Annals of Tropical Medicine and Public Health | 2019
Caution from using cardiac glycosides digoxin drug which have properties therapeutic index (Ti) narrow compare with the medications wide therapeutic index
Abstract
Clinical research will be based on the practical application of randomly assigned patients over the age of 25 who numbered 730 at the Academic Teaching Hospital in Iraq Samawa. We used drugs narrow therapeutic index (NTI), which is used with caution at a specific and calculated dose because it is life-threatening and has high toxicity. Compared to drugs that have wide therapeutic index (WTI) and less serious effects (such as aspirin, acetaminophen (paracetamol), penicillin, etc.), we selected acetaminophen (paracetamol) in patient research (a wide therapeutic index) and the dose and ratio between the toxic dose and the safe therapeutic dose of the drug, the research focuses on dilution To limit the risk of medication to patients (mortality), which is used as a measure of the relative safety of the drug in a particular drug treatment, our main work is limited to digoxin (cardiac glycosides) used in heart disease, discrimination with other drugs and knowledge, and in comparison to drugs. We used acetaminophen (paracetol) which is a broad indicator, so we based on previous knowledge in clinical pharmacy, dosage medications, therapeutic toxic dose, maximum dose, initial dose, maintenance dose, lethal dose, by knowing Therapeutic index for drug identification, therapeutic index, therapeutic ratio, TI can be calculated as a lethal dose of the drug by 50% of the population (LD50) divided by the minimum effective dose for 50% of the population (ED50), that is, TI = LD50 / ED50. This academic definition of TI is easier to follow in preclinical trials but opens the door to changing explanations in clinical practice. In fact, the definition of therapeutic and / or toxic effect in humans is highly dependent on the type of therapeutic or toxic effect under study, and the drug is generally considered to have a good safety appearance if its TI values exceed the value of 10. The situation is quite different from so-called narrow TI drugs (NTIDs) , Where only a very small set of doses produce a beneficial effect without causing severe and fatal complications, i.e. small differences in their plasma concentrations can lead to inadequate therapeutic response or the appearance of harmful toxic effects. The term “critical dose medication” is sometimes used to refer to drugs where relatively small differences in dosage or concentration may lead to serious therapeutic failure and / or serious drug reactions. Other terms used also include narrow therapeutic window drugs , narrow therapeutic range , critical anti-dose drugs or narrow therapeutic ratio , According to:The US Food and Drug Administration (FDA) defines a medication product as containing NTI when (a) there is less than a double difference in LD50 and medium effective dose values (ED50) or (b) there is less than a double difference in toxic concentrations Minimum (MTC) and minimum effective concentrations (MEC) in the blood and (c) safe and effective use of the drug requires careful calibration and patient monitoring 2018.