Digitalis adverse effects

Dlgltoxin. Digitoxin is a cardiac glycoside obtained from Digitalis purpurea. Digitoxin is indicated in the treatment of atrial flutter, atrial fibrillation, and supraventricular tachycardia. Its electrophysiologic and adverse effects are similar to those described for digoxin (87). 

It is indicated in all grades of essential hypertension and renovascular hypertension where standard therapy is ineffective or inappropriate because of adverse effects and in congestive heart failure. It should be used as an adjunctive therapy with digitalis and/or diuretics. 

Besides the adverse effects just described, glucocorticoid therapy is contraindicated under the following circumstances diabetes mellitus, digitalis therapy, glaucoma, hypertension, infection, osteoporosis, peptic ulcer, tuberculosis, and viral infection. 

Many drugs produce both their desired effects and adverse effects by acting on a single receptor type in different tissues. Examples discussed in this book include digitalis glycosides, which act by inhibiting Na+/K+ ATPase in cell membranes methotrexate, which inhibits the enzyme dihydrofolate reductase and glucocorticoid hormones. 

Adverse effects Thiazide diuretics induce hypokalemia and hyperuricemia in 70% of patients, and hyperglycemia in 10% of patients. Serum potassium levels should be monitored closely in patients who are predisposed to cardiac arrhythmias (particularly individuals with left ventricular hypertrophy, ischemic heart disease, or chronic congestive heart failure) and who are concurrently being treated with both thiazide diuretics and digitalis glycosides (see p. 160). Diuretics should be avoided in the treatment of hypertensive diabetics or patients with hyperlipidemia. 

Color vision abnormality is a well-known adverse effect of digitalis (SEDA-20, 173), and particularly occurs in patients with digitalis toxicity. 

Daunorubicin is primarily used in the treatment of AML in combination with Ara-C and has largely been replaced by idarubicin. The toxic manifestations of daunorubicin as well as idarubicin include bone marrow depression, stomatitis, alopecia, G1 disturbances, and dermatological manifestations. Cardiac toxicity is a peculiar adverse effect observed with these agents. It is characterized by tachycardia, arrhythmias, dyspnea, hypotension, pericardial effusion, and CHF that is poorly responsive to digitalis. 

C. Toxicity Adverse effects include bloating, constipation, and an unpleasant gritty taste. Absorption of vitamins (eg, vitamin K, dietary folates) and drugs (.eg, digitalis, thiazides, warfarin, pravastatin, fluvastatin) may be impaired by the resins. 

Epinephrine usually Is administered slowly by Intravenous (IV) Injection to relieve acute asthmatic attacks not controlled by other treatments. Intravenous Injection produces an Immediate response. Use of EPI with drugs that enhance cardiac arrhythmias (digitalis or quinidine) Is not recommended. Tricyclic antidepressants and MAO Inhibitors will potentiate the effects of EPI on the heart. Epinephrine should be used with caution In Individuals suffering from hyperthyroidism, cardiovascular disease, hypertension, or diabetes. Adverse effects Include palpitations, tachycardia, sweating, nausea and vomiting, respiratory difficulty, dizziness, tremor, apprehension, and anxiety. 

Among the well-recognised adverse effects of amphotericin B is hypoka-laemia, which can be severe. Although there seem to be no reports of adverse interactions, it would be logical to expect that digitalis toxicity could develop in patients given both drugs if the potassium levels fall. Amiloride has been successfully used to counteract the potassium loss caused by amphotericin B. ... 

The adverse effects of carbenoxolone include an increase in blood pressure (both systolic and diastolic), fluid retention and reduced serum potassium levels. The incidence of these adverse effects is said in some reports to be as high as 50% others quote lower figures. Hypertension and fluid retention occur early in carbenoxolone treatment, whereas the hypokalae-mia develops later and may occur in the absence of the other two adverse effects. " Carbenoxolone is therefore unsuitable for patients with congestive heart failure, or those taking digitalis glycosides, unless measures to avoid hypokalaemia are taken. 

DCAA (17,21-di-monochloroacetyl ajmaline) abolished digitalis-induced arrhythmias in the majority of dogs and significantly reduced mortality rate. No adverse effect on myocardial function was observed.47... 

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