medical information

Digitalis Drugs |Diagnosis | Description | Side effects| Risks

Definition

Digitalis drugs are medicines made from a type of foxglove plant (Digitalis purpurea ) that have a stimulating effect on the heart.

Purpose

Digitalis drugs are used to treat heart problems such as congestive heart failure and irregular heartbeat. These medicines help make the heart stronger and more efficient. This, in turn, improves blood circulation and helps relieve the swelling of the hands and ankles that is common in people with heart problems.

Description

Digitalis drugs, also known as digitalis glycosides, are available only with a physician's prescription. They are sold in tablet, capsule, liquid, and injectable forms. Commonly used digitalisdrugs are digitoxin (Crystodigin) and digoxin (Lanoxin).

Recommended dosage

The recommended dosage is different for each patient. The physician who prescribes the medicine will determine the correct dose. Taking exactly the right amount of medicine and taking it exactly as directed are very important. Never take larger or more frequent doses. During treatment with adigitalis heart medicine, the physician will monitor blood levels of the drug and will decide whether the dose needs to be changed. Patients should never change the dose of this medicine unless told to do so by their physicians.

Precautions

Seeing a physician regularly while taking digitalis drugs is very important. The physician will check to make sure the medicine is working as it should and will make any necessary changes in dosage or in instructions for taking the medicine.

Patients taking digitalis drugs should learn to take their pulse and should check it regularly while under treatment with this medicine. Changes in pulse rate, rhythm, or force could be signs of side effects.

Do not stop taking this medicine suddenly without checking with the physician who prescribed it. This could cause a serious change in heart function.

Digitalis drugs are responsible for many accidental poisonings in children. Keep this medicine out of the reach of children.

Be alert to the signs of overdose. Overdosing is a serious concern with digitalis drugs, because the amount of medicine that most people need to help their heart problems is very close to the amount that can cause problems from overdose. If any of these signs of overdose occur, check with a physician as soon as possible:

· loss of appetite

· nausea

· vomiting

· pain in the lower stomach

· diarrhea

· extreme tiredness or weakness

· extremely slow or irregular heartbeat (or fast heartbeat in children)

· blurred vision or other vision changes

· drowsiness

· confusion or depression

· headache

· fainting

Anyone who is taking digitalis drugs should be sure to tell the health care professional in charge before having any surgical or dental procedures or receiving emergency treatment. Physicians may advise people taking digitalis drugs to wear or carry medical identification indicating that they are taking this medicine.

Patients need to be very careful not to accidentally take this medicine in place of another medicine that looks similar. Patients who are taking other medicines that look like their digitalis medicine should ask their pharmacists for suggestions on how to avoid mix-ups.

Anyone who has had unusual reactions to digitalis drugs in the past should let his or her physician know before taking the drugs again. The physician should also be told about any allergies to foods, dyes, preservatives, or other substances.

Women who are pregnant or breastfeeding or who may become pregnant should check with their physicians before using digitalis drugs.

Older people may be especially sensitive to the effects of digitalis drugs, which may increase the chance of overdose.

Before using digitalis drugs, people with any of the following the medical problems should make sure their physicians are aware of their conditions:

· heart disease

· heart rhythm problems

· severe lung disease

· kidney disease

· liver disease

· thyroid disease

Side effects

Side effects are rare with this medicine. Check with a physician as soon as possible if a skin rash,hives, or any other unusual or troublesome symptoms occur. Watch for signs of overdose.

Interactions

Digitalis drugs may interact with a number of other medicines. When this happens, the effects of one or both of the drugs may change or the risk of side effects may be greater. For example:

· Taking digitalis drugs with other heart medicines, amphetamines, or diet pills could increase the risk of heart rhythm problems.

· Calcium channel blockers, used to treat high blood pressure, may cause higher than usual levels of digitalis drugs in the body that could lead to symptoms of overdose as covered in the above section.

· Diuretics (water pills) or other medicines that lower the amount of potassium in the body may increase the side effects ofdigitalis drugs.

· Medicines that increase the amount of potassium in the body may raise the risk of serious heart rhythm problems when taken with digitalis drugs.

· Diarrhea medicine or cholesterol-lowering drugs such as cholestyramine (Questran) and colestipol (Colestid) may keepdigitalis medicines from being absorbed into the body. To prevent this problem, digitalis drugs should be taken several hours before or after taking these medicines.

The list above does not include every drug that may interact with digitalis drugs. Be sure to check with a physician or pharmacist before taking any other prescription or nonprescription (over-the-counter) medicine.

In addition, a diet high in fiber may interfere with the effects of digitalis drugs by preventing the medicine from being absorbed into the body. To avoid this problem, eat high fiber foods (such as bran products, whole wheat bread, and fresh fruits and vegetables) several hours before or after taking digitalis medicine.

Dilatation and curettage

Definition

Dilatation and curettage (D&C) is a gynecological procedure in which the lining of the uterus (endometrium) is scraped away.

Purpose

D&C is commonly used to obtain tissue for microscopic evaluation to rule out cancer. The procedure may also be used to diagnose and treat heavy menstrual bleeding and to diagnose endometrial polyps and uterine fibroids. D&C can be used to remove pregnancy tissue after a miscarriage, incomplete abortion, or childbirth, or as an early abortion technique up to 16 weeks. Endometrial polyps may be removed, and sometimes benign uterine tumors (fibroids) may be scraped away.

Description

D&C is usually performed under general anesthesia, although local or epidural anesthesia can also be used. Using local anesthesia reduces risk and costs, but the patient will feel cramping during the procedure. The type of anesthesia used often depends upon the reason for the D&C.

To begin the procedure (which takes only minutes to perform), the doctor inserts an instrument to hold open the vaginal walls, and then stretches the opening of the uterus to the vagina (the cervix). This is done by inserting a series of tapering rods, each thicker than the previous one, or by using other specialized instruments. The process of opening the cervix is called dilation.

Once the cervix is dilated, the physician inserts a spoon-shaped surgical device called a curette into the uterus. The curette is used to scrape away the uterine lining. One or more small tissue samples from the lining of the uterus or the cervical canal are sent for analysis by microscope to check for abnormal cells.

Although simpler, less expensive techniques such as a vacuum aspiration are quickly replacing the D&C as a diagnostic method, it is still often used to diagnose and treat a number of conditions, especially when cancer is suspected.

Preparation

Because opening the cervix can be painful, sedatives may be given before the procedure begins. Deep breathing and other relaxation techniques may help ease cramping during cervical dilation.

Aftercare

A woman who has had a D&C performed in a hospital can usually go home the same day or the next day. Many women experience backache and mild cramps after the procedure, and may pass small blood clots for a day or so. Vaginal staining or bleeding may continue for several weeks.

Most women can resume normal activities almost immediately. Patients should avoid sexual intercourse, douching, and tampon use for at least two weeks to prevent infection while the cervix is closing and to allow the endometrium to heal completely.

Risks

The primary risk after the procedure is infection. Signs of infection include:

· fever

· heavy bleeding

· severe cramps

· foul-smelling vaginal discharge

A woman should report any of these symptoms to her doctor, who can treat the infection withantibiotics before it becomes serious.

D&C is a surgical operation, which carries certain risks associated with general anesthesia. Rare complications include puncture of the uterus (which usually heals on its own) or puncture of the bowel or bladder (which requires further surgery to repair).

Normal results

Results are considered normal if no unusual thickening, growths, or cancers are found. Removal of the uterine lining causes no side effects, and may be beneficial if the lining has thickened so much that it causes heavy periods. The uterine lining soon grows again normally, as part of the menstrual cycle.

Abnormal results

Some types of uterine thickening, called hyperplasia, are considered abnormal. Simple hyperplasia is a benign condition in which the uterine lining becomes thicker and with more endometrial glands. In complex hyperplasia, another condition where the uterine lining has thickened, the endometrial glands are crowded together. In 80% of cases these conditions will improve, and there is little risk of cancer. Only 1% of simple hyperplasia and 3% of complex hyperplasia will become cancerous.

Atypical hyperplasia is a more serious finding. In this type of endometrial thickening, the cells are abnormal. Twenty-nine percent of women with atypical hyper-plasia develop cancer. In fact, in 17% to 25% of women with atypical hyperplasia who have a hysterectomy within one month of diagnosis, acarcinoma is found elsewhere in the endometrium.

A D&C is not a fool-proof procedure because only a portion of the uterine lining is sampled. Therefore, it is possible for a cancer to be missed. Because of this, patients with atypical hyperplasia must have another D&C in three or four months. Combining a hysteroscopy (a procedure where a physician can see the lining of the uterus using a special tool) with D&C may increase the accuracy of the diagnosis in some cases. However, this combination is not recommended when endometrial carcinoma is suspected because of the possibility that the hysteroscopy itself can aid in the spread of cancer through the fallopian tubes.

Resources

BOOKS

Berman, Michael L. and Michael T. McHale. "Uterus." In Cancer Treatment, 5th ed., edited by Charles M. Haskell. Philadelphia: W.B. Saunders, 2001, pp. 951-55.

Byers, Lowell J. et al. "Uterus." In Clinical Oncology, 2nd ed., edited by Abeloff, Martin D. et al. Philadelphia: Churchill Livingstone, 2000, pp. 1987-97.

Carlson, Karen J., Stephanie A. Eisenstat, and Terra Ziporyn. The Harvard Guide to Women's Health. Cambridge: Harvard University Press, 1996.