Cleveland Clinic journal of medicine
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Digoxin, the oldest known cardiovascular drug, is still used today to treat heart failure and atrial fibrillation. Because it has a narrow therapeutic index and multiple interactions, it frequently causes toxicity with a wide range of symptoms and cardiac arrhythmias. More importantly, elevated serum digoxin levels have been linked to a higher risk of death in patients with heart failure or atrial fibrillation, even without signs or symptoms of toxicity. This article reviews the current state of digoxin use, its pharmacologic principles, and the mechanisms, clinical presentation, and management of toxicity.
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Internists are integral in the multidisciplinary approach to diabetic retinopathy, contributing significantly to the management of diabetes and diabetes-related complications. Effective screening processes, timely referrals, and strategic diabetes management are imperative to prevent and mitigate the consequences of diabetic retinopathy. The evolution of treatments for diabetic retinopathy has markedly improved vision outcomes and reduced the burden on patients. Despite these advances, a collaborative approach to care is essential to prevent the progression of vision impairment and manage associated complications.
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Despite current therapies, heart failure and chronic kidney disease continue to be major causes of morbidity and mortality. Sodium-glucose cotransporter 2 (SGLT-2) inhibitors have recently become standard-of-care therapy for these conditions. This review summarizes important randomized controlled trials of SGLT-2 inhibitors and guidelines for using these agents in patients with heart failure and chronic kidney disease in both clinic and hospital settings.