scholarly journals A CASE REPORT ON DIGOXIN INTOXICATION IN A CLINICAL PHARMACIST’S PERSPECTIVE

2018 ◽  
Vol 11 ◽  
Author(s):  
Saranya Punniyakotti ◽  
Benazeer Begum N
Keyword(s):  
Renal Function ◽  
Case Report ◽  
Drug Therapy ◽  
Drug Interactions ◽  
Therapeutic Range ◽  
Cardiac Failure ◽  
Digoxin Toxicity ◽  
Narrow Therapeutic Range ◽  
Digoxin Intoxication ◽  
Drug Therapy Problems

 Context: Digoxin is a commonly used inotropic drug that has a narrow therapeutic range and is monitored poorly for its plasma concentration. It is commonly used in the management of cardiovascular disorders for its inotropic effects. Increased risk of chronic digoxin toxicity among the patients receiving digoxin pharmacotherapy is related to its narrow therapeutic range. Apart from its inotropic properties, it can also produce chronotropic and dromotropic effect. Its serum levels vary due to changes in body weight, age, renal function, hepatic impairment, and concomitant drug administrations. Patients receiving digoxin should be monitored periodically for potential drug interactions, adverse effects, toxicity, and other drug-related problems. Symptoms of digoxin-induced cardiotoxicity are difficult to be identified and may become fatal too. Therapeutic drug monitoring will play a significant role in reducing such drug therapy problems and will ensure safety and efficacy of the given drug. Case Report: We report a case of chronic digoxin toxicity in a 22-year-old male with congestive cardiac failure - Class IV and atrial fibrillation with ventricular bigeminy. Results: Patient’s renal parameters were elevated and among electrolytes, sodium level was decreased and potassium level was increased. A reduction in the volume of the distribution of digoxin, due to impairment of renal function or congestive cardiac failure, might be one of the reasons for digoxin toxicity. Drug therapy problems (DTPs) such as untreated indication, inappropriate drug therapy, potential major drug-drug interactions, and drugs prescribed when contraindicated were observed. Conclusion: Monitoring digoxin drug therapy can bring down the risk of digoxin intoxication.

Life-threatening digoxin toxicity due to drug–drug interactions in an HIV-positive man

2016 ◽  
Vol 28 (3) ◽  
pp. 297-301 ◽  
Author(s):  
Kathir Yoganathan ◽  
Beth Roberts ◽  
Martyn K Heatley
Keyword(s):  
Drug Interaction ◽  
Case Report ◽  
Drug Interactions ◽  
Digoxin Toxicity ◽  
Hiv Positive ◽  
Hiv Patients ◽  
First Case ◽  
Life Threatening ◽  
Drug Drug Interaction ◽  
Positive Population

Drug–drug interactions with corticosteroids, causing Cushing’s syndrome with secondary adrenal suppression, are well known in HIV patients. Corticosteroids are widely prescribed in the HIV-positive population. However, digoxin is rarely used in HIV patients; hence, digoxin toxicity due to drug–drug interaction is not widely recognised. Nevertheless, this practice might change in the future as HIV cohorts of patients are ageing, due to the successful treatment of HIV infection with combination antiretroviral therapy. We report a case of digoxin toxicity in an HIV-positive 51-year-old man, due to a combination of drug–drug interaction and renal impairment. The first case report of digoxin toxicity due to drug–drug interaction with ritonavir in an HIV-positive woman was published in 2003. To the best of our knowledge, no similar case report has since been published in the literature. This case alerts the profession to the importance of drug–drug interaction and highlights the clinical features of digoxin toxicity.

Apresentação e Evolução Atípicas da Granulomatose de Wegener: Relato de Caso/Atypical Presentation and Evolution of Wegener's Granulomatosis: Case Report

1970 ◽  
Vol 5 (3) ◽  
pp. 53-67
Author(s):  
Aline Dos Santos ◽  
Ana Caroline Balducci Scafi ◽  
Luciene Azevedo Morais ◽  
Pablo Girardelli Mendonça Mesquita
Keyword(s):  
Renal Failure ◽  
Renal Function ◽  
Case Report ◽  
Chronic Renal Failure ◽  
Early Diagnosis ◽  
Wegener’S Granulomatosis ◽  
Immunosuppressive Treatment ◽  
Clinical Manifestations ◽  
Wegener's Granulomatosis ◽  
Creatinine Concentration

RESUMOIntrodução: A Granulomatose de Wegener (GW) é uma vasculite rara e idiopática associada à presença do anticorpo Anticitoplasma de Neutrófilo (ANCA) que acomete, preferencialmente, os pequenos vasos. As manifestações clínicas são diversas, ocorrendo em mais de 90% dos casos, sintomas do trato respiratório. O comprometimento renal é tardio e preditor de mau prognóstico.  Sua morbidade a médio e longo prazo inclui insuficiência renal crônica. A probabilidade de sucesso de manutenção da função renal depende da concentração sérica de creatinina ao início do tratamento, o que indica a importância do diagnóstico e terapêutica adequada precoces. Casuística: Relata-se o caso de uma paciente do sexo feminino, 61 anos, portadora de GW com comprometimento renal avançado à apresentação não precedido por sintomas pulmonares esperados. O tratamento imunossupressor associado a plasmaferese permitiu a melhora da função renal da paciente poupando-a de tornar-se dialítica- dependente. Discussão: A paciente iniciou a doença através de insuficiência renal assintomática, com valores de função renal compatíveis com o estágio mais avançado de doença renal crônica, ultrassonografia dos rins sem alterações compatíveis e sem os sintomas respiratórios esperados. Segundo a literatura, a combinação de imunossupressores e plasmaferese associa-se à recuperação renal em três meses com sobrevivência sem necessidade de diálise por 12 meses, no caso relatado, obteve-se tal resultado em 22 dias sem a necessidade de diálise após um ano. Conclusão: Devido ao diagnóstico precoce, o tratamento adequado foi instalado rapidamente proporcionando à paciente um aumento da expectativa e da qualidade de vida, evitando dependência de terapia renal substitutiva.Palavras-Chave: Granulomatose de Wegener, Plasmaferese, Doença renal crônica.  ABSTRACTIntroduction: The Wegener's Granulomatosis (WG) is a rare and idiopathic vasculitis associated with the presence of Antineutrophil Cytoplasmic Antibody (ANCA), that affects, preferentially, the small vessels. The clinical manifestations are diverse, occurring in over 90% of cases, symptoms in the respiratory tract. Kidney damage is a late and bad prognostic predictor. Morbidity in the medium and long term includes chronic renal failure. The probability of renal function maintenance success depends on serum creatinine concentration at the beginning of treatment that indicates the importance of early diagnosis and deployment of an appropriate therapy. Case Report: We present a case of a 61-year-old female patient, carrier of GW with advanced renal impairment presentation, not preceded by expected pulmonary symptoms. The immunosuppressive treatment associated with plasmapheresis allowed the improvement of the patient’s renal function, saving her from becoming dialysis-dependent Discussion: The patient developed the disease through asymptomatic renal failure, renal function with values that are compatible with the most advanced stage of chronic kidney disease, ultrasound of the kidneys without compatible changes and without the expected respiratory symptoms. According to the literature, the combination of immunosuppressive drugs and plasmapheresis is associated with renal recovery in three months with survival without dialysis for 12 months. In this case, a result was obtained in 22 days without the need for dialysis after one year. Conclusion: Due to the early diagnosis, appropriate treatment was quickly installed giving the patient increased life expectancy and quality, preventing dependence on renal replacement therapy.Keywords: Wegener’s granulomatosis, Plasmapheresis, Chronic renal failure.

scholarly journals Drug therapy problems identified among older adults placed in a nursing home: the Croatian experience

2020 ◽  
Vol 48 (6) ◽  
pp. 030006052092879
Author(s):  
Katarina Fehir Šola ◽  
Iva Mucalo ◽  
Andrea Brajković ◽  
Ivona Jukić ◽  
Donatella Verbanac ◽  
...  
Keyword(s):  
Nursing Home ◽  
Drug Therapy ◽  
Medication Management ◽  
Institutional Care ◽  
Nursing Home Residents ◽  
Median Number ◽  
Cross Sectional ◽  
High Prevalence ◽  
Care Facilities ◽  
Drug Therapy Problems

Objective The aim of this study was to determine the frequency and type of drug therapy problems (DTPs) in older institutionalized adults. Method We conducted a cross-sectional observational study from February to June 2016 at a 150-bed public nursing home in Croatia, where comprehensive medication management (CMM) services were provided. A rational decision-making process, referred to as the Pharmacotherapy Workup method, was used to classify DTPs. Results Data were prospectively collected from 73 residents, among which 71% were age 75 years or older. The median number of prescribed medications per patient was 7 (2–16) and polypharmacy (> 4) was recorded for 54 (74.0%) patients. A total 313 DTPs were identified, with an average of 4.3 ± 2 DTPs per patient. The most frequent DTP was needing additional drug therapy (n = 118; 37.7%), followed by adverse drug reaction (n = 55; 17.6%). Lactulose (14.4%), tramadol (6.7%), and potassium (6.4%) were the medications most frequently related to DTPs. Conclusion The high prevalence of DTPs identified among older institutionalized adults strongly suggests the need to incorporate new pharmacist-led CMM services within existing institutional care facilities, to improve the care provided to nursing home residents.

scholarly journals Herb–Drug Interactions: Worlds Intersect with the Patient at the Center

Medicines ◽  
2021 ◽  
Vol 8 (8) ◽  
pp. 44
Author(s):  
Mary Beth Babos ◽  
Michelle Heinan ◽  
Linda Redmond ◽  
Fareeha Moiz ◽  
Joao Victor Souza-Peres ◽  
...  
Keyword(s):  
Drug Interaction ◽  
Case Report ◽  
Drug Interactions ◽  
Clinical Studies ◽  
Drug Information ◽  
Case Reports ◽  
Full Information ◽  
Information Need ◽  
Herbal Products ◽  
Reduce Risk

This review examines three bodies of literature related to herb–drug interactions: case reports, clinical studies, evaluations found in six drug interaction checking resources. The aim of the study is to examine the congruity of resources and to assess the degree to which case reports signal for further study. A qualitative review of case reports seeks to determine needs and perspectives of case report authors. Methods: Systematic search of Medline identified clinical studies and case reports of interacting herb–drug combinations. Interacting herb–drug pairs were searched in six drug interaction resources. Case reports were analyzed qualitatively for completeness and to identify underlying themes. Results: Ninety-nine case-report documents detailed 107 cases. Sixty-five clinical studies evaluated 93 mechanisms of interaction relevant to herbs reported in case studies, involving 30 different herbal products; 52.7% of these investigations offered evidence supporting reported reactions. Cohen’s kappa found no agreement between any interaction checker and case report corpus. Case reports often lacked full information. Need for further information, attitudes about herbs and herb use, and strategies to reduce risk from interaction were three primary themes in the case report corpus. Conclusions: Reliable herb–drug information is needed, including open and respectful discussion with patients.

Multiple drug interactions - induced serotonin syndrome: a case report

2009 ◽  
Vol 34 (4) ◽  
pp. 485-487 ◽  
Author(s):  
E. Montané ◽  
A. Barriocanal ◽  
I. Isern ◽  
T. Parajon ◽  
J. Costa
Keyword(s):  
Case Report ◽  
Drug Interactions ◽  
Serotonin Syndrome ◽  
Multiple Drug

scholarly journals Nitrofurantoin-Associated Acute Granulomatous Interstitial Nephritis

2021 ◽  
Vol 9 ◽  
pp. 232470962110016
Author(s):  
B. K. Anupama ◽  
Parth Sampat ◽  
Harvir S. Gambhir
Keyword(s):  
Acute Kidney Injury ◽  
Renal Function ◽  
Case Report ◽  
Interstitial Nephritis ◽  
Visual Hallucination ◽  
Kidney Injury ◽  
Corticosteroid Administration ◽  
Granulomatous Interstitial Nephritis ◽  
Rare Association ◽  
New Onset

We report the case of a 71-year-old female who was incidentally found to have nonoliguric acute kidney injury on a routine workup for new-onset visual hallucination. Further history revealed inadvertent usage of nitrofurantoin for 3 months for an anticipated urological procedure. Renal biopsy demonstrated acute granulomatous interstitial nephritis. The renal function significantly improved following discontinuation of nitrofurantoin and corticosteroid administration. We highlight a rare association of nitrofurantoin with acute granulomatous interstitial nephritis through this case report.

HEMANGIOMA OF THE LIVER WITH HEART FAILURE: A CASE REPORT

PEDIATRICS ◽  
1954 ◽  
Vol 14 (2) ◽  
pp. 117-121
Author(s):  
ROBERT W. WINTERS ◽  
SAUL J. ROBINSON ◽  
GEORGE BATES
Keyword(s):  
Heart Failure ◽  
Congenital Heart Disease ◽  
Heart Disease ◽  
Case Report ◽  
Cardiac Hypertrophy ◽  
Cardiac Failure ◽  
Congenital Heart ◽  
Signs And Symptoms ◽  
Post Mortem ◽  
Great Vessels

A case of multiple hemangiomata of the liver is reported in an infant who presented signs and symptoms strongly suggesting congenital heart disease. The post mortem examination revealed no gross anomalies of the heart or great vessels, but did show a heart with cardiac hypertrophy. A mechanism to explain the cardiac failure in this case is discussed.

scholarly journals EVALUATION OF DRUG THERAPY PROBLEMS IN ASTHMA PATIENTS RECEIVING CARE IN TWO HOSPITALS IN SOUTH-EASTERN NIGERIA

2018 ◽  
Vol 10 (2) ◽  
pp. 50
Author(s):  
Kosisochi Chinwendu Amorha ◽  
Anthony Chukwuma Onu ◽  
Chigozie Gloria Anene-okeke ◽  
Chinwe Victoria Ukwe
Keyword(s):  
Drug Therapy ◽  
Adverse Reactions ◽  
Tertiary Hospital ◽  
Medical Centre ◽  
New Drugs ◽  
Inappropriate Drug ◽  
Cross Sectional ◽  
South Eastern ◽  
Asthma Patients ◽  
Drug Therapy Problems

Objective: To evaluate drug therapy problems in asthma patients visiting a secondary and tertiary hospital in South-Eastern Nigeria.Methods: This study was a retrospective, cross-sectional analyses of the medical records of adult asthmatic patients receiving care in two hospitals in Enugu State, within a 15-year period. The Pharmaceutical Network Care Europe (PCNE) tool version 6.2 was used to assess drug therapy problems. The IBM Statistical Product for Services Solution (SPSS) version 20.0 was used for analysis. For all results, P ≤ 0.05 was considered statistically significant.Results: Majority of the patients were below 60 y old (81.2%); female (68.8%) and were on more than two drugs (95.3%). Majority of the identified drug therapy problems (DTPs) were adverse reactions (65.7%). The inappropriate drug combination was the major cause of DTPs (65.6%). Only about 23.4% of the intervention outcomes were known. University of Nigeria Teaching Hospital (UNTH) had more interventions (35.9%) than Medical Centre (8.0%) (χ2 = 6.323; df = 1; **P = 0.012); and more of the outcomes of their interventions known (38.5%) compared to Medical Centre (0.0%) (χ2 = 12.559; df = 1; **P ˂ 0.001).Conclusion: Adverse reactions and inappropriate drug selection were the major identified DTPs and major cause of DTPs, respectively. Most DTPs had no interventions. The documented interventions included stopping of the drugs, change of drugs or dosage, change of instructions for use and starting of new drugs. Most interventions had unknown outcomes. UNTH had more interventions with known outcomes than the University of Nigeria Medical Centre.

scholarly journals Transient hyperammonaemia in an adult German shepherd dog : case report

1997 ◽  
Vol 68 (2) ◽  
Author(s):  
R.G. Lobetti ◽  
D.B. Miller ◽  
T. Dippenaar
Keyword(s):  
Case Report ◽  
Liver Disease ◽  
Urinary Tract ◽  
Drug Therapy ◽  
Urea Cycle ◽  
Urinary Tract Obstruction ◽  
German Shepherd ◽  
Cycle Enzyme ◽  
German Shepherd Dog ◽  
Urea Cycle Enzyme

A 3-year-old male German shepherd dog was presented with severe generalised seizures. The dog was protein-intolerant and showed severe hyperammonaemia on ammonia stimulation. The hyperammonaemic state was present for at least 6 weeks and then spontaneously resolved. No obvious cause (liver disease, portocaval shunts, urea cycle enzyme deficiencies, drug therapy or urinary tract obstruction) could be identified. It is possible that this dog had a variation of transient hyperammonaemic syndrome, described in man and recently in a juvenile Irish wolfhound, that extended into adulthood.

Sign in / Sign up

Export Citation Format

Share Document