Cardiac Glycosides: Part II: Pharmacokinetics and Clinical Pharmacology

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Generally the symptoms are reversible after drug therapy is discontinued. Patients who are slow metabolizers are more likely to develop drug-induced lupus Wikipedia: drug-induced lupus.

  1. Cardiac Glycosides: Part II: Pharmacokinetics and Clinical Pharmacology.
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Benowitz NL : Antihypertensive agents. Maille N et al : Mechanism of hydralazine-induced relaxation in resistance arteries during pregnancy: Hydralazine induces vasodilation via a prostacyclin pathway. Vascular Pharmacology Most commonly prescribed in combination tablets , e. New York NY. MedlinePlus NIH. Therefore they are less effective in lowering BP than thiazide diuretics Saseen Loop diuretics are drugs of choice for patients with severe edema is present and a potent diuresis is needed , including:. Congestive heart failure to reduce the workload on the heart.

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Acute pulmonary edema , where a rapid diuresis is needed to reduce pulmonary congestion, and improve pulmonary function. Clinical situations where gastrointestinal absorption is impaired or oral medication is not practicable furosemide is available in both oral and i. For other indications see Loop Diuretics. Patients who are allgeric to sulfonamides Furosemide is a sulfonamide derivative; ethacrynic acid is not. Duration of effect is hours half life depends on renal function ; requires multiple doses per day.

Dobutamine Trade Name: generic. In animal studies, dobutamine produces less increase in heart rate and less decrease in peripheral vascular resistance for a given inotropic effect than does isoproterenol. Dobutamine is contraindicated in patients with idiopathic hypertrophic subaortic stenosis and in patients who have shown previous manifestations of hypersensitivity to dobutamine.

Onset of action of dobutamine is 1 to 2 minutes; however, with peak effect within 10 minutes; plasma half-life is 2 minutes. Because of potential physical incompatibilities, it is recommended that dobutamine not be mixed with other drugs in the same solution. Dobutamine should not be used in conjunction with other agents or diluents containing both sodium bisulfite and ethanol. Systemic effects on baroreceptors, and the parasympathetic nervous system result in an increase in vagal tone that can be useful in controlling ventricular rate in patients with atrial tachyarrhythmias.

Patients with mild to moderate heart failure with reduced ejection fraction HFrEF who remain symptomatic after being treated with diuretics and ACE inhibitors. These can help reduce resting heart rate. There appears to be a sex-difference in the clinical effects achieved with digoxin. A post-hoc analysis of the DIG trial indicates digoxin therapy is associated with an increased risk of death in women, but not in men with HFrEF Rathore et al, In male patients, digoxin has been reported to improve survival HFrEF if serum digoxin levels are relatively low e. Rate control in patients with both atrial fibrillation AND systolic heart failure because it treats both conditions Colucci, Historically digoxin was used to control ventricular rate in patients with chronic atrial fibrillation without systolic heart failure.

However a recent retrospective study suggests that routine use of digoxin in this patient subgroup is associated with an increased mortality and hospitalization. This may be related to increased digoxin levels which are known to be more arrhythmic ; serum digoxin levels are not routinely monitored in community practice Freeman et al, Renal excretion of digoxin is proportional to glomerular filtration rate and is largely independent of urine flow.

In healthy volunteers with normal renal function, digoxin has a half-life of 1. Adverse effects are dose-dependent and typically occur at doses higher than those needed to achieve a therapeutic effect. They include:. This will increase the incidence of digitalis-induced arrhythmias. Some interactions can result in a doubling of digoxin serum levels.

Erythromycin and clarithromycin and possibly other macrolide antibiotics and tetracycline may increase digoxin absorption in patients who inactivate digoxin by bacterial metabolism in the lower intestine, so that digitalis intoxication may result. Digoxin increases left ventricular ejection fraction and improves heart failure symptoms as evidenced by increased exercise capacity and decreased heart failure-related hospitalizations and emergency care. European Heart Journal Am J Cardiol 1 Freeman JV et al : Digoxin and risk of death in adults with atrial fibrillation.

World Health Organization. Archived PDF from the original on 13 December Retrieved 14 December Archived from the original on Digoxin comes from Digitalis lanata". April International Drug Price Indicator Guide. Retrieved 22 December November European Journal of Clinical Pharmacology. European Heart Journal. The Canadian Journal of Cardiology. Gynecological Endocrinology. Part I: Patients with Digitalis -induced arrhythmias ].

Zeitschrift Fur Kardiologie in German. Drug Safety. Essentials of Medical Pharmacology 6th ed. New Delhi: Jaypee Publications. September Medical Toxicology. Retrieved USA Today. Federal Drugs Administration. Recall News. Wall Street Journal. December Bibcode : PNAS.. Human Pathology. Pharmacology 5th ed.

Pharmacology in Clinical Practice

Edinburgh: Churchill Livingstone. Summary of Product Characteristics , Digoxin 0. Pharmakologie und Toxikologie 15th ed. Georg Thieme Verlag.

Cardiac glycosides. Handbook of experimental pharmacology

Cardiac glycosides C01A. Arenobufagin Bufotalin Cinobufagin Marinobufagin. Proscillaridin Scilliroside. Ouabain g-Strophanthin k-Strophanthin Cymarin. Antiarrhythmic agents C01B. Diltiazem Verapamil.


Adenosine Benzodiazepines Barbiturates. Amiodarone Bretylium Quinidine Verapamil. Digitoxin Digoxin Ouabain. Pharmacokinetics Greek: Kinesis —movement — What the body does to the drug. Some other important aspects of pharmacology are:. Pharmacotherapeutics It is the application of pharmacological information together with knowledge of the disease for its prevention, mitigation or cure.

Cardiac glycosides. Handbook of experimental pharmacology - PDF Free Download

Selection of the most appropriate drug, dosage and duration of treatment in accordance with the specific features of a patient are a part of pharmacotherapeutics. Clinical pharmacology It is the scientific study of drugs both new and old in man.

It includes pharmacodynamic and pharmacokinetic investigation in healthy volunteers and in patients; evaluation of efficacy and safety of drugs and comparative trials with other forms of treatment; surveillance of patterns of drug use, adverse effects, etc. Pharmacodynamic agents These are designed to have pharmacodynamic effects in the recipient. Pharmacy It is the art and science of compounding and dispensing drugs or preparing suitable dosage forms for administration of drugs to man or animals.

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  • It includes collection, identification, purification, isolation, synthesis, standardization and quality control of medicinal substances. The large scale manufacture of drugs is called Pharmaceutics. It is primarily a technological science. Toxicology It is the study of poisonous effect of drugs and other chemicals household, environmental pollutant, industrial, agricultural, homicidal with emphasis on detection, prevention and treatment of poisonings. It also includes the study of adverse effects of drugs, since the same substance can be a drug or a poison, depending on the dose.

    Plants Many plants contain biologically active substances and are the oldest source of drugs. Chemically the active ingredients fall in several categories:. Alkaloids: These are alkaline nitrogenous bases having potent activity, and are the most important category of vegetable origin drugs.