- Directly by increasing the positive ionotropic effect on the heart muscles.
- Indirectly by increasing sympathetic nervous system activity (decrease vagal nerve activity).
a) Chemistry of Cardiac glycosides:
Chemistry of aglycone part of cardiac glycosides-
|Structure of cardenolides/cardiac glycosides.|
Chemistry of sugar moieties or glycone part of cardiac glycosides-
b) Pharmacology of cardiac glycosides:
Mechanism of action of cardiac glycosides-
Absorption, metabolism and excretion of cardiac glycosides-
Drug interactions of cardiac glycosides-
- In kidney, p-gp mediated renal tubular secretion of the digoxin do occurs but quinidine inhibits p-gp hence decrease the excretion of digoxin which can raise the plasma con. of the drug to toxic level.
- Verapamil decrease p-gp of intestine and hence decrease intestine excretion of the drug.
- Rifampin induces p-gp and hence enhances the excretion of cardiac glycosides.
- Thiazine and digoxin shows additive or synergism which ultimately leads to increased hypokalemia.
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