new_n_lost
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A 67 year old man presents with sudden onset atrial fibrillation (ventricular rate of 150/minute). His serum creatinine concentration was 250 umol/L (70-110).
What is the main factor that determines the choice of loading dose of digoxin in this patient?
1) Absorption.
2) Apparent volume of distribution.
3) Lipid solubility.
4) Plasma half-life.
5) Renal clearance.
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| mytime
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If it's a lipid solube drug then it's that otherwise absorption.
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| asherif
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for the loading dose i think it will be
2) Apparent volume of distribution
5) Renal clearance. would be important for the maintainance dose
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| asherif
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so correct answer should be 2) Apparent volume of distribution.
correct me if I'm wrong.
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| dr_student
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 it should be 2) apparent volume of distribution
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| new_n_lost
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| new_n_lost
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The loading dose is mainly dependent on the Volume of Distribution of a drug but this patient has moderate renal failure. The loading dose is calculated (using various models) by taking into account age, creatinine clearance, body surface area etc. Volume of distribution becomes important particularly when body weight is 40kg or less. On balance it is the renal failure that is the most important factor in this patient in determining the loading dose.
Digoxin is cleared by the kidneys so the maintenance dose would require adjustment in renal failure
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| lq2006
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