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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.
Drug management
Published in Gregory YH Lip, Atrial Fibrillation in Practice, 2020
Cardiac glycosides were first used by William Withering over 200 years ago, where the purple foxglove (Digitalis purpurea, which contains digitoxin) for the treatment of the ‘drops’, which is now recognized as cardiac failure, although many of his patients also had AF. Commercially available digoxin is obtained from the white foxglove. Digitalis lanata. Pharmacokinetic differences exist between digoxin and digitoxin, but the former is the more popular drug (in the UK, at least). An overview of digoxin for AF is summarized in the box.
Pharmacological actions of chemical constituents
Published in C. P. Khare, Evidence-based Ayurveda, 2019
Digitalis leaves contain more than 40 cardiac glycosides based on four genins: digitoxigenin, gitoxigenin, gitaloxigenin and gitaligenin. Primary glycosides (tetraglycosides) and triglycosides form the major compounds in the leaves. Digitoxin improves the rhythm of the heartbeat, making the contraction of the heart more powerful, and helping the heart to pump blood at the time of heart failure. Gitalin and many other glycosides exhibit similar properties.
Digitalis therapy in patients with ventricular tachyarrhythmias
Published in Scandinavian Cardiovascular Journal, 2022
Tobias Schupp, Julian Müller, Max von Zworowsky, Mohammad Abumayyaleh, Kathrin Weidner, Jonas Rusnak, Kambis Mashayekhi, Thomas Bertsch, Ibrahim Akin, Michael Behnes
Firstly, the univariable Kaplan–Meier method was applied to evaluate prognostic differences within the entire cohort. Then, the impact of digitalis was analyzed separated for AF and HF, allowing the combination of AF and HF. Secondly, multivariable Cox regression models were developed using the “forward selection” option, where only statistically significant variables (p < .05) were included and analyzed simultaneously. Predefined variables being used for multivariable Cox-regressions included: baseline parameters (age, gender), chronic diseases (chronic kidney disease, diabetes mellitus), acute myocardial infarction (AMI), AF, LVEF <35%, the presence of an ICD and digitalis therapy. Thereafter, the prognosis of patients with digitoxin was compared to those treated with digitoxin. Finally, time trend analyses were applied within the entire study cohort, as well as separated for patients with AF and HF. Chi2 test was applied to compare frequencies of digitalis prescription rates.
Efflux pump inhibitors as a promising adjunct therapy against drug resistant tuberculosis: a new strategy to revisit mycobacterial targets and repurpose old drugs
Published in Expert Review of Anti-infective Therapy, 2020
Liliana Rodrigues, Pedro Cravo, Miguel Viveiros
This strategy also identified several antiarrhythmic, antihypertensive drugs that potentially target a probable metal cation transporter P-type ATPase A CtpF (Rv1997) in M. tuberculosis. Deslanoside is a cardiac glycoside used to treat congestive heart failure, supraventricular arrhythmias and to control ventricular rate in the treatment of chronic atrial fibrillation. This compound inhibits the Na+/K+-ATPase pump, resulting in an increase in intracellular sodium and calcium concentrations that may promote activation of contractile proteins, such as actin and myosin [162]. Acetyldigitoxin is a cardioactive derivative of lanatoside A or of digitoxin used for fast digitalization in congestive heart failure. The proposed mode of action is similar to deslanoside: inhibition of the Na+/K+ pump that leads to increased amounts of calcium [163]. Ethacrynic acid is used in the treatment of high blood pressure and edema caused by diseases like congestive heart failure, liver failure, and kidney failure. It inhibits the symport of sodium, potassium, and chloride primarily in the ascending limb of Henle. This pharmacological action results in excretion of these ions, increased urinary output, and reduction in extracellular fluid [164]. Finally, the last drug in this group is bretylium, used in emergency medicine, cardiology, and other specialties for the acute management of ventricular tachycardia and ventricular fibrillation. The main mode of action for bretylium is thought to be inhibition of voltage-gated potassium channels and the Na+/K+-ATPase [165].
Preventable ADRs leading to hospitalization — results of a long-term prospective safety study with 6,427 ADR cases focusing on elderly patients
Published in Expert Opinion on Drug Safety, 2018
S Schmiedl, M Rottenkolber, J Szymanski, B Drewelow, W Siegmund, M Hippius, K Farker, I R Guenther, J Hasford, P A Thuermann
Apart from drug–drug interactions, we found a high proportion of missing prevention strategies (47.3%), prescribing inappropriate drugs (39.3%) or inappropriate dosage (21.3%) in elderly patients worth mentioning in a more detailed way. For example, choosing an inappropriate antidiabetic (with regard to chronic comorbidities) or lacking dose reduction in patients with reduced food intake due to acute conditions (e.g. gastrointestinal complaints) were of outstanding importance (Table 4). Furthermore, lacking or sporadic HbA1c or blood glucose monitoring were major issues in hypoglycaemic patients related to antidiabetics, too. Missing non-drug-related prevention strategies were also relevant in patients receiving digitoxin (ECGs, monitoring of clinical symptoms, or therapeutic drug monitoring) and in patients receiving phenprocoumon (sporadic measurement of INR; Table 4). Whereas irregular food intake is predominantly a patient-related issue, lack of blood glucose monitoring could be both patient- and physician-related. On the other hand, regular measurement of INR, digitoxin serum levels, or conducting ECGs is primarily a physician-related issue but, for digitalis glycosides in particular, recommendations regarding the frequency of therapeutic drug monitoring are missing even in recently published guidelines [37,38]. A relevant association between laboratory or physiological abnormalities and drug-related visits (emergency room visits and hospital admissions) was found in a recently published systematic review underscoring the relevance of monitoring, e.g. diabetes therapy, anticoagulants, or other specific compounds [48].