October 2018
Hello! It's been officially one month since I last checked in, and a lot has happened in that time! The weather has gone down a couple of degrees as fall officially commenced, we've had two more tests in the pharmacology program I am a student in, and I have learned so many new things about the city I have called home for the past 22 years. I have been facing difficulty sorting out the logistics of my volunteer service, but will be starting very soon in the beginning of November (so hopefully these posts will be more reflective of those experiences!) However, in the meantime I have been keeping myself quite busy with the material taught in the pharmacology program. Recently we have started the Cardiovascular/Renal block of our curriculum, and have immersed ourselves into learning about anti-hypertensive drugs, treatments for heart failure, renal physiology, and medications that regulate the blood clotting processes. Perhaps the drug that has piqued my interest most in this curriculum so far is not one of the heavyweight commonly prescribed medications like statins or beta-blockers, but the humble but mighty companion drug, digoxin.
I recently presented a paper on the drug and it's effects on mortality and it was quite interesting to see how the treatment of heart failure started with treatment via digoxin as the 1st drug of choice and progressed to the current gold standard of care it is today. Digoxin is a cardiac glycoside which acts on the sodium-potassium ATPase pump in cardiac muscle cells and eventually increased the contractile force of the heart (positive inotropic effects) and decrease the heart rate (negative chronotropic effects). Originally it was the main treatment for heart failure, but over time one dangerous feature was noticed about this drug. It had an extremely low therapeutic index of 2, meaning that at just double the dose, it could be extremely toxic!! Digoxin toxicity can cause almost any cardiac arrhythmia which is especially dangerous for patients that already have CHF so it is something that should be kept on extreme watch. Not only that, but there are a lot of other factors that can affect how much digoxin is absorbed in the body, such as the potassium, calcium, and magnesium levels in the body as well as the use of potassium wasting diuretics (another common treatment for patients with heart failure). Eventually, considering all of these factors, the standard of care shifted away from digoxin as the primary drug of choice to a triple therapy of an ACE/ARB inhibitor, beta blocker, and diuretic with digoxin sometimes used in combination. I found the evolution of treatment to be quite interesting when studying it, and it is just one example of the many unique and interesting drugs I have been learning about in the program!
I recently presented a paper on the drug and it's effects on mortality and it was quite interesting to see how the treatment of heart failure started with treatment via digoxin as the 1st drug of choice and progressed to the current gold standard of care it is today. Digoxin is a cardiac glycoside which acts on the sodium-potassium ATPase pump in cardiac muscle cells and eventually increased the contractile force of the heart (positive inotropic effects) and decrease the heart rate (negative chronotropic effects). Originally it was the main treatment for heart failure, but over time one dangerous feature was noticed about this drug. It had an extremely low therapeutic index of 2, meaning that at just double the dose, it could be extremely toxic!! Digoxin toxicity can cause almost any cardiac arrhythmia which is especially dangerous for patients that already have CHF so it is something that should be kept on extreme watch. Not only that, but there are a lot of other factors that can affect how much digoxin is absorbed in the body, such as the potassium, calcium, and magnesium levels in the body as well as the use of potassium wasting diuretics (another common treatment for patients with heart failure). Eventually, considering all of these factors, the standard of care shifted away from digoxin as the primary drug of choice to a triple therapy of an ACE/ARB inhibitor, beta blocker, and diuretic with digoxin sometimes used in combination. I found the evolution of treatment to be quite interesting when studying it, and it is just one example of the many unique and interesting drugs I have been learning about in the program!
Till next time,
Lekha Thangada
October 31, 2018
# of Volunteer hours (total): 0 hrs.
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