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Medication Information - Anticoagulants
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*Anticoagulant Information |
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written by the APS
Foundation of America, Inc. |
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A New Era of Anticoagulation |
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US Pharm.
2007;32(3):HS-35-HS-48. Much of the
published clinical data indicate that
newer anticoagulants are at least as
effective as traditional anticoagulants,
and some are more effective (i.e.,
fondaparinux in orthopedic surgery,
hirudin in acute coronary syndromes).
DTIs have the potential to decrease
bleeding risk, compared with traditional
anticoagulants in some circumstances
(e.g., bivalirudin in patients given
percutaneous intervention). Oral
formulations of DTIs are not currently
available but are in developmental
phases. Oral agents showing promise have
the potential to revolutionize
antithrombotic therapy, allowing for
safer and more convenient
administration, as well as equal or
superior therapeutic effectiveness.
However, to date, warfarin is the only
oral agent available in the U.S. for
chronic antithrombotic therapy. |
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ACETAMINOPHEN INTERACTIONS WITH WARFARIN |
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Warfarin Institute of
America |
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Advanced Women's Health: Anticoagulants |
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Description of the
use and side effects of Coumadin |
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American Heart Association/American
College of Cardiology Foundation Guide
to Warfarin Therapy: Management of Oral
Anticoagulant Therapy |
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HIRSH et al., AHA/ACC
Expert Consensus Document on Warfarin
Therapy. JACC 2003;41:1633-52. © 2003 by
the American Heart Association, Inc.,
and the American College of Cardiology
Foundation |
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Anticoagulant Therapy Monitoring
Guidelines |
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Anticoagulant treatment at a specialized
outpatient anticoagulant therapy unit, a
descriptive study |
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Thrombosis Journal
2005, 3:20 doi:10.1186/1477-9560-3-20 |
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Anticoagulation Forum |
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Anticoagulation Service - Links to
Serveral Guidelines |
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The University of
Michigan Anticoagulation Service
consists of a team of nurses,
pharmacists, physicians, and clerical
staff whose goal is to provide safe and
effective anticoagulant therapy to
patients at risk of thrombosis.
Anticoagulation Clinic staff assist
physicians seeking advice on the optimal
management of patients requiring
anticoagulant therapy, provide patient
education, and coordinate the periodic
monitoring and dose adjustment of
warfarin and other anticoagulant drugs.
Both inpatients and outpatients can be
referred to the Anticoagulation Service.
Outpatient Anticoagulation Clinics,
which provide point-of-care INR
monitoring, are located at the
University of Michigan Health System
facilities. |
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Anticoagulation Therapy |
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Hematology 2001 ©
2001 The American Society of Hematology.
Despite refinements and standardization
in the use of anticoagulants, many
problems remain for clinicians. Dr.
Crowther describes appropriate starting
and maintenance doses of warfarin,
factors accounting for inter- and
intra-observer variability and
importantly, the management of the over-anticoagulated
patients and bleeding patients. Dr.
White compares unfractionated heparin (UFH)
and low molecular weight heparin (LMWH)
and addresses whether there truly are
differences in the efficacy and safety
of different LMWH's for both arterial
and venous indications. Dr. Ortel
discusses the management of the problem
patient who requires anticoagulants, the
management of heparin-induced
thrombocytopenia, the pregnant patient,
the obese patient, patients who have
renal insufficiency and/or liver
disease, patients with malignant
disease, and other challenging patient
populations. |
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BLOOD THINNING WITH WARFARIN (COUMADIN) |
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Information about
Coumadin |
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Breastfeeding and Coumadin® |
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Last Updated:
2/15/2004 |
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Bridge Therapy: Antiphospholipid
Antibody Syndrome (APS) |
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Written by: Liza
Alarid, Pharm. D. Candidate University
of Colorado at Denver and Health
Sciences Center School of Pharmacy
Reviewed by: Al Lodwick, RPh, MA Bridge
therapy, is a non-FDA approved treatment
measure commonly used in patients at
risk for clotting who must halt warfarin
therapy when an invasive or surgical
procedure is required. |
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Can better INR control be achieved, and
if so, how will new anticoagulants
compare to warfarin (Coumadin)? |
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Henry I. Bussey,
Pharm.D., FCCP, FAHA March, 2007 |
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Can I get a Tattoo While Taking
Warfarin? |
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To put it simply,
warfarin increases the amount of time
your blood takes to clot; therefore, if
a person gets a tattoo while taking
warfarin, it may bleed longer and take
longer to heal. ©2006 Rebecca Muñiz |
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Can I take Tylenol with Coumadin®
(warfarin)? |
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Overall, there have
been very few reports of
acetaminophen-associated effects on
warfarin therapy. For decades,
acetaminophen, the medicine in Tylenol,
has been recognized as the
over-the-counter pain reliever of choice
for patients on warfarin therapy because
Tylenol — unlike aspirin, naproxen
sodium, ketoprofen, and even ibuprofen —
does not cause gastrointestinal
bleeding, nor does it inhibit the
aggregation of platelets critical to
normal blood clotting. It is very
important that patients on warfarin have
their blood clotting function monitored
by their doctor and not change
over-the-counter pain relievers without
first consulting their doctors. If you
are under a doctor's care for any
serious condition or are taking any
other drug, you should talk to your
doctor if you want to know more or have
other questions. |
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Colonoscopy or surgery while on
coumadin® (Bridging Therapy) |
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Last Updated: 8/24/05 |
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Conventional-intensity warfarin therapy
more effective in preventing recurring
VTE |
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New study finds
conventional- intensity warfarin better
than low-intensity at preventing
recurrent VTE. |
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Cough and Cold & Coumadin |
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Coumadin |
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Warfarin sodium.
Official manufacturer's site. |
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Coumadin |
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Recurrent Systemic
Embolism: In cases where the risk of
thromboembolism is great, such as in
patients with recurrent systemic
embolism, a higher INR may be required.
An INR of greater than 4.0 appears to
provide no additional therapeutic
benefit in most patients and is
associ-ated with a higher risk of
bleeding. |
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Coumadin |
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Copyright 1996-2003
Cerner Multum, Inc. Version: 8.01.
Revision date: 5/13/03. |
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Coumadin |
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A pharmacist explains
how Coumadin works, why doctors
prescribe this blood thinner, and common
side effects of the drug. |
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Coumadin (Warfarin) |
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Revised: 01/01/2007 |
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Coumadin (warfarin) and Your Diet |
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The main dietary
concern of taking warfarin (common brand
name: Coumadin) has to do with the
amount of vitamin K in your diet.
Vitamin K changes the way warfarin
affects the blood. When you eat foods
that are high in vitamin K, you can
decrease the effect of warfarin.
Likewise, eating less vitamin K can
increase the effect of the medication. |
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Coumadin Cookbook |
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A complete Guide to
Healthy Eating When Takin Coumadin/ A
link to where you can order this book
from |
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Coumadin FAQ |
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Coumadin Interaction List |
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All of the
medications listed on this page interact
with warfarin. |
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COUMADIN OR GENERIC WARFARIN, IS THERE A
DIFFERENCE? |
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Warfarin Institute of
America |
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Coumadin resistance |
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Last Updated:
2/15/2004 |
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Daily Low-dose Vitamin K Supplementation
Stabilizes INRs |
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February, 2006 |
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Dental Extraction and Rat Poison |
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Sunday 22 January
2006 |
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Drug Interactions with Coumadin |
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Although access to
this page is not restricted, the
information found here is intended for
use by medical providers. Patients
should address specific medical concerns
with their physicians. © 2000, Family
Practice Notebook, LLC . These pages are
best viewed with Microsoft Internet
Explorer 5.0 or greater for full
functionality. |
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FOOD INTERACTIONS WITH WARFARIN |
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Warfarin Institute of
America |
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Future Technology for Warfarin Dosing |
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US Pharm.
2007;32(3):34-38. Clinicians continue to
find warfarin challenging to prescribe,
despite its widespread use. Through the
use of technology to determine genetic
information, future personalizing or
tailoring of warfarin dosing is
estimated to save over a billion health
care dollars in the U.S. each year.
Researchers recommend that genetic
analysis of VKORC1 be an essential
component of future prospective studies
focusing on investigating the value of
genotyping for warfarin therapy.
Prospective, clinical study is now
underway at multiple study sites. As
scientists accumulate more evidence and
a better understanding of the genes
associated with varied medication
responses, additional testing methods
for relevant gene variants will be
developed. Pharmacogenetics will
eventually shift from the laboratory to
clinical practice, with the goal of
tailored dosing based on a patient's
individual characteristics. |
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Generic warfarin versus brand coumadin® |
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Last Updated:
1/1/2004 |
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Hereditary warfarin resistance.
Investigation of a rare phenomenon. |
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Arch Intern Med. 1985
Mar;145(3):499-501. |
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How warfarin works |
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How warfarin affects
clotting factors |
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IF SOMEONE TAKING WARFARIN HITS HIS/HER
HEAD |
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ANY HEAD INJURY, NO
MATTER HOW SLIGHT IT MIGHT SEEM AT THE
TIME, IS CAUSE FOR CONCERN WHEN A PERSON
IS TAKING WARFARIN. THIS DOES NOT MEAN
THAN AN AMBULANCE RIDE TO THE HOSPITAL
IS ALWAYS NECESSARY. IN FACT, IT MAY
TAKE UP TO A WEEK FOR THERE BE ANY
INDICATION OF A BRAIN INJURY. IT IS
POSSIBLE TO HAVE TESTS DONE TOO SOON
AFTER THE INJURY WHICH CAN LEAD TO A
FALSE SENSE OF SECURITY. CLOSE
OBSERVATION FOR A LONG PERIOD OF TIME
MAY BE NECESSARY. DO NOT OVERLOOK THE
FACT THAT A BRAIN INJURY MAY CAUSE THE
INJURED PERSON TO DEVELOP POOR JUDGMENT
CAUSING THEM TO NOT RELATE THEIR
CONDITION TO SIGNIFICANT OTHERS. Last
modified August 29, 2004 |
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Initiation and Management of Coumadin
Therapy |
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INR too high? Vitamin K or Fresh Frozen
Plasma? |
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Anticoagulation with
warfarin is very effective for
preventing blood clots. Unfortunately,
sometimes a person taking warfarin has a
level that is too high. Questions
persist about the risks and management
of an INR that is too high. The
management of bleeding in the
over-anticoagulated patient is complex
and is based on balancing the risks and
benefits of each treatment. |
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Intensity of Warfarin Anticoagulation
for Different Thrombotic Disorders |
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Chest , Sept.. 2004
(Suppl) Notes: 1. These indications and
recommended intensities of treatment are
derived from the Seventh American
College of Chest Physicians Consensus
Conference (2004). 2. For most
indications a therapeutic range of 2.0
to 3.0 is recommended. A higher INR
range of 2.5 to 3.5 is recommended for
parents with mechanical prosthetic
valves and post myocardial infarction
and for some patients with
antiphospholipid syndrome and a history
of thrombosis. |
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Listen to the Patient — Anticoagulation
Is Critical in the Antiphospholipid
(Hughes) Syndrome |
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© 2003. The Journal
of Rheumatology Publishing Company
Limited. Patients can tell when their
INR is off. |
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Literacy, readability and cultural
barriers: critical factors to consider
when educating older African Americans
about anticoagulation therapy |
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Journal of Clinical
Nursing Volume 12 Page 275 - March 2003
doi:10.1046/j.1365-2702.2003.00711.x |
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Liver damage induced by coumarin
anticoagulants. |
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Semin Thromb Hemost.
1999;25(1):79-83. Except for bleeding
complications, relevant adverse effects
of coumarin anticoagulants are
comparatively rare considering the
widespread use of these substances. Here
we present the case of a 56-year-old
woman who developed recurrent episodes
of severe hepatitis following repeated
exposure to phenprocoumon (Marcumar;
Roche, Grenzach-Wyhlen, Germany) and
warfarin (Coumadin; DuPont Pharma, Bad
Homburg, Germany) after replacement of
the mitral valve with a mechanical
prosthesis. The diagnosis of
"coumarin-induced hepatitis" is
compatible with the time relationship
between start of the drug and the onset
of hepatopathy (first episode 8 months,
second episode 4 weeks, and third
episode 7 days), the rapid improvement
following discontinuation of the drug,
recurrence of liver dysfunction after
re-exposure to the drug, and liver
histology. After anticoagulant therapy
was changed to heparin and acenocoumarol
(Sintrom; Ciba-Geigy, Basel,
Switzerland), the patient's general
state was markedly improved and her
liver values became almost normal. This
case will be discussed and compared with
other reports of coumarin-induced
hepatic lesions. Although liver damage
induced by coumarin derivates is rare,
it is important to be aware of the
hepatotoxic potential of these drugs,
which, in most cases, mimics the
clinical presentation of viral
hepatitis. |
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Long-term, low-intensity warfarin
prevents recurrent VT |
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Results of the
Prevention of Recurrent Venous
Thromboembolism (PREVENT) trial
illustrate how pharmacist-managed
anticoagulation dosing can help patients
and clinicians walk a very important
'tightrope.' |
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Long-Term, Low-Intensity Warfarin
Therapy for the Prevention of Recurrent
Venous Thromboembolism |
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NEJM article
describing the results of the PREVENT
clinical trial. |
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Low Dose Warfarin Prevents Recurrence of
Blood Clots — NHLBI Stops Study |
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National Heart, Lung,
and Blood Institute (NHLBI)- February
24, 2003 A study of long-term, low-dose
warfarin to prevent the recurrence of
the blood clotting disorders deep vein
thrombosis (DVT) and pulmonary embolism
resulted in such a high degree of
benefit to the patients — without
significant adverse effects — that the
National Heart, Lung, and Blood
Institute (NHLBI) of the National
Institutes of Health has stopped the
study early. |
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MANAGING WARFARIN WHEN A PATIENT
REQUIRES A PROCEDURE |
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This editorial relies
heavily on the article The Management of
Anticoagulation Before and After
Procedures by John Spandorfer, M.D. in
Medical Clinics of North America,
Postoperative Medical Complications,
2001;85: 1109-1116. |
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Monitoring of Coumadin Anticoagulation |
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Scroll to the bottom
of the page on this link for Additional
Links about Coumadin |
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My Guide to Coumadin®/Warfarin Therapy |
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Agency for Healthcare
Research and Quality, Rockville, MD. |
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My hair is falling out. Is warfarin
(Coumadin) to blame? |
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January, 2006.
Unfortunately, there is not much data on
this issue, but some patients on
warfarin (Coumadin) do report hair loss.
In over approximately 20 years of
managing anticoagulation in several
hundred patients annually, I have seen a
few patients who have noticed hair loss
after starting on warfarin... |
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New Anticoagulant Drugs |
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Limitations of
heparin have led to the development of
new classes of drugs. |
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New anticoagulant with an "on-off"
switch |
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A novel anticoagulant
using RNA aptamer technology in early
development is hoped to overcome many of
the limitations of current agents, in
that it is selective, has a rapid onset
of action, can be easily titrated, and
is fully reversible with the use of an
antidote. (Dyke CK et al. Circulation
2006; published online before print
November 13, 2006. American Heart
Association 2006 Scientific Sessions.) |
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ODP: Warfarin |
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Links to
warfarin/Coumadin sites. |
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Of Blood, Bones, and Broccoli:
Warfarin–Vitamin K Interactions |
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Home Healthcare Nurse
March 2004 Volume 22 Number 3 Pages 178
- 182 |
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Oral contraceptives and coumadin |
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I rather not see a
woman who has had a thrombosis
associated with oral contraceptives or
hormone replacement therapy, who is now
on coumadin take the pill or hormones.
However, one can make an argument that
that it is probably o.k., since the
patient is now protected by coumadin.
However, if the woman has fluctuating
INRs and has low INRs at times (i.e. is
below her therapeutic range), the pill
or hormones may pose a risk for
recurrence of clots. Also, in women with
antiphospholipid antibody syndrome, who
may be at particularly increased risk
for re-clotting, even with therapeutic
INRs, I strongly recommend against
resuming the pill and hormones. Last
Updated: 2/15/2004 |
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Outpatient Management of Anticoagulation
Therapy |
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Am Fam Physician
2007;75:1031-42. Copyright © 2007
American Academy of Family Physicians.
The Seventh American College of Chest
Physicians (ACCP) Conference on
Antithrombotic and Thrombolytic Therapy
provides guidelines for outpatient
management of anticoagulation therapy.
The ACCP guidelines recommend short-term
warfarin therapy, with the goal of
maintaining an International Normalized
Ratio (INR) of 2.5 ± 0.5, after major
orthopedic surgery. Therapy for venous
thromboembolism includes an INR of 2.5 ±
0.5, with the length of therapy
determined by associated conditions. For
patients with atrial fibrillation, the
INR is maintained at 2.5 ± 0.5
indefinitely; for most patients with
mechanical valves, the recommended INR
is 3.0 ± 0.5 indefinitely. Use of
outpatient low-molecular-weight heparin
(LMWH) is as safe and effective as
inpatient unfractionated heparin for
treatment of venous thromboembolism. The
ACCP recommends starting warfarin with
unfractionated heparin or LMWH for at
least five days and continuing until a
therapeutic INR is achieved. Because
patients with venous thromboembolism and
cancer who have been treated with LMWH
have a survival advantage that extends
beyond their venous thromboembolism
treatment, the ACCP recommends beginning
their therapy with three to six months
of LMWH. When invasive procedures
require the interruption of oral
anticoagulation therapy, recommendations
for bridge therapy are determined by
balancing the risk of bleeding against
the risk of thromboembolism. Patients at
higher risk of thromboembolization
should stop warfarin therapy four to
five days before surgery and start LMWH
or unfractionated heparin two to three
days before surgery. |
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Preventative Pointers for APS Patients
Having Surgery |
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Written by: Gale A
McCarty, MD, FACP, FACR Management of
the APS patient before, during, and
after even minor surgery requires
special thinking and planning. As blood
flow changes to an area when a patient
is lying down or position for surgery,
there are general approaches to make all
procedures safer. Surgery is associated
with anesthesia of different types, and
any patient knows the temperature is
cool in operating rooms. Decreasing
blood flow to the surgical site to make
surgery easier, lack of usual activity
(being supine in a bed), and having a
predisposition to make blood clots
already puts the APS patient at more
than the usual risk of having a blood
clot after surgery. A classic lesson
students in healthcare learn early in
their studies is that a clot occurs if
“Virchow’s Triad” is met-a state of low
blood flow called stasis, injury to the
blood vessel lining cells (endothelial
cells), and a hypercoagulable
state-patients with APS may already have
the latter 2 predispositions prior to
the “second hit” of surgery and
anesthesia. |
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Purple Toes Syndrome Associated with
Warfarin Therapy in a Patient with
Antiphospholid Syndrome |
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Pharmacotherapy
23(5):674-677, 2003. © 2003
Pharmacotherapy Publications
Registration Required. Posted 05/30/2003 |
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Randomized Trial of Genotype-Guided
Versus Standard Warfarin Dosing in
Patients Initiating Oral Anticoagulation |
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SAFETY OF OUTPATIENT DENTAL TREATMENT
FOR PATIENTS ON COUMADIN (WARFARIN)
THERAPY |
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Warfarin Insitute of
America |
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SURGICAL MANAGEMENT OF THE PRIMARY CARE
DENTAL PATIENT ON WARFARIN |
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Warfarin does not
need to be stopped before primary care
dental surgical procedures Date of
original preparation: July 2001 Date of
first revision: March 2004 Date of next
revision: March 2006 |
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The Effects of Complementary Medicines
on Anticoagulant Therapy |
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THE LACK OF EFFECT OF WARFARIN ON
PLATELETS |
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Warfarin Institute of
America |
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The Legend of Warfarin—It’s Rat Poison
Isn’t It? |
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Written by: Al
Lodwick, RPh, MA |
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THE MOST OUTRAGEOUS PIECES OF ADVICE
GIVEN TO WARFARIN PATIENTS |
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Warfarin Institute of
America |
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THE USE OF VITAMIN K |
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The first part of
this page is about treating a high INR.
If you are looking for advice about
multivitamins, go to the last section.
Vitamin K is an antidote for warfarin.
This applies whether you are treating a
high INR, looking for a multivitamin to
take, stopping a multivitamin, or
thinking about changing what you eat. |
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The Use of Warfarin in Children:
Information and Patient Stories |
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Hearing that your
child will require warfarin (Coumadin®)
therapy can be a frightening experience
for parents. With proper information and
counseling most fears can be addressed.
Your child’s physician is a great
resource for information. Most, if not
all, hospitals will provide parents with
information on the use of warfarin
before discharging a child. If your
child requires frequent monitoring of
his or her blood, the clinic in which
their blood tests are performed is
another good source of information.
Remember, "there are no dumb questions,
the only dumb question is one that is
not asked". Your child’s healthcare
providers are there to help, so never be
afraid to ask a question. With this
paper I hope to address questions you
may have about warfarin use in children.
I have also included stories from
parents whose children are on warfarin
therapy. |
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Toxicity, Warfarin and Superwarfarins |
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Last Updated: August
24, 2005. Article by John C Stein, Jr,
MD |
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UCSF STUDY FINDS POPULAR BLOOD THINNER
DOES NOT WEAKEN BONES |
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Warfarin, a popular
blood thinner used to treat conditions
such as heart and leg clots and
irregular heart beats, does not weaken
the bones of older women, a new UC San
Francisco study has found. 18 June 1998 |
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Understanding Teenagers and Children
Taking Coumadin® |
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Understanding the Anticoagulant
Medication: Warfarin (Coumadin) |
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Warfarin and Menstruation |
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Written by: Gretchen
Kunze, Pharm.D Candidate University of
Colorado Health Sciences Center Reviewed
by: Al Lodwick, RPh, MA |
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Warfarin Dose Adjustment |
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Remember: 1. Always
consider trend in INRs when making
warfarin management decisions. 2.
Consider repeating INR same day or next
day if observed value markedly different
than expected value. Mayo Protocol
Reviewed 9/27/04 |
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Warfarin Dose Adjustment |
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Reviewed 9/27/04 |
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Warfarin dosing Primer on Antithrombotic
Therapy |
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Warfarin FAQs |
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Last updated January
1, 2006 |
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Warfarin induced skin necrosis |
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Warning: Picture is
quite graphic. |
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Warfarin Institute of America |
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Articles about a
variety of topics concerning warfarin
use |
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Warfarin Resistance |
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Written by: Thomas L
Ortel, MD, PhD “Warfarin resistance” can
mean different things, depending on the
laboratory results and the clinical
situation. |
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Warfarin resistance: diagnosis and
therapeutic alternatives. |
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Pharmacotherapy. 1996
Nov-Dec;16(6):1009-17. |
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Warfarin Therapy in Children |
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May 2004 |
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Warfarin Therapy: Evolving Strategies in
Anticoagulation |
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Published in the
American Family Physician, Feb. 1999. A
good general article, promotes an INR of
3-4 for APS patients. |
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Warfarin-Induced Skin Necrosis (WISN) |
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Last updated July 17,
2005 |
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Warfarin-Induced Skin Necrosis (WISN) |
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What are anticoagulants? |
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WHY DO SOME PEOPLE TAKE BOTH WARFARIN
(Coumadin, Jantoven) AND ASPIRIN? |
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Warfarin Institute of
America - Last update January 23, 2007 |
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Top of Page |
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Medication Information - Antiplatelets
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Aggrenox Oral |
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This medication is
used to reduce the risk of stroke in
patients who have had "mini-strokes"
(transient ischemic attacks) or a
previous stroke due to a blood clot and
are at high risk for another stroke. It
contains two medications, a very low
dose of aspirin (25 milligrams per
tablet) and dipyridamole in a
slow-release form. Low-dose aspirin and
dipyridamole are anti-platelet drugs
that work to keep blood flowing to the
brain by stopping platelets from
clumping together. This helps prevent
the platelets from forming blood clots,
which can lodge in the brain and cause a
certain type of stroke (ischemic
stroke). |
| |
|
Aggrenox® (aspirin/extended-release
dipyridamole) |
|
|
Prescribing
Information - 2007 |
| |
|
Antiplatelet Agents in the Prevention of
Atherothrombotic Events |
|
|
CVD is a complex and
burdensome group of illnesses.
Atherothrombosis is a feature common to
the most devastating of the CV events.
Low-dose aspirin and clopidogrel have
been shown to substantially reduce the
incidence of vascular events in a
variety of patient populations, while
simultaneously increasing the risk of
major hemorrhage. Thus, it is imperative
that these agents be utilized when
appropriate, yet monitored closely.
Pharmacists can play a crucial role in
the management of CVD generally and in
the utilization of antiplatelet agents
in particular. |
| |
|
Antiplatelet Therapy |
|
|
November 2004
Antiplatelet agents are drugs which
interfere with the ability of platelets
to aggregate and form a platelet plug.
As antithrombotic agents, they are most
useful in clinical states due to
arterial vascular disease. |
| |
|
Aspirin reduces risk of cardiovascular
events, increases risk of bleeding |
|
|
|
| |
|
Aspirin resistance found to raise risk
for heart attack, strokes |
|
|
Testing patients for
resistance is becoming more common, but
it's not clear how useful this
information is or what to do with it. |
| |
|
Aspirin Resistance: Is it Real? Is it
Clinically Significant? |
|
|
The American Journal
of Medicine. Volume 120, Issue 1 ,
January 2007, Pages 1-4. |
| |
|
Aspirin, Plavix®, Coumadin® - when to
use what |
|
|
Veins are made up
very differently compared to arteries.
Veins are thin blood vessels with slow
flowing blood. Blood clots that form in
veins (deep vein thrombosis, pulmonary
embolism) are mainly made up of clotting
proteins; platelets do not play a big
role in venous clots. Coumadin (=
warfarin) is an effective "blood
thinner" by preventing the production of
clotting factors in the liver,
increasing the INR. It is therefore the
drug of choice in venous thrombosis.
Anti-platelet drugs do not play much of
a role in preventing venous clots. |
| |
|
Biological efficacy of low versus medium
dose aspirin after coronary surgery:
results from a randomized trial |
|
|
BMC Medicine 2006,
4:12. doi:10.1186/1741-7015-4-12.
Conclusions: Contrary to recent
findings, low dose aspirin is effective
and medium dose aspirin did not prove
superior for inhibiting platelet
aggregation after coronary surgery. |
| |
|
Clopidogrel Bisulfate Oral - Plavix |
|
|
WedMD Health |
| |
|
Daily aspirin therapy |
|
|
Is an aspirin a day
the right thing for you? It's not as
easy a decision as it sounds. Know the
benefits and risks first. |
| |
|
New Data on Aspirin vs. Warfarin in TIA
Patients, but Questions Persist |
|
|
Henry I. Bussey,
Pharm.D., FCCP, FAHA March, 2005 |
| |
|
Plavix |
|
|
Drug commonly given
to heart and stroke patients to reduce
plaque buildup (clots). |
| |
|
Top of Page |
|
|
Medication Information - Antithrombotics
|
|
*Low Molecular Weight Heparin Brochure |
|
|
written by the APS
Foundation of America, Inc. |
| |
|
Alternatives to coumadin® (= warfarin) |
|
|
Last Updated:
4/26/2007 |
| |
|
Alternatives to Warfarin |
|
|
written by Al
Lodwick, RPh, MA |
| |
|
AN EDITORIAL ABOUT BRIDGING THERAPY |
|
|
IT MUST BE NOTED THAT
THE US FDA HAS NEVER GIVEN APPROVAL TO
USING ANY HEPARIN OR LOW MOLECULAR
WEIGHT HEPARIN AS A BRIDGE THERAPY WHEN
WARFARIN MUST BE STOPPED. Last reviewed
July 8, 2005 |
| |
|
Arixtra SubQ |
|
|
Fondaparinux is a
type of "blood thinner" medication
(heparinoids) used to help prevent the
formation of blood clots following
abdominal, hip or knee surgery. |
| |
|
ARIXTRA® (fondaparinux sodium) |
|
|
Prescribing
Information - October 2005 |
| |
|
Arixtra® during pregnancy |
|
|
Last Updated:
3/13/2007. Neither low molecular weight
heparins (LMWH; in the U.S.: Fragmin®,
Lovenox®, or Innnohep®) nor Fondaparinux
(=Arixtra®) have FDA approval to be used
in pregnancy. This reflects that neither
one has been tested in any larger trials
in pregnant women. Thus, it is not known
whether one is more or less effective as
a blood thinner during pregnancy than
the other, or more or less safe. Both,
low molecular weight heparins and
Arixtra®, are categorized as "class B"
drugs during pregnancy, meaning that
"animal studies show no risk or adverse
fetal effects, but controlled human 1st
trimester studies are not available;
there is no evidence of 2nd or 3rd
trimester risk; fetal harm is possible
but unlikely". In pregnant women who
need blood thinners, most physicians
probably use LMWH and not Arixtra®,
because LMWHs have been in use much
longer and there is much more clinical
experience with them during pregnancy.
While there are a large number of
publications reporting the use of LMWH
during pregnancy, for Arixtra® there are
only a few case reports (references
1-4). Arixtra® is, therefore, typically
only used in the pregnant woman with a
history or heparin allergy, called "HIT"
(or heparin induced thrombocytopenia). |
| |
|
Aventis - Lovenox Prescribing
Information |
|
|
enoxaparin sodium
injection. Rx only. Rev. (c) 2007 |
| |
|
DABIGATRAN (Rendix), A POSSIBLE
REPLACEMENT FOR WARFARIN (Coumadin,
Jantoven) |
|
|
Exanta (ximelagatran)
had been touted as the replacement for
warfarin. However, an FDA Advisory
Committee recommended against approval
in September 2004. Since that time,
dabigatran etexilate has become the
rising star of the oral, direct thrombin
inhibitor world. Like ximelagatran,
dabigatran etexilate is an orally active
prodrug. This means that it is not
active in the form that is given by
mouth, but it is metabolized to the
active form dabigatran. For purposes of
this review the drug will be simply
referred to as dabigatran. Last updated
April 8, 2007 |
| |
|
Dalteparin Sodium (porcine) Subcutaneous
- Fragmin |
|
|
WebMD Health |
| |
|
Danaparoid & Lepirudin |
|
|
Alternative
Pharmacologic Agents for Prophylactic &
Therapeutic Anticoagulation in Patients
with Heparin-induced Thrombocytopenia |
| |
|
Effects of Unfractionated and Low
Molecular Weight Heparin on
Antiphospholipid Antibody Binding In
Vitro |
|
|
Obstetrics &
Gynecology 2003;101:455-462 © 2003 by
The American College of Obstetricians
and Gynecologists |
| |
|
Enoxaparin (Low Molecular Weight
Heparin) Guidelines |
|
|
|
| |
|
Enoxaparin Sodium Subcutaneous - Lovenox |
|
|
WebMD Health |
| |
|
Establishing Therapeutic Range for
Heparin |
|
|
May 2004 |
| |
|
Fragmin SubQ - DALTEPARIN |
|
|
Dalteparin is used to
treat or prevent harmful blood clots.
Preventing harmful blood clots helps to
reduce the risk of a stroke or heart
attack. This medication helps keep your
blood flowing smoothly by lowering the
activity of clotting proteins in the
blood. Dalteparin is a type of heparin,
and works as an anticoagulant (commonly
called a "blood thinner"). |
| |
|
Fragmin® (dalteparin sodium injection) |
|
|
Prescribing
Information - April 2007 |
| |
|
Giving LMWH shots |
|
|
from Tamara on the
FVL mailing list |
| |
|
Heparin (Systemic) |
|
|
from WebMd |
| |
|
Heparin in Children |
|
|
May 2004 |
| |
|
Heparin-induced
thrombocytopenia: an update |
|
|
Thrombosis
Journal 2005, 3:14
doi:10.1186/1477-9560-3-14 |
| |
|
Heparin-induced
thrombocytopenia: the female
factor |
|
|
Blood, 1
November 2006, Vol. 108, No. 9,
pp. 2884-2885. |
| |
|
Innohep |
|
|
Tinzaparin
sodium (LMW Heparin). Official
manufacturer's site. |
| |
|
Innohep |
|
|
|
| |
|
Lovenox |
|
|
Enoxaparin
sodium (LMW Heparin). Official
manufacturer's site. |
| |
|
Newer Form of Heparin Drug Of
Choice |
|
|
07/06/2004
Copyright © 2004-2005 Duke
University Health System |
| |
|
ODP: Heparin |
|
|
Links to
heparin sites. |
| |
|
Otamixaban - a Factor Xa
Inhibitor being studied as a
possible replacement for
warfarin |
|
|
The advantage
that is being sought among this
class of drugs is lowered
bleeding risk compared to
warfarin. If this proves true,
this class of drugs will be very
advantageous. When otamixaban
was administered IV to healthy,
male subjects, it was found to
have rapid plasma distribution
and elimination, low
intersubject variability and was
excreted by both the liver and
the kidney. Last updated April
8, 2007 |
| |
|
RIVAROXABAN (BAY 59-7939), A
POSSIBLE REPLACEMENT FOR
WARFARIN |
|
|
A new Factor
Xa inhibitor is in development.
It looks promising up through
Phase II testing. In a safety
study, oral BAY 59-7939 in
single doses up to 80 mg was
safe and well tolerated and was
not associated with an increased
risk of bleeding compared with
placebo. Pharmacodynamic effects
(inhibition of factor Xa
activity, prothrombin time,
activated partial thromboplastin
time, and Hep Test) and plasma
concentration profiles were
dose-dependent. Maximum
inhibition of factor Xa activity
was achieved 1 to 4 hours after
administration of BAY 59-7939
and ranged from 20% to 61% for
the 5- to 80-mg doses. Last
updated April 8, 2007 |
| |
|
Self-Managed Long-Term
Low-Molecular-Weight Heparin
Therapy: The Balance of Benefits
and Harms |
|
|
The American
Journal of Medicine. Volume 120,
Issue 1 , January 2007, Pages
72-82.e3. Conclusion: Our study
shows that LMWH is similar in
effectiveness to the usual-care
vitamin K antagonist treatment
for preventing recurrent venous
thromboembolism in a broad
spectrum of patients. It causes
less harm and enhances the
clinicians’ therapeutic options
for patients with proximal deep
vein thrombosis. Our findings
reported here suggest the
possibility of a broader role
for long-term LMWH in selected
patients. |
| |
|
Tinzaparin (Innohep) |
|
|
This
information has been developed
and provided by an independent
third-party source. Merck & Co.,
Inc. does not endorse and is not
responsible for the accuracy of
the content, or for practices or
standards of non-Merck sources. |
| |
|
What Is the Long-Term Safety of
Lovenox? |
|
|
Written by:
Kai Davids, Pharm.D Candidate
University of Colorado Health
Sciences Center Reviewed by: Al
Lodwick, RPh, MA |
| |
|
Ximelagatran versus Warfarin for
the Prevention of Venous
Thromboembolism after Total Knee
Arthroplasty |
|
|
Annals of
Internal Medicine; 15 October
2002, Volune 137, Number 8,
Pages 649-659 |
| |
|
Ximelagatran: a new drug to
replace warfarin? |
|
|
Warfarin
Institute of America |
| |
|
Top of Page |
|
|
Medication Information - Herbals
|
|
*ClotCare International Registry
of Interactions between Oral
Anticoagulants and Dietary
Supplements |
|
|
The ClotCare
International Registry of
Interactions Between Oral
Anticoagulants and Dietary
Supplements is now available
online. At this time,
anticoagulation clinicians are
invited to begin using the
registry to report observed
interactions between warfarin
and dietary or herbal
supplements. The system will ask
the reporting clinician to check
responses to several questions
in order to grade the strength
of the data being reported.
Development is currently
underway to make this registry
searchable so that cases
reported may be reviewed by
others. |
| |
|
A dose of herbal reality |
|
|
Wednesday,
August 31, 2005 - Page updated
at 12:00 AM By Kyung M. Song
Seattle Times staff reporter |
| |
|
Are Natural Alternatives to
Warfarin Safe and Effective? |
|
|
Written by:
Randy Rauber, Pharm.D Candidate
University of Colorado Health
Sciences Center. Reviewed by: Al
Lodwick, RPh, MA. Is there any
evidence to support the use of
herbal supplement “blood
thinners” in patients with
antiphospholipid antibody
syndrome (APS) as natural
alternatives to Warfarin? |
| |
|
Black Cohosh |
|
|
Am Fam
Physician 2003;68:114-6.
Copyright© 2003 American Academy
of Family Physicians. The herb
black cohosh, or Actaea racemosa
(formerly named Cimicifuga
racemosa), is native to North
America. The roots and rhizomes
of this herb are widely used in
the treatment of menopausal
symptoms and menstrual
dysfunction. Studies have
demonstrated that this botanic
medicine, when standardized
properly to the terpene
glycoside fraction, appears to
be effective in alleviating
menopausal symptoms. Adverse
effects are extremely uncommon,
and there are no known
significant adverse drug
interactions. |
| |
|
Complimentary and Alternative
Healing University |
|
|
|
| |
|
Dehydroepiandrosterone (DHEA)
for systemic lupus erythematosus |
|
|
Copyright ©
2007 The Cochrane Collaboration.
Published by John Wiley & Sons,
Ltd. Studying effectiveness of
DHEA for SLE is difficult,
reflecting the problems of
studying any treatment for a
disease as complex as SLE. From
the seven RCTs to date, there
was evidence that DHEA had a
modest but clinically
significant impact on health
related quality of life in the
short term. Impact on disease
activity was inconsistent, with
DHEA showing no benefit over
placebo in terms of change in
SLEDAI in all but one of the 6
studies reporting this outcome.
Long term outcomes and safety
remain unstudied. |
| |
|
DHEA (dehydroepiandrosterone) |
|
|
DHEA may
increase the risk of blood
clotting. Patients who take
anticoagulants (blood thinners)
or antiplatelet drugs (such as
aspirin) to prevent blood clots
should discuss the use of DHEA
with a healthcare professional.
Examples of blood thinning drugs
include warfarin (Coumadin®),
heparin, and clopidogrel
(Plavix®). The risk of blood
clots is also increased by
smoking or by taking other
hormones (such as oral
contraceptives or hormone
replacement therapy), and these
should not be combined with DHEA
unless under medical
supervision. |
| |
|
Dietary and Herbal Supplements
in Patients on Anticoagulation –
Serious Unknowns and an Online
Registry to Help |
|
|
Henry I.
Bussey, Pharm.D., FCCP, FAHA.
February, 2008 |
| |
|
Experiments with Natto and
Nattokinase |
|
|
|
| |
|
Ginkgo biloba |
|
|
Ginkgo has
been shown to improve symptoms
of impaired arterial
circulation: In patients with
hardening of the arteries of the
legs (= arteriosclerosis)
patients treated with ginkgo can
walk farther without pain than
patients treated with placebo
(reference 1). However, Ginkgo
has not been compared in
efficacy to aspirin or any other
pharmaceutical anti-platelet
agent, such as Plavix®, Tiklyd®,
or Aggrenox®. Up to this point
there are no published studies
of the use of Ginkgo in the
treatment or prevention of
stroke. I would not count on it
having sufficient effect to
prevent stroke or heart attacks.
I would clearly not recommend it
as sole treatment for a TIA.
Last Updated: 3/14/07 |
| |
|
GINKGO BILOBA INTERACTIONS WITH
WARFARIN |
|
|
You have to
be careful when evaluating all
studies with ginkgo, because as
mentioned in the first
paragraph, there is variation
from batch to batch even with
the same product. Therefore, if
a study used only one batch, it
only means that there was not
enough of the terpenoids in that
batch to cause no harm. It
cannot be inferred that there
will not be enough terpenoids in
another batch or brand to cause
harm. |
| |
|
Is There a Natural Alternative
to Coumadin? |
|
|
|
| |
|
Is there a safe, natural
alternative to warfarin (brand
name Coumadin)? |
|
|
The bottom
line is that although "natural"
products may have some health
benefits, they are poorly
studied, poorly understood, and
poorly monitored. Even products
that have been USP verified may
be dangerous. Especially if you
are on warfarin (brand name
Coumadin), you should talk to
your doctor before starting any
dietary supplement or natural
remedy. |
| |
|
Nattokinase |
|
|
Written by:
Stephan Moll, MD “Nattokinase is
not a substitute for Warfarin!
If you take it – don’t count on
it having any clinical effect.
It has also not been studied
regarding its safety profile,
particularly when taken together
with Warfarin or aspirin. ” |
| |
|
Nattokinase |
|
|
I think it is
fair to conclude at present that
Nattokinase may have some
potential to protect from blood
clots. However, it has not been
appropriately studied in humans.
Nattokinase is not a substitute
for warfarin! If you take it -
don't count on it having any
clinical effect. It has also not
been studied regarding its
safety profile, particularly
when it is taken together with
warfarin or aspirin. The FDA
concluded in 2002 that there is
no "adequate basis to conclude
that NKCP [Natto extract]
containing 0.01 % of Nattokinase
enzyme is reasonably expected to
be safe" and that "there is
inadequate information to
provide reasonable assurance
that such ingredient does not
present a significant or
unreasonable risk of illness or
injury" [reference10].
Furthermore, the FDA has warned
as recently as September 21,
2006, that unsubstantiated and
illegal claims are being
published about the
effectiveness of NSK-SD
Nattokinase (ref. 11). Other
health care professionals have
also concluded that there is an
absence of data at this time
that Nattokinase has clinical
effectiveness (ref. 12). Last
Updated: 3/18/07 |
| |
|
Quinine Sensitivity: A New Cause
of the Hemolytic Uremic Syndrome |
|
|
|
| |
|
Top of Page |
|
|
Medication Information - Other
|
|
*IVIG Brochure |
|
|
written by
the Hospital for Special Surgery |
| |
|
Amerge (Naratriptan) |
|
|
AMERGE
Tablets should not be given to
patients with history, symptoms,
or signs of ischemic cardiac,
cerebrovascular, or peripheral
vascular syndromes. In addition,
patients with other significant
underlying cardiovascular
diseases should not receive
AMERGE Tablets. Ischemic cardiac
syndromes include, but are not
limited to, angina pectoris of
any type (e. g., stable angina
of effort and vasospastic forms
of angina such as the
Prinzmetal's variant), all forms
of myocardial infarction, and
silent myocardial ischemia.
Cerebrovascular syndromes
include, but are not limited to,
strokes of any type as well as
transient ischemic attacks.
Peripheral vascular disease
includes, but is not limited to,
ischemic bowel disease. AMERGE
Tablets should not be
administered to patients with
hemiplegic or basilar migraine. |
| |
|
Axert (Almotriptan Malate) |
|
|
AXERT®
(almotriptan malate) Tablets
should not be given to patients
with ischemic heart disease
(angina pectoris, history of
myocardial infarction, or
documented silent ischemia), or
to patients who have symptoms or
findings consistent with
ischemic heart disease, coronary
artery vasospasm, including
Prinzmetal's variant angina, or
other significant underlying
cardiovascular disease. AXERT®
should not be given to patients
with hemiplegic or basilar
migraine. |
| |
|
Birth control options in
thrombophilia |
|
|
Last Updated:
9/28/2006 |
| |
|
Celebrex |
|
|
A
nonsteroidal anti-inflammatory
drug commonly given to people
taking blood thinners since it
has the least interaction with
Coumadin of all
anti-inflammatories. |
| |
|
Clomid® |
|
|
Clotting
events appear to be rare with
Clomid®, and it is not known
whether they are coincidental or
causatively related. There is,
therefore, no clear indication
for a patient like the one above
to be on a blood thinner while
taking Clomid®. Blood thinners
may, actually, increase the risk
of bleeding into the developing
ovarian follicle and, thus,
cause unwanted side effects.
Weighing the risk and benefit it
may be appropriate not to have
this patient on blood thinners
during Clomid® therapy, but only
during pregnancy. Last Updated:
12/22/06 |
| |
|
Common Adverse Events and
Interactions with OTC Pain
Medications |
|
|
US Pharm.
2008;33(5):44-56. CONCLUSION:
OTC pain medications should be
used at the lowest effective
dose for the shortest duration
possible to minimize the
potential risk for an adverse
event. Patients taking
acetaminophen should not exceed
the recommended maximum daily
dose, while patients taking
NSAIDs should not exceed the
recommended single or daily
dose. Doses given to children
and infants should be very
carefully measured, with the
dosing device that comes
packaged with the drug product.
Labels for prescription
medications containing OTC
ingredients should be clear and
should not contain abbreviations
such as APAP. Patient and
consumer education is also
essential in preventing damage
caused by these seemingly
harmless medications. The
pharmacist has a great
opportunity to intervene.
Encourage patients who take
prescription medications
containing acetaminophen or an
NSAID to pay special attention
to the ingredients on any OTC
medication labels they are also
using to reduce the incidence of
accidental analgesic overdosing.
Provide educational materials to
patients so that they may learn
to recognize the generic names
of these medications. Warn
consumers of the risks of
misusing OTC pain relievers.
While these drugs are safe and
effective when taken at
recommended doses, they may be
quite harmful, even fatal, when
taken inappropriately.
Pharmacists can make a
critically important
contribution to the safety of
patients taking acetaminophen-
and NSAID-containing products.
It is our duty to help patients
use OTC medications safely. |
| |
|
Community Options for Safe
Needle Disposal |
|
|
|
| |
|
Dangers of Used Sharps in
Household Trash: Implications
for Home Care |
|
|
© 2007
Lippincott Williams & Wilkins,
Inc. Volume 25(9), October 2007,
p 602–607 |
| |
|
Effects of Prednisone on the
International Normalized Ratio |
|
|
Am J
Health-Syst Pharm.
2006;63(23):2354-2356. ©2006
American Society of
Health-System Pharmacists.
Posted 01/17/2007. Conclusion: A
patient’s INR values increased
after the addition of prednisone
to his warfarin regimen.
Registration Required. |
| |
|
Frova (Frovatriptan succinate) |
|
|
Do not use
FROVA if you have uncontrolled
high blood pressure; have heart
disease or a history of heart
disease; have had a stroke; have
circulation (blood flow)
problems; or have hemiplegic or
basilar migraine (if you are not
sure about this, ask your
doctor). If you're taking a
selective serotonin reuptake
inhibitor (SSRI) or another
medication to treat depression,
talk to your doctor before
taking FROVA. Do not take FROVA
if you have an allergic reaction
to the tablet or within 24 hours
of taking any triptans or
ergotamine medications. The most
common side effects associated
with the use of FROVA are
dizziness, tiredness, feeling of
tingling, hot flashes, headache
(other than migraine headache),
dry mouth, hot or cold
sensation, pain in joints or
bones, chest pain, and
indigestion. |
| |
|
Generic Medications Save Money -
But Are They as Good? |
|
|
Posted Fri,
Aug 31, 2007, 1:25 am PDT. ©
2007 Johns Hopkins University |
| |
|
Hydroxychloroquine |
|
|
Last Revised
- 04/01/2003 |
| |
|
HYDROXYCHLOROQUINE (Plaquenil) |
|
|
Updated Oct
2006. Written by Michael Cannon,
MD, and reviewed by the American
College of Rhematology Patient
Education Task Force. |
| |
|
HYDROXYCHLOROQUINE - EVERYTHING
OLD IS NEW AGAIN! |
|
|
By: Gale
McCarty, MD, FACR, FACP.
Hydroxychloroquine (HCQ, or its
trade name-Plaquenil) has a long
and honored history of use in
systemic lupus erythematosus (SLE)
as a general medication to
decrease activity of the immune
system and decrease symptoms.
For years it has been approved
for use by the FDA for lupus and
rheumatoid arthritis, and has
been used most frequently for
skin and joint manifestations.
It is considered a mainstay of
therapy for any patient with SLE
by many lupus experts and
rheumatologists. It has many
mechanisms of action, some
related to decrease in the
activity of the immune system,
and some related to effects on
blood clotting mechanisms. HCQ
belongs to the class of drugs
call anti-malarials, which
includes Chloroquine and
Atabrine. (This does not mean
that anyone thinks that SLE or
APS is caused by the agent that
causes malaria-like most
discoveries in medicine, it was
the chance observation that
patients with some autoimmune
diseases who got anti-malarial
drugs to prevent malaria when
traveling to likely areas of
infection noted their symptoms
improved on HCQ). One of the
most complete and excellent
reviews of all the literature on
the anti-malarials to which all
patients and their physicians
are directed is Dr. Dan
Wallace’s Chapter 59 in the
Wallace-Hahn Dubois’ Lupus
Erythematosus textbook. Another
excellent review on APS therapy
in general has been published by
Dr. Robert Roubey. |
| |
|
Hydroxychloroquine Sulfate Oral
- Plaquenil |
|
|
WebMD Health |
| |
|
Imitrex (Sumatriptan Succinate) |
|
|
Sumatriptan
succinate tablets should not be
given to patients with history,
symptoms, or signs of ischemic
cardiac, cerebrovascular, or
peripheral vascular syndromes.
In addition, patients with other
significant underlying
cardiovascular diseases should
not receive sumatriptan
succinate tablets. Ischemic
cardiac syndromes include, but
are not limited to, angina
pectoris of any type (e.g.,
stable angina of effort and
vasospastic forms of angina such
as the Prinzmetal variant), all
forms of myocardial infarction,
and silent myocardial ischemia.
Cerebrovascular syndromes
include, but are not limited to,
strokes of any type as well as
transient ischemic attacks.
Peripheral vascular disease
includes, but is not limited to,
ischemic bowel disease.
Sumatriptan succinate tablets
should not be administered to
patients with hemiplegic or
basilar migraine. |
| |
|
Imuran (Azathioprine) |
|
|
Although
access to this page is not
restricted, the information
found here is intended for use
by medical providers. Patients
should address specific medical
concerns with their physicians.
Please see the Terms and
Conditions. This page was
written by Scott Moses, MD, and
was last revised 1/24/2007.
Please send comments and
questions to the editor. Contact
information may be found on the
page About the Family Practice
Notebook. © 2000, Family
Practice Notebook, LLC . These
pages are best viewed with
Microsoft Internet Explorer 5.0
or greater for full
functionality. |
| |
|
Isosorbide Mononitrate Oral -
Imdur |
|
|
WebMd Health |
| |
|
Lipitor (Atorvastatin Calcium) |
|
|
|
| |
|
LYRICA |
|
|
Prescribing
Information |
| |
|
Maxalt (rizatriptan) |
|
|
MAXALT should
not be given to patients with
ischemic heart disease (e.g.,
angina pectoris, history of
myocardial infarction, or
documented silent ischemia) or
to patients who have symptoms or
findings consistent with
ischemic heart disease, coronary
artery vasospasm, including
Prinzmetal's variant angina, or
other significant underlying
cardiovascular disease. MAXALT
should not be administered to
patients with hemiplegic or
basilar migraine. |
| |
|
Methadone Treatment for Pain
States |
|
|
April 1, 2005
- American Family Physician |
| |
|
Methotrexate |
|
|
Last Revised
- 10/01/2006 |
| |
|
Nitrostat Sublingual |
|
|
WebMD Health |
| |
|
Nonprescription Analgesic Use:
Precautions and New Concerns |
|
|
US Pharm.
2008;33(5):18-21. |
| |
|
Nonprescription Analgesic Use:
Precautions and New Concerns |
|
|
US Pharm.
2008;33(5):18-21. W. Steven
Pray, PhD, DPh, Bernhardt
Professor of Nonprescription
Drugs and Devices, College of
Pharmacy, Southwestern Oklahoma
State University, Weatherford,
Oklahoma |
| |
|
ORTHO MICRONOR |
|
|
ORTHO
MICRONOR also known as the
mini-pill, is a "progestin-only"
pill. Unlike conventional birth
control pills ("combination
pills"), ORTHO MICRONOR contains
no estrogen and a lower level of
progestin than conventional
birth control pills. Click here
for prescribing information:
http://www.orthomicronor.com/products/pi/pdfs/micro.pdf#zoom=100 |
| |
|
Persantin |
|
|
This medicine
contains the active ingredient
dipyridamole, which is a type of
medicine known as an
antiplatelet agent. It prevents
blood cells called platelets
from clumping together inside
the blood vessels, and is
sometimes referred to as a
'blood thinner'. It also dilates
the blood vessels. |
| |
|
Prednisone Oral |
|
|
WebMD Health |
| |
|
Progressive Multifocal
Leukoencephalopathy (PML) in Two
Lupus Patients Treated with
Rituximab (Rituxan): An HSS
Rheumatology Perspective |
|
|
January 03,
2007 |
| |
|
Relpax (Eletriptan hydrobromide) |
|
|
RELPAX
Tablets should not be given to
patients with ischemic heart
disease (e.g., angina pectoris,
history of myocardial
infarction, or documented silent
ischemia) or to patients who
have symptoms, or findings
consistent with ischemic heart
disease, coronary artery
vasospasm, including
Prinzmetal's variant angina, or
other significant underlying
cardiovascular disease. RELPAX
Tablets should not be given to
patients with cerebrovascular
syndromes including (but not
limited to) strokes of any type
as well as transient ischemic
attacks. RELPAX Tablets should
not be given to patients with
peripheral vascular disease
including (but not limited to)
ischemic bowel disease. RELPAX
Tablets should not be
administered to patients with
hemiplegic or basilar migraine. |
| |
|
Rheumatrex, Trexall
(methotrexate) |
|
|
|
| |
|
Rituximab in rheumatic diseases |
|
|
Joint Bone
Spine. Volume 74, Issue 1 ,
January 2007, Pages 4-6. |
| |
|
Safe Options for Home Needle
Disposal |
|
|
|
| |
|
The morning-after pill
(postcoital emergency
contraceptive pill) |
|
|
While the
safety of the morning-after pill
has not been studied in women
who have a prior history of
blood clots or have a known
clotting disorder, such as
factor V Leiden or protein S
deficiency, the pill likely does
not predispose to a significant
excess risk in these
individuals, since (a) the
treatment is very short and (b)
any potential risk is likely
less than the thrombotic risk
associated with the pregnancy
that treatment is being offered
to prevent. |
| |
|
The Treatment of Lupus -
Antimalarials |
|
|
|
| |
|
Thrombolytic Agents (Systemic) |
|
|
Revised:
12/2003 |
| |
|
Transition to an oral
anticoagulant in patients with
heparin-induced thrombocytopenia |
|
|
CHEST, Feb,
2005 by John R. Bartholomew |
| |
|
What You Should Know About
Contraception |
|
|
The Female
Patient. |
| |
|
Zomig (Zolmitriptan) |
|
|
ZOMIG should
not be given to patients with
ischemic heart disease (angina
pectoris, history of myocardial
infarction, or documented silent
ischemia) or to patients who
have symptoms or findings
consistent with ischemic heart
disease, coronary artery
vasospasm, including
Prinzmetal's variant angina, or
other significant underlying
cardiovascular disease. ZOMIG
should not be administered to
patients with hemiplegic or
basilar migraine. |
| |
|
Top of Page |
|
|
Migraine & Headache Information
|
|
American Council for Headache
Education |
|
|
|
| |
|
Anatomical Alterations of the
Visual Motion Processing Network
in Migraine with and without
Aura |
|
|
Granziera C,
DaSilva AFM, Snyder J, Tuch DS,
Hadjikhani N (2006) Anatomical
Alterations of the Visual Motion
Processing Network in Migraine
with and without Aura. PLoS Med
3(10): e402. Conclusions: A
structural abnormality in the
network of motion-processing
areas could account for, or be
the result of, the cortical
hyperexcitability observed in
migraineurs. The finding in
patients with both MWA and MWoA
of thickness abnormalities in
area V3A, previously described
as a source in spreading changes
involved in visual aura, raises
the question as to whether a
“silent” cortical spreading
depression develops as well in
MWoA. In addition, these
experimental data may provide
clinicians and researchers with
a noninvasively acquirable
migraine biomarker. |
| |
|
Cluster Headaches Worldwide
Support Group |
|
|
|
| |
|
Cluster Headaches: What You
Should Know |
|
|
This handout
is provided to you by your
family doctor and the American
Academy of Family Physicians.
Other health-related information
is available from the AAFP
online at
http://www.familydoctor.org.
This information provides a
general overview and may not
apply to everyone. Talk to your
family doctor to find out if
this information applies to you
and to get more information on
this subject. Copyright © 2005
American Academy of Family
Physicians. |
| |
|
Headache and Sleep: Examination
of Sleep Patterns and Complaints
in a Large Clinical Sample of
Migraineurs |
|
|
Headache.
2005;45(7):904-910. ©2005
Blackwell Publishing |
| |
|
Headaches and Mind-Body Therapy:
What You Should Know |
|
|
This handout
is provided to you by your
family doctor and the American
Academy of Family Physicians.
Other health-related information
is available from the AAFP
online at
http://www.familydoctor.org.
This information provides a
general overview and may not
apply to everyone. Talk to your
family doctor to find out if
this information applies to you
and to get more information on
this subject. Copyright © 2007
American Academy of Family
Physicians. |
| |
|
Help for Headaches |
|
|
|
| |
|
Managing Menstrual Migraine |
|
|
|
| |
|
Migraine and Other Headaches |
|
|
Information
and Links |
| |
|
Migraine Awareness Group: MAGNUM |
|
|
|
| |
|
Migraine During Pregnancy Linked
to Significant Risk for Stroke,
Other Vascular Diseases |
|
|
Medscape
Medical News 2007. © 2007
Medscape |
| |
|
Migraine Headache |
|
|
|
| |
|
Migraine Headaches: How to Deal
with the Pain |
|
|
This handout
is provided to you by your
family doctor and the American
Academy of Family Physicians.
Other health-related information
is available from the AAFP
online at
http://www.familydoctor.org.
This information provides a
general overview and may not
apply to everyone. Talk to your
family doctor to find out if
this information applies to you
and to get more information on
this subject. |
| |
|
Migraine Prophylaxis: Who, Why
and How |
|
|
Cleveland
Clinic Journal of Medicine,
Volume 73, Number 9, September
2006, Pages 793-816 |
| |
|
Migraine Relief May Be Found in
the Heart |
|
|
Minimally
Invasive Heart Surgery Shown to
Treat Some Migraines June 23,
2005 |
| |
|
Migraines Myth Vs. Reality |
|
|
An
Understanding of Migraine
Disease & Tips for Migraine
Management |
| |
|
Migraines/Headaches Health
Center |
|
|
Approximately
45 million Americans suffer from
chronic headaches, and of them,
28 million suffer from
migraines. Get information about
migraines and headaches, their
causes, triggers, and
treatments. Plus, find daily
support in our online support
group. |
| |
|
MigraineTrial.com - Migraines |
|
|
Researchers
are conducting a new clinical
research study to determine
whether a study drug may prevent
episodic migraines from
developing into chronic daily
headache. The study drug is
approved for sale by
prescription for migraine
headache prevention in adults.
You may qualify to take part in
this important study. If you
qualify and agree to take part,
you will receive study related
examinations, procedures and
study medicine at no cost to
you. You may be compensated for
travel expenses. And you don't
need health insurance to take
part. |
| |
|
Mind-Body Therapies for Headache |
|
|
Am Fam
Physician 2007;76:1518-22,
1523-4. Copyright © 2007
American Academy of Family
Physicians. |
| |
|
National Headache Foundation |
|
|
|
| |
|
Olfactory aura symptoms |
|
|
Author: Klaus
Podoll Last modification of this
page: Sat. Dec, 11. 2004 |
| |
|
Oral Contraceptives are Safe in
Women with Systemic Lupus
Erythematosus |
|
|
CLEVELAND
CLINIC JOURNAL OF MEDICINE
VOLUME 73 • NUMBER 3 MARCH 2006.
SYNOPSIS OF THE STUDY
Conventional wisdom has been
that oral contraceptives should
not be given to women with SLE
because of theoretical concerns
that estrogens play a role in
disease activity. In this study,
the authors identified 183 women
younger than 40 years (younger
than 36 years if smokers) with
stable or improving disease.
Exclusion criteria included
hypertension, a history of
thromboembolic disease,
anticardiolipin antibodies,
lupus anticoagulant, gynecologic
cancer, a history of myocardial
infarction, migraines, or liver
disease. Study patients were
randomly assigned (allocation
concealed) to triphasic ethinyl
estradiol plus norethindrone
(Ortho-Novum 7/7/7) or matching
placebo and followed up for 1
year. Slightly more than one
third in each group discontinued
the study medication; analysis
was by intention to treat,
though, which is appropriate.
During follow-up there was no
difference in the frequency of
flares (7.6% vs 7.7%) and no
difference between groups
regarding a disease-specific
symptom score. There was also no
difference between groups in the
number of thromboembolic events. |
| |
|
Sinus Headaches |
|
|
|
| |
|
Tension Headaches: What You
Should Know |
|
|
This handout
is provided to you by your
family doctor and the American
Academy of Family Physicians.
Other health-related information
is available from the AAFP
online at
http://www.familydoctor.org.
This information provides a
general overview and may not
apply to everyone. Talk to your
family doctor to find out if
this information applies to you
and to get more information on
this subject. |
| |
|
What is the Best Way to Treat
Migraines in Patients with
Clotting Disorders? |
|
|
Written by:
Jacqueline Puga, Pharm. D.
Candidate University of Colorado
at Denver and Health Sciences
Center School of Pharmacy.
Reviewed by: Al Lodwick, RPh, MA |
| |
|
Top of Page |
|
|
No Clots but Test Positive
|
|
Hughes' Syndrome: A Patient's
Guide to the Antiphospholipid
Syndrome |
|
|
Doctor Hughes
Book on a website |
| |
|
Medical Progress-
Antiphospholipid Antibody
Syndrome |
|
|
PDF File from
the New England Journal of
Medicine |
| |
|
Top of Page |
|
|
Other Medical Problems
|
|
AACFS: American Association for
Chronic Fatigue Syndrome |
|
|
|
| |
|
ACOG Guidelines on Endometrial
Ablation |
|
|
Endometrial
ablation refers to minimally
invasive surgical procedures
that treat abnormal uterine
bleeding in select women who
have no desire for fertility. In
its guidelines for endometrial
ablation, the American College
of Obstetricians and
Gynecologists (ACOG) compare
standard resectoscopic
endometrial ablation with
nonresectoscopic endometrial
ablation techniques and devices.
ACOG also reviewed the
indications, effectiveness,
safety, and limitations of
endometrial ablation. Copyright
© 2008 by the American Academy
of Family Physicians. |
| |
|
ACOG Guidelines on Endometrial
Ablation |
|
|
Obstetrics &
Gynecology, May 2007 |
| |
|
Adrenal Hemorrhage |
|
|
Last Updated:
August 12, 2005. Article by
Nicholas A Tritos, MD, DSc,
FACE, FACP |
| |
|
AllThyroid.org |
|
|
Resources for
people with Thyroid Problems |
| |
|
American Academy of
Endocrinologists |
|
|
They give
guidelines for treatment |
| |
|
American Fibromyalgia
Association |
|
|
|
| |
|
An unusual case of chorea
gravidarum |
|
|
Postgrad Med
J 2000;76:374-375 ( June ) |
| |
|
Aspirin plus dipyridamole is
better than aspirin alone for
cerberal ischemia |
|
|
The ESPRIT
Study Group; Halkes PH, van Gijn
J, Kappelle LJ, Koudstaal PJ,
Algra A. Aspirin plus
dipyridamole versus aspirin
alone after cerebral ischaemia
of arterial origin (ESPRIT):
randomised controlled trial.
Lancet 2006; 367:1665–1673. In
this nonblinded study, the
combination of aspirin plus
dipyridamole was more effective
than aspirin alone in preventing
death from all vascular causes,
nonfatal stroke, nonfatal
myocardial infarction, or major
bleeding complications. However,
patients taking the combination
of aspirin and dipyridamole were
much more likely to experience
headaches sufficient to make
them stop taking it. |
| |
|
Asthma |
|
|
|
| |
|
Asthma from Veritas Medicine |
|
|
|
| |
|
Benign Paroxysmal Positional
Vertigo |
|
|
|
| |
|
Carpal Tunnel Syndrome Homepage |
|
|
|
| |
|
CDC: Chronic Fatigue Syndome |
|
|
|
| |
|
Chorea and related disorders |
|
|
Postgraduate
Medical Journal 2004;80:527-534 |
| |
|
Chorea Gravidarum Article by
Tarakad S Ramachandran, MD |
|
|
Last Updated:
August 9, 2005 Chorea gravidarum
(CG) is the term given to chorea
occurring during pregnancy. This
is not an etiologically or
pathologically distinct morbid
entity but a generic term for
chorea of any cause starting
during pregnancy. Chorea is an
involuntary abnormal movement,
characterized by abrupt, brief,
nonrhythmic, nonrepetitive
movement of any limb, often
associated with nonpatterned
facial grimaces. CG is regarded
as a syndrome rather than a
specific disease entity. |
| |
|
Common Variable ImmunoDeficiency |
|
|
|
| |
|
Congestive Heart Failure and
Pulmonary Edema |
|
|
Last Updated:
April 15, 2005 |
| |
|
Demyelinating Diseases |
|
|
from WebMD
Scientific American® Medicine
Posted 05/06/2003 |
| |
|
Diagnosing the Cause of Chest
Pain |
|
|
Am Fam
Physician 2005;72:2012-21.
Copyright © 2005 American
Academy of Family Physicians |
| |
|
Does phlebotomy contribute to
changes in hemoglobin and
hematocrit levels in
hospitalized patients? |
|
|
The typical
patient admitted for a 6-day
hospitalization will have 75 mL
of blood drawn, and this will
reduce his or her hemoglobin
level by 0.79 g/dL and
hematocrit by 2.1 percentage
points. As a result, one in six
patients will become anemic as a
result of blood draws. |
| |
|
eMedicine - Mesenteric Ischemia
Article by Christopher MB
Fernandes, MD |
|
|
Last Updated:
January 12, 2004 |
| |
|
eMedicine - Sudden Visual Loss
Article by Gino A Farina, MD |
|
|
Sudden visual
loss is a common complaint among
patients of different ages with
variable presentations. Some
patients describe it as a
gray-black curtain that
gradually descends, blurring,
fogging, or dimming vision. It
usually lasts a few minutes but
can persist for hours. The
frequency varies from a single
episode to many during a day; it
may continue for years but more
often lasts for seconds to
hours. Ischemia is the most
common mechanism of acute visual
dysfunction and it can affect
any aspect of the visual system.
Last Updated: November 8, 2005 |
| |
|
Epstein-Barr Virus and
Infectious Mononucleosis |
|
|
Updated:10/26/2002 17:45:17
Epstein-Barr virus, frequently
referred to as EBV, is a member
of the herpesvirus family and
one of the most common human
viruses. The virus occurs
worldwide, and most people
become infected with EBV
sometime during their lives. In
the United States, as many as
95% of adults between 35 and 40
years of age have been infected.
Infants become susceptible to
EBV as soon as maternal antibody
protection (present at birth)
disappears. Many children become
infected with EBV, and these
infections usually cause no
symptoms or are
indistinguishable from the other
mild, brief illnesses of
childhood. In the United States
and in other developed
countries, many persons are not
infected with EBV in their
childhood years. When infection
with EBV occurs during
adolescence or young adulthood,
it causes infectious
mononucleosis 35% to 50% of the
time. |
| |
|
Evaluation of Syncope |
|
|
Am Fam
Physician 2005;72:1492-500.
Copyright © 2005 American
Academy of Family Physicians. |
| |
|
Evidence-Based Guidelines for
Neuroimaging in Patients with
Nonacute Headache |
|
|
Practice
Guidelines - March 15, 2005 -
American Family Physician |
| |
|
FibroHugs: Fibromyalgia Support
Site |
|
|
|
| |
|
Fibromyalgia Aches and Pains as
a "Symptom" of Hypothyroidism: |
|
|
When muscle
and joint aches and pains
accompany hypothyroidism, are
they a separate problem --
fibromyalgia -- or is
fibromyalgia a symptom of the
thyroid problem itself? |
| |
|
Fibromyalgia and CFS Basics |
|
|
Description
of fibromyalgia syndrome (FMS),
but because of its substantial
symptom overlap with chronic
fatigue syndrome (CFS), it can
be viewed as applying to chronic
fatigue syndrome patients as
well. |
| |
|
Fibromyalgia and Chronic Fatigue
Syndrome |
|
|
Support and
Message Boards |
| |
|
Fibromyalgia Association UK |
|
|
|
| |
|
Fibromyalgia Aware Magazine |
|
|
Pretty good
E-zine |
| |
|
Fibromyalgia Network |
|
|
|
| |
|
Fibromyalgia Syndrome |
|
|
Symptoms of
fibromyalgia include muscle
aches and pain, stiffness, sleep
disturbances, fatigue, decrease
in physical activity and
tenderness over discrete tender
points. Issue Date: 12/15/2006 |
| |
|
Fibromyalgia Syndrome: An Update
for Pharmacists |
|
|
US Pharm.
2006;1:HS-14-HS-22. |
| |
|
Fibromyalgia/CFIDS Health Center |
|
|
Fibromyalgia
affects an estimated 5.8 million
Americans, and 500,000 more live
with chronic fatigue syndrome.
Here you'll find in-depth
information about fibromyalgia
and chronic fatigue syndrome,
their symptoms, pain relief, and
promising treatments. Plus, find
daily help in our online support
groups. |
| |
|
Gilbert's Syndrome |
|
|
. |
| |
|
How to Approach Hair Loss in
Women |
|
|
Dermatol
Nurs. 2007;19(6):531-535. ©2007
Jannetti Publications, Inc.
Posted 03/26/2008 |
| |
|
Hypothyroidism: Symptoms,Dangers
and Treatment |
|
|
|
| |
|
Idiopathic Thrombocytopenic
Purpura |
|
|
Idiopathic
thrombocytopenic purpura (ITP),
also known as primary immune
thrombocytopenic purpura and
autoimmune thrombocytopenic
purpura, is defined as isolated
thrombocytopenia with normal
bone marrow and the absence of
other causes of
thrombocytopenia. The 2 distinct
clinical syndromes manifest as
an acute condition in children
and a chronic condition in
adults. ITP is a decrease in the
number of circulating platelets
in the absence of toxic exposure
or a disease associated with a
low platelet count. Last
Updated: May 10, 2006 |
| |
|
INATE.org |
|
|
An extensive
resource for both physicians and
patients interested in
prevention and/or treatment of
Venous Thromboembolism |
| |
|
Initial Evaluation of Vertigo |
|
|
Am Fam
Physician 2006;73:244-51, 254.
Copyright © 2006 American
Academy of Family Physicians.
Benign paroxysmal positional
vertigo, acute vestibular
neuronitis, and Ménière's
disease cause most cases of
vertigo; however, family
physicians must consider other
causes including cerebrovascular
disease, migraine, psychological
disease, perilymphatic fistulas,
multiple sclerosis, and
intracranial neoplasms. Once it
is determined that a patient has
vertigo, the next task is to
determine whether the patient
has a peripheral or central
cause of vertigo. Knowing the
typical clinical presentations
of the various causes of vertigo
aids in making this distinction.
The history (i.e., timing and
duration of symptoms, provoking
factors, associated signs and
symptoms) and physical
examination (especially of the
head and neck and neurologic
systems, as well as special
tests such as the Dix-Hallpike
maneuver) provide important
clues to the diagnosis.
Associated neurologic signs and
symptoms, such as nystagmus that
does not lessen when the patient
focuses, point to central (and
often more serious) causes of
vertigo, which require further
work-up with selected laboratory
and radiologic studies such as
magnetic resonance imaging. |
| |
|
Interactive Sleep Test |
|
|
|
| |
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Intermittent Pneumatic
Compression of the Foot and Calf
May Help in Arterial
Claudication CME |
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Intracranial Hypertension or
Pseudotumor Cerebri |
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Intracranial
Hypertension Research Foundation
6517 Buena Vista Drive
Vancouver, WA 98661 Phone:
(360)693-IHRF (4473) Fax:
(360)694-7062 Email: info@IHRFoundation.org |
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Irritable Bowel Syndrome |
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JAMA.
2006;295:960. |
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Lipoprotein (a): its role in
childhood thromboembolism. |
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PEDIATRICS
Vol. 99 No. 6 June 1997, p. e11
Copyright ©1997 by the American
Academy of Pediatrics |
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Lupus Nephritis |
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Lymphatic Disorders |
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Last full
review/revision February 2003 |
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Management of peripheral
arterial disease in the elderly |
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Jan 1, 2007
By: Wilbert S. Aronow, MD
Geriatrics |
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Management of Vascular Leg
Ulcers |
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Advances in
Skin & Wound Care: The Journal
for Prevention and Healing
October 2005 Volume 18 Number 8
Pages 437 - 445 |
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Managing menorrhagia |
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Menieres.org |
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Menieres.org
was founded to provide a "home"
of support for those of you who
are suffering from Meniere's
Disease, which can be quite
dreadful at times. Our primary
goal is to provide a warm home
on the web for you to lean a
shoulder on, share your tips,
experiences, and tears with
other sufferers. |
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Menorrhagia: causes, diagnosis
and treatment options. |
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Gould D
(2007) Nursing Standard. 21, 24,
44-52. Date of acceptance:
September 27 2006. |
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Microangiopathic Ulcers of the
Lower Extremities A Daily
Challenge |
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The
International Journal of Lower
Extremity Wounds, Vol. 5, No. 2,
76-77 (2006) DOI:
10.1177/1534734606288814 © 2006
SAGE Publications |
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Microscopic Polyangiitis |
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Myasthenia Gravis Fact Sheet |
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|
Myasthenia
gravis is a chronic autoimmune
neuromuscular disease
characterized by varying degrees
of weakness of the skeletal
(voluntary) muscles of the body.
The name myasthenia gravis,
which is Latin and Greek in
origin, literally means "grave
muscle weakness." With current
therapies, however, most cases
of myasthenia gravis are not as
"grave" as the name implies. In
fact, for the majority of
individuals with myasthenia
gravis, life expectancy is not
lessened by the disorder. Last
updated July 14, 2006 |
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National Fibromyalgia
Association |
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|
The National
Fibromyalgia Association
(previously known as the
National Fibromyalgia Awareness
Campaign) is a nonprofit
organization whose mission is:
To develop and execute programs
dedicated to improving the
quality of life for people with
Fibromyalgia by increasing the
awareness of the public, media,
government and medical
communities. |
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National Institute on Deafness
and Other Communication
Disorders (NIDCD) |
|
|
Page last
updated: February 26, 2007 |
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Near Death at the ER Window |
|
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Book
describing one group member's
battle with a near fatal PE. |
| |
|
Neuromyelitis Optica |
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|
Whether
neuromyelitis optica (NMO), the
co-occurrence of myelitis and
optic neuritis, is a variant of
multiple sclerosis (MS) or a
unique disease is controversial.
Distinct neuropathological
features and a fulminant
clinical course argue in favor
of NMO as a distinct disease.
However, the combination of
neurological impairments of
myelitis and optic neuritis
occurs in patients with several
inflammatory disorders,
including multiple sclerosis and
collagen vascular diseases. NMO
is also associated with certain
infectious diseases. The fact
that the NMO phenotype occurs in
a variety of disease states
suggests that NMO does not
represent a specific clinical
entity. To better understand NMO
and its associations with
recognized diseases, a
systematic review of the
literature using MEDLINE was
conducted. The history of NMO,
its nosology, associations with
other diseases, and current
concepts of its pathogenesis and
treatment is reviewed in this
article. |
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NINDS Thoracic Outlet Syndrome
Information Page |
|
|
Thoracic
outlet syndrome (TOS) consists
of a group of distinct disorders
that affect the nerves in the
brachial plexus (nerves that
pass into the arms from the
neck) and various nerves and
blood vessels between the base
of the neck and axilla (armpit).
For the most part, these
disorders have very little in
common except the site of
occurrence. The disorders are
complex, somewhat confusing, and
poorly defined, each with
various signs and symptoms of
the upper limb. Last updated
January 25, 2006 |
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Optic Neuritis (ON) |
|
|
Optic
Neuritis (ON) is an
inflammation, with accompanying
demyelination, of the Optic
Nerve (Cranial Nerve II) serving
the retina of the eye. It is a
variable condition and can
present with any of the
following symptoms: blurring of
vision, loss of visual acuity,
loss of some or all color
vision, complete or partial
blindness and pain behind the
eye. |
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OsteoArthritis Research Society
International: OARSI |
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Peripheral Arterial Disease and
Claudication |
|
|
Copyright ©
2000-2005 American Academy of
Family Physicians Permission is
granted to print and photocopy
this material for nonprofit
educational uses. |
| |
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Pseudotumor Cerebri |
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|
Synonyms:
Idiopathic Intracranial
Hypertension, Benign
Intracranial hypertension |
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Recovering from Depression |
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Restless Legs.com |
|
|
Support,
Information and Message Board |
| |
|
Sudden Visual Loss |
|
|
Last Updated:
November 8, 2005. Article by
Gino A Farina, MD |
| |
|
The Ménière's Page |
|
|
page last
updated November 2005 |
| |
|
The National Institute of
Diabetes & Digestive & Kindey
Diseases |
|
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| |
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Thrombocytopenia |
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Thrombocytopenia During
Pregnancy |
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| |
|
Thrombocytopenic Purpura |
|
|
Thrombotic
thrombocytopenic purpura (TTP)
is a life-threatening
multisystem disorder that is
considered a true medical
emergency. Moschcowitz first
described TTP in 1924 when he
noted that his 16 year-old
patient had anemia; petechiae;
microscopic hematuria; and at
autopsy, disseminated
microvascular thrombi. Since
that time, the pathophysiology,
etiology, and medical management
of TTP has expanded. This
life-threatening condition may
have positive outcomes if
recognized early and if medical
intervention is initiated early.
Last Updated: November 30, 2005 |
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Thrombocytosis |
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Thrombophlebitis |
|
|
A MEDLINE
Plus site with links to
information and studies |
| |
|
Thrombophlebitis |
|
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| |
|
Thyroid Disease |
|
|
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| |
|
Thyroid Disease Manager |
|
|
Online
Version of a Heavy Duty Endo
Book Related to All Things
Thyroid |
| |
|
Thyroid Federation International |
|
|
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| |
|
Thyroid History |
|
|
Thyroid
Information from the past and
present... for the future |
| |
|
Transverse Myelitis Information
Page |
|
|
Transverse
myelitis is a neurological
disorder caused by inflammation
across both sides of one level,
or segment, of the spinal cord.
The segment of the spinal cord
at which the damage occurs
determines which parts of the
body are affected. Damage at one
segment will affect function at
that segment and segments below
it. In people with transverse
myelitis, inflammation usually
occurs at the thoracic (upper
back) level, causing problems
with leg movement and bowel and
bladder control, which require
signals from the lower segments
of the spinal cord. What usually
begins as a sudden onset of
lower back pain, muscle
weakness, or abnormal sensations
in the toes and feet can rapidly
progress to more severe
symptoms, including paralysis,
urinary retention, and loss of
bowel control. Last updated
January 25, 2006 |
| |
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Treatment of Vertigo |
|
|
Treatment of
Vertigo - March 15, 2005 -
American Family Physician |
| |
|
Ulcerative Colitis |
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| |
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Understanding Depression |
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| |
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Venous Skin Ulcer |
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| |
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Vertigo-A Type of Dizziness |
|
|
Vertigo-A
Type of Dizziness - March 15,
2005 - American Family Physician |
| |
|
Vertigo: What You Should Know |
|
|
Copyright ©
2006 American Academy of Family
Physicians. |
| |
|
Vestibular Disorders Association |
|
|
VEDA provides
information, resources, support,
and advocacy. We strive to
elevate public awareness about
vestibular disorders in order to
promote understanding, access to
diagnosis and treatment,
research, and help for those
facing the challenges of living
with a vestibular disorder. |
| |
|
What Is Idiopathic
Thrombocytopenic Purpura? |
|
|
Idiopathic
thrombocytopenic purpura (ITP)
is a bleeding disorder in which
the blood does not clot as it
should. The bleeding is due to a
low number of platelets
(PLATE-lets), blood cells that
help the blood clot and stop
bleeding. People with ITP often
have purple bruises that appear
on the skin. The bruises mean
that bleeding has occurred in
small blood vessels under the
skin. February 2006 |
| |
|
What You Should Know About
Endometerial Ablation |
|
|
The Female
Patient. 12/2005 |
| |
|
Your Thyroid Gland Central |
|
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