atrial fibrillation --房（性）颤（动）
intracellular – a. 细胞内折
depolarization – n. 去极化
inotropic effect – 变力效应
chronotropic effect – 变时效应
“RN-ISPN考试复习要点提示”
帮助您尽快理清复习思路，准确抓住复习重点，是ISPN/RN考试复习的一大利器！
————RN/ISPN Review ————
Prototype Drug: Digoxin 原型药：地高辛
Indications: Treatment of HF, atrial fibrillation. 适应症：HF、房性颤动 的治疗 Actions: Increases intracellular calcium and allows more calcium to enter the myocardial cell during depolarization; this causes a positive inotropic effect (increased force of contraction), increased renal perfusion with a diuretic effect and decrease in renin release, a negative chronotropic effect (slower heart rate), and slowed conduction through the AV node. 作用：增加细胞内钙水平，使更多的钙在去极化期间进入心肌细胞；引起正性肌力效应（收缩力增强），以利尿作用增加肾灌注，减少肾素释放，负性变时效应（减缓心率），AV结传导减缓
Pharmacokinetics:药代动力学
Route Onset Peak Duration
途径 起效 达峰 持续时间
Oral 30-120 min 2-6 h 6-8 d
IV 5-30 min 1-5 h 4-5 d
T1/2: 30 to 40 hours; largely excreted unchanged in the urine. 半衰期：30 – 40 h；大部分随尿原型排出 Adverse Effects: Headache, weakness, drowsiness, visual disturbances, arrhythmias, GI upset. 不良效应：头痛、无力、嗜睡、视觉紊乱、心律不齐、GI不适
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Digoxin – Cardiac Glycosides
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1. Which of the following is a contraindication for digoxin administration?
A. Blood pressure of 140/90.
B. Heart rate above 80.
C. Heart rate below 60.
D. Respiratory rate above 20. 2. The therapeutic drug level for digoxin is:
A. 0.1-2.0 ng/mg
B. 1.0-2.0 ng/mg
C. 0.1-0.5 ng/mg
D. 0.5-2.0 ng/mg
奥医教育“在线自测”题库 ISPN/RN复习练习、效果检验一站完成。
答案 Answer 1. C. Rationale: The apical heart rate must be monitored during therapy with digoxin, and the drug held for a pulse below 60 and above 120. Remember that digoxin lowers the heart rate; therefore, the choice that reflects a low heart rate is the best selection. Digoxin toxicity is clinically relevant as it can lead to fatal cardiac arrhythmias. The estimated frequency is at about 0.8 to 4% of patients on steady digoxin therapy. The rate of toxicity increases as serum digoxin concentration reaches over 2.0 ng/ml. 2. D. Rationale: This is the correct therapeutic range for digoxin. Every nurse should know this information. The rate of toxicity increases as serum digoxin concentration reaches over 2.0 ng/ml. However, toxicity can also occur at lower levels, especially in the setting of other risk factors such as low body weight, advanced age, decreased renal function, and hypokalemia.
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