pharmacokinetics – ABC CARDIOL

ABCHF

Viewpoint

Digoxin in Heart Failure with Reduced Ejection Fraction: A Proposal for a Practical Precision Medicine-Based Guide

Introduction: the paradox of digitalis therapy

Digoxin holds a unique position in the history of cardiovascular medicine. Although it is the oldest drug in continuous use for heart failure (HF) treatment, there has been a sharp decline in prescriptions over the past two decades. Overshadowed by the advent of disease-modifying therapies and stigmatized due to concerns regarding toxicity, digoxin was relegated to a Class IIa recommendation in the Brazilian guideline and a third-line recommendation (Class IIb) in the major international guidelines.^,

Nonetheless, the systematic exclusion of digoxin may represent a historical error based on incomplete interpretations of old data. In a scenario where heart failure with reduced ejection fraction (HFrEF) still imposes high morbidity, mortality, and residual symptoms despite optimized therapy, the premise of this viewpoint is unequivocal: digoxin is not obsolete; what has become obsolete is the empirical fixed-dose prescription model. In light of contemporary evidence, we propose a revival of digitalis therapy guided by precision medicine.

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IJCS

Case Report

A Rare Case of Cardiorespiratory Arrest after Metoclopramide Infusion

Cássio Alexandre Oliveira Rodrigues et al. Eduardo Queiroz da Cunha Priscila Ribeiro de Paula Rand Randall Martins

Introduction

Commonly used as an antiemetic and prokinetic agent, especially in critically-ill patients to reverse gastroparesis and increase in gastric emptying, metoclopramide use can result in important adverse reactions, leading the European Medicines Agency to recommend its use at minimum doses and for a short period of time, due to the risk of neurotoxicity.

Although often associated to neurological events, reactions to this drug affecting the cardiovascular system are less frequent when compared to those that affect the central nervous system. There have been reports of total atrioventricular block and sinus arrest, but the occurrence of metoclopramide-induced cardiorespiratory arrest (CRA) is a rare and poorly described event.

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ABC

Artigo de Pesquisa

Pharmacokinetics of statins

Francisco Antonio Helfenstein Fonseca

Statins are lipid lowering agents that promote their effects on plasma lipids through the inhibition of HMG-CoA reductase, a crucial enzyme in the cascade of cholesterol synthesis, leading to reduction of tissue cholesterol pool and consequently, to an upregulation of the LDL receptor expression. There are considerable differences among statins regarding some pharmacokinetic properties, such as the coefficient of hydrophilicity, via liver metabolism (especially regarding P450 cytochrome and isoenzymes), plasma half-life and efficacy of serum lipid changes. They may also differ regarding interactions with other drugs that share the same pathway of metabolism. Recently, many pleiotropic effects have been reported with these drugs, such as anti-inflammatory properties, improvement in endothelial function and benefits on hemostasis.

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Digoxin in Heart Failure with Reduced Ejection Fraction: A Proposal for a Practical Precision Medicine-Based Guide

Introduction: the paradox of digitalis therapy

A Rare Case of Cardiorespiratory Arrest after Metoclopramide Infusion

Introduction

Pharmacokinetics of statins

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Electronic Document Format (Vancouver)

Electronic Document Format (ABNT)

Electronic Document Format (APA)

Electronic Document Format (ISO)

Electronic Document Format (Vancouver)

Electronic Document Format (ABNT)

Electronic Document Format (APA)

Electronic Document Format (ISO)