Tamoxifen Citrate
Indication:
This hormonal agent is used for the treatment of breast cancer.
Side effects:
Transient fall in the white blood cell or platelet counts, nausea, vomiting, loss of appetite, vaginal discharge, vaginal bleeding, weight gain, increased blood calcium, rash, temporary bone pain and hot flashes.
Interactions :
1. Using with antacids may decrease tamoxifen effect. Separate dosing by at least three hours.
2. Monitor FBC closely.
3. Using with oestrogens can decrease tamoxifen effect.
4. Using with famotidine, ranitidine, or cimetidine, can decrease tamoxifen effect.
5. Using with Warfarin can increase anticoagulant effect.
Dose:
Adults: oral, 10 or 20 mg once a day.
Deep Venous Thrombosis
Deep Venous Thrombosis is a condition wherein a blood clot develops in a deep vein that accompanies an artery, mostly in the lower limbs. Consequently, the clot affects blood circulation.
Usually thrombosis sets in when the coagulation function is impaired or imbalanced due to abnormalities in the blood, altered blood flow or damage to the blood vessels. Typically the main veins affected by deep venous thrombosis are inner thigh, calf, groin and lower abdomen. A person suffering from deep venous thrombosis is likely to experience pain and swelling in the affected limbs. The pain in the affected leg can become so severe that the person is unable to bear weight on it. This condition is different from arterial thrombosis where the clot forms in the arteries. The main risk factor associated with deep venous thrombosis is that the clot may break off and travel along the blood stream to lodge itself in the lungs, heart or brain. This disease is usually noticed in adults over 60 years.
Deep venous thrombosis is brought about by reduced blood flow or thickening of the blood. Persons who have undergone surgery and been given anti-clotting drugs are likely to develop this condition. Long car or plane journeys, fractures, birth control pills and surgery are potential conditions that may lead to this disease. Those with a history of polycythemia vera or hypercoagulability are more likely to suffer this condition. One of the potential dangers of deep venous thrombosis is pulmonary embolism. Pulmonary embolism is a serious, life-threatening condition where the embolism blocks or closes the artery in the lung. Another complication of deep venous thrombosis is post-thrombotic syndrome characterized by edema, hyperpigmentation and skin ulceration.
Some of the diagnostic tests that help detect deep venous thrombosis are ultrasound Doppler, venograpy of the legs and D-dimer blood test. The Doppler ultrasound aids in studying the reduced blood flow in the affected limbs. The venogram is a special x-ray that reveals any blood clot that is responsible for obstructed blood flow. The blood tests can reveal the clotting tendency. Heparin is an anticoagulant that has been intravenously given to a patient along with oral warfarin. These medications cause an increase in clotting time. But careful monitoring is of the essence so as to avoid risk of haemorrhage.
Peripheral Vascular Disease
Peripheral Vascular Disease(PVD) or Peripheral artery disease (PAD) is a condition where the arteries supplying blood to the limbs and internal organs get blocked as a consequence of atherosclerosis. Fatty deposits get built up in the arteries and reduce the flow of blood to the organs being supplied by the peripheral arteries. Atherosclerosis is by far the leading cause for Peripheral Vascular Disease. Diabetes is a condition that puts a person at high risk for PVD. Smoking and obesity increases the risk for Peripheral Vascular Disease. Persons who are obese and suffer from hypertension are at higher risk for Peripheral Vascular Disease. A sedentary lifestyle without any exercise should be avoided.
Intermittent claudication is noticed in patients suffering from Peripheral Vascular Disease. Symptoms associated with Peripheral Vascular Disease include numbness or tingling in the limbs, sores that do not heal and pain in the buttocks. A patient suffering from Peripheral Vascular Disease notices changes in skin color and temperature. There may be a dull and cramping pain in the calf, thigh and hip muscles. Ankle Brachial Index (ABI) involves a ratio of the blood pressure in your ankle to the pressure in your arm. Angiogram is a dye test that reveals any possible blockage in the arteries. Ultrasound Doppler Test uses imaging to check for plaque build-up in the arteries. Duplex ultrasound helps in accurate detection of the size of the artery stenosis and the extent of blockage.
Medication is prescribed to eliminate the narrowing of the arteries thereby improving the heart efficiency. Anti-platelet or anti-clotting agents such as cilostazol and pentoxifylline or aspirin and clopidogrel help in improving blood supply to the extremities. Heparin and Warfarin are anticoagulant drugs that can prevent blood clotting. Blood viscocity is controlled to improve blood flow. Drugs to control hypertension and cholesterol may also be prescribed. Bypass surgery allows a new blood route that circumvents the blocked areas of the peripheral arteries. Endarterectomy is a surgical procedure whereby a surgeon cleans out plaque buildup inside the artery of the affected leg or arm. Cryoplasty, a newer form of angioplasty uses liquid nitrous oxide to open a narrowed artery and destroy the plaque within. Regular supervised exercise can reduce symptoms of intermittent claudication.
Bibliography / Reference
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