**Question:** Treatment of digoxin overdose includes administration of all of the following except:

A. Activated charcoal
B. Hemodialysis
C. H2-receptor antagonists
D. Propranolol

**Core Concept:**
Digoxin is a cardiac glycoside commonly used for the management of atrial fibrillation, heart failure, and ventricular arrhythmias. Overdose can lead to toxicity and potential side effects such as cardiotoxicity, gastrointestinal symptoms, and neurotoxicity. Digoxin toxicity treatment options include:

1. **Activated charcoal:** This is a common method for absorbing ingested toxins, including digoxin. Activated charcoal binds to digoxin molecules, reducing its absorption and preventing further absorption from the gastrointestinal tract.

2. **Hemodialysis:** In severe cases or when activated charcoal is ineffective, hemodialysis can be employed to remove digoxin from the bloodstream. It is a renal replacement therapy that filters blood through an artificial kidney, allowing the elimination of excess digoxin.

3. **H2-receptor antagonists:** These include medications like ranitidine (Zantac) and cimetidine (Tagamet). H2-receptor antagonists are used to reduce gastric acid secretion, but they are not directly involved in treating digoxin toxicity.

4. **Propranolol:** Propranolol is a beta-blocker, which is used for its anti-arrhythmic effects. However, propranolol is not specifically indicated for treating digoxin toxicity.

**Why the Correct Answer is Right:**

The correct answer (D) is "Propranolol," because:

1. Activated charcoal and hemodialysis directly target and remove digoxin from the body, reducing its concentration in the blood.
2. H2-receptor antagonists are not applicable for treating digoxin toxicity because they are designed to reduce gastric acid secretion, not remove digoxin from the body.
3. Propranolol is a beta-blocker with anti-arrhythmic effects, often used to treat arrhythmias. Although it has potential benefits in treating arrhythmias due to digoxin toxicity, it is not specifically designed or proven to be effective in managing digoxin poisoning.

**Why Each Wrong Answer is Incorrect:**

1. Activated charcoal and hemodialysis are direct, established interventions for treating digoxin toxicity.
2. H2-receptor antagonists are not appropriate for digoxin toxicity treatment as they target gastric acid secretion rather than digoxin elimination.
3. Propranolol is not specifically indicated for treating digoxin toxicity, although it has potential benefits in managing arrhythmias due to digoxin poisoning.

**Why the Correct Answer is Right:**

The correct answer (D) propranolol is right because:

1. In severe digoxin toxicity, propranolol, a beta-blocker, can be used to treat arrhythmias caused by digoxin poisoning.