Heart failure occurs when the heart is unable to pump enough blood to meet the body's needs. It has a high mortality rate. The most common cause is coronary artery disease. When the heart does not contract well, blood backs up in the lungs and periphery. Chronic activation of compensatory mechanisms like the sympathetic nervous system contributes to cardiac remodeling over time.
Right heart failure causes issues like leg swelling and liver enlargement due to blood backing up. Left heart failure can cause pulmonary edema. Treatment focuses on reducing symptoms, slowing disease progression, and improving survival through drugs that target the renin-angiotensin-aldosterone system, beta-blockers, diuretics, and vasodilators. Dentists
Previously termed acute renal failure
Reversible deterioration of renal function over hours to days manifested by:
Increase in BUN
Increase in creatinine
Reduced urine output
Oliguria : <400><100 ml urine output in 24 hours
Previously termed acute renal failure
Reversible deterioration of renal function over hours to days manifested by:
Increase in BUN
Increase in creatinine
Reduced urine output
Oliguria : <400><100 ml urine output in 24 hours
Antihypertensives are a class of drugs that are used to treat hypertension (high blood pressure). Antihypertensive therapy seeks to prevent the complications of high blood pressure, such as stroke and myocardial infarction.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
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Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
2. What is Heart Failure?
A symptom complex due to
the inability of the heart to
function efficiently as a
pump - there is a
disproportion between the
hemodynamic demand and
the capacity of the heart to
handle the demand
( Supply ≠ Demand)
3. Heart Failure
• Heart failure occurs when cardiac
output is inadequate to provide the
oxygen needed by the body.
• It is a highly lethal condition, with a 5-
year mortality rate conventionally said to
be about 50%.
• The most common cause of heart
failure is coronary artery disease.
4. If Heart does not contract well (systolic
HF) traffic (blood) piles up before the
heart (lungs and periphery).
5. Role of physiologic compensatory
mechanisms in the progression of HF
• Chronic activation of the sympathetic
nervous system and the renin-
angiotensin-aldosterone axis is
associated with remodeling of cardiac
tissue, characterized by:
• loss of myocytes.
• Hypertrophy.
• fibrosis.
6. Sequelae of Heart Failure
Right Heart Failure
Systemic venous
congestion:
1. distended neck
veins.
2. enlarged liver.
3. peripheral
edema.
4. ascites.
Left Heart Failure
• Pulmonary
edema
(Dyspnea)
7. Symptoms of Heart Failure
Compensated (Asymptomatic)
Uncompensated (Symptomatic)
• Fatigue
• Dyspnea
• Orthopnea
(shortness of breath (dyspnea) which occurs when lying flat)
• Paroxysmal Nocturnal Dyspnea
• Ankle Edema
• Weight Gain
15. Angiotensin - converting enzyme inhibitors
Actions on the heart:
ACE inhibitors decrease:
1. Vascular resistance.
2. Venous tone.
3. Blood pressure.
preload andafterload
.
ACE inhibitors also blunt the usual
angiotensin II mediated increase in
epinephrine and aldosterone seen in HF.
16. Angiotensin - converting enzyme
inhibitors,
• Indications:
1. Single-agent therapy in patients who present with mild
dyspnea on exertion and do not show signs or symptoms
of volume overload.
2. In asymptomatic patients with an ejection fraction of
less than 35 % (left ventricular dysfunction).
(The term "ejection fraction" refers to the percentage of blood that's pumped out of a filled
ventricle with each heartbeat.)
1. Recent myocardial infarction also benefit from long-
term ACE inhibitor therapy.
2. In patients with all stages of left ventricular failure,
with and without symptoms, and therapy should be
initiated immediately after myocardial infarction.
17. • ACE inhibitors improve clinical signs and
symptoms in patients also receiving
thiazide or loop diuretics and/or digoxin.
• The use of ACE inhibitors in the treatment
of HF has significantly decreased both
morbidity and mortality.
18. Angiotensin - converting enzyme
inhibitors,
• Pharmacokinetics:
• Adequately but incompletely absorbed following oral
administration.
• The presence of food may decrease absorption, so they should be
taken on an empty stomach.
• ACE inhibitors are prodrugs that require activation by hydrolysis
via hepatic enzymes (Except for captopril ).
• Renal elimination of the active moiety is important (Except for
fosinopril) .
• t½ 2 to 12 hours.
19. Angiotensin - converting enzyme
inhibitors,
• Adverse effects:
• postural hypotension,
• renal insufficiency,
• hyperkalemia,
• Angioedema.
• persistent dry cough.
• ACE inhibitors should not be used in pregnant women,
because they are fetotoxic
20. Angiotensin receptor blockers, &
related agents
• losartan (AT1 receptor-blockers) appear to
have similar but more limited beneficial
effects.
• Angiotensin receptor blockers should be
considered in patients intolerant of ACE
inhibitors.
21. Angiotensin receptor blockers, &
related agents (ARBs)
• extremely potent competitive antagonists of the angiotensin type
1 (AT1)receptor.
• ARBs have the advantage of more complete blockade of
angiotensin action, because ACE inhibitors inhibit only one
enzyme responsible for the production of angiotensin II.
• ARBs do not affect bradykinin levels.
22. Angiotensin receptor blockers, &
related agents (ARBs)
• All the ARBs are approved for treatment of
hypertension based on their clinical efficacy in
lowering blood pressure and reducing the
morbidity and mortality associated with
hypertension.
• Their use in HF is as a substitute for ACE
inhibitors in those patients with severe cough
or angioedema.
23. Angiotensin receptor blockers, &
related agents (ARBs)
• Pharmacokinetics:
• orally active.
• require only once-a-day dosing.
• Losartan, the first approved member of the class,
differs from the others in that it undergoes extensive
first-pass hepatic metabolism, including conversion to
its active metabolite. The other drugs have inactive
metabolites.
• Elimination in the urine and feces
• All are highly plasma protein bound (greater than 90
percent)
24. Angiotensin receptor blockers, &
related agents (ARBs)
• Adverse effects:
• ARBs have an adverse effect profile similar to
that of ACE inhibitors.
• However, ARBs do not produce cough.
• ARBs are contraindicated in pregnancy.
25. β -adrenoceptor blockers
• Most patients with chronic heart failure respond
favorably to certain β blockers in spite of the fact
that these drugs can precipitate acute
decompensation of cardiac function.
• Studies with bisoprolol, carvedilol, and
metoprolol showed a reduction in mortality in
patients with stable severe heart failure.
• Suggested mechanisms include attenuation of
the adverse effects of high concentrations of
catecholamines.
26. β -adrenoceptor blockers
• Most patients with chronic heart failure respond
favorably to certain β blockers in spite of the fact
that these drugs can precipitate acute
decompensation of cardiac function. Studies with
bisoprolol, carvedilol, and metoprolol showed a
reduction in mortality in patients with stable
severe heart failure.
• Suggested mechanisms include attenuation of
the adverse effects of high concentrations of
catecholamines.
28. Diuretics
• Their major mechanism of action in heart failure is to
reduce venous pressure and ventricular preload. This
results in reduction of edema and its symptoms, and
reduction of cardiac size, which leads to improved pump
efficiency.
• Loop diuretics, such as furosemide (Lasix), block the Na+-
K+ - 2Cl
_
in the ascending limb of the loop of Henle. loop diuretics are
still part of the mainstay of therapy for CHF despite these
potential problems
• Spironolactone and eplerenone, the aldosterone antagonist
diuretics have the additional benefit of decreasing
morbidity and mortality in patients with severe heart
failure.
29. Vasodilators
• The vasodilators are effective in acute
heart failure because they provide a
reduction in preload (through
venodilation), or reduction in afterload
(through arteriolar dilation), or both.
Some evidence suggests that long-term
use of hydralazine and isosorbide
dinitrate can also reduce damaging
remodeling of the heart.
30. Drug Therapy - Digitalis
Glycosides
Action: Increases the
force and velocity of
myocardial
contraction
Digoxin (Lanoxin)
Digitoxin
(Crystodigin)
Purple foxglove - digitalis
31. Drug Considerations - Digitalis
Glycosides
• Vasoconstrictor Interaction: concurrent
use may increase the risk of cardiac
arrhythmias – avoid if possible
• Oral Manifestations: increased gag reflex,
nausea/vomiting
• Other Considerations:
– macrolide antibiotics (erythromycin) can
increase bioavailability of DG resulting in
toxicity; avoid these drugs
– watch for DG toxicity (tachycardia, N/V,
hypersalivation, vision changes, fatigue, HA)
32. DIGITALIS
• Introduction
• Digitalis is the genus name for the family of
plants that provide most of the medically useful
cardiac glycosides, eg, digoxin.
33. Inotropic Definition
• Force of myocardial contraction
• Positive inotropic drug: increases force
of contractions
• Negative inotropic drug: decreases
force of contraction
34. Digitalis Glycosides
• Increase force of myocardial
contraction.
• Increase myocardial contractility
causing more complete emptying.
• Causes improved heart’s pumping
ability
35. Pharmacokinetics
A. Absorption:
• 65-80% absorbed after oral administration.
B. Distribution:
• widely distributed to tissues, including the
central nervous system.
C. Metabolism:
• Small amount in liver & GI flora.
D. Excretion:
• Unchanged drug from kidneys
36. Pharmacodynamics
• At the molecular level, all therapeutically useful
cardiac glycosides inhibit Na+/K+ ATPase, the
membrane-bound transporter often called the
sodium pump.
37. Pharmacodynamics
• Cardiac glycosides increase contraction
of the cardiac sarcomere , by increasing
the free calcium concentration in the
vicinity of the contractile proteins during
systole.
1. An increase of intracellular sodium
concentration because of Na+/K+ ATPase
inhibition.
2. Relative reduction of calcium expulsion
from the cell by the sodium-calcium
exchanger caused by the increase in
intracellular sodium, ( contractile force,
39. Toxicity
1. Gastrointestinal
– Salivation
– Anorexia
– Nausea
– Vomiting
– Diarrhea
2. CNS
– Headache
– Visual disturbances
characteristic (green
yellow halos around
bright objects).
– Fatigue
– Drowsiness
• Digitalis is a fat-soluble steroid that
crosses the blood-brain barrier and
enhances vagal tone
• This action involves:
• sensitization of the baroreceptors.
• central vagal stimulation.
40. Toxicity
3. Cardiac
• Atrioventricular (AV) block.
• Excessive slowing of the
heart
• supraventricular and
ventricular tachycardia.
4. Miscellaneous
• Excessive urination
• Because cholinergic
innervation is much richer
in the atria.
• Enhanced vagal nerve
activity causes a decrease
in sinoatrial beating rate
and velocity of
atrioventricular
conduction.
• facilitation of muscarinic
transmission at the cardiac
muscle cell
41. Treatment for digitalis toxicity:
• Mild cases that respond to simply
stopping the drug temporarily.
• In severe cases the use of
antidigoxin drug, antidote is given
intravenously and inactivates
digoxin in life-threatening situations.
43. Dobutamine.
• The selective β1 agonist that has been most
widely used in patients with heart failure.
• Tachycardia and an increase in myocardial
oxygen consumption have been reported.
Therefore, the potential for producing angina or
arrhythmias in patients with coronary artery
disease must be considered.
• Dopamine has also been used in acute heart
failure and may be particularly helpful if there is a
need to raise blood pressure.
44. Drugs without positive inotropic effects
• Paradoxically, these agents-not positive
inotropic drugs-are the first-line
therapies for chronic heart failure.
• In acute failure, diuretics and
vasodilators play important roles.
45. Beneficial effects of pharmacologic intervention in
HF
1. Reduction of the load on the
myocardium.
2. Decreased extracellular fluid volume.
3. Improved cardiac contractility.
4. Slowing of the rate of cardiac
remodeling.
47. Stress Factors
-Eliminate needless stress for cardiac patients, especially
anxiety or pain associated with dental procedures. Patients
being treated for heart failure possess limited cardiac function.
-These patients are at special risk in stressful situations
because stress puts a greater workload on the heart and
stimulates the release of endogenous catecholamines.
-catecholamines increase the risk of digoxin-induced
arrhythmias.
-Fear and apprehension may also increase the likelihood of
adverse CNS reactions to digoxin.
-One practical conclusion is that antianxiety therapy or
analgesics should be used preemptively if emotional stress or
pain is likely.
48. Drug Interactions
The use of catecholamines in local anesthetic injections for
patients taking digoxin is not contraindicated but should be
approached with special caution.
Proper injection technique to avoid intravascular injection
should be followed.
Many factors influence the decision to use vasoconstrictors in
local anesthetic solutions, including the ability to achieve
adequate anesthesia without vasoconstrictors and the volume
of anesthetic solution required.
The chief danger of sympathomimetic vasoconstrictors for
patients taking digoxin is that the combination of drugs
increases the risk of cardiac arrhythmias if significant amounts
of vasoconstrictor enter the vascular space
49. - The use of gingival retraction cords impregnated with
epinephrine is not recommended in patients taking digoxin.
Cardiac disease in general is a contraindication for their use.
Considerable amounts of vasoconstrictor may be absorbed
systemically from these retraction cords, and the possibility of
cardiac arrhythmias developing is significant. If hemostatic
retraction cords are to be used in patients who are on digoxin,
the cords should be impregnated with an astringent in place
of a vasoconstrictor.
50. • Antisialagogues such as atropine and
methantheline should not be used in patients
taking digoxin because they tend to reduce
the effects of digoxin.
• Muscarinic receptor agonists such as
pilocarpine enhance the effect of digoxin on
the SA node, the atria, and the AV node.
• Excessive salivation may be a sign of toxicity
owing to digoxin.
51. Antibiotic therapy may alter the intestinal flora
and, in so doing, increase the absorption of
digoxin in patients whose gastrointestinal flora
metabolizes digoxin.
Erythromycin, and presumably other macrolides,
has been shown to have this effect.
Tetracyclines also seem to interact through this
mechanism.