Cardiac glycosides increase the force of myocardial contraction and reduce conductivity within the atrio-ventricular (AV) node. These are most useful in the treatment of supraventricular tachycardias.
Indications: treatment of all degrees of congestive heart failure and supraventiricular arrhythmias (particularly atrial fibrillation).
Contraindications: ventricular fibrillations، intermittent complete heart block, second degree AV block, supraventiricular arrhythmias caused by wolf – Parkinson white syndrome، hypertrophic obstructive cardiomyopathy toxic effects present from prior administration of any digitalis preparation, ventricular fibrillation.
Dose and Administration: Orally, rapid digitalization, 1 – 1.5 mg in divided doses over 24 hours; less urgent digitalization, 250 – 500 mcgs daily (higher dose divided). Maintenance، 62.5 – 500 mcgs daily (higher dose divided) according to renal function and, in atrial fibrillation, on heart-rate response; usual range 125 – 250 mcgs daily (elderly125 mcgs). Emergency loading dose by intravenous infusion Adult, 250 – 500 mcgs, over 10 – 20 minutes, followed by further fractions at intervals of 4 – 8 hours (depending on the response), to a total loading dose of 0.5 – 1mg. Note: The above doses may need to be reduced if digoxin (or another cardiac glycoside) has been given in the preceding 2 weeks. For plasma concentration monitoring, blood should ideally be taken at least 6 hours after a dose.
Antidiarrhoeal agents are used as adjuncts in the symptomatic treatment of diarrhea, although the main aim in the management of acute diarrhoea is the correction of fluid and electrolyte depletion with rehydration therapy;
Proton pump inhibitors inhibit gastric acid secretion by blocking the hydrogen-potassium adenosine triphosphatase enzyme system (the ‘proton pump’) of the gastric parietal cell. Proton pump inhibitors are effective short-term treatments for gastric and duodenal ulcers; they are also used in combination with antibacterials for the eradication of Helicobacter pylori In patients with peptic ulcer bleeding, treatment with a proton pump inhibitor reduces the risk of rebleeding and the need for surgery.
Antacids are basic compounds, which neutralize hydrochloric acid in the gastric secretions. They are used to prevent and relieve pain in the symptomatic management of gastro-intestinal disorders associated with gastric hyperacidity such as dyspepsia, gastro-oesphageal reflux disease, and peptic ulcer.
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