the Na+/K+ ion pump leading to aaa buildup of Na+ in the cell leading to excitability? But it can also slow heart rate through vagotonic activity (hyperexcitablity of vagus nerve)
it is renally cleared, so alter dose if you have renal failure. reduce dose in elderly too. its cat A and can be used for fetal arrhythmia as well. ok for breastfeeding too.
digoxin can have series side effects and can also worsen arrhythmia. its a drug of narrow therapeutic range.
some common side effects: anorexia, nausea, comiting, diarrhoea and visual disturbances. you can also get nightmares, dizziness and depression.
dosing is tailored according to renal function and drug monitoring is required. In adults with normal renal function: loading is 250 - 500 mcgs e/ 4-6 hours with a max of 1.5mg. For maintenance, dose is decreased to 125 - 250 mcgs once daily.
Digoxin 62.5 mcg tablets are for the renally impaired and for the elderly for maintenance.

When first starting on the course, it may take 5 days to reach a steady state. digoxin's half life is 36 hours. The therapeutic range of digoxin is .5 - 2 mcg/L but your toxic effects occur in that range as well. You get anorexia at around 1mcg/L and nausea from 1.8mcg/L etc.
In heart failure with sinus rhythm, consider lowering the therapeutic range to .5-.8mcg/L because it has been found that higher concentrations can lead to hospitalisation and mortality. Can i just say, wth is sinus rhythm? i looked it up and its basically the medical term for heart beat, but are they talking about abnormal or normal rhythm in this case?
It takes 4-6 hours for onset of effect after initial dosing.
if the patient takes another arrhythmic agent, reduce and stop digoxin if possible once they are stable.
in children, any arrythmetic effects during the course of digoxin is suspected to be because of digoxin until proven otherwise. GUILTY UNTIL PROVEN INNOCENTTTT? :O I WONT STAND FOR THIS *war cry*