WordNet

a powerful cardiac stimulant obtained from foxglove (同)digitalis_glycoside, digitalin
any of several plants of the genus Digitalis (同)digitalis
relating to or performed with the fingers; "digital examination"
displaying numbers rather than scale positions; "digital clock"; "digital readout"
of a circuit or device that represents magnitudes in digits; "digital computer"

PrepTutorEJDIC

〈C〉ジギタリス(ゴマノハグサ科の植物) / 〈U〉その葉からとった強心剤
ジギタリス(釣り鐘状の紅紫色または白色の花をつける;葉は強心剤に用いる)
指の / 数字の;計数型の / (タイプライターなどの)鍵(けん),キー

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2014/07/13 23:16:09」(JST)

wiki en

Digitalis /ˌdɪdʒɨˈteɪlɨs/^[2] or /ˌdɪdʒɨˈtælɨs/^[3] is a genus of about 20 species of herbaceous perennials, shrubs, and biennials commonly called foxgloves. This genus was traditionally placed in the figwort family Scrophulariaceae, but recent phylogenetic research has placed it in the much enlarged family Plantaginaceae.^[1] This genus is native to western and southwestern Europe,^[4] western and central Asia, Australasia and northwestern Africa. The scientific name means "finger-like" and refers to the ease with which a flower of Digitalis purpurea can be fitted over a human fingertip. The flowers are produced on a tall spike, are tubular, and vary in colour with species, from purple to pink, white, and yellow. The best-known species is the common foxglove, Digitalis purpurea. This biennial plant is often grown as an ornamental plant due to its vivid flowers which range in colour from various purple tints through various shades of light gray, and to purely white. The flowers can also possess various marks and spottings.

The first year of growth of the common foxglove produces only the stem with its long, basal leaves. During the second year of the plant's life, a long, leafy stem from 50 to 255 centimeters tall grows atop the roots of healthy plants.

The larvae of the moth the "foxglove pug" consume the flowers of the common foxglove for food. Other species of Lepidoptera eat the leaves, including lesser yellow underwing.

The term digitalis is also used for drug preparations that contain cardiac glycosides, particularly one called digoxin, extracted from various plants of this genus.

Etymology

Many suggestions for the derivation of the name "foxglove" have been proffered. According to the 19th-century book, English Botany, Or, Coloured Figures of British Plants:

Dr. Prior, whose authority is great in the origin of popular names, says "It seems probably that the name was in the first place, foxes' glew, or music, in reference to the favourite instrument of an earlier time, a ring of bells hung on an arched support, the tintinnabulum"... we cannot quite agree with Dr. Prior for it seems quite probable that the shape of the flowers suggested the idea of a glove, and that associated with the name of the botanist Fuchs, who first gave it a botanical name, may have been easily corrupted into foxglove. It happens, moreover, the name foxglove is a very ancient one and exists in a list of plants as old as the time of Edward III. The "folks" of our ancestors were the fairies and nothing is more likely than that the pretty coloured bells of the plant would be designated "folksgloves," afterwards, "foxglove." In Wales it is declared to be a favourite lurking-place of the fairies, who are said to occasion a snapping sound when children, holding one end of the digitalis bell, suddenly strike the other on the hand to hear the clap of fairy thunder, with which the indignant fairy makes her escape from her injured retreat. In south of Scotland it is called "bloody fingers" more northward, "deadman's bells" whilst in Wales it is known as "fairy-folks-fingers" or "lambs-tongue-leaves".^[5]

Habitat

Digitalis species thrive in acidic soils, in partial sunlight to deep shade, in a range of habitats, including open woods, woodland clearings, moorland and heath margins, sea-cliffs, rocky mountain slopes and hedge banks.^[4]^[6] It is commonly found on sites where the ground has been disturbed, such as recently cleared woodland, or where the vegetation has been burnt.^[7]

Medicinal uses

Cardiac

A group of medicines extracted from foxglove plants are called Digitalin. The use of D. purpurea extract containing cardiac glycosides for the treatment of heart conditions was first described in the English-speaking medical literature by William Withering, in 1785,^[8] which is considered the beginning of modern therapeutics.^[9]^[10] It is used to increase cardiac contractility (it is a positive inotrope) and as an antiarrhythmic agent to control the heart rate, particularly in the irregular (and often fast) atrial fibrillation. Digitalis is hence often prescribed for patients in atrial fibrillation, especially if they have been diagnosed with congestive heart failure. Digoxin was approved for heart failure in 1998 under current regulations by the Food and Drug Administration on the basis of prospective, randomized study and clinical trials. It was also approved for the control of ventricular response rate for patients with atrial fibrillation. American College of Cardiology/American Heart Association guidelines recommend digoxin for symptomatic chronic heart failure for patients with reduced systolic function, preservation of systolic function, and/or rate control for atrial fibrillation with a rapid ventricular response. Heart Failure Society of America guidelines for heart failure provide similar recommendations. Despite its relatively recent approval by the Food and Drug Administration and the guideline recommendations, the therapeutic use of digoxin is declining in patients with heart failure—likely the result of several factors. Digoxin has not been promoted by the pharmaceutical industry and has received little attention at national and international meetings—possibly due to the development and promotion of other, newly patented therapies for heart failure. Safety concerns regarding a proposed link between digoxin therapy and increased mortality in women may also be contributing to the decline in therapeutic use of digoxin.

Variations

A group of pharmacologically active compounds are extracted mostly from the leaves of the second year's growth, and in pure form are referred to by common chemical names, such as digitoxin or digoxin, or by brand names such as Crystodigin and Lanoxin, respectively. The two drugs differ in that digoxin has an additional hydroxyl group at the C-3 position on the B-ring (adjacent to the pentane). Both molecules include a lactone and a triple-repeating sugar called a glycoside.

Mechanism of action

Digitalis works by inhibiting sodium-potassium ATPase. This results in an increased intracellular concentration of sodium ion and thus a decreased concentration gradient across the cell membrane. This increase in intracellular sodium causes the Na/Ca exchanger to reverse potential, i.e., transition from pumping sodium into the cell in exchange for pumping calcium out of the cell, to pumping sodium out of the cell in exchange for pumping calcium into the cell. This leads to an increase in cytoplasmic calcium concentration, which improves cardiac contractility. Under normal physiological conditions, the cytoplasmic calcium used in cardiac contractions originates from the sarcoplasmic reticulum, an intracellular organelle that specializes in the storage of calcium. Human newborns, some animals, and patients with chronic heart failure lack well developed and fully functioning sarcoplasmic reticula and must rely on the Na/Ca exchanger to provide all or a majority of the cytoplasmic calcium required for cardiac contraction. For this to occur, cytoplasmic sodium must exceed its typical concentration to favor a reversal in potential, which naturally occurs in human newborns and some animals primarily through an elevated heart rate; in patients with chronic heart failure it occurs through the administration of digitalis. As a result of increased contractility, stroke volume is increased. Ultimately, digitalis increases cardiac output (Cardiac Output=Stroke Volume x Heart Rate). This is the mechanism that makes this drug a popular treatment for congestive heart failure, which is characterized by low cardiac output. Digitalis also has a vagal effect on the parasympathetic nervous system, and as such is used in re-entrant cardiac arrhythmias and to slow the ventricular rate during atrial fibrillation. The dependence on the vagal effect means digitalis is not effective when a patient has a high sympathetic nervous system drive, which is the case with acutely ill persons, and also during exercise.

Toxicity

Digitalis toxicity (Digitalis intoxication) results from an overdose of digitalis and causes nausea, vomiting and diarrhoea, as well as sometimes resulting in xanthopsia (jaundiced or yellow vision) and the appearance of blurred outlines (halos), drooling, abnormal heart rate, cardiac arrhythmias, weakness, collapse, dilated pupils, tremors, seizures, and even death. Bradycardia also occurs. Because a frequent side effect of digitalis is reduction of appetite, some individuals have used the drug as a weight-loss aid.

Digitalis is an example of a drug derived from a plant that was formerly used by folklorists and herbalists; herbalists have largely abandoned its use because of its narrow therapeutic index and the difficulty of determining the amount of active drug in herbal preparations. Once the usefulness of digitalis in regulating the human pulse was understood, it was employed for a variety of purposes, including the treatment of epilepsy and other seizure disorders, which are now considered to be inappropriate treatments.

Digitalis purpurea drawings by Franz Köhler

Depending on the species, the digitalis plant may contain several deadly physiological and chemically related cardiac and steroidal glycosides. Thus, the digitalis plants have earned several, more sinister, names: dead man’s bells and witch's gloves.

The entire plant is toxic (including the roots and seeds). Mortality is rare, but case reports do exist. Most plant exposures occur in children younger than six years and are usually unintentional and without associated significant toxicity. More serious toxicity occurs with intentional ingestions by adolescents and adults.^[11] Early symptoms of ingestion include nausea, vomiting, diarrhoea, abdominal pain, wild hallucinations, delirium, and severe headache. Depending on the severity of the toxicosis, the victim may later suffer irregular and slow pulse, tremors, various cerebral disturbances, especially of a visual nature (unusual colour visions (see xanthopsia) with objects appearing yellowish to green, and blue halos around lights), convulsions, and deadly disturbances of the heart. For a case description, see the paper by Lacassie.^[12] Vincent van Gogh's "Yellow Period" may have been influenced by digitalis therapy which, at the time, was thought to control seizures. As noted above, other oculotoxic effects of digitalis include generalized blurry vision, as well as seeing a "halo" around each point of light.^[13]

In some instances, people have confused digitalis with the relatively harmless comfrey (Symphytum ) plant, which is often brewed into a tea, with fatal consequences. Other fatal accidents involve children drinking the water in a vase containing digitalis plants.^[14] Drying does not reduce the toxicity of the plant. The plant is toxic to animals, including all classes of livestock and poultry, as well as felines and canines.

Digitalis poisoning can cause heart block and either bradycardia (decreased heart rate) or tachycardia (increased heart rate), depending on the dose and the condition of one's heart. Notably, the electric cardioversion (to "shock" the heart) is generally not indicated in ventricular fibrillation in digitalis toxicity, as it can increase the dysrhythmia.^{[citation needed]} Also, the classic drug of choice for ventricular fibrillation in emergency setting,^[15] amiodarone, can worsen the dysrhythmia caused by digitalis, therefore, the second-choice drug lidocaine is more commonly used.^{[citation needed]}

Digoxigenin

Digoxigenin (DIG) is a steroid found exclusively in the flowers and leaves of the plants D. purpurea and D. lanata. It is used as a molecular probe to detect DNA or RNA. It can easily be attached to nucleotides by chemical modifications. DIG molecules are often linked to uridine nucleotides; DIG-labelled uridine (DIG-U) can then be incorporated into RNA probes via in vitro transcription. Once hybridisation occurs in situ, RNA probes with the incorporated DIG-U can be detected with anti-DIG antibodies that are conjugated to alkaline phosphatase. To reveal the hybridised transcripts, alkaline phosphatase can be reacted with a chromogen to produce a coloured precipitate.

Digitalis lutea

Footnotes

^ ^a ^b Olmstead, R. G., dePamphilis, C. W., Wolfe, A. D., Young, N. D., Elisons, W. J. & Reeves P. A. (2001). "Disintegration of the Scrophulariaceae". American Journal of Botany (American Journal of Botany, Vol. 88, No. 2) 88 (2): 348–361. doi:10.2307/2657024. JSTOR 2657024. PMID 11222255.
^ OED: "Digitalis"
^ Digitalis at Dictionary.com]
^ ^a ^b Anon. "Foxglove (Digitalis purpurea)". Arkive: images of life on Earth. Wildscreen. Retrieved 6 May 2010.
^ Lankester, Mrs. (1866). Boswell J.T., ed. English Botany, Or, Coloured Figures of British Plants (full text). VI campanulacae to verbanacea. Sowerby J, Smith C, Johnson J.E, Salter J.W. (III ed.). London: Edward Hardwicke. p. 128.
^ Anon. "Foxglove: Digitalis purpurea (Scrophulariaceae)". Wildflowers in Bloom. Wildseed farms. Retrieved 7 May 2010.
^ Klein, Carol (18 May 2002). "How to grow: Foxgloves". The Telegraph (London, UK: Telegraph Media Group Limited). Retrieved 6 May 2010.
^ Goldthorp WO (2009). "Medical Classics: An Account of the Foxglove and Some of its Medicinal Uses by William Withering, published 1785". Brit Med J 338: b2189.
^ In contemporary medicine, a purer form of digitalis (usually digoxin) is obtained from D. lanata.
^ Digoxin comes from Digitalis lanata. Hollman A. BMJ 1996;312:912. online version accessed 18 October 2006 [1]
^ "Cardiac Glycoside Plant Poisoning: Medscape reference". Retrieved 3 July 2012.
^ A non-fatal case of intoxication with foxglove, documented by means of liquid chromatography-electrospray-mass spectrometry. Lacassie E et al., J Forensic Sci. 2000 Sep;45(5):1154-8. Abstract accessed online 19 September 2006. [2]
^ Goldfrank LW (2006). Goldfrank's Toxicologic Emergencies (8th ed.). New York: McGraw-Hill.
^ Anon. "Notes on poisoning:Digitalis purpura". Canadian poisonous plants information system. Canadian Biodiversity Information Facility. Retrieved 9 March 2013.
^ "European Resuscitation Council". ^{[verification needed]}

References

Richard B. Silverman, The Organic Chemistry of Drug Design and Drug Action.
Flora of Turkey. Edinburgh University Press.

External links

Wikimedia Commons has media related to Digitalis.

Look up digitalis in Wiktionary, the free dictionary.

"Digitalis". Natural Resources Conservation Service PLANTS Database. USDA.
Flora Europaea: Digitalis species list
Molecule of the Month - Digitalis
eMedicine link
Grecian Foxglove USDA Noxious Weed List.
Purple Foxglove USDA Noxious Weed List.
"Digitalis". Encyclopædia Britannica (11th ed.). 1911.
"Foxglove". Collier's New Encyclopedia. 1921.

UpToDate Contents

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1. ジゴキシンによる治療：初回投与、モニタリング、および用量変更 treatment with digoxin initial dosing monitoring and dose modification
2. ジギタリス（強心配糖体）中毒 digitalis cardiac glycoside poisoning
3. 収縮能障害による心不全におけるジゴキシンの使用 use of digoxin in heart failure due to systolic dysfunction
4. ジゴキシン中毒による不整脈 cardiac arrhythmias due to digoxin toxicity
5. ジゴキシン中毒患者におけるジゴキシン特異的抗体（Fab）フラグメントに対する投与レジメン dosing regimen for digoxin specific antibody fab fragments in patients with digoxin toxicity

English Journal

Medicinal plants, human health and biodiversity: a broad review.

Sen T1, Samanta SK.
Advances in biochemical engineering/biotechnology.Adv Biochem Eng Biotechnol.2015;147:59-110. doi: 10.1007/10_2014_273.
: Biodiversity contributes significantly towards human livelihood and development and thus plays a predominant role in the well being of the global population. According to WHO reports, around 80 % of the global population still relies on botanical drugs; today several medicines owe their origin to
PMID 25001990

Calcium store stability as an antiarrhythmic endpoint.

Zaza A, Rocchetti M1.
Current pharmaceutical design.Curr Pharm Des.2015;21(8):1053-61.
Cardiac arrhythmias are electrical phenomena; thus, sarcolemmal ion channels have long been considered as targets of antiarrhythmic therapy. The contribution of abnormal intracellular Ca(2+) handling to digitalis-induced arrhythmogenesis is an old concept; however, the role of abnormal Ca(2+) handli
PMID 25354186

Purification of Δ(5)-3-ketosteroid isomerase from Digitalis lanata.

Meitinger N1, Geiger D2, Augusto TW2, Maia de Pádua R3, Kreis W2.
Phytochemistry.Phytochemistry.2015 Jan;109:6-13. doi: 10.1016/j.phytochem.2014.10.025. Epub 2014 Nov 14.
The isomerization of 5-pregnene-3,20-dione into 4-pregnene-3,20-dione was investigated to shed further light on cardenolide biosynthesis and to characterize the enzymes involved in cardenolide formation. It was shown that the Δ(5)-3-ketosteroid isomerase of Digitalis lanata, which catalyzes this is
PMID 25468533

Japanese Journal

精神症状の鑑別に苦慮しジギタリス中毒の診断に至ったアルツハイマー型認知症の1例

出口裕彦,橋本博史,小西章仁 [他]
臨床精神医学 43(8), 1193-1197, 2014-08
NAID 40020171522

New Cardenolide Glycosides from the Seeds of Digitalis purpurea and Their Cytotoxic Activity

KURODA Minpei,KUBO Satoshi,MATSUO Yukiko,ATOU Tomomi,SATOH Junichi,FUJINO Tomofumi,HAYAKAWA Makio,MIMAKI Yoshihiro
Bioscience, biotechnology, and biochemistry 77(6), 1186-1192, 2013-06-23
NAID 10031184679

ジギタリス様物質に関する研究 : 医療薬学的取り組み

井尻好雄,加藤隆児
大阪薬科大学紀要 (7), 143-150, 2013
NAID 40019614638

Related Pictures

★リンクテーブル★

リンク元	「100Cases 76」「ジギタリス」「強心配糖体」「foxglove」
拡張検索	「erosio interdigitalis blastomycetica」
関連記事	「digital」

「100Cases 76」

Foxglove
	Digitalis purpurea (Common Foxglove)
Scientific classification
Kingdom:	Plantae
(unranked):	Angiosperms
(unranked):	Eudicots
(unranked):	Asterids
Order:	Lamiales
Family:	Plantaginaceae
Genus:	Digitalis; L.
Species
	Over 20 species, including:; Digitalis canariensis; Digitalis cariensis; Digitalis ciliata; Digitalis davisiana; Digitalis dubia; Digitalis ferruginea; Digitalis x fulva; Digitalis grandiflora; Digitalis isabelliana; Digitalis laevigata; Digitalis lanata; Digitalis leucophaea; Digitalis lutea; Digitalis mariana; Digitalis micrantha; Digitalis obscura; Digitalis parviflora; Digitalis purpurea; Digitalis sceptrum; Digitalis thapsi; Digitalis trojana; Digitalis viridiflora

　　[★]

☆case76　頭痛

■glossary

傾眠 drowsiness 正常、病的の区別なく眠り込む場合に用いられる

意識不鮮明　 confusion 周囲に対する認識や理解は低下し、思考の清明さや、記憶の正確さが失われる

錯乱　 confusion　夢幻様状態より見当識障害と思考の滅裂が見られる状態(PSY.40)

MA = Master of Arts 文学修士

　The Master of Arts (BrE: MA, UsE: M.A.) is awarded in Arts, Humanities, Theology and Social Sciences (Wikipedia)

graduate student 大学院生

rousable adj. 覚醒できる、目を覚ますことができる

rouse vt. ～の目を覚まさせる、呼び起こす。喚起する、鼓舞する、奮起させる。(感情を)起こさせる、かき立てる

lateralize vt. (生理)(大脳が)(左右半球に心的機能差がある、左右差がある。(器官・機能・活動などが)大脳の(左右いずれかの)片側優位下にある。(医学)(障害などが)大脳の片半球にあると診断される

乳頭浮腫 papilledema 原因を問わず視神経乳頭が腫脹している状態

うっ血乳頭 choked disc 脳圧亢進による乳頭浮腫

■症例

24歳、男性　精神学の修士過程を専攻している大学院生

主訴：激しい頭痛

現病歴：頭部全体に痛みがある。2回嘔吐。傾眠と錯乱が認められるようになった。明るい光を嫌う()he finds bright lights uncomfortable。

既往歴：病気の既往はない。アレルギーはない。タバコ1日10本。アルコール24 unit/week(缶ビール(350ml)13.7本/週)。薬は服用してない。

家族歴：彼女と同居。3歳と4歳の子供がいる。

・診察 examination

　見た感じ紅潮しており、調子が悪そう。体温：39.2℃。項部硬直あり(he has stiffness on passice flexion of his neck)。皮疹なし。副鼻腔に圧痛なし。鼓膜所見は正常。脈拍：120/分。血圧：98/74 mmHg。心血管系、胸部、腹部に異常所見なし(normal)。意識レベル低下。命令に応じて覚醒する(JCS10？)。局所神経症状認めない。眼底所見正常

・検査 investigation

　血液検査

　　白血球：上昇。血清 Na：低下。血清尿素：上昇。血清クレアチニン：上昇。血液培養：検査中

　画像検査

　　胸部X線：異常所見なし。頭部 CT：正常

　心電図：洞性頻脈

　腰椎穿刺

　　髄液所見：混濁。白血球：増多。蛋白：増多。糖：低下(普通の人の血糖100mg/dLと考える。→　1g/L　→　1/180　mol/L　→　5.56 mmol/L。グラム染色：結果待ち

■Q

　診断、鑑別診断、管理

■A

　細菌性髄膜炎、髄膜炎・クモ膜下出血、経験的抗菌薬投与・

■解説

(第1パラグラフ)細菌性髄膜炎

・(症状)突然発症。激しい頭痛、嘔吐、錯乱、羞明、項部硬直

・低血圧、白血球増多、腎機能低下　→　ウイルス性よりむしろ細菌性の感染を示唆する。　←　重症敗血症～敗血症ショックかな？(私見)

・(髄膜炎菌の種類)

＜テーブル挿入　髄膜炎＞

・(疫学)HIM. 2621 (多分、全患者中(←私見))

　Streptococcus pneumoniae ～50%

　Neisseria meningitidis ～25%、

　group B streptococci ～15%

　Listeria monocytogenes ～10%

　Haemophilus influenzae type B <10%

・Neisseria meningitidisは全身性の脈管の皮疹(点状出血、紫斑)が特徴的(generalized vasculitic rash)

(第2パラグラフ)鑑別診断

・激しい頭痛

　・the most severe headaches are experienced in meningitis, subarachnoid hemorrhage and classic migraine.

　　・meningitis：単回の発作(single episode)。症状は時間単位で出現。

　　・subarachnoid hemorrhage：単回の発作(single episode)。突然発症(突発完成？)。硝子体出血を認めることがある。

　　・classic migraine：繰り返す(数回/年～1回/週。平均月2回。発作は4-72時間継続)

・髄膜刺激：急性に発熱をきたした多くの病態でみられる(acute febrile conditions)。特に子供。　←　そうなの？

・頚部硬直：頚部や脊椎の局所感染症でも起こる。　←　パーキンソン病などによる筋トーヌスの異常亢進も除外しよう

・他の髄膜炎：脳脊髄液所見で鑑別する

(第3パラグラフ)経験的治療

・(細菌性)髄膜炎が疑われたら、確定診断する前に適切な抗菌薬を投与(empirical treatment)。　→　数時間の経過で死亡することがある。

・ペニシリンアレルギーがなければ、ceftriaxoneかceftaximeの静脈内投与が一般的な治療法

(第4パラグラフ)腰椎穿刺

・乳頭浮腫がない、あるいは占拠性病変を示唆する片側性の神経徴候(lateralized neurological signs)がある患者では(CTの結果を待たずに)腰椎穿刺をすぐにやるべき(CASES)　←　どういう事？

・局在性の神経徴候(localized neurological sign)がある場合はまずCTを撮るべき(CASES)。　→　the dangers of coning　←　鉤ヘルニアの事？

(第5パラグラフ)細菌性髄膜炎の管理

・診断：CSF 検査(グラム染色、髄液培養(確定診断、感受性試験)

・管理

　・意識が低下しているのでそれなりの看護(must be nursed)。アヘン剤による鎮痛。生理食塩水による低ナトリウム血症の補正。低血圧を補正するために inotrope(a drug with positive inotropic effects, e.g. dobutamine, digitalis, milrinone )も必要かもしれない。(100CASES)

　・感受性のある抗菌薬の投与(大量静注、髄液移行性の高いもの)、髄液所見の正常化・CRP 陰転後、1週間抗菌薬を投与して治療を終了。対症療法として脳圧亢進には高張脳圧降下薬(マンニトールなど)を投与。(IMD.1042)

(第6パラグラフ)家族構成を考えた治療

・(意訳)誰が3-4歳の世話をしていたのか分からないけど、子供も検査すべき。髄膜炎菌か原因菌が不明だったら、リファンピシンによる予防的治療と髄膜炎球菌に対する予防接種をすべき。　←　日本ではどうなんでしょうか。

□350ml アルコール5%

350x0.05/10=1.75 unit

■莢膜を有し、髄膜炎を起こす細菌　→　莢膜を有することで血液中で補体などを介した貪食を免れ、血行性にクモ膜下腔まで到達しうる。

・Streptococcus pneumoniae

・Haemophilus influenzae type b

・Neisseria meningitidis

■敗血症

・定義

　感染症による全身性炎症反応症候群(SIRS)をセプシス(sepsis, 広義の敗血症？)とする

　感染症の病原体は、一般細菌(グラム陽性菌・陰性菌)、真菌、寄生虫、ウイルスなど

　皮膚や粘膜の傷とか、種々の臓器にある感染巣から、細菌がリンパ流から血中に入り、全身に播種されて、新たに転移性の感染巣をつくり、重篤な全身症状を引き起こす。

・全身性炎症反応症候群の診断基準

　下記項目のうち2項目以上が当てはまる

　　1. 体温>38℃ or 体温<36℃

　　2. 心拍数>90bpm

　　3. 呼吸数>20回/min or PaCO2<32mmHg

　　4. (白血球数>12,000/ul or 白血球数<4,000/ul) or ( 幼若好中球>10% )　←　ここでいう幼若好中球とは桿状好中球のことである。

・敗血症の周辺疾患概念

　1. 全身性炎症反応症候群 systemic inflammatory response syndrome SIRS

　　発熱や白血球増加などの全身の炎症の徴候によって特徴づけられる病態(SIRSの診断基準に合致する病態)

　2. 敗血症 sepsis

　　SIRSが感染の結果である場合

　3. 重症敗血症 severe sepsis

　　主要臓器障害を伴う敗血症

　4. 敗血症性ショック septic shock

　　輸液投与に不応性の低血圧を伴う重症敗血症

　5. 多臓器機能障害症候群 multiorgan dysfunction syndrome MODS

　　2つ以上の主要臓器の機能異常

　6. 多臓器不全 multiorgan failure MOF

　　2つ以上の主要臓器の不全状態

■参考文献

HIM = Harrison's Principles of Internal Medicine 17th Edition

PSY = 標準精神医学第3版

CASES = 100 Cases in Clinical Medicine Second edition

IMD = 内科診断学第2版

「ジギタリス」

　　[★]

英: digitalis
関: 強心薬、強心配糖体, cardiac glycosides、ジギタリス効果。メチルジゴキシン、ジゴキシン、ジギトキシン

血中薬物濃度：

薬物血中濃度モニタリングすべき薬物

強心配糖体

	effect expression	max ffect	sustain	half-time	absorbance	excertion	治療域血中濃度
ジゴキシン	-1hr	3-6hr	2-6day	36hr	60-85%	kidney	1-2 ng/ml
ジギトキシン	1-4hr	5-10hr	2-3week	4-5day	90-100%	liver	10-25 ng/ml

特徴

構造

薬理作用

1. 心筋収縮の増強 (mechanical effect)
2. 房室結節で不応期を延長 (electrical effect)

洞房結節での伝導速度が低下し、不応期が延長する　→　だから上室性頻拍のおいて心拍数を下げることができるし、リエントリー性の上室性頻拍を洞調律に戻すことができる。

作用機序

Na+-K+ポンプを阻害

房室結節で不応期を延長 (mechanical effect)

→心筋収縮を増強する

房室結節で不応期を延長 (electrical effect)

→房室結節をブロックする。

1. 心臓組織に直接作用
2. 自律神経に作用し、副交感神経の緊張亢進、交感神経の活動性抑制

動態

ジゴキシンは腎代謝で半減期が短い。治療濃度 1-2ng/ml
ジギトキシンは肝代謝で半減期が長い。

適応

強心薬

心不全患者の心不全入院を減らす。予後は改善しない。
AFを伴うHFでは、心室レートをコントロールし十分な心室充満圧を得るためにジギタリスが用いられる。(ジゴキシンは1-2ng/mlで用いる)

注意

低カルシウム血症、腎機能低下例、薬物相互作用に注意

禁忌

YN.C-59

副作用

ジギタリス中毒(早期では胃腸症状(嘔吐・下痢)、心臓症状(二連脈、三連脈、ブロックを伴う心房頻拍、心室細動))

also see GOO.922

女性化乳房

「強心配糖体」

　　[★]

英: cardiac glycoside, cardiotonic glycoside
同: 強心ステロイド cardiotonic steroid、植物心臓毒 plant heart poison
関

ジギタリス digitalis
- ジゴキシン digoxin
- ジギトキシン digitoxin

「foxglove」

　　[★]

キツネノテブクロ

関: digitalis

「erosio interdigitalis blastomycetica」

　　[★] カンジダ性指趾間びらん症

「digital」

　　[★]

adj.

計数的な、デジタル

関: quantal; 直腸診の略

[olmstead-1] Olmstead, R. G., dePamphilis, C. W., Wolfe, A. D., Young, N. D., Elisons, W. J. & Reeves P. A. (2001). "Disintegration of the Scrophulariaceae". American Journal of Botany (American Journal of Botany, Vol. 88, No. 2) 88 (2): 348–361. doi:10.2307/2657024. JSTOR 2657024. PMID 11222255.

[2] OED: "Digitalis"

[3] Digitalis at Dictionary.com]

[Arkive-4] Anon. "Foxglove (Digitalis purpurea)". Arkive: images of life on Earth. Wildscreen. Retrieved 6 May 2010.

[5] Lankester, Mrs. (1866). Boswell J.T., ed. English Botany, Or, Coloured Figures of British Plants (full text). VI campanulacae to verbanacea. Sowerby J, Smith C, Johnson J.E, Salter J.W. (III ed.). London: Edward Hardwicke. p. 128.

[6] Anon. "Foxglove: Digitalis purpurea (Scrophulariaceae)". Wildflowers in Bloom. Wildseed farms. Retrieved 7 May 2010.

[7] Klein, Carol (18 May 2002). "How to grow: Foxgloves". The Telegraph (London, UK: Telegraph Media Group Limited). Retrieved 6 May 2010.

[8] Goldthorp WO (2009). "Medical Classics: An Account of the Foxglove and Some of its Medicinal Uses by William Withering, published 1785". Brit Med J 338: b2189.

[Silverman-9] In contemporary medicine, a purer form of digitalis (usually digoxin) is obtained from D. lanata.

[Hollman-10] Digoxin comes from Digitalis lanata. Hollman A. BMJ 1996;312:912. online version accessed 18 October 2006 [1]

[11] "Cardiac Glycoside Plant Poisoning: Medscape reference". Retrieved 3 July 2012.

[Lacassie-12] A non-fatal case of intoxication with foxglove, documented by means of liquid chromatography-electrospray-mass spectrometry. Lacassie E et al., J Forensic Sci. 2000 Sep;45(5):1154-8. Abstract accessed online 19 September 2006. [2]

[13] Goldfrank LW (2006). Goldfrank's Toxicologic Emergencies (8th ed.). New York: McGraw-Hill.

[14] Anon. "Notes on poisoning:Digitalis purpura". Canadian poisonous plants information system. Canadian Biodiversity Information Facility. Retrieved 9 March 2013.

[15] "European Resuscitation Council". ^{[verification needed]}

Foxglove

Digitalis purpurea (Common Foxglove)
Scientific classification
Kingdom:	Plantae
(unranked):	Angiosperms
(unranked):	Eudicots
(unranked):	Asterids
Order:	Lamiales
Family:	Plantaginaceae^[1]
Genus:	Digitalis L.
Species
Over 20 species, including: Digitalis canariensis Digitalis cariensis Digitalis ciliata Digitalis davisiana Digitalis dubia Digitalis ferruginea Digitalis x fulva Digitalis grandiflora Digitalis isabelliana Digitalis laevigata Digitalis lanata Digitalis leucophaea Digitalis lutea Digitalis mariana Digitalis micrantha Digitalis obscura Digitalis parviflora Digitalis purpurea Digitalis sceptrum Digitalis thapsi Digitalis trojana Digitalis viridiflora

匿名

検索

案内

digitalis