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Toxins in Neuro-Ophthalmology
Published in Vivek Lal, A Clinical Approach to Neuro-Ophthalmic Disorders, 2023
Visual side effects of digitalis are less common than cardiac or other noncardiac symptoms. The spectrum of toxicity varies and includes decreased visual acuity, central scotomas or visual field reduction, photopsia most pronounced in daylight, photophobia, blurry or snowy vision, visual hallucinations, diplopia and dyschromatopsia including xanthopsia (yellow vision), cyanopsia (blue vision) and chloropsia (green vision). Dyschromatopsia can remain asymptomatic and detected only by formal testing. The mechanism of ocular toxicity postulated to be Na+ K+ ATPase inhibition [37–39]. Most appropriate test to support a diagnosis of digoxin ocular toxicity is photopic and scotopic electroretinogram (ERG) seeking for b-wave-delayed implicit time and decreased b-wave amplitude.
Digitalis Toxicity
Published in Charles Theisler, Adjuvant Medical Care, 2023
Digitalis toxicity can arise from long-term drug therapy (Lanoxin, Digoxin) as well as taking an excessive amount of the drug at one time. Digitalis toxicity is serious and can be life-threatening. Symptoms can include headache, confusion, anxiety, or hallucinations; loss of appetite, nausea, vomiting, or diarrhea; fast or slow palpitations or irregular heartbeat; blurred vision and seeing halos around bright lights. Severe toxicity requires hospital admission.
Cardiovascular Drugs during Pregnancy
Published in “Bert” Bertis Britt Little, Drugs and Pregnancy, 2022
No scientific studies regarding the safety of cardiac glycosides in pregnant women have been published. Among 34 infants born after exposure to digitalis during the first trimester, the frequency of birth defects (2.9 percent) was not greater than that expected. Fetal digitalis toxicity has been reported but it was secondary to maternal overdose (Sherman and Locke, 1960). In this latter report, it is estimated that the mother ingested 8.9 mg of digitoxin, resulting in significant fetal toxicity and neonatal death. Very limited information supports the view that cardiac glycosides are probably safe for use during pregnancy at therapeutic doses.
Anticalin® proteins: from bench to bedside
Published in Expert Opinion on Biological Therapy, 2021
Friedrich-Christian Deuschle, Elena Ilyukhina, Arne Skerra
One of the first Anticalins with therapeutic potential was selected on the basis of the BBP with sub-nanomolar affinity against the heart glycoside digitalis [16]. While this plant steroid is traditionally used for the treatment of ventricular tachyarrhythmias and congestive heart failure, its therapeutic window is narrow and cases of accidental or intentional overdosing are common. After intravenous administration of the cognate Anticalin [30], dubbed ‘DigiCal’, in a rat model of digitalis overdose the concentration of free digoxin in plasma was lowered beneath the toxicity threshold within a very short period of time as a consequence of tight complex formation. Thus, DigiCal can effectively compete with the inhibition of the Na+/K+-ATPase in the cardiocyte plasma membrane by digoxin, scavenge the poison and direct its renal excretion. Indeed, a positive dose-dependent effect on the overall survival, heart arrhythmia as well as hemodynamics was observed.
Henry Herbert Donaldson’s (1857–1938) contribution to an organized approach to the experimental study of the mammalian central nervous system
Published in Journal of the History of the Neurosciences, 2018
Before his thesis work with Hall, which reflected their psychological interests, Donaldson pursued physiological issues related to the heart, showing Martin’s influence. He, along with fellow students M. Warfield and L. T. Stevens, experimented with the effects of digitaline [sic]3Also spelled digitalin, it is a powerful cardiac stimulant containing the active components of digitalis., digitalis, and quinine on heart and other circulatory organs. One of these efforts was published in the Journal of Physiology in 1883 (Donaldson and Stevens, 1883). With another fellow student, William Henry Howell (1860–1945, eventually Professor of Physiology at Johns Hopkins University and Dean of the Medical School), he experimented with coagulation of blood, blood volume of the left ventricle, venous pressure, arterial pressure, and pulse rate.
Current challenges in managing comorbid heart failure and COPD
Published in Expert Review of Cardiovascular Therapy, 2018
J. Alberto Neder, Alcides Rocha, Maria Clara N. Alencar, Flavio Arbex, Danilo C. Berton, Mayron F. Oliveira, Priscila A. Sperandio, Luiz E. Nery, Denis E. O’Donnell
Owing to its inotropic properties, digitalis has been used for centuries in the treatment of HF. The safety of digitalis has been questioned by recent meta-analysis [121]. Indeed, digitalis has a narrow therapeutic range: age, decreased renal function, and low body weight are known risk factors for digitalis toxicity [122]. Patients with HF–COPD are generally older [52], the cardiorenal syndrome is commonly associated with negative lung-right heart-kidney interactions [123], and cachexia is a common feature in HF–COPD [124]. Moreover, digitalis may add to the increased sympathetic stimulation in some patients with COPD causing calcium overload and multifocal atrial tachycardia, the commonest tachyarrhythmia in COPD [125]. These considerations make digitalis a poorly attractive treatment nowadays in HF–COPD patients, except for controlling HR on top of β-blockers in the presence of atrial fibrillation (Afib) (Table 3).