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    TAMOXIFEN ASSOCIATED CHANGES • endometrial hyperplasia: can occur in ~1-20% of women treated • endometrial polyps: can occur in ~8-36% of women in treated • endometrial carcinoma • cystic endometrial atrophy Ultrasound • Tamoxifen may cause the endometrium to appear thickened, irregular, and cystic. Changes tend to be subendometrial in location and cause subendometrial cysts that can be demonstrated at an ultrasound. • Most patients tend to have a multiplicity of findings. According to one study, ~50% of sonograms in those on Tamoxifen revealed an endometrial thickness of 8 mm or more 2. • It has also been reported that the degree of endometrial thickening corresponds to the duration of Tamoxifen therapy. • Ultrasound screening of asymptomatic patients taking tamoxifen has been shown to be problematic due to a high number of false positives. It has been proposed that patients taking tamoxifen who present with vaginal bleeding should go directly to hysteroscopy and endometrial biopsy 7 • Postmenopausal women taking tamoxifen should be closely monitored for symptoms of endometrial hyperplasia or cancer. Soy Isoflavones Linus Pauling Institute Oregon State. metformin hyperglycemia Endometrial Stripe Average Size, Symptoms of Thickening ICD-10-BE
     
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    Prophylaxis 80 mg/day PO divided q6-8hr initially; may be increased by 20-40 mg/day every 3-4 weeks; not to exceed 160-240 mg/day divided q6-8hr Inderal LA: 80 mg/day PO; maintenance: 160-240 mg/day Withdraw therapy if satisfactory response not seen after 6 weeks Hemangeol: Indicated for treatment of proliferating hemangioma requiring systemic therapy Initiate treatment at aged 5 weeks to 5 months Starting dose: 0.6 mg/kg (0.15 m L/kg) PO BID for 1 week, THEN increase dose to 1.1 mg/kg (0.3 m L/kg) BID; after 2 more weeks, increase to maintenance dose of 1.7 mg/kg (0.4 m L/kg) BID PO: 0.5-1 mg/kg/day divided q6-8hr; may be increased every 3-7 days; usual range: 2-6 mg/kg/day; not to exceed 16 mg/kg/day or 60 mg/day IV: 0.01-0.1 mg/kg over 10 minutes; repeat q6-8hr PRN; not to exceed 1 mg for infants or 3 mg for children PO: 1 mg/kg/day divided q6hr; after 1 week, may be increased by 1 mg/kg/day to maximum of 10-15 mg/kg/day if patient refractory; allow 24 hours between dosing changes IV: 0.01-0.2 mg/kg over 10 minutes; not to exceed 5 mg Immediate-release: 40 mg PO q12hr initially, increased every 3-7 days; maintenance: 80-240 mg PO q8-12hr; not to exceed 640 mg/day Inderal LA: 80 mg/day PO initially; maintenance: 120-160 mg/day; not to exceed 640 mg/day Inno Pran XL: 80 mg/day PO initially; may be increased every 2-3 weeks until response achieved; maintenance: not to exceed 120 mg/day PO Consider lower initial dose PO: 10 mg q6-8hr; may be increased every 3-7 days IV: 1-3 mg at 1 mg/min initially; repeat q2-5min to total of 5 mg Once response or maximum dose achieved, do not give additional dose for at least 4 hours Aggravated congestive heart failure Bradycardia Hypotension Arthropathy Raynaud phenomenon Hyper/hypoglycemia Depression Fatigue Insomnia Paresthesia Psychotic disorder Pruritus Nausea Vomiting Hyperlipidemia Hyperkalemia Cramping Bronchospasm Dyspnea Pulmonary edema Respiratory distress Wheezing Allergic: Hypersensitivity reactions, including anaphylactic/anaphylactoid; agranulocytosis, erythematous rash, fever with sore throat Skin: Stevens-Johnson syndrome, toxic epidermal necrolysis, exfoliative dermatitis, erythema multiforme, urticaria Musculoskeletal: Myopathy, myotonia May exacerbate ischemic heart disease after abrupt withdrawal Hypersensitivity to catecholamines has been observed during withdrawal Exacerbation of angina and, in some cases, myocardial infarction occurrence after abrupt discontinuance When discontinuing long-term administration of beta blockers (particularly with ischemic heart disease), gradually reduce dose over 1-2 weeks and carefully monitor If angina markedly worsens or acute coronary insufficiency develops, reinstate beta-blocker administration promptly, at least temporarily (in addition to other measures appropriate for unstable angina) Warn patients against interruption or discontinuance of beta-blocker therapy without physician advice Because coronary artery disease is common and may be unrecognized, slowly discontinue beta-blocker therapy, even in patients treated only for hypertension Asthma, COPD Severe sinus bradycardia or 2°/3° heart block (except in patients with functioning artificial pacemaker) Cardiogenic shock Uncompensated congestive heart failure Hypersensitivity Overt heart failure Sick sinus syndrome without permanent pacemaker Do not use Inno Pran XL in pediatric patients Long-term beta blocker therapy should not be routinely discontinued before major surgery; however, the impaired ability of the heart to respond to reflex adrenergic stimuli may augment the risks of general anesthesia and surgical procedures Use caution in bronchospastic disease, cerebrovascular insufficiency, congestive heart failure, diabetes mellitus, hyperthyroidism/thyrotoxicosis, liver disease, renal impairment, peripheral vascular disease, myasthenic conditions Sudden discontinuance can exacerbate angina and lead to myocardial infarction Use in pheochromocytoma Increased risk of stroke after surgery Hypersensitivity reactions, including anaphylactic and anaphylactoid reactions, have been reported Cutaneous reactions, including Stevens-Johnson syndrome, toxic epidermal necrolysis, exfoliative dermatitis, erythema multiforme, and urticaria, have been reported Exacerbation of myopathy and myotonia has been reported Less effective than thiazide diuretics in black and geriatric patients May worsen bradycardia or hypotension; monitor HR and BP Avoid beta blockers without alpha1-adrenergic receptor blocking activity in patients with prinzmetal variant angina; unopposed alpha-1 adrenergic receptors may worsen anginal symptoms May induce or exacerbate psoriasis; cause and effect not established Prevents the response of endogenous catecholamines to correct hypoglycemia and masks the adrenergic warning signs of hypoglycemia, particularly tachycardia, palpitations, and sweating May cause or worsen bradycardia or hypotension Pregnancy category: C; intrauterine growth retardation, small placentas, and congenital abnormalities reported, but no adequate and well-controlled studies conducted Lactation: Use is controversial; an insignificant amount is excreted in breast milk Nonselective beta adrenergic receptor blocker; competitive beta1 and beta2 receptor inhibition results in decreases in heart rate, myocardial contractility, myocardial oxygen demand, and blood pressure Class 2 antidysrhythmic Bioavailability: 30-70% (food increases bioavailability) Onset: Hypertension, 2-3 wk; beta blockade, 2-10 min (IV) or 1-2 hr (PO) Duration: 6-12 hr (immediate release); 24-27 hr (extended release) Peak plasma time: 1-4 hr (immediate release); 6-14 hr (extended release) Solution: Most common solvents Additive: Dobutamine, verapamil Syringe: Inamrinone, milrinone Y-site: Alteplase, fenoldopam, gatifloxacin, heparin, hydrocortisone, sodium succinate, inamrinone, linezolid, meperidine, milrinone, morphine, potassium chloride, propofol, tacrolimus, tirofiban, vitamins B and C IV administration rate should not exceed 1 mg/min IV dose is much smaller than oral dose Give by direct injection into large vessel or into tubing of free-flowing compatible IV solution Continuous IV infusion generally is not recommended The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information. Inderal Oral Uses, Side Effects, Interactions, Pictures, Warnings. metoprolol dose for afib Using Propranolol for Migraine Prevention - Verywell Health The dose of propranolol for migraine prophylaxis. Efficacy of low doses.
     
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