Conference vmszoo::medical

    OK Coumadin has a long half life, about two and a half days. Heparin is
    the opposite, a few hours, and its effect can easily be neutralised.

    So when they are putting catheters into you they want you on an
    anticoagulant to stop any clots forming in eddies caused by the
    catheters. However at the same time they want to be able to close the
    blood vessels when they remove the catheters.

    Heparin is therefore usually used for catherisation. If the patient was
    on Coumadin they must be transferred to Heparin before any surgery is
    done.

    As Heparin has a very short half life they usually connect you up to a
    heparin pump. This is a massive syringe which goes into an IV line. The
    the syringe plunger is very slowly pushed home, it takes days to empty
    it. Thus the need for the patient to be hospitalised during the
    transfer.

    Jamie.
             

    Thank you!  I knew you'd know! :-)
    
    So, is it because of the long half life, that one needs to be
    tested periodically for toxicity?  His "PT" # is coming down 
    very slowly, so the coumadin is not being "absorbed"/used up/whatever
    as quickly as they would have thought.  
    
    And the heparin is going in now....but they still don't expect him
    to be ready for the catheterization until Friday or so.
    
    He's bored silly sitting there, feeling fine *now*, but not able to
    get any fresh air.  
    
    Sue

    >Thank you!  I knew you'd know! :-)
    
    I didn't actually know, I used the PDR to find out the reason. Coumadin
    is used for long term self medication, but it is difficult to control
    quickly. Heparin is used when they wish to be able to switch the
    coagulation on and off quickly, but that can only be done in the
    controlled environment of a hospital. 

    >So, is it because of the long half life, that one needs to be tested
    >periodically for toxicity?

    For short term use of a drug they stabilise you and leave it at that. 
    
    When you are on a drug for long term or permanent use a some of the
    rules change. Some drugs you can become tolerant to, other may tend to
    build up. In these cases they check the level at intervals to ensure
    that the blood levels are staying stable.

    For example I am checked 4 times a year on my cyclosporine. Apart from
    the beginning when they were stabilising me, my blood tests have never
    caused the dosage to be altered. I inquired why it was still necessary
    to keep checking and discovered that I was the odd man out, most people
    need the dose altered every so often.
    
    Jamie.

    Another question....again, probably "answerable" by Jamie :-)
    
    Have you heard of a drug called Endure, Indure...something like
    that?  I haven't seen the label myself so am not sure of the 
    spelling or the purpose or the drug.
    
    My Dad was on Digoxin, Coumadin, and Lopressor, and in the last 
    week, they've added Nitrostat, Captopril and this Endure_thing.
    From what I can figure out, they've covered all the bases with
    the other drugs, so I'm confused by this last one.
    
    And, I'm back up here now, away from my parents again, and have no 
    idea what this drug is...And they are of the era where one doesn't 
    question the doctor, you follow his/her directions :-)
    
    Any ideas?
    
    Thanks,
    Sue
                  

    		Without the spelling I'll take a stab at it and guess that
    it's Inderal?  This is a beta-blocker that will slow the heart rate and
    reduce BP.  It's used to treat angina, hypertension and arrhythmias.
    	       Be sure that he follows the prescribed dosages and as with
    most drugs DO NOT stop taking it abrubtly.
    		  Hope this helps...
    
    				Bob

    Thanks, I thought of that, but even in the hospital, the nurses
    made it sound like "endure"...there was no "al" sound in there.
    
    but, thanks anyway...

    The closest thing that I can find is Enduron which is a diuretic
    saluretic used in the control of hypertension. 

    Translated into human talk it makes you wee a lot and gets rid of salt
    to control high blood pressure.

    Jamie.

    I found it.  Imdur is a nitrate, vasodilator, and is used in
    folks with CHF.  Not to be used with potassium-sparing diuretics.
    Can cause headaches (but that's a sign it's working) so doctors
    sometimes prescribe an aspirin along with it ..... an added
    benefit being the anti-coagulant effect from the aspirin.
    
    Apparently my Dad's heart was damaged so extensively by the heart
    attack, and the blockages so many and diffused that it is too risky 
    for them to consider bypasses.  But, in a couple of months when the 
    heart muscle has had a chance to recover somewhat from the attack, 
    they will have to scrape out one of his carotid arteries, because 
    right now it is 90% blocked .....another reason for the vasodilators 
    and anti-coagulants.  
    
    Sue