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The bicentenary of William Withering's now famous medical report entitled "An Account of the Foxglove and Some of its Medical Uses" has given us the occasion to analyze the state of the art. Cardiac glycosides in 1985 are considered tobe the basis for medical treatment of myocardial failure, together with diuretics and vasodilators in the more severe cases. Nevertheless, the controversy as to their exact place in the treatment of heart failure with sinus rhythm has never ceased. Although cardiac glycosides are of unquestionable value in tachycardia caused by atrial fibrillation or atrial flutter, the chronic use of these drugs in sinus rhythm is not generally accepted. The development of tolerance has been reported. It is of interest that Withering hirnself wrote: "-let it (foxglove) be continued until it either acts on the kidneys, the stomach, the pulse, or the bowels; Iet it be stopped upon the first appearance of any of these effects, and I will maintain that the patient will not suffer from its exhibition, nor the practitioner be disappointed in any reasonable expectation. " In West Germany alone, more than three million patients (about 5% of the total population) are constantly taking cardiac glycosides. These drugs are the most prescribed medicaments in many countries. Thus, we considered it worthwhile and necessary to review in a critical way today's knowledge about the foxglove; to report new findings and to evaluate old Statements.
The bicentenary of William Withering's now famous medical report entitled "An Account of the Foxglove and Some of its Medical Uses" has given us the occasion to analyze the state of the art. Cardiac glycosides in 1985 are considered tobe the basis for medical treatment of myocardial failure, together with diuretics and vasodilators in the more severe cases. Nevertheless, the controversy as to their exact place in the treatment of heart failure with sinus rhythm has never ceased. Although cardiac glycosides are of unquestionable value in tachycardia caused by atrial fibrillation or atrial flutter, the chronic use of these drugs in sinus rhythm is not generally accepted. The development of tolerance has been reported. It is of interest that Withering hirnself wrote: "-let it (foxglove) be continued until it either acts on the kidneys, the stomach, the pulse, or the bowels; Iet it be stopped upon the first appearance of any of these effects, and I will maintain that the patient will not suffer from its exhibition, nor the practitioner be disappointed in any reasonable expectation. " In West Germany alone, more than three million patients (about 5% of the total population) are constantly taking cardiac glycosides. These drugs are the most prescribed medicaments in many countries. Thus, we considered it worthwhile and necessary to review in a critical way today's knowledge about the foxglove; to report new findings and to evaluate old Statements.
Following the monographs by STRAUB (1924) and LENDLE (1935), this is the third contribution to the "Pharmacology of Cardiac Glycosides" within the Handbook of Experimental Pharmacology, which was founded by ARTHUR HEFFTER and con tinued by WOLFGANG HEUBNER. Because of the need created by the length of time that had elapsed since LENDLE'S work, the editorial board requested the rapid ap pearance of this 56th volume, which represents current knowledge of the pharma cology and clinical pharmacology of cardiac glycosides. In order to avoid any delay, numerous authors were invited to contribute because shorter contributions take less time to prepare and are consequently more up-to-date. The disadvantage is that some overlap between certain chapters could not be avoided, despite the editor's efforts. Overlapping can, however, actually be useful, in that differing opinions may be provided and topical issues discussed from varying viewpoints. This re minds the reader that scientific horizons in medicine should often be widened or revised. I would like to thank DR. ALANNA Fox and DR. K. ANANTHARAMAN for their help and advice in the revision of certain chapters. I am also grateful to Springer Verlag, and particularly to MR. WINSTANLEY and MR. EMERSON, for their contribu tion to the completion of this volume through translation and corrections. In con clusion I would like to thank MRS. WALKER, MR. BISCHOFF, MRS. SEEKER, and MR. BERGSTEDT of Springer-Verlag for their helpful support.
An essential text, this is a fully updated second edition of a classic, now in two volumes. It provides rapid access to information on molecular pharmacology for research scientists, clinicians and advanced students. With the A-Z format of over 2,000 entries, around 350 authors provide a complete reference to the area of molecular pharmacology. The book combines the knowledge of classic pharmacology with the more recent approach of the precise analysis of the molecular mechanisms by which drugs exert their effects. Short keyword entries define common acronyms, terms and phrases. In addition, detailed essays provide in-depth information on drugs, cellular processes, molecular targets, techniques, molecular mechanisms, and general principles.
The pharmacokinetics of digitalis glycosides have been the subject of extensive re view (IISALO, 1977; ARONSON, 1980; PERRIER et ai., 1977). Research on glycoside kinetics has progressed at a rapid pace, requiring continuing reevaluation of the state of our understanding of this problem. The present article focuses on the effect of disease states (renal, gastrointestinal, thyroid, and cardiac) on the absorption, distribution, and clearance of a number of digitalis glycosides. Evidence is critically reviewed, and interpreted with respect to possible clinical implications. A. Renal Insufficiency I. Strophanthin Strophanthin disposition in renal failure has been evaluated in only two studies. KRAMER et ai. (1970) determined an elimination half-life of 14 h in normals as com pared to 60 h in anuric patients. Similar results were reported by BRASS and Pm LIPPS (1970) using tritiated strophanthin. They found a half-life value of 18 h in healthy individuals as compared to 68 h in anuric patients. The findings clearly in dicate that the elimination half-life of strophanthin is prolonged in renal failure.
Elsevier now offers a series of derivative works based on the acclaimed Meylers Side Effect of Drugs, 15th Edition. These individual volumes are grouped by specialty to benefit the practicing physician or health care clinician. Each year, heart disease kills more people than cancer. Patients are treated by a variety of specialists and primary care practitioners, depending on the organ system involved. This volume enables practitioners to assess the adverse effects of the complete range of drugs used in cardiovascular medicine, including antihypertensive drugs, and drugs used in the treatment of heart failure, angina, angina pectoris, and cardiac arrhythmia and enable practitioners to prescribe preventative treatments with medications such as blood pressure reducers, aspirin, and cholesterol-lowering drugs, as well as drugs used for more aggressive therapy.The material is drawn from the 15th edition of the internationally renowned encyclopedia, Meyler's Side Effects of Drugs, and the latest volumes in the companion series, Side Effects of Drugs Annuals. Drug names have usually been designated by their recommended or proposed International Non-proprietary Names (rINN or pINN); when those are not available, clinical names have been used. In some cases, brand names have been used.This volume is critical for any health professional involved in the administration of cardiovascular mediations. - Surpasses the Physician's Desk Reference © by including clinical case studies and independent expert analysis - Complete index of drug names - Most complete cross referencing of drug-drug interactions available - Extensive references to primary and secondary literature - Also includes information on adverse effects in pregnancy The book is divided into six sections: - Drugs used to treat hypertension, heart failure and angina pectoris - Diuretics – a general introduction to their adverse effects, followed by monographs on individual drugs - Antidysrhythmic drugs - a general introduction to their adverse effects, followed by monographs on individual drugs - Drugs that act on the cerebral and peripheral circulations - Anticoagulants, thrombolytic agents, and anti-platelet drugs - Cardiovascular adverse effects of non-cardiovascular drugs