Digoxin (Lanoxin) is a cardiac glycoside that is among the oldest medications used for heart failure.
What are its two primary actions?

This is because digoxin inhibits the Na-K-ATPase pump on the membrane of cardiac cells, which can cause extracellular potassium levels to rise.Hypokalemia (low potassium) caused by large dosages of diuretics may result in digoxin toxicity even at low serum digoxin levels.Digoxin toxicity can cause gastrointestinal, constitutional, and/or cardiovascular symptoms, as well as ECG changes such as signs of increased automaticity and atrioventricular node blockade.

Choice B is wrong because calcium 9.2 mg/dL is within the normal range of 8.5 to 10.5 mg/dL.Hypercalcemia (high calcium) can increase sensitivity to digoxin effects and lead to toxicity even with a lower concentration of serum digoxin, but this is not the case here.

Choice C is wrong because potassium 4.8 mEq/L is within the normal range of 3.5 to 5.0 mEq/L.

Hyperkalemia (high potassium) can also increase the risk of digoxin toxicity, but this is not the case here.

Choice D is wrong because calcium 10.3 mg/dL is within the normal range of 8.5 to 10.5 mg/dL.Hypercalcemia (high calcium) can increase sensitivity to digoxin effects and lead to toxicity even with a lower concentration of serum digoxin, but this is not the case here.

HDL stands for high-density lipoprotein, which is a type of cholesterol that carries excess cholesterol from other parts of the body to the liver, where it can be removed.

HDL is sometimes called “good” cholesterol because it helps protect against heart disease.Having high HDL levels is not a characteristic of metabolic syndrome, but rather a protective factor.

Metabolic syndrome is a group of conditions that increase the risk of heart disease, stroke, and type 2 diabetes.These conditions include:

• Low HDLs (choice A): Having low levels of HDL cholesterol is a risk factor for metabolic syndrome, as it means there is less “good” cholesterol to remove excess cholesterol from the blood vessels.

• Type II diabetes mellitus (choice B): This is a condition where the body does not use insulin properly, leading to high blood sugar levels.

Insulin is a hormone that helps the cells take up glucose from the blood.

Insulin resistance is a key feature of metabolic syndrome.

• Hypertension (choice C): This means having high blood pressure, which can damage the heart and blood vessels over time.

High blood pressure is often associated with obesity and insulin resistance, which are common in metabolic syndrome.

• Abdominal obesity (choice E): This means having excess fat around the waist and trunk, also known as central or visceral obesity.

This type of fat is more harmful than fat in other parts of the body, as it can release inflammatory substances that affect the metabolism and increase the risk of cardiovascular disease.

• Hyperglycemia (choice F): This means having high blood sugar levels, which can damage the blood vessels and organs over time.

Hyperglycemia can result from insulin resistance or type 2 diabetes, which are both components of metabolic syndrome.

The normal ranges for some of these conditions are:

• HDL cholesterol: more than 40 mg/dL for men and more than 50 mg/dL for women

• Blood pressure: less than 120/80 mmHg

• Blood sugar: less than 100 mg/dL after fasting or less than 140 mg/dL two hours after eating

• Waist circumference: less than 40 inches for men and less than 35 inches for women