Differential Pharmacokinetics of Digoxin in Elderly Patients

Digoxin remains one of the most commonly prescribed of all cardiac medications. The main indications for digoxin usage include atrial fibrillation and heart failure; both these conditions are more prevalent in older patients. Given the aging population and the increasing incidence of heart failure we would expect prescribing of digoxin to remain as frequent or to even increase in older patients. Older patients are also more likely to develop toxicity and diagnosis of digoxin toxicity can be difficult in this group. Numerous components contribute to the development of toxicity in older patients, ranging from aging-related changes in renal function or body mass to polypharmacy and possible interactions with digoxin. It is therefore important to understand how the pharmacokinetics of digoxin may be altered in the older population. Application of basic pharmacological principles may be helpful in anticipating these problems. This review describes the pharmacokinetics of digoxin, the changes in pharmacokinetics with increasing age and how concomitant disease states or drug interactions may affect the pharmacokinetics of digoxin. Greater knowledge about the causes and prevention of digoxin toxicity should further reduce the morbidity and mortality arising from digoxin toxicity, especially in the elderly population.
For over 200 years debate has raged regarding the use of digitalis glycosides in cardiac disease. At present digoxin is the most commonly prescribed digitalis compound. This review describes the pharmacokinetics of digoxin and in particular how they are altered with increasing age. When considering the elderly population it is important to recognise the heterogeneity of response in this group, therefore there are no rules, with regards to prescribing, that can apply to the entire elderly population.

The Voice as Transcursive Inscriber: The Relation of Body and Instrument Understood through the Workings of a Machine

This article examines the relationship of the body with a musical instrument; specifically it looks at the vital threshold conditions that occur during the interplay of voice and instrument. By examining the work ‘IKAS’ (1982) for solo saxophone by German composer Hans-Joachim Hespos, the unusual timbral relationships created between vocal and instrumental sounds are exposed. I argue that this particular work highlights the performer/instrument relation as one marked by Gilles Deleuze’s notion of the workings of a machine and a machine’s relation to a ‘flow’, in particular a machine’s function with view to the break in the flow. By turning towards Deleuze’s concept of the machine, this article offers a slightly different vocabulary for music analysis, one that more easily encompasses certain works of the twentieth century, specifically those that are more timbre- than pitch-based.