Included topics in this exam are: 1. “”2008 Annual Report of the American Association of Poison Control Centers’ National Poison Data System (NPDS): 26th Annual Report””. — С. Digoxin ( Digitek, Lanoxin) is an inexpensive drug used to treat congestive heart failure and heart rhythm problems. What threatens this pathology is important to know all patients with severe cardiovascular disease.

Cardiac glycosides can be more specifically categorized based on the plant they are derived from, as in the following list. The steroid core consists of five condensed rings, to which other functional groups can be attached, such as methyl, hydroxyl and aldehyde groups, affecting the biological activity of the entire molecule.Cardiac glycosides vary in groups attached at both ends of the steroid. The fuller name that is used in professional medical sources is postmiocardic cardiosclerosis.Among all cardiovascular pathologies, the most frequent complication of infectious diseases is myocarditis. The atherogenic coefficient (CA) is calculated using certain cholesterol fractions. J Emerg Med. Sax 5thAvenue. Cardiac glycosides – types, indications and contraindicationsCardiac glycosides (SG) are a class of organic compounds that increase cardiac output and reduce the rate of contractions of the myocardium.The main effect is directed to the cellular sodium-potassium ATP-azny pump.Medical prescription is the treatment of heart failure and cardiac arrhythmias.The relative toxicity of SG does not allow them to be widely used.Cardiac glycosides, most commonly found as secondary metabolites in several plants, such as digitalis, have a diverse biochemical effect on the function of heart cells.As a result of recent studies, SG has also been proposed for the integrated treatment of cancer.The general structure of cardiac glycosides consists of a steroid molecule attached to a sugar (glycoside) and an R-group.The steroid core consists of five condensed rings, to which other functional groups can be attached, such as methyl, hydroxyl and aldehyde groups, affecting the biological activity of the entire molecule.The structure of the ring attached to the R-end of the molecule, allows us to classify cardiac glycosides into two classes:Cardenolides are distinguished from bufadienolides by the presence of an “enolide,” a five-membered ring with one double bond at the end of the lactone.On the other hand, bufadienolide contain “dienolide” - a six-membered ring with two double bonds at the end of the lactone.Although the compounds of both groups can be used to influence the cardiac output of the heart, cardenolides are more commonly used in medicine.This is mainly due to the availability of the raw material from which they are produced.Cardiac glycosides can be more specifically classified based on the plants from which they are produced.A similar distribution is presented in the list below.For example, cardenolides were mainly obtained from digitalis purpurea and Digitalis lanata digitalis plants, whereas boufadienolides are derived from the venom of cane Bufo marinus.From the name of the reptile, they get part of their medical definition.The following is a complete list of plants from which cardiac glycosides can be obtained.Convalia vulgaris or Convallaria majalis (plant): convallotoxin.Anchar or Antiaris toxicaria (evergreen trees and shrubs): antiarin.Strofant Combe or Strophanthus kombe (Strophanthus vine): ouabain (g-strophanthin) and other strophanthins.Digitalis lanata and digitalis purpurea or Digitalis lanata and Digitalis purpurea: digoxin, digitoxin.Kalanchoe Degremona or Kalanchoe daigremontiana and other types of Kalanchoe.Cardiac glycosides inhibit the action of the sodium-potassium pump in cardiomyocytic sarcolem.Thus, they increase the intracellular concentration of sodium and calcium, thereby exerting a positive inotropic effect, increasing the strength of contractions.The effect on the vessels and the heart is direct and indirect, while the control is carried out by the sympathetic and parasympathetic nervous system.Cardiac glycosides affect the parasympathetic system, activating it.Stimulation of the vagus nerve has a suppressive effect on the sinus node and atrio-ventricular node (negative dromotropic effect), thereby reducing the heart rate (negative chronotropic effect).The indirect effect of the activation of the vagus nerve also leads to a decrease in atrial myocardial contractility, a reduction in the refractory period and an acceleration of the conduction of impulses in the atria.Glycosides increase atrial muscle contractility, prolonging the refractory period and promoting the conduction of impulses.In addition, hypertension increases atrial automatics.An increase in the secretion of norepinephrine reduces the period of refraction of Purkinje fibers and increases their automatism.The same direct effect on Purkinje fibers is exerted by glycosides.The effect of noradrenaline and glycosides on the muscles of the ventricle is the same - the contractility of the heart increases, the period of refraction of the muscle fibers is shortened and the automatism of the heart muscle increases.Cardiac glycosides increase the sensitivity of baroreceptors.Cardiac glycosides reduce the activity of the sympathetic nervous system, reducing the resistance of peripheral arterioles.The direct effect of glycosides is opposite and increases resistance.Digoxin and digitoxin can be prescribed for administration in the form of tablets.Digoxin is excreted through the kidneys with a half-life of 1.5 days, and digitoxin mainly by the liver and bile, followed by excretion through the intestines (enterohepatic circulation), which causes a half-life of 7 days.Therefore, in view of potential toxicity, digoxin is usually preferred.Strofantin is administered intravenously due to poor absorption in the intestines, but currently has no clinical / therapeutic significance.The long half-life leads to the fact that a higher initial dose is required for saturation than a subsequent daily maintenance dose.Since many narcotic substances can affect the activity of cardiac glycosides, fluctuations in the concentration of the electrolyte, they also have only a limited therapeutic range, their use should be carried out in individual doses with careful monitoring of blood count.This applies in particular to digitalis glycosides (digoxin, digitoxin), in which the therapeutic and toxic areas can sometimes overlap.Cardiac glycosides have long been the main treatment for congestive heart failure and cardiac arrhythmias.This is due to the effect of these diseases on the force of contraction of the myocardium while reducing the heart rate.Heart failure is characterized by the inability to pump a sufficient amount of blood to maintain the body.This may be due to a decrease in blood volume or a decrease in myocardial contractile force.The treatment of this condition focuses on lowering blood pressure so that the heart does not need to put a lot of effort to pump the required amount of blood.The contractile force of the heart can also be directly increased, which allows it to overcome the resulting load.Cardiac arrhythmia is a change in the heart rate towards an increase (tachycardia) or slowdown (bradycardia).The treatment tactics of this condition are primarily aimed at eliminating tachycardia or atrial fibrillation by slowing the heart rhythm, as cardiac glycosides do.However, due to toxicity and dosage issues, cardiac glycosides have been replaced by synthetic drugs, such as ACE inhibitors and beta-blockers.They are no longer used as primary medical care for arrhythmias and heart failure.However, depending on the severity of the condition, they can still be administered in combination with other types of drugs.Chronic heart failure with atrial fibrillation or flutter and fast ventricular rhythm (the drug of choice).Patients with chronic heart failure, sinus rhythm, NYHA class III class.Patients with heart failure are, respectively, Grade II NYHA with sinus rhythm, in which their condition has improved and they have switched to the lower NYHA class after treatment with glycosides.Cardiac glycosides are most often used for therapeutic purposes, but their toxicity is widely recognized.For example, American poison control centers reported 2,632 cases of digoxin toxicity and 17 deaths from digoxin in 2008.

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