Fifth stage

TDM- Digoxin
Dr. Yasir Qasim

Q1. UV is a 75-year-old, 62-kg (5 ft 9 in) male with atrial fibrillation. His current serum creatinine
is 1.3 mg/dL, and it has been stable since admission. Compute an intravenous loading and
maintenance digoxin dose for this patient to provide a steadystate concentration of 1.5 ng/mLor
digoxin total body store equal to 15 μg/kg.
Q2. Patient UV (please see problem 1) was prescribed digoxin 200 μg/d intravenously, and this
dose has been given for 2 weeks. A steady-state digoxin concentration was 2.4 ng/mL. Compute a
revised digoxin dose for this patient to provide a steady-state concentration of 1.5 ng/mL.
Q3. Patient UV (please see problem 1 and 2) had a dosage change to digoxin 125 μg/d
intravenously which produced a steady-state concentration equal to 1.4 ng/mL. Compute an oral
tablet digoxin dose for this patient that will provide about the same steady-state drug concentration
as that found during intravenous therapy.
Q4. SD is a 35-year-old, 75-kg (5 ft 7 in) female with NYHA class IV heart failure secondary to
viral cardiomyopathy. Her current serum creatinine is 3.7 mg/dL, and it has been stable since
admission. Compute oral digoxin loading and maintenance doses using tablets for this patient to
provide a steady-state concentration of 1 ng/mL.
Q5. Patient SD (please see problem 4) was prescribed digoxin 187.5 μg/d orally as tablets. A
steady-state digoxin concentration was obtained and equalled 0.7 ng/mL. Compute a revised
digoxin dose for this patient using oral tablets to provide a steadystate concentration of 1 ng/mL.
Q6. Patient SD (please see problem 4 and 5) had a dosage change to digoxin 250 μg/d orally as
tablets which produced a steady-state concentration equal to 1.2 ng/mL. Compute an intravenous
digoxin dose for this patient that will provide about the same steady-state drug concentration as
that found during oral tablet therapy.
Q7. BN is a 55-year-old, 140-kg (5 ft 8 in) male with atrial fibrillation. His current serum creatinine
is 0.9 mg/dL, and it has been stable since admission. Compute an intravenous loading dose and
oral tablet maintenance dose of digoxin for this patient to provide a steady-state concentration of
1.2 ng/mL.
Q8. Patient BN (please see problem 7) was prescribed digoxin tablets 500 μg/d. A steadystate
digoxin concentration was obtained and was 2.4 ng/mL. Compute a revised digoxin tablet dose for
this patient to provide a steady-state concentration of 1.5 ng/mL.
Q9. VG is a 75-year-old, 180-kg (5 ft 2 in) female with NYHAclass III heart failure. Her current
serum creatinine is 6 mg/dLand is stable. Compute digoxin oral capsule loading and maintenance
doses for this patient to provide a steady-state concentration of 1 ng/mL.
Q10. Patient VG (please see problem 9) was prescribed digoxin capsules 100 μg every other day.
A steady-state digoxin concentration was obtained and was 0.5 ng/mL. Compute a revised digoxin
capsule dose for this patient to provide a steady-state concentration of 1 ng/mL.
Q11. QW is a 34-year-old, 50-kg (5 ft 4 in) female with atrial fibrillation secondary to
hyperthyroidism. Her current serum creatinine is 0.8 mg/dL and stable. Compute a digoxin
intravenous loading dose and oral capsule maintenance dose for this patient to provide a steady-
state concentration of 1.2 ng/mL.