www.medicinenet.com/ace_inhibitors/article.htmACE Inhibitors
(Angiotensin Converting Enzyme Inhibitors)
Pharmacy Author: Omudhome Ogbru, Pharm.D.
Medical Editor: Jay W. Marks, M.D.

•What are ACE inhibitors, and how do they work?
•For what conditions are ACE inhibitors used?
•Are there any differences amont the different types of ACE inhibitors?
•What are the side effects of ACE inhibitors?
•With which drugs do ACE inhibitors interact?
•What are some examples of ACE inhibitors?

What are ACE inhibitors, and how do they work?

Angiotensin II is a very potent chemical that causes the muscles surrounding blood vessels to contract, thereby narrowing the vessels. The narrowing of the vessels increases the pressure within the vessels causing high blood pressure (hypertension). Angiotensin II is formed from angiotensin I in the blood by the enzyme angiotensin converting enzyme (ACE). ACE inhibitors are medications that slow (inhibit) the activity of the enzyme ACE, which decreases the production of angiotensin II. As a result, the blood vessels enlarge or dilate, and blood pressure is reduced. This lower blood pressure makes it easier for the heart to pump blood and can improve the function of a failing heart. In addition, the progression of kidney disease due to high blood pressure or diabetes is slowed.


For what conditions are ACE inhibitors used?

ACE inhibitors are used for controlling blood pressure, treating heart failure, preventing strokes, and preventing kidney damage in people with hypertension or diabetes. They also improve survival after heart attacks. In studies, individuals with hypertension, heart failure, or prior heart attacks who were treated with an ACE inhibitor lived longer than patients who did not take an ACE inhibitor. Because they prevent early death resulting from hypertension, heart failure or heart attacks, ACE inhibitors are one of the most important group of drugs. Some individuals with hypertension do not respond sufficiently to ACE inhibitors alone. In these cases, other drugs are used in combination with ACE inhibitors.


Are there any differences among the different types of ACE inhibitors?

ACE inhibitors are very similar. However, they differ in how they are eliminated from the body and their doses. Some ACE inhibitors need to be converted into an active form in the body before they work. In addition, some ACE inhibitors may work more on ACE that is found in tissues than on ACE that is present in the blood. The importance of this difference or whether one ACE inhibitor is better than another has not been determined.


What are the side effects of ACE inhibitors?

ACE inhibitors are well-tolerated by most individuals. Nevertheless, they are not free of side effects, and some patients should not use ACE inhibitors.

ACE inhibitors usually are not prescribed for pregnant patients because they may cause birth defects.

Individuals with bilateral renal artery stenosis (narrowing) may experience worsening of kidney function, and people who have had a severe reaction to ACE inhibitors probably should avoid them.

The most common side effects are:

•cough,


•elevated blood potassium levels,


•low blood pressure, dizziness,


•headache,


•drowsiness,


•weakness,


•abnormal taste (metallic or salty taste), and


•rash.

Heart catheterization or coronary angiography

This test is the gold standard for the diagnosis of coronary artery disease. A cardiologist inserts and then threads a small tube through the groin or arm into the coronary arteries, where dye is injected to directly visualize the arteries on an x-ray. This test defines the anatomy of the coronary arteries.

CT coronary angiogram is a fairly new test to diagnose coronary artery disease. During this procedure, intravenous dye containing iodine is injected into the patient and CT scanning is performed to image the coronary arteries.


What is the treatment for heart disease?

Coronary artery disease is usually treated in a multi-step approach depending upon a patient's symptoms. The patient and healthcare provider need to work together to return the patient to a normal lifestyle.


Prevention of heart disease

The key to the treatment is prevention. A healthy lifestyle is the key, including exercise, proper nutrition, and smoking cessation.

An aspirin a day is recommended to decrease the risk for heart disease and should be started with the recommendation of a healthcare provider.

A little alcohol (one drink per day for women or two drinks per day for men) decreases the risk of heart disease compared to nondrinkers. However, it is not recommended that nondrinkers begin drinking.


Modifying risk factors for heart disease

While patients cannot choose their family and alter their genetic predisposition to coronary artery disease, the rest of the risk factors are under control of the patient. Keeping blood pressure, cholesterol and other lipid levels, and diabetes under control needs to become a life-long goal. Smoking cessation is highly encouraged.

Heart Disease (cont.)

Echocardiography

Used with or without exercise, echocardiography can assess how the heart works. Using sound waves to generate an image, a cardiologist can evaluate many aspects of the heart. Echocardiograms can examine the structure of the heart including the thickness of the heart muscle, the septum (the tissues that separate the four heart chambers from each other) and the pericardial sac (the outside lining of the heart).

The test can indirectly assess blood flow to parts of the heart muscle. If there is decreased blood flow, then segments of the heart wall may not beat as strongly as adjacent heart muscle. These wall motion abnormalities signal the potential for coronary artery disease.

The echocardiogram can also assess the efficiency of the heart by measuring ejection fraction. Normally when the heart beats, it pushes more than 60% of the blood in the ventricle out to the body. Many diseases of the heart, including coronary artery disease, can decrease this percentage (the ejection fraction).


Perfusion studies

Radioactive chemicals like thallium or technetium can be injected into a vein and their uptake measured in heart muscle cells. Abnormally decreased uptake can signify decreased blood flow to parts of the heart because of coronary artery narrowing. This test may be used when the patient's baseline EKG is not normal and is less reliable when used to monitor a stress test.


Computerized tomography

The latest generation of CT scanners can take detailed images of blood vessels and may be used as an adjunct to determine whether coronary artery disease is present. In some institutions, the heart CT is used as a negative predictor. That means that the test is done to prove that the coronary arteries are normal rather than to prove that the disease is present.

Heart Disease (cont.)

How is heart disease diagnosed?

The diagnosis of heart disease begins with obtaining a history that the potential for coronary artery disease exists. Risk factors need to be assessed, and then testing may be required to confirm the presence of heart disease.


Heart disease tests

Not every patient with chest pain needs heart catheterization (the most invasive test). Instead, the healthcare provider will try to choose the testing modality that will best provide the diagnosis, and if coronary artery disease is present, decide what impairment, if any, is present.


Electrocardiogram (ECG or EKG)

The heart is an electrical pump, and the electrical impulses it generates can be detected on the surface of the skin. Normal muscle conducts electricity in a reproducible fashion. Muscle that has decreased blood supply conducts electricity poorly. Muscle that has lost its blood supply and has been replaced with scar tissue cannot conduct electricity. The electrocardiogram (EKG) is a noninvasive test used to reflect underlying heart conditions by measuring the electrical activity of the heart.

Some people have "abnormal" EKGs at baseline but this may be normal for them. It is important that an electrocardiogram be compared to previous tracings. If a patient has a baseline abnormal EKG, they should carry a copy with them for reference if they ever need another EKG.


Stress testing

If the baseline EKG is relatively normal, then monitoring the EKG tracing while the patient exercises may uncover electrical changes that may indicate the presence of coronary artery disease. There are a variety of testing protocols used to determine whether the exercise intensity is high enough to prove that the heart is normal.

Some patients are unable to exercise on a treadmill test, but they can still undergo cardiac stress testing by using intravenous medication that causes the heart to work harder.

Stress testing is done under the supervision of medical personnel because of the potential of provoking angina, shortness of breath, abnormal heart rhythms, and heart attack.

Heart Disease

(Coronary Artery Disease)
Medical Author: Benjamin C. Wedro, MD, FAAEM
Medical Editors: Daniel Kulick, MD, FACC, FSCAI and Melissa Conrad Stöppler, MD

•Introduction to heart disease
•What are the risk factors for heart disease?
•What are the symptoms of heart disease?
•How is heart disease diagnosed?
◦Electrocardiogram (ECG or EKG)
◦Stress testing
◦Echocardiography
◦Perfusion studies
◦Computerized tomography
◦Heart catheterization or coronary angiography
•What is the treatment for heart disease?
◦Prevention of heart disease
◦Modifying risk factors for heart disease
◦Medications
◦Angioplasty and stents
◦Surgery
•Heart Disease At A Glance
•Pictures of Heart Disease (Coronary Artery Disease) - Slideshow
A Tale of Two Heart Attacks
Medical Author: Benjamin Wedro, MD, FAAEM
Medical Editor: Melissa Conrad Stöppler, MD

Life isn't fair. The tales of Kelsey Grammer and Tim Russert show the two extremes when it comes to heart disease. Mr. Grammer had some chest pain, wandered into a hospital, found out that he had a heart attack myocardial infarction) and walks out a few days later. Mr. Russert has no particular chest pain, but drops dead because of his heart attack.

A heart attack means that part of the heart muscle has lost its blood supply, has died, and has been replaced by scar tissue. Injured heart muscle causes injured electrical systems and can lead to ventricular fibrillation, in which the heart jiggles instead of beats. No heart beat means no blood to the body, which leads to sudden cardiac death.

Sudden cardiac death doesn't really care if the heart attack was mild or not. The most common reason people die in the midst of a heart attack is due to an electrical short circuit caused by heart muscle that has been irritated.

In Mr. Russert's case, bystanders were ready to use an automatic external defibrillator (AED), but the paramedics arrived at the same time to deliver electrical shocks to the heart to treat the ventricular fibrillation. The treatment failed, and they were unable to reverse Mr. Russert's death.

Read more about the types of heart attacks, and the odds of surviving one »
Top Heart Disease Terms
coronary, congenital, rheumatic, symptoms, valvular, ischemic, heart disease in women, cardiovascular, congestive, risk factors, causes, prevention, heart attack
Introduction to heart disease

The heart is like any other muscle, requiring blood to supply oxygen and nutrients for it to function. The heart's needs are provided by the coronary arteries, which begin at the base of the aorta and spread across the surface of the heart, branching out to all areas of the heart muscle.

The coronary arteries are at risk for narrowing as cholesterol deposits, called plaques, build up inside the artery. If the arteries narrow enough, blood supply to the heart muscle may be compromised (slowed down), and this slowing of blood flow to the heart causes pain, or angina.

A heart attack or myocardial infarction occurs when a plaque ruptures, allowing a blood clot to form. This completely obstructs the artery, stopping blood flow to part of the heart muscle, and that portion of muscle dies.


What are the risk factors for heart disease

Risk factors for heart disease include:

•Smoking


•High blood pressure (hypertension)


•High cholesterol


•Diabetes


•Family history


•Peripheral artery disease


•Obesity

What are the symptoms of heart disease?

The typical symptoms of coronary artery disease are associated chest pain with shortness of breath. Classically, the pain of angina is described as a pressure or heaviness behind the breast bone with radiation to the jaw and down the arm accompanied by shortness of breath and sweating. Unfortunately, angina has a variety of presentations, and there may not even be specific chest pain. There may be shoulder or back ache, nausea, indigestion or upper abdominal pain.

Women, the elderly, and people with diabetes may have different perceptions of pain or have no discomfort at all. Instead, they may complain of malaise or fatigue.

Healthcare providers and patients may have difficulty understanding each other when symptoms of angina are described. Patients may experience pressure or tightness but may deny any complaints of pain.

People with coronary artery disease usually have gradual progression of their symptoms over time. As an artery narrows over time, the symptoms that it causes may increase in frequency and/or severity. Healthcare providers may inquire about changes in exercise tolerance (How far can you walk before getting symptoms? Is it to the mailbox? Up a flight of stairs?) and whether there has been an acute change in the symptoms.

Once again, patients may be asymptomatic until a heart attack occurs. Of course, some patients also may be in denial as to their symptoms and procrastinate in seeking care.

Heart Disease

(Coronary Artery Disease)
Medical Author: Benjamin C. Wedro, MD, FAAEM
Medical Editors: Daniel Kulick, MD, FACC, FSCAI and Melissa Conrad Stöppler, MD

•Introduction to heart disease
•What are the risk factors for heart disease?
•What are the symptoms of heart disease?
•How is heart disease diagnosed?
◦Electrocardiogram (ECG or EKG)
◦Stress testing
◦Echocardiography
◦Perfusion studies
◦Computerized tomography
◦Heart catheterization or coronary angiography
•What is the treatment for heart disease?
◦Prevention of heart disease
◦Modifying risk factors for heart disease
◦Medications
◦Angioplasty and stents
◦Surgery
•Heart Disease At A Glance
•Pictures of Heart Disease (Coronary Artery Disease) - Slideshow
A Tale of Two Heart Attacks
Medical Author: Benjamin Wedro, MD, FAAEM
Medical Editor: Melissa Conrad Stöppler, MD

Life isn't fair. The tales of Kelsey Grammer and Tim Russert show the two extremes when it comes to heart disease. Mr. Grammer had some chest pain, wandered into a hospital, found out that he had a heart attack myocardial infarction) and walks out a few days later. Mr. Russert has no particular chest pain, but drops dead because of his heart attack.

A heart attack means that part of the heart muscle has lost its blood supply, has died, and has been replaced by scar tissue. Injured heart muscle causes injured electrical systems and can lead to ventricular fibrillation, in which the heart jiggles instead of beats. No heart beat means no blood to the body, which leads to sudden cardiac death.

Sudden cardiac death doesn't really care if the heart attack was mild or not. The most common reason people die in the midst of a heart attack is due to an electrical short circuit caused by heart muscle that has been irritated.

In Mr. Russert's case, bystanders were ready to use an automatic external defibrillator (AED), but the paramedics arrived at the same time to deliver electrical shocks to the heart to treat the ventricular fibrillation. The treatment failed, and they were unable to reverse Mr. Russert's death.

Read more about the types of heart attacks, and the odds of surviving one »
Top Heart Disease Terms
coronary, congenital, rheumatic, symptoms, valvular, ischemic, heart disease in women, cardiovascular, congestive, risk factors, causes, prevention, heart attack
Introduction to heart disease

The heart is like any other muscle, requiring blood to supply oxygen and nutrients for it to function. The heart's needs are provided by the coronary arteries, which begin at the base of the aorta and spread across the surface of the heart, branching out to all areas of the heart muscle.

The coronary arteries are at risk for narrowing as cholesterol deposits, called plaques, build up inside the artery. If the arteries narrow enough, blood supply to the heart muscle may be compromised (slowed down), and this slowing of blood flow to the heart causes pain, or angina.

A heart attack or myocardial infarction occurs when a plaque ruptures, allowing a blood clot to form. This completely obstructs the artery, stopping blood flow to part of the heart muscle, and that portion of muscle dies.


What are the risk factors for heart disease

Risk factors for heart disease include:

•Smoking


•High blood pressure (hypertension)


•High cholesterol


•Diabetes


•Family history


•Peripheral artery disease


•Obesity

What are the symptoms of heart disease?

The typical symptoms of coronary artery disease are associated chest pain with shortness of breath. Classically, the pain of angina is described as a pressure or heaviness behind the breast bone with radiation to the jaw and down the arm accompanied by shortness of breath and sweating. Unfortunately, angina has a variety of presentations, and there may not even be specific chest pain. There may be shoulder or back ache, nausea, indigestion or upper abdominal pain.

Women, the elderly, and people with diabetes may have different perceptions of pain or have no discomfort at all. Instead, they may complain of malaise or fatigue.

Healthcare providers and patients may have difficulty understanding each other when symptoms of angina are described. Patients may experience pressure or tightness but may deny any complaints of pain.

People with coronary artery disease usually have gradual progression of their symptoms over time. As an artery narrows over time, the symptoms that it causes may increase in frequency and/or severity. Healthcare providers may inquire about changes in exercise tolerance (How far can you walk before getting symptoms? Is it to the mailbox? Up a flight of stairs?) and whether there has been an acute change in the symptoms.

Once again, patients may be asymptomatic until a heart attack occurs. Of course, some patients also may be in denial as to their symptoms and procrastinate in seeking care.

Understanding Your Breast Cancer Pathology Report

To classify exactly what kind of breast cancer you have, your doctor may take a biopsy of your tumor, which is a sample taken from the tumor either during surgery or using a needle. That sample tissue is then studied in a lab to determine exactly what kind of tumor it is. Tests are done to look for different substances in the tumor, and each test result is assigned a status, such as positive or negative. The results are called your pathology report.

Knowing the details about the tumor helps the doctor understand how quickly the cancer might grow and what treatments may be best.

Download Your Guide to Your Breast Cancer Pathology Report

..Who is Herceptin for?
Herceptin is approved for the adjuvant treatment of HER2-overexpressing, node-positive or node-negative (ER/PR-negative or with one high-risk feature) breast cancer. Herceptin can be used several different ways:

As part of a treatment regimen including doxorubicin, cyclophosphamide, and either paclitaxel or docetaxel
With docetaxel and carboplatin
As a single agent following multi-modality anthracycline-based therapy
Herceptin in combination with paclitaxel is approved for the first-line treatment of HER2-overexpressing metastatic breast cancer. Herceptin as a single agent is approved for treatment of HER2-overexpressing breast cancer in patients who have received one or more chemotherapy regimens for metastatic disease.

What important safety information should I know about Herceptin?
Herceptin treatment can result in heart problems, including those without symptoms (reduced heart function) and those with symptoms (congestive heart failure). The risk and seriousness of these heart problems were highest in people who received both Herceptin and a certain type of chemotherapy (anthracycline). Your doctor will stop or strongly consider stopping Herceptin if you have a significant drop in your heart function.

You should be monitored for decreased heart function before your first dose of Herceptin, and frequently during the time you are receiving Herceptin and after your last dose of Herceptin. If you must permanently or temporarily stop Herceptin due to heart problems, you should be monitored more frequently. In one study with Herceptin and certain types of chemotherapy, an inadequate blood supply to the heart occurred.

Some patients have had serious infusion reactions and lung problems; fatal infusion reactions have been reported. In most cases, these reactions occurred during or within 24 hours of receiving Herceptin. Your Herceptin infusion should be temporarily stopped if you have shortness of breath or very low blood pressure. Your doctor will monitor you until these symptoms go away. If you have a severe allergic reaction, swelling, lung problems, inflammation of the lung, or severe shortness of breath, your doctor may need to completely stop your Herceptin treatment.

Worsening of low white blood cell counts associated with chemotherapy has also occurred.

Herceptin can cause low amniotic fluid levels and harm to the fetus when taken by a pregnant woman.

The most common side effects associated with Herceptin were fever, nausea, vomiting, infusion reactions, diarrhea, infections, increased cough, headache, fatigue, shortness of breath, rash, low white and red blood cells, and muscle pain.

Because everyone is different, it is not possible to predict what side effects any one person will have. If you have questions or concerns about side effects, talk to your doctor.

Please see the Herceptin full prescribing information including Boxed WARNINGS and additional important safety information.

Global References

© 2009 Genentech USA. All rights reserved.
WebMD does not endorse any specific product, service, or treatment.

Possible Herceptin Side Effects

What important safety information should I know about Herceptin?
Why is my heart being monitored while I'm on Herceptin?
How many women had to stop Herceptin due to heart problems in the Herceptin adjuvant trials?
What happened to women after their Herceptin was stopped?
What side effects may I experience with my first dose of Herceptin?
Are the potential side effects with Herceptin the same as with chemotherapy?
What should I look out for when I'm on Herceptin therapy, and what symptoms should I immediately report to my doctor?
Can I take Herceptin if I am pregnant?
Can I drive after my Herceptin treatment?
Is Herceptin right for me?
What important safety information should I know about Herceptin?
Herceptin treatment can result in heart problems, including those without symptoms (reduced heart function) and those with symptoms (congestive heart failure). The risk and seriousness of these heart problems were highest in people who received both Herceptin and a certain type of chemotherapy (anthracycline). Your doctor will stop or strongly consider stopping Herceptin if you have a significant drop in your heart function. In one study with Herceptin and certain types of chemotherapy, an inadequate blood supply to the heart occurred.

You should be monitored for decreased heart function before your first dose of Herceptin, and frequently during the time you are receiving Herceptin and after your last dose of Herceptin. If you must permanently or temporarily stop Herceptin due to heart problems, you should be monitored more frequently. In one study with Herceptin and certain types of chemotherapy, an inadequate blood supply to the heart occurred.

Some patients have had serious infusion reactions and lung problems; fatal infusion reactions have been reported. In most cases, these reactions occurred during or within 24 hours of receiving Herceptin. Your Herceptin infusion should be temporarily stopped if you have shortness of breath or very low blood pressure. Your doctor will monitor you until these symptoms go away. If you have a severe allergic reaction, swelling, lung problems, inflammation of the lung, or severe shortness of breath, your doctor may need to completely stop your Herceptin treatment.

Worsening of low white blood cell counts associated with chemotherapy has also occurred.

Herceptin can cause low amniotic fluid levels and harm to the fetus when taken by a pregnant woman.

The most common side effects associated with Herceptin were fever, nausea, vomiting, infusion reactions, diarrhea, infections, increased cough, headache, fatigue, shortness of breath, rash, low white and red blood cells, and muscle pain.

Because everyone is different, it is not possible to predict what side effects any one person will have. If you have questions or concerns about side effects, talk to your doctor.

Why is my heart being monitored while I'm on Herceptin?
Herceptin can cause heart problems including an inability to pump blood effectively, irregular heartbeats, high blood pressure, disabling heart failure, weakening of the heart muscle, and sudden loss of heart function leading to death. Herceptin may cause reduced heart function even if there are no symptoms.

Before taking your first dose of Herceptin, your doctor should check to see if you have any health conditions that may increase your chance of having serious heart problems. This includes a review of your health history and tests to see how well your heart muscle is working. These tests may include an echocardiogram, which is an ultrasound image of the heart, or a MUGA scan, which takes a moving picture of your heart pumping blood following an injection of a radioactive substance.

In addition, you should be frequently monitored for decreasing heart function during the time you are receiving Herceptin and after your last dose of Herceptin. If you must permanently or temporarily stop Herceptin due to heart problems, you should be monitored more frequently.

How many women had to stop Herceptin due to heart problems in the Herceptin adjuvant trials?
16% of patients in one study who received Herceptin with doxorubicin, cyclophosphamide, and paclitaxel

2.6% of patients in a second study, who received Herceptin alone after all chemotherapy was completed

2.9% of patients in a third study who received Herceptin with docetaxel and carboplatin, and 5.7% of patients in the same study who received Herceptin with doxorubicin, cyclophosphamide, and docetaxel

What happened to women after their Herceptin was stopped?
In 2 of the clinical trials, among 32 patients with significant heart problems:

One died of significantly weakened heart muscle

All others were on heart medication at their last checkup

Approximately half of the surviving patients had heart function that returned to normal while on ongoing heart medications

For patients with Herceptin-related decrease in heart function, the safety of continuing or restarting Herceptin therapy has not been studied

What side effects may I experience with my first dose of Herceptin?
When you receive the first dose of Herceptin, you may have chills and fever as well as nausea, vomiting, pain, headache, dizziness, shortness of breath, low blood pressure, rash, and weakness.

In most cases, these reactions occurred during or within 24 hours of receiving Herceptin.

If you have shortness of breath or very low blood pressure during an infusion, Herceptin treatment should be temporarily stopped. Your doctor will monitor you until these symptoms go away.

Serious and fatal reactions have been reported. If you have severe or life-threatening side effects while receiving treatment, your doctor should stop Herceptin completely.

Are the potential side effects with Herceptin the same as with chemotherapy?
Herceptin is not chemotherapy. Once you finish your chemotherapy and are receiving Herceptin alone, many of the chemotherapy-related side effects will likely go away or be less severe. For instance, Herceptin does not usually cause hair loss. See "What are the possible side effects of Herceptin?" section for more information.

What should I look out for when I'm on Herceptin therapy, and what symptoms should I immediately report to my doctor?
Be sure to tell your doctor about any health conditions you have had, as well as any new symptoms that arise. Call your doctor immediately if you have any of the following: new or worsening shortness of breath; cough; swelling of the ankles or legs; swelling of the face; heartbeats that are unusually strong, fast, slow, or irregular in rhythm; weight gain of more than 5 pounds in 24 hours; dizziness; or loss of consciousness.

Can I take Herceptin if I am pregnant?
Herceptin can cause harm to the fetus when taken by a pregnant woman. This may be related to a lowering of amniotic fluid levels in the second and third trimesters.

You should use effective contraceptive methods while receiving Herceptin and for at least 6 months after you finish taking Herceptin.

Talk to your doctor if you are pregnant or become pregnant while taking Herceptin. If you are pregnant and receiving Herceptin, consider joining the Cancer and Childbirth Registry by calling 1-800-690-6720. By joining this registry, you can help others understand the effects of taking Herceptin while pregnant.

Can I drive after my Herceptin treatment?
During the period you are taking both chemotherapy and Herceptin, you will have to discuss with your doctor or nurse whether you will be able to drive home after your infusion. After chemotherapy has been completed, and you are taking Herceptin alone, you will likely be able to drive home from your treatment. Everyone is different, however. It is not possible to predict whether you will feel well enough to drive after each infusion. Talk to your doctor or nurse.

Is Herceptin right for me?
Because everyone is different, it is not possible to predict what side effects any one person will have, or whether Herceptin treatment will be effective for you. It's important to discuss potential treatment benefits and risks with your doctor and to have realistic expectations of Herceptin therapy.

Please see the Herceptin full prescribing information including Boxed WARNINGS and additional important safety information.

..Who is Herceptin for?
Herceptin is approved for the adjuvant treatment of HER2-overexpressing, node-positive or node-negative (ER/PR-negative or with one high-risk feature) breast cancer. Herceptin can be used several different ways:

As part of a treatment regimen including doxorubicin, cyclophosphamide, and either paclitaxel or docetaxel
With docetaxel and carboplatin
As a single agent following multi-modality anthracycline-based therapy
Herceptin in combination with paclitaxel is approved for the first-line treatment of HER2-overexpressing metastatic breast cancer. Herceptin as a single agent is approved for treatment of HER2-overexpressing breast cancer in patients who have received one or more chemotherapy regimens for metastatic disease.

What important safety information should I know about Herceptin?
Herceptin treatment can result in heart problems, including those without symptoms (reduced heart function) and those with symptoms (congestive heart failure). The risk and seriousness of these heart problems were highest in people who received both Herceptin and a certain type of chemotherapy (anthracycline). Your doctor will stop or strongly consider stopping Herceptin if you have a significant drop in your heart function.

You should be monitored for decreased heart function before your first dose of Herceptin, and frequently during the time you are receiving Herceptin and after your last dose of Herceptin. If you must permanently or temporarily stop Herceptin due to heart problems, you should be monitored more frequently. In one study with Herceptin and certain types of chemotherapy, an inadequate blood supply to the heart occurred.

Some patients have had serious infusion reactions and lung problems; fatal infusion reactions have been reported. In most cases, these reactions occurred during or within 24 hours of receiving Herceptin. Your Herceptin infusion should be temporarily stopped if you have shortness of breath or very low blood pressure. Your doctor will monitor you until these symptoms go away. If you have a severe allergic reaction, swelling, lung problems, inflammation of the lung, or severe shortness of breath, your doctor may need to completely stop your Herceptin treatment.

Worsening of low white blood cell counts associated with chemotherapy has also occurred.

Herceptin can cause low amniotic fluid levels and harm to the fetus when taken by a pregnant woman.

The most common side effects associated with Herceptin were fever, nausea, vomiting, infusion reactions, diarrhea, infections, increased cough, headache, fatigue, shortness of breath, rash, low white and red blood cells, and muscle pain.

Because everyone is different, it is not possible to predict what side effects any one person will have. If you have questions or concerns about side effects, talk to your doctor.

Please see the Herceptin full prescribing information including Boxed WARNINGS and additional important safety information.

Global References

© 2009 Genentech USA. All rights reserved.
WebMD does not endorse any specific product, service, or treatment. www.webmd.com/treating-her2-breast-cancer/possible-side-effects-of-treatment

How Does Herceptin Work?
Herceptin is not chemotherapy or hormonal therapy. Herceptin is a type of targeted cancer therapy known as a monoclonal antibody (sometimes called targeted biologic therapy). Antibodies are part of the body's normal defense against bacteria, viruses, and abnormal cells, such as cancer cells.

Monoclonal antibodies are produced in a laboratory by making multiple copies of a single cell. Monoclonal antibodies are designed to recognize a specific protein on certain cells and signal the body's immune system to destroy the cell
Monoclonal antibodies are generally a more targeted therapy than chemotherapy
To receive Herceptin, your tumor must be tested and be HER2+. Talk to your doctor to find out if Herceptin is right for you.

..Who is Herceptin for?
Herceptin is approved for the adjuvant treatment of HER2-overexpressing, node-positive or node-negative (ER/PR-negative or with one high-risk feature) breast cancer. Herceptin can be used several different ways:

As part of a treatment regimen including doxorubicin, cyclophosphamide, and either paclitaxel or docetaxel
With docetaxel and carboplatin
As a single agent following multi-modality anthracycline-based therapy
Herceptin in combination with paclitaxel is approved for the first-line treatment of HER2-overexpressing metastatic breast cancer. Herceptin as a single agent is approved for treatment of HER2-overexpressing breast cancer in patients who have received one or more chemotherapy regimens for metastatic disease.

What important safety information should I know about Herceptin?
Herceptin treatment can result in heart problems, including those without symptoms (reduced heart function) and those with symptoms (congestive heart failure). The risk and seriousness of these heart problems were highest in people who received both Herceptin and a certain type of chemotherapy (anthracycline). Your doctor will stop or strongly consider stopping Herceptin if you have a significant drop in your heart function.

You should be monitored for decreased heart function before your first dose of Herceptin, and frequently during the time you are receiving Herceptin and after your last dose of Herceptin. If you must permanently or temporarily stop Herceptin due to heart problems, you should be monitored more frequently. In one study with Herceptin and certain types of chemotherapy, an inadequate blood supply to the heart occurred.

Some patients have had serious infusion reactions and lung problems; fatal infusion reactions have been reported. In most cases, these reactions occurred during or within 24 hours of receiving Herceptin. Your Herceptin infusion should be temporarily stopped if you have shortness of breath or very low blood pressure. Your doctor will monitor you until these symptoms go away. If you have a severe allergic reaction, swelling, lung problems, inflammation of the lung, or severe shortness of breath, your doctor may need to completely stop your Herceptin treatment.

Worsening of low white blood cell counts associated with chemotherapy has also occurred.

Herceptin can cause low amniotic fluid levels and harm to the fetus when taken by a pregnant woman.

The most common side effects associated with Herceptin were fever, nausea, vomiting, infusion reactions, diarrhea, infections, increased cough, headache, fatigue, shortness of breath, rash, low white and red blood cells, and muscle pain.

Because everyone is different, it is not possible to predict what side effects any one person will have. If you have questions or concerns about side effects, talk to your doctor.

Please see the Herceptin full prescribing information including Boxed WARNINGS and additional important safety information.

Global References

© 2009 Genentech USA. All rights reserved.
WebMD does not endorse any specific product, service, or treatment.

What is HER2?
HER2+ Breast Cancer
Studies show that approximately 25% of breast cancer patients have tumors that are HER2+. HER2 stands for Human Epidermal growth factor Receptor 2. It is very important to find out your cancer's HER2 status. This is because HER2+ tumors tend to grow and spread more quickly than tumors that are not HER2+. In addition, the treatment of HER2+ breast cancer is different than the treatment of breast cancer that is not HER2+. Women who are uncertain of their cancer's HER2 status should talk to their doctor.

HER2+ breast cancer is aggressive, so it is important to find out your cancer's HER2 status. This can help your doctor choose which treatments may be right for you.

How is HER2+ breast cancer different?
HER2 stands for Human Epidermal growth factor Receptor 2. Each normal breast cell contains copies of the HER2 gene, which helps normal cells grow. The HER2 gene is found in the DNA of a cell, and this gene contains the information for making the HER2 protein.

The HER2 protein, also called the HER2 receptor, is found on the surface of some normal cells in the body. In normal cells, HER2 proteins help send growth signals from outside the cell to the inside of the cell. These signals tell the cell to grow and divide.

In HER2+ breast cancer, the cancer cells have an abnormally high number of HER2 genes per cell. When this happens, too much HER2 protein appears on the surface of these cancer cells. This is called HER2 protein overexpression. Too much HER2 protein is thought to cause cancer cells to grow and divide more quickly. This is why HER2+ breast cancer is considered aggressive.

HER2+ breast cancer is aggressive, so it is important to find out your cancer's HER2 status. This can help your doctor choose which treatments may be right for you.
Getting HER2 Tested
Women who are uncertain of their cancer's HER2 status should talk to their doctor. HER2+ breast cancer is aggressive, so it is important to find out your cancer's HER2 status. This can help your doctor choose which treatments may be right for you.

HER2 testing is performed with the tumor sample removed during surgery or using a needle.

There are two types of tests available to determine HER2 status: Fluorescence In Situ Hybridization (FISH) and ImmunoHistoChemistry (IHC).

A FISH test checks to see whether or not the cancer cells have a normal number of HER2 genes. Using a special microscope the pathologist looks at cancer cells to see how many HER2 genes there are compared with some other normal genes
An IHC test measures how much HER2 protein there is on the surface of the cancer cells. The test is scored on a scale of 0 to 3+
Accurate testing is important; your pathology report may contain inconclusive results. Sometimes one test may not be enough to determine with certainty whether your tumor is HER2+. Ask your doctor to discuss the results of your pathology report, explain how your tumor's HER2 status was determined, and to let you know whether another test may be necessary.

..Who is Herceptin for?
Herceptin is approved for the adjuvant treatment of HER2-overexpressing, node-positive or node-negative (ER/PR-negative or with one high-risk feature) breast cancer. Herceptin can be used several different ways:

As part of a treatment regimen including doxorubicin, cyclophosphamide, and either paclitaxel or docetaxel
With docetaxel and carboplatin
As a single agent following multi-modality anthracycline-based therapy
Herceptin in combination with paclitaxel is approved for the first-line treatment of HER2-overexpressing metastatic breast cancer. Herceptin as a single agent is approved for treatment of HER2-overexpressing breast cancer in patients who have received one or more chemotherapy regimens for metastatic disease.

What important safety information should I know about Herceptin?
Herceptin treatment can result in heart problems, including those without symptoms (reduced heart function) and those with symptoms (congestive heart failure). The risk and seriousness of these heart problems were highest in people who received both Herceptin and a certain type of chemotherapy (anthracycline). Your doctor will stop or strongly consider stopping Herceptin if you have a significant drop in your heart function.

You should be monitored for decreased heart function before your first dose of Herceptin, and frequently during the time you are receiving Herceptin and after your last dose of Herceptin. If you must permanently or temporarily stop Herceptin due to heart problems, you should be monitored more frequently. In one study with Herceptin and certain types of chemotherapy, an inadequate blood supply to the heart occurred.

Some patients have had serious infusion reactions and lung problems; fatal infusion reactions have been reported. In most cases, these reactions occurred during or within 24 hours of receiving Herceptin. Your Herceptin infusion should be temporarily stopped if you have shortness of breath or very low blood pressure. Your doctor will monitor you until these symptoms go away. If you have a severe allergic reaction, swelling, lung problems, inflammation of the lung, or severe shortness of breath, your doctor may need to completely stop your Herceptin treatment.

Worsening of low white blood cell counts associated with chemotherapy has also occurred.

Herceptin can cause low amniotic fluid levels and harm to the fetus when taken by a pregnant woman.

The most common side effects associated with Herceptin were fever, nausea, vomiting, infusion reactions, diarrhea, infections, increased cough, headache, fatigue, shortness of breath, rash, low white and red blood cells, and muscle pain.

Because everyone is different, it is not possible to predict what side effects any one person will have. If you have questions or concerns about side effects, talk to your doctor.

Please see the Herceptin full prescribing information including Boxed WARNINGS and additional important safety information.

Global References

© 2009 Genentech USA. All rights reserved.
WebMD does not endorse any specific product, service, or treatment.

http://www.blogger.com/www.webmd.com/treating-her2-breast-cancer/what-is-her2-breast-cancer

About Breast Cancer

What is Breast Cancer?
Cancer is a general term that refers to cells that grow and multiply out of control and possibly spread to other parts of the body. There are many different types of breast cancer. Each may have different characteristics, and each one may require a different treatment.

Cancer can cause harm in different ways. Cancer cells take nutrition and space away from normal cells. A lump of cancer cells, called a tumor, can invade or destroy normal tissue. Cancer cells can also spread to other parts of the body. This is called metastasis.

Breast cancer is a common cancer among women in the United States and second only to skin cancer, affecting about 178,480 women in the United States in 2007.

Most breast cancer begins in the milk ducts. These ducts connect the milk-producing glands (called lobules) to the nipple. Some breast cancer begins in the lobules themselves, and the rest begins in other tissues. The diagram shows where these body parts are within the breast.

Breast Cancer Stages
A cancer's stage refers to how much the cancer has grown and where it has spread. Tumors can be noninvasive or invasive.

Noninvasive breast cancer, or carcinoma in situ, is a tumor that has not spread beyond the ducts or the lobules, depending on where it started.
Ductal carcinoma in situ (DCIS) is cancer that is confined to the ducts.
Lobular carcinoma in situ (LCIS) is a condition that is confined to the lobules or milk-making glands. Although not considered a true cancer, having LCIS increases the risk of getting cancer later
An invasive tumor has spread beyond where it began, and there are three different stages of invasiveness:

Localized stage: The tumor is still only within the breast
Regional stage: The tumor has spread to the tissue surrounding the breast or there are cancer cells within nearby lymph nodes. Lymph nodes are small masses of tissues found throughout the body that are involved in fighting infection. The more lymph nodes with cancer, the more serious the cancer may be
Distant (advanced/metastatic) stage: The tumor has spread away from the breast to other tissues in the body (eg, lung, liver, bone, or brain)
..Who is Herceptin for?
Herceptin is approved for the adjuvant treatment of HER2-overexpressing, node-positive or node-negative (ER/PR-negative or with one high-risk feature) breast cancer. Herceptin can be used several different ways:

As part of a treatment regimen including doxorubicin, cyclophosphamide, and either paclitaxel or docetaxel
With docetaxel and carboplatin
As a single agent following multi-modality anthracycline-based therapy
Herceptin in combination with paclitaxel is approved for the first-line treatment of HER2-overexpressing metastatic breast cancer. Herceptin as a single agent is approved for treatment of HER2-overexpressing breast cancer in patients who have received one or more chemotherapy regimens for metastatic disease.

What important safety information should I know about Herceptin?
Herceptin treatment can result in heart problems, including those without symptoms (reduced heart function) and those with symptoms (congestive heart failure). The risk and seriousness of these heart problems were highest in people who received both Herceptin and a certain type of chemotherapy (anthracycline). Your doctor will stop or strongly consider stopping Herceptin if you have a significant drop in your heart function.

You should be monitored for decreased heart function before your first dose of Herceptin, and frequently during the time you are receiving Herceptin and after your last dose of Herceptin. If you must permanently or temporarily stop Herceptin due to heart problems, you should be monitored more frequently. In one study with Herceptin and certain types of chemotherapy, an inadequate blood supply to the heart occurred.

Some patients have had serious infusion reactions and lung problems; fatal infusion reactions have been reported. In most cases, these reactions occurred during or within 24 hours of receiving Herceptin. Your Herceptin infusion should be temporarily stopped if you have shortness of breath or very low blood pressure. Your doctor will monitor you until these symptoms go away. If you have a severe allergic reaction, swelling, lung problems, inflammation of the lung, or severe shortness of breath, your doctor may need to completely stop your Herceptin treatment.

Worsening of low white blood cell counts associated with chemotherapy has also occurred.

Herceptin can cause low amniotic fluid levels and harm to the fetus when taken by a pregnant woman.

The most common side effects associated with Herceptin were fever, nausea, vomiting, infusion reactions, diarrhea, infections, increased cough, headache, fatigue, shortness of breath, rash, low white and red blood cells, and muscle pain.

Because everyone is different, it is not possible to predict what side effects any one person will have. If you have questions or concerns about side effects, talk to your doctor.

Please see the Herceptin full prescribing information including Boxed WARNINGS and additional important safety information.

Global References

© 2009 Genentech USA. All rights reserved.
WebMD does not endorse any specific product, service, or treatment. www.webmd.com/treating-her2-breast-cancer/breast-cancer-101

Treating HER2+ Breast Cancer

Who is Herceptin for?
Herceptin is approved for the adjuvant treatment of HER2-overexpressing, node-positive or node-negative (ER/PR-negative or with one high-risk feature) breast cancer. Herceptin can be used several different ways:

As part of a treatment regimen including doxorubicin, cyclophosphamide, and either paclitaxel or docetaxel
With docetaxel and carboplatin
As a single agent following multi-modality anthracycline-based therapy
Herceptin in combination with paclitaxel is approved for the first-line treatment of HER2-overexpressing metastatic breast cancer. Herceptin as a single agent is approved for treatment of HER2-overexpressing breast cancer in patients who have received one or more chemotherapy regimens for metastatic disease.

What important safety information should I know about Herceptin?
Herceptin treatment can result in heart problems, including those without symptoms (reduced heart function) and those with symptoms (congestive heart failure). The risk and seriousness of these heart problems were highest in people who received both Herceptin and a certain type of chemotherapy (anthracycline). Your doctor will stop or strongly consider stopping Herceptin if you have a significant drop in your heart function.

You should be monitored for decreased heart function before your first dose of Herceptin, and frequently during the time you are receiving Herceptin and after your last dose of Herceptin. If you must permanently or temporarily stop Herceptin due to heart problems, you should be monitored more frequently. In one study with Herceptin and certain types of chemotherapy, an inadequate blood supply to the heart occurred.

Some patients have had serious infusion reactions and lung problems; fatal infusion reactions have been reported. In most cases, these reactions occurred during or within 24 hours of receiving Herceptin. Your Herceptin infusion should be temporarily stopped if you have shortness of breath or very low blood pressure. Your doctor will monitor you until these symptoms go away. If you have a severe allergic reaction, swelling, lung problems, inflammation of the lung, or severe shortness of breath, your doctor may need to completely stop your Herceptin treatment.

Worsening of low white blood cell counts associated with chemotherapy has also occurred.

Herceptin can cause low amniotic fluid levels and harm to the fetus when taken by a pregnant woman.

The most common side effects associated with Herceptin were fever, nausea, vomiting, infusion reactions, diarrhea, infections, increased cough, headache, fatigue, shortness of breath, rash, low white and red blood cells, and muscle pain.

Because everyone is different, it is not possible to predict what side effects any one person will have. If you have questions or concerns about side effects, talk to your doctor.

Please see the Herceptin full prescribing information including Boxed WARNINGS and additional important safety information.

Global References

© 2009 Genentech USA. All rights reserved.
WebMD does not endorse any specific product, service, or treatment www.webmd.com/treating-her2-breast-cancer/default.htm

Featured: Blood Clots Main Article www.medicinenet.com/blood_clots/index.htm
Blood clots can occur in the venous and arterial vascular system. Blood clots can form in the heart, legs, arteries, veins, bladder, urinary tract and uterus. Risk factors for blood clots include high blood pressure and cholesterol, diabetes, smoking, and family history. Symptoms of a blood clot depend on the location of the clot. Some blood clots are a medical emergency. Blood clots are treated depending upon the cause of the clot. Blood clots can be prevented by lowering the risk factors for developing blood clots.

Medicationsibuprofen, Advil, Children's Advil/Motrin, Medipren, Motrin, Nuprin, PediaCare Fever, etc.
acetaminophen, Tylenol and Others
warfarin, Coumadin
alteplase, Activase, TPA
View All 5 Blood Clots Medications »Procedures & TestsCT Scan (Computerized Axial Tomography)
Ultrasound
Electrocardiogram (ECG or EKG)
Cardiac Catheterization
Related Diseases & ConditionsUrinary Tract Infection (UTI In Adults)
Rectal Bleeding
High Blood Pressure
Diabetes
View All 27 Blood Clots Related Diseases & Conditions »GlossaryBlood Clots Glossary



Terms related to Blood Clots:
Clot, Blood

Blood Clots At A Glance

•Blood clots form when blood fails to circulate adequately.


•Arterial thrombi form when a plaque ruptures and promotes an acute clot formation.


•Venous thrombosis occurs when prolonged immobilization allows blood to pool in an extremity and then clot.


•The diagnosis is suggested by the history and physical examination and often confirmed with a radiologic test.


•Treatment may require surgery, anti-coagulation medications, or a combination of the two.


•Prevention of blood clots involves attention to the risk factors for vascular disease.


•Serious complications can arise from blood clots, and individuals should seek medical care if they believe a blood clot exists.

What are the complications of blood clots?

Blood clots prevent proper circulation of blood.

Deep vein thrombosis of the leg or arm may cause permanent damage to the veins themselves and cause persistent swelling of the extremity. The life-threatening issue that may arise from deep venous clots is a clot that breaks off and embolizes to the lungs (pulmonary embolus), causing problems with lung function and oxygenation of the blood.

Arterial thrombus often is a life- or limb threatening event, since organs and cells do not get enough oxygen.


How can blood clots be prevented?

Prevention is key in thrombosis or clot formation.

Arterial thrombosis

•For arterial thrombosis, the most likely precipitating event is a plaque rupture with clot formation in the artery.


•Minimizing the risk of vascular disease requires life-long attention to the risk factors that lead to plaque buildup and "hardening" of the arteries.


•Blood pressure and cholesterol control, diabetes management, and refraining from smoking all minimize the risk of arterial disease.


•Although family history is an important risk factor, one needs to be even more vigilant about the other risk factors if there is a family history of vascular disease.
Deep vein thrombosis

The main risk factor for deep vein thrombosis risks is immobilization. It is important to move around routinely so that blood can circulate in the venous system. On long trips, it is recommended to get out of the car every couple of hours and in an airplane routinely get up and stretch.

Physicians and nurses work hard at getting people moving after surgery or while in the hospital for medical conditions. Enoxaparin (Lovenox) can also be used in low doses to prevent clot formation. Patients are often given tight stockings to promote blood return from the legs and prevent pooling of blood.

In patients with atrial fibrillation, warfarin (Coumadin) is used to prevent clot formation and minimize the risk of embolus and stroke

How are blood clots treated?

Depending upon their location, blood clots may be aggressively treated or may need nothing more than symptomatic care.

Venous blood clots

Venous thrombosis in the leg may occur in the superficial or deep systems of veins.

Clots in the superficial system are often treated symptomatically with warm compresses and acetaminophen or ibuprofen since there is no risk for clots in the superficial veins to embolize to the lung. They are connected to the deep system by perforator veins that have valves that act like a sieve to strain and prevent any clots form getting to the lung.

Deep venous thrombosis usually requires anticoagulation to prevent the clot from growing and causing a pulmonary embolus. Initial therapy with injectable enoxaparin (Lovenox) is used to immediately "thin" the blood. Meanwhile, warfarin (Coumadin) is prescribed as an anti-coagulation pill. It takes a few days for warfarin to reach therapeutic levels and in this time frame, both the injectable and oral medications are used.

Blood clots below the knee are at lower risk for embolization to the lung, and an alternative to anti-coagulation treatment is serial ultrasound examinations to monitor the clot to see if it is growing or being resorbed by the body.

Pulmonary emboli are treated similarly to deep venous thrombosis, but often the patient is admitted to hospital for observation. This is especially true if lung function is compromised and the patient is short of breath or is experiencing hypoxia, or low oxygen levels in the blood.

Arterial blood clots

Arterial blood clots are often managed more aggressively. Surgery may be attempted to remove the clot, or medication may be administered directly into the clot to try to dissolve it. Alteplase (Activase, TPA) or tenecteplase (TNKase) are examples of medications that may be used in peripheral arteries to try to restore blood supply.

This is the same approach that is used for heart attack. If possible, cardiac catheterization is performed to locate the blocked blood vessel and a balloon is used to open the occluded area, restore blood flow, and place a stent to keep it open. This is a time-sensitive procedure and if a hospital is not available to do the procedure emergently, TPA or TNK is used intravenously to try to dissolve the thrombus and minimize heart damage.

Stroke is also treated with TPA if the patient is an appropriate candidate for this therapy.

What are the symptoms of blood clots?

Venous clots do not allow blood to return to the heart and symptoms occur because of this damming effect. Most often occurring in the legs or the arms, symptoms include:

•swelling,


•warmth,


•redness, and


•pain.
Arterial clots do not allow blood get to the affected area.

•Pain is the initial symptom of this ischemia, or oxygen deprivation due to loss of blood supply.


•Other symptoms depend upon the location of the clot, and often the effect will be a loss of function. Heart attack and stroke are self-explanatory.


•In an arm or leg, in addition to pain, the limb may appear white, and weakness, loss of sensation, or paralysis may occur.


•If the blood supply is lost to an area of the bowel, in addition to intense pain, there may be bloody diarrhea.

How are blood clots diagnosed?

The initial step in making the diagnosis of a blood clot is obtaining a patient history. Since people rarely are able to tell that they have a blood clot, the health care practitioner will ask questions about what might be occurring. If a blood clot or thrombus is a consideration, the history may expand to explore risk factors or situations that might put the patient at risk for forming a clot.

Venous blood clots often develop slowly with a gradual onset of swelling, pain, and discoloration. Symptoms of a venous thrombus will progress over hours.

Arterial thrombi occur as an acute event. Tissues need oxygen immediately, and the loss of blood supply creates a situation in which symptoms begin immediately.

Physical examination can assist in providing additional information that may increase the suspicion for a blood clot.

•Venous thrombi may cause swelling of an extremity. It may be red, warm, and tender; sometimes the appearance is difficult to distinguish from cellulitis or an infection of the extremity. If there is concern about a pulmonary embolus, the examiner may listen to the lungs, looking for abnormal sounds caused by an area of inflamed lung tissue.


•Arterial thrombus symptoms are much more dramatic. If a leg or arm is involved, the tissue may be white because of the lack of blood supply. As well, it may be cool to touch and there may be loss of sensation and movement. The patient may be writhing in pain.
Arterial thrombus is also the cause of heart attack (myocardial infarction) and stroke (cerebrovascular accident) and their associated symptoms.

Testing for venous blood clots

Venous blood clots may be detected in a variety of ways, though ultrasound is most commonly used. Occasionally, the patient's size and shape limit the ability for ultrasound to provide a definitive answer.

Venography is an alternative test to look for a clot. In this test a radiologist injects contrast dye into a small vein in the hand or foot and using fluoroscopy (video X-ray) and watches the dye fill the veins in the extremity as it travels back to the heart. The area of clot or obstruction can thus be visualized.

Sometimes, a blood test is used to screen for blood clots. D-Dimer is a breakdown product of a blood clot, and its levels in the bloodstream may be measured. Blood clots are not stagnant; the body tries to dissolve them at the same time as new clot is being formed. D-Dimer is not specific for a blood clot in a given area and cannot distinguish a "good” or needed blood clot, one that forms after surgery or due to bruising from a fall, from one that is causing medical problems. It is used as a screening test with hopes that the result will be negative and show that there is no need to look further for blood clots.

Should a blood clot embolize to the lung, this may be a medical emergency. There are a variety of tests to look for pulmonary emboli. A plain chest X-ray will not show blood clots, but it may be done to look for other conditions that can cause chest pain and shortness of breath, which are the symptoms of a pulmonary embolus. An electrocardiogram (EKG) may show abnormalities suggestive of a pulmonary embolus and also may reveal other causes of chest pain.

Computerized tomography (CT scan) is often the test of choice when suspicion of pulmonary embolus is high. Contrast material is injected intravenously, and the radiologist can determine whether a clot is present in the pulmonary vessels.

On occasion, a ventilation perfusion (V/Q) scan is performed to look for pulmonary emboli. This test uses labeled chemicals to identify inhaled air into the lungs and match it with blood flow in the arteries. If a mismatch occurs, meaning that there is lung tissue that has good air entry but no blood flow, it may be indicative of a pulmonary embolus. It is less accurate that a CT scan and more subjectective to variances in interpretation.

Testing for arterial blood clots

Arterial thrombosis is an emergency, since tissue cannot survive long without blood supply before there is irreversible damage. When this occurs in an arm or leg, often a surgeon is consulted on an emergency basis. Arteriography may be considered, a test in which contrast material is injected into the artery in question to look for blockage on imaging studies. Sometimes, if there is a large artery that is occluded, this test is done in the operating room with the presumption that a surgical procedure will be needed to open the vessel and restore blood flow.

For a heart attack (acute myocardial infarction, MI), the EKG may establish the diagnosis, although blood tests may be used to look for enzymes (troponin, myoglobin, CPK) that leak into the bloodstream from irritated heart muscle. In an acute heart attack, the diagnostic and therapeutic procedure of choice is a heart catheterization.

For an acute stroke (cerebrovascular accident, CVA), the test of choice is a computerized tomography (CT) scan of the head to look for bleeding or tumor as the cause of stroke symptoms. If the symptoms resolve, the diagnosis is a transient ischemic attack (TIA, mini-stroke), and further tests may include carotid ultrasound to look for blockages in the major arteries of the neck and echocardiography to look for blood clots in the heart that may embolize to the brain.

Blood Clots (cont.)

What are the risk factors for blood clots?

The risk factors for arterial clots are those that are common to all diseases that cause narrowing of blood vessels. They include:

•high blood pressure,


•high cholesterol levels,


•diabetes,


•smoking, and


•family history.
Venous clots are formed due to one of two main reasons.

1.Most commonly, when the body stops moving, the risk of blood clots increases, since the lack of muscle movement allows blood to become stagnant in veins.


•This typically may occur when a person is hospitalized or bedridden after illness or surgery.


•It may also occur with long trips either in a car or a plane where hours may pass without a person getting up to walk or stretch.


•Orthopedic injuries and casting also put the patient at risk.


•Pregnancy is a risk factor for forming blood clots in the legs and pelvis, since the growing uterus may slow blood flow back to the heart to a sufficient extent that blood clots may form.
2.There may be a genetic or inborn error in the clotting mechanism, making a person hypercoagulable (hyper=more + coagulation= clotting) and at greater risk for forming clots.

What types of conditions are caused by blood clots?

Blood clots may cause life-threatening medical conditions, and for that reason are foremost in the mind of health care practitioners when it comes to diagnosis and prevention.

Deep venous thrombosis and pulmonary embolism

Deep venous thrombosis may lead to a pulmonary embolism, a condition in which the clot breaks off in a leg vein, travels in the veins back to the heart, and is pumped out of the heart through the pulmonary artery to the lungs with blood to be oxygenated in the lungs. In the lungs, the blood clot becomes lodged in the small blood vessels of the lung.

An embolus is the medical term for a blood clot that has moved with the bloodstream to a different location. With pulmonary embolus (pulmonary embolism), two issues occur.

1.The lungs' blood supply is comprised and the affected area of lung tissue may infarct, or die.


2.Because of the blockage, the ability of the lung to provide oxygen to the body is decreased and hypoxia (decreased levels of oxygen in the blood and throughout the body) may occur.
Even if venous blood clots do not embolize, they may cause significant local issues with swelling and pain. Since blood cannot return to the heart if a vein is blocked by a clot, the limbs may chronically swell and have decreased function in a condition called chronic thrombophlebitis.

Arterial thrombus

An arterial thrombus stops the blood supply to the tissues beyond the blockage, depriving cells of oxygen and nutrients. This quickly leads to tissue death. Arterial thrombus is the mechanism that causes:

•heart attack (when it occurs in the coronary arteries that supply the heart)


•stroke (when it occurs in arteries within the brain), and


•peripheral vascular disease (occurring in the arteries of the legs).
Atrial fibrillation

In atrial fibrillation, small clots may form along the walls of the atrium or the upper chambers of the heart. Should one of these clots break off, if can embolize, or travel in the bloodstream to the brain, blocking an artery and causing a stroke. Other arteries may also be involved by this process, including those that supply the bowel. This can cause mesenteric ischemia (mesentery=lining of the bowel + ischemia=loss of blood supply) and potential necrosis (tissue death) of the intestine.

Blood should clot anytime it becomes stagnant. This also means that clots will form when blood leaks out of blood vessels.

Examples include some of the following:

•With bleeding peptic ulcers, patients may vomit liquid blood mixed with clot.


•Patients with rectal bleeding may also have clot mixed with the bloody stool if there has been time for the clot to form.


•Sometimes patients with urinary tract or bladder infections develop associated bleeding in their urine, and small clots can form. On occasion these clots may be so big that they cannot be passed and block the urethra, preventing urination and causing urinary retention.


•Vaginal bleeding is a normal event for most women in the reproductive years and occasionally, blood can pool in the vagina and form clots before being expelled. If clots form in the uterus, they may cause significant pain and pressure as they pass through the cervix while being expelled

Blood Clots

What are blood clots?

Blood is a liquid that flows within blood vessels. It is constantly in motion as the heart pumps blood through arteries to the different organs and cells of the body. The blood is propelled back to the heart in the veins. When muscles contract, they squeeze the veins and allow the blood to be pushed back to the heart.

Blood clotting is an important mechanism to help the body repair injured blood vessels. Blood consists of:

•red blood cells containing hemoglobin that carry oxygen to cells and remove carbon dioxide,


•white blood cells that fight infection, and


•platelets that are part of the clotting process of the body, and


•blood plasma, which contains fluid, chemicals and proteins that are key to bodily functions.
Complex mechanisms exist in the bloodstream to form clots where they are needed. If the lining of the blood vessels becomes damaged, platelets are recruited to the injured area to form an initial plug. These activated platelets release chemicals that start the clotting cascade, activating a series of clotting factors. Ultimately, fibrin is formed, the protein that crosslinks with itself to form a mesh that makes up the final blood clot.

The medical term for a blood clot is a thrombus (plural= thrombi). When a thrombus is formed as part of a normal repair process of the body, there is little consequence. Unfortunately, there are times when a thrombus (blood clot) will form when it is not needed, and this can have potentially significant consequences.


What causes blood clots?

Blood clots form when there is damage to the lining of a blood vessel, either an artery or a vein. The damage may be obvious, such as a laceration, or may occur on the microscopic level. As well, blood will begin to clot if it stops moving and becomes stagnant.

Venous thrombosis or blood clots in a vein occur when a person becomes immobilized and muscles are not contracting to push blood back to the heart. This stagnant blood begins to form small clots along the lining walls of the vein that gradually grow to partially or completely occlude the vein. An analogy to this process is a slow moving river. Over time, weeds and algae start to accumulate along the banks of the river where the water flows more slowly. Gradually, as the weeds start to grow, they begin to invade the center of the river because they can withstand the pressure of the water.

Arterial thrombi (blood clots in an artery) occur by a different mechanism. For those with atherosclerotic disease, plaque deposits form along the lining of the artery and grow to cause narrowing of the vessel. This is the disease process that may cause heart attack, stroke, and peripheral artery disease. If a plaque ruptures, a blood clot can form at the site of the ruptured plaque that can completely or partially occlude the blood flow at that point.

Blood clots can also form in the heart. In atrial fibrillation, the atrium or upper chamber of the heart does not beat in an organized manner. Instead, it jiggles, and blood tends to become stagnant along the walls of the atrium. Over time, this may cause small blood clots to form. Clots can also form in the ventricle after a heart attack when part of the heart muscle is injured and unable to contract normally. Since the damaged area doesn't contract with the rest of the heart, blood can start to pool or stagnate, leading to clot formation.

www.medicinenet.com/heart_disease_pictures_slideshow/article.htm

Production Facilities

Hilton Pharma’s production facilities are located at Korangi Industrial Area in Karachi, which is also the base for several multinational pharmaceutical companies. The company adheres strictly to the principles of current Good Manufacturing Practices (cGMP), resulting in high standards of production, quality, industrial safety, occupational health and environmental control.

Raw materials, sourced from globally renowned manufacturers, are subjected to a demanding schedule of various testing procedures to produce quality products at the manufacturing facility approved through regular inspections by local regulatory authorities and the principal companies whose products are manufactured by Hilton Pharma under license.

At Hilton Pharma quality management is the foremost concern, as we believe in building in quality during the manufacturing process. The qualitative edge at Hilton Pharma stems from a highly skilled work force and professional management reinforced by an ongoing integrated human resource training and development program.

This in turn ensures that every product bearing the name of Hilton Pharma meets the highest international quality standards of production, safety and efficacy. Our ISO 14001 & 9001:2000 certification is a testament to the success of our quality management systems.

WELCOME TO HILTON

HILTON in brief

Hilton Pharma is a member of the well-known Progressive Group of Companies. Combining the best of Pakistani cultural values, entrepreneurship, a strong work ethic and strict compliance with current Good Manufacturing Practices (cGMP), Hilton has emerged as the largest national pharmaceutical company. We market products under license from several world-renowned, research-based pharmaceutical companies besides our own branded generic specialties.

From its very inception, Hilton Pharma has given top priority to promoting research-based pharmaceutical products. Our key competitive strength lies in strong and innovative marketing strategies, which has helped us to be strategically positioned in the respective therapeutic areas in which our products are placed.

When it comes to the manufacturing aspects of its operations, Hilton Pharma has always been committed to strict adherence to cGMP and international standards of quality, which has resulted in the award of ISO 14001 & 9001:2000 certification.

Hilton Pharma has attained this prestigious position through its continuous focus on human resource development, proactive teamwork, innovative marketing skills and the modernization of its production facilities. Its collaboration with research-based, world-renowned multinational companies demonstrates Hilton Pharma's commitment to bring the best and most innovative Health Care products to Pakistan www.hiltonpharma.com/

Therapeutic Segment
Anti-hypertensive

Generic Name
Candesartan cilexetil

Indication
For the treatment of Hypertension. It may be used alone or in combination with other anti-hypertensive agents.

Brand
Advant

Form
Tablet

Therapeutic Segment
Anti-rheumatic

Generic Name
Diclofenac Sodium

Indication
A treatment for pain and inflammation arising from arthritis, gout or rheumatic diseases.

Brand
Panslay

Form
Tablet

Therapeutic Segment
Anti-rheumatic

Generic Name
Diclofenac Sodium + Misoprostol

Indication
A combination product with GI safety for the treatment of pain and inflammation associated with arthritis, gout or rheumatic diseases.

Brand
Cytopan

Form
Tablet

Therapeutic Segment
Anti-rheumatic

Generic Name
Celecoxib

Indication
For symptomatic treatment of osteoarthritis (OA), rheumatoid arthritis (RA) and ankylosing spondyliltis.

Brand
Celcoxx

Form
Capsules

Getz Pharma Pakistan

www.getzpharma.com/countries/pakistan/Getz Pharma, the largest branded generic pharmaceutical company in Pakistan, started its operations in 1995. Since its inception, Getz Pharma has shown unparalleled growth both in qualitative as well as quantitative aspects. According to the IMS, Getz Pharma was ranked 195th out of 200 Pharma companies in Pakistan in the year 1995. But in a quick 11 years, Getz Pharma has achieved the 6th position among 650 pharmaceutical companies and has been recognized as one of the fastest growing pharma concerns in Pakistan. During the last five years, the average growth rate of Getz Pharma has been 70% compared to the Pakistan pharma industry’s average growth rate of 12% for the same period. With the current pace, Getz Pharma is destined to become the second largest pharma company in Pakistan by the year 2010. Currently, 732 people are working in sales and marketing only – making Getz Pharma one of the largest pharma companies in terms of human resources in sales and marketing.

Getz Pharma is considered the leading pharmaceutical concern with a wealth of manufacturing and marketing experience. Getz Pharma has a well-entrenched leadership position with major shares in hepatology, gastroenterology, diabetology, cardiology and infertility, as well as a strong presence in following therapeutic areas:

Pulmonology
Orthopedics
Rheumatology
Infectious diseases
Pediatrics
ENT
A large number of Getz Pharma brands hold market leadership in their respective classes including Uniferon and Risek which are the 13th and 20th largest brands respectively of the entire pharma industry of Pakistan. The following brands are market leaders in their respective classes.

Generic Name Getz Pharma Brand
Interferon Uniferon
Ribavirin Ribazole
Mesalamine Asacol
Atorvastatin Lipiget
Omeprazole Risek
Esomeprazole Nexum
Levofloxacin Leflox
Celecoxib Celbexx
Terresteris Tribulus comb Gonadil-f
Fexofenadine Fexet
Candesartin Advant
Rosuvastatin Rovista
Glimepiride Getryl

We aim to continue rapid growth in Pakistan by aggressively launching new brands, entering new therapeutic segments, and driving existing brands to market leadership positions. Our vision is to become the second largest pharmaceutical company in the Pakistan by 2010.

Getz Pharma is associated with Muller & Phipps, the largest distribution company of Pakistan. Muller & Phipps has 1200 full-time employees in twenty-three locations throughout Pakistan, with a coverage of 33,000 retail outlets.


Best In Class

Giving our partners the results they seek takes agility, passion and a spirit of continuous improvement. We are known to excel in every aspect of our operations that range from Manufacturing to Marketing; Systems to Sales; Quality Control to Corporate Social Responsibility.







Need to contact us in Pakistan?
Getz Pharma (Private) Limited
29-30/27, Korangi Industrial Area
Karachi 74900
Pakistan.
UAN +9221-111-111-511
Fax: +9221-5060141
Email: business.partnerships@getzpharma.com
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©2009 Getz Pharma (Pvt) Ltd.

Screening’s age of insecurity

High-throughput screening hasn’t given us more drugs. Can better data management make a difference?
Researchers at today’s biotechnology and pharmaceutical companies should be brimming with confidence. The data are fruitful and multiplying. Many crucial target systems have been well characterized, and druglike behavior is better understood. Besides this knowledge, we have the technology—the robust assays, automation, and detection methods—necessary to move from targets, to hits, to leads, to drugs.

Yet the pace of research remains frenetic, and the competitive landscape cutthroat. That’s because organizations have little to show for all of the innovations of the 1990s, at least in terms of new chemical entities. High-throughput screening (HTS), in particular, has not lived up to the expectations that greeted its initial adoption in the first half of the decade. HTS has matured as a field, but lead attrition rates remain high, and little time has been shaved off R&D pipelines. Screeners seem confident in their programs’ ability to generate data. But they are less sure about whether they and their organizations are doing the best things with data generated.

“What we’ve entered now is an age of insecurity,” says Peter Hecht, senior vice president of discovery research operations at Tripos. “We have more than ever to choose from in terms of targets, compounds, and options for what we should be doing next. But we’re discovering that all the data around us isn’t making the answers come any easier.”

Maturation and industrialization
In the beginning, there was screening. Then came the 96-well plate and the concept of increasing throughput. The appeal was obvious: Why screen just a few compounds in an assay when you could screen whole plates at a time, particularly when a convenient new technique called combinatorial chemistry was letting you synthesize new compounds faster than ever before? By the mid-1990s, most pharmaceutical and biotechnology organizations had initiated HTS programs, and it was not long before the “ultra” modifier was added to the acronym.

Yet while screening’s modifiers have become increasingly superlative, emphasizing both speed and miniaturization, today’s screeners often reject these labels. “We don’t have a badge that says, ‘We are high throughput,’” points out Mike Snowden, head of the molecular discovery department at Glaxo Wellcome.

Snowden credits HTS’s active “conference culture” with perpetuating the notion that the technique is somehow set apart. In practice, Snowden and others say screening is screening, scaled according to the project at hand and balanced on a continuum with respect to quality and throughput. Says Bob Burrier, senior director of biochemical technologies at GelTex Pharmaceuticals, “We chose to focus on developing an infrastructure that would support our various projects, rather than a platform for a particular volume of screening. We have the ability to screen 100,000 data points a day, but we only do it when the project requires it.”

Such considerations demonstrate that screening has come of age—an industrial age in which high-throughput techniques are no longer adopted faddishly but applied as just one more tool in the biologist’s research repertoire. Much of screening’s maturation can be credited to experience, which has revealed the technique’s strengths as well as its limitations. But technological advances have also played an important role. Factors influencing screening’s maturation and industrialization include the following:

screening scientists having more experience managing the logistics of scaling assays to a high-throughput environment;
access to more sensitive detection devices, particularly the wide range of fluorescence techniques that are now commonplace even in primary screening;
standardization of the 96- and 384-well plate formats, which can now accommodate most assays. Rather than pursuing further miniaturization, most screening groups are looking at pooling or high-content screening as methods for increasing throughput;
better-engineered automation, with more options available both in terms of workstations and fully integrated automated systems; and
the emergence of software systems tailored specifically to the needs of screening scientists and their organizations.

Managing data: Then versus now
Screening’s industrialization, particularly the availability of robust data management tools, has freed screeners to adopt a more systematic, process-oriented mind-set toward the techniques. “If you’d asked me five years ago to name my crucial data management need, I’d have answered, ‘Just get the data into Excel, please,’” says Snowden. “Today, getting data out of the readers, processing it for percent inhibition, and updating Oracle tables are of little interest to anyone because we can all do it, ad nauseam. It’s what you do with the data in your database, how you mine it—that’s where the competitive advantage is.”

The need to pause and think more carefully about data explains why increasing throughput has become less of a priority even as screening technology has made it easier to achieve. In the early days of screening, most assays generated single data points, such as a percent-inhibition value. Not surprisingly, higher-throughput techniques are at their most productive when generating data that can be easily interpreted. In fact, today’s data management systems are often customized to identify and automatically advance compounds from a screening run possessing a particular percent inhibition value.

But the high-throughput model works less well as the data get more complex—and complexity comes in many forms. Modern assay techniques, such as fluorescence and pooling, generate multiple data points for a well that must be resolved before scientists can act on the results. Cell-based assays and other high-content screens also tend to generate data that are not readily mappable back to a standard database unit. And then there are the logistical concerns arising from the focus on projects rather than particular screening platforms. Compounds stored on 96-well plates, for example, may be run in 384-well plates, requiring some way to map back to the original compounds before scientists can begin comparing plates or deciding which compounds show the most promise in an assay.

“As you generate more and more interrelated data points, you end up spending much more time interpreting that data,” explains Neil Carlson, a senior software engineer in the advanced discovery sciences group at Applied Biosystems. “The value of focusing purely on the volume of data produced drops as the amount of knowledge you gain from each data point increases.”

Screeners have confidence that they can generate data. They know they can put the results into a database, even those generated by newer detection devices or by more complicated assays. The bottlenecks—and the key opportunities for creative solutions to speed the process—now center on two key questions: Are the data produced by screening any good? And how can the good data be used to make better, faster decisions?

Online, unseen QC
The emphasis on quality and process control—on tracking HTS data in real time during the course of a project—is a direct outgrowth of screening’s industrialization. Not that quality is a new concern for screening scientists, who have always had tools available to help them spot problems with an assay. But screeners today don’t just want to weed out the junk; they want to stop it before it starts.

“A long time ago, when screening was a manual process, you could set up your 50 plates to run, get a cup of tea, wait for the reader to read the plates, and then sit down to work out whether the experiment had failed or not,” says Snowden. But today, Snowden and colleague Chris Molloy, head of HTS information technology (IT) and automation, note that online, immediate analysis of assay performance saves organizations critical time and money. Glaxo Wellcome’s online quality control system monitors and examines plates as they come off robots. Potential problems can be identified immediately and the entire operation shut down to make necessary corrections. It is a process that hearkens to a manufacturing assembly line rather than a research laboratory, and Molloy points out that such online, unseen data management has changed the screening work flow by removing tedious tasks. “Screeners today can spend time on more cerebral problem solving rather than wading through the mass of high-quality data that doesn’t need their attention,” Molloy says.

The availability of commercial software designed for screening has helped companies implement their own unique data management tools. Glaxo Wellcome’s internal IT staff built the quality control functionality as a module to an underlying commercial system; they also created software for hit definition and cheminformatics. All three of the major suppliers of screening data management software claim to provide fully functional packages along with tools and consulting services for helping customers build custom solutions (see box at right).The reason is simple, according to GelTex’s Burrier. “For commercial software to be useful, it must not only work out of the box, but adapt easily. Drug discovery is arguably the most data-intensive industry out there, so we need products that will move with us as our needs change,” Burrier says.

Yet some companies dislike the overhead associated with out-of-the-box commercial applications. “We found that most commercial solutions forced us to follow a number of procedures to get the data into the database and knowledge back out of the database that just weren’t relevant to our existing processes,” says Applied Biosystems’ Carlson. Applied Biosystems chose to build its own visualization system for assessing screening performance, which enables a scientist to validate and analyze screens in just two hours rather than eight.

Integration expectations
Although data management systems have helped streamline many of the tasks essential to screening, they have been less successful at providing the context to assist medicinal chemists and others with interpreting and acting on screening results. The problem is not new, according to Trevor Heritage, senior vice president of discovery technology operations and marketing at Tripos. “Even when we were screening in tubes, we had trouble storing the metadata associated with each data point,” Heritage says. “Moving to 96-well plates made the problem worse, and now, at really high throughputs, it’s become nearly impossible.”

Lack of integration could be tolerated during screening’s infancy, when other data management and logistical issues had yet to be resolved. But with screening itself no longer a bottleneck, organizations can now afford to ask why screening has failed to jump-start stalled R&D pipelines. Jack Elands, vice president of marketing at IDBS, points out that disillusionment with HTS has led scientists back to another technique that was once viewed as a drug discovery panacea: rational drug design.

“In the early 1990s, computational chemistry was the technique that would lead to new drugs, and testing would simply confirm these new leads,” Elands recalls. “But when pure rational design didn’t pay off, the pendulum swung wildly the other way to blitz-screening of everything in a compound library. Today, both techniques have matured. Perhaps together, they will be able to achieve what they couldn’t separately.”

Better integration may be the solution, but it is not something that can be easily provided in a one-size-fits-all, out-of-the-box package. “The real questions that you need to answer during HTS are, ‘What do you want to test, and what do you want to make?’” says GelTex’s Burrier. Different companies answer these questions in different ways, and they are not interested in sharing their particular way of answering the questions. As a result, organizations expect vendors to provide open systems that readily hook into the components that scientists might need to access.

Possible solutions typically involve rationalizing screening using available data from genomics; cheminformatics; and absorption, distribution, metabolism, and excretion studies. Outsourcing screening organizations, such as Applied Biosystems and Discovery Technologies, Ltd., have implemented integrated lead-finding processes to make their services more attractive to customers. Tripos recently patented a method of characterizing the structural diversity of large combinatorial libraries, which can aid screeners in selecting compounds for testing. And Glaxo Wellcome points to its in-house cheminformatics system, which lets scientists consider chemical information immediately after primary screening.

A security blanket?
HTS’s growth from fad to industrialized process has been mirrored by a change in mind-set. More data, it turns out, does not mean more answers—and it certainly does not translate automatically into more viable leads. “You can’t count on serendipity,” says Burrier. Whether an organization is intent on focused screening or backing out to run broader diversity screens, the emphasis today is on collecting good data and doing good things with the information. Only time will tell whether this increased attention on data management will help screening outgrow its age of insecurity.



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Deborah J. Ausman is a freelance science writer living in Houston. Send your comments or questions regarding this article to mdd@acs.org or the Editorial Office by fax at 202-776-8166 or by post at 1155 16th Street, NW; Washington, DC 20036.
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