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Obesity and cardiovascular disease

Obesity is a major contributor to the risk of cardiovascular disease. In the Fram-ingham Heart Study, the 26-year incidence of coronary heart disease (CHD) was increased by a factor of 2.4 in obese women and 2 in obese men under age of 50 years (Hubert et al., 1983). Excess weight was an independent predictor of coronary artery disease, coronary death and congestive heart failure after adjusting for other known recognized risk factors. In the Nurses' Health Study from the United States, the risk of developing CHD increased 3.3-fold with BMI > 29 kg m2 and 1.8-fold between 25 and 29 kg m2, compared to those women with BMI < 21 kg m2 (Manson et al., 1990, 1995). Each kg of weight gained from the age of 18 years was associated with 3.1 higher risk of cardiovascular disease (Willett et al., 1995). This increased risk extends to overweight children and adolescents, who are at risk of premature cardiovascular morbidity and death. Excess weight in adolescence was a better predictor of...

Appetite Suppression in Obesity

At the time of writing, seven phase III clinical trials are in progress focusing on rimonabant's effect on weight loss and smoking cessation. None of these has yet been published in peer-reviewed journals, but two have been completed and the results presented at a U.S. cardiology conference in 2004. According to information supplied by the manufacturer, overweight patients treated with rimonabant 20 mg daily for 1 year lost significantly more weight than placebo patients (p < 0.001). Improvement in some associated cardiovascular risk factors (e.g. waist circumference, HDL cholesterol and triglyceride plasma levels, C-reactive protein levels) were also reported. Unwanted effects were described as consisting mainly of mild and transient nausea and dizziness, though twice as many patients dropped out on rimonabant 20 mg than placebo. A second study suggested that smokers seeking abstinence were twice as likely to be successful when treated with rimonabant 20 mg for 10 weeks in...

What is the therapy for peripheral neuropathy

The usual starting dose of gabapentin is 300-400 mg the first day, and then immediately from the second day a doubling of the dose (300400 mg twice a day). The dose can subsequently be increased up to 1800 mg day, depending on the patient's responsiveness. Maximal therapeutic dose is 3600 mg day. Pharmacokinetic properties are not affected by food intake. An advantage of the medicine is that it does not cause weight gain. Patients with renal insufficiency should receive a smaller dose (creatinine clearance > 60ml min 1200 mg day clearance 3060 ml min 600 mg day clearance 15-30 ml min 300 mg day and clearance < 10 ml min 300 mg every other day).

Treatment Phases and Goals

Clinicians are usually consistent in their agreement with the APA or BAP recommended guidelines for the treatment of depression.2'3 The goals of the three phases of treatment are defined in Table 8. Owing to the widespread use of antidepressants, clinicians now demand that an NCE has an acceptable safety profile (Table 7). The incidence of all transient side-effects, such as nausea, headache, dizziness, agitation, sexual dysfunction, and weight gain, should be measured.

Reversible sideeffects

In chronically treated patients, the most common side-effects involve the central nervous system (CNS) and include cerebello-vestibular and oculomotor symptoms (ataxia, dysarthria, dizziness, tremor, diplopia, blurred vision and nystagmus), drowsiness, fatigue, impairment of cognitive function, and disorders of mood and behaviour. Chronic non-CNS side-effects include weight gain with valproate and vigabatrin, nephro-lithiasis with topiramate, and endocrine disturbances with a variety of AEDs. It has been suggested that some of the newer AEDs are overall better tolerated than older agents, but this claim should be regarded cautiously because in many comparative studies the choice of titration schedules or dosing regimens was biased in favour of the innovative product. Moreover, clinical exposure to the newer drugs is still relatively limited and experience shows that it may take many years for important adverse effects to be discovered (see Table 2.11).

Gerontologic Alert

Some patients taking the antiparkinsonism drugs experience gastrointestinal disturbances such as nausea, vomiting, or constipation. This can affect the patient's nutritional status. It is a good idea for the nurse to create a calm environment, serve small frequent meals, and serve foods the patient prefers to help improve nutrition. The nurse also may monitor the patient's weight daily. Gastrointestinal disturbances are sometimes helped by taking the drug with meals. Severe nausea or vomiting may necessitate discontinuing the drug and changing to a different antiparkinsonism drug. With continued use of the drug, nausea usually decreases or is resolved. If constipation is a problem, the nurse stresses the need for a diet high in fiber and increasing fluids in the diet. A stool softener may be needed to help prevent constipation.

Hazard Identification

In the design of experiments, careful attention must be given to technical factors and strain differences in the production of nitrite. Chickens cannot synthesize L-arginine because they lack select enzymes in the urea cycle (Tamir and Ratner, 1963). Therefore, the diet must be supplemented with L-arginine. Other genetic factors influence the amount of L-arginine available for the production of NO. Production depends, in part, on the renal arginase levels. Arginase levels are genetically determined and may differ between species and strains (Nesheim et al., 1971). In mammals, L-arginine is produced by enzymes in the urea cycle using ornithine, ammonia, and aspartate as building blocks. Supplemental dietary L-ar-ginine may influence macrophage function in some species but not in others. Rats and mice may also differ in baseline levels of nitrite, the ability to produce nitrite, and the amount of nitrate produced following stimulation with LPS (Mills, 1991)

Autoimmunity in Juveniles

Was associated with iodine restriction in the diet and disappearance of antibodies capable of blocking the TSH-R 20 . In another study of 21 children with atrophic thyroiditis and 48 children with a lymphocytic goitre, all treated with thyroxine, five of the goitrous patients recovered normal thyroid function 21 . In relation to environmental factors, diffuse autoimmune thyroiditis and high levels of thyroid autoantibodies are rare in children in moderately iodine-deficient areas, although TG and TPO antibodies occur at low levels quite frequently 41 . Overall however the prevalence of thyroid antibodies in children in relation to iodine intake is not well established, although pilot data show equal prevalence of TPO antibodies in iodine replete and moderately iodine-deficient patients 42 . Overall, therefore, the effect of dietary iodine on thyroid autoimmunity appears, at best, modest.

Gender Ethnicracial And Life Span Considerations

Patients with suspected goiter most often complain of visible enlargement of the neck or difficulty in activities such as buttoning shirts with no accompanying weight gain to account for the problem. In advanced stages, they may complain of pressure on the neck or chest, difficulty in swallowing, or respiratory distress. Other symptoms may reflect either hypothy-roidism or hyperthyroidism.

Classification Antipsychotic

Contraindications Myeloprolifera-tive disorders. Use with other agents known to suppress bone marrow function. Severe CNS depression or coma due to any cause. Lactation. Special Concerns Use with caution in clients with known CV disease, prostatic hypertrophy, narrow angle glaucoma, hepatic or renal disease. Side Effects Hematologie Agranu-locytosis, leukopenia, neutropenia, eosinophilia. CNS Seizures (appear to be dose dependent), drowsiness or sedation, dizziness, vertigo, headache, tremor, restlessness, nightmares, hypokinesia, akinesia, agitation, akathisia, confusion, rigidity, fatigue, insomnia, hyperkinesia, weakness, lethargy, slurred speech, ataxia, depression, anxiety, epilepti-form movements. CV Orthostatic hypotension (especially initially), tachycardia, syncope, hypertension, angina, chest pain, cardiac abnormalities, changes in ECG. Neuroleptic malignant syndrome Hyperpyrexia, muscle rigidity, altered mental status, irregular pulse or BP, tachycardia, diaphoresis,...

Antidepressant Medication

Drowsiness, increased appetite, weight gain Mirtazapine (Remeron) is a novel antidepressant that appears to produce antidepressant effects by blocking both the a2-adrenoreceptor and two postsynaptic serotonin receptors, 5-HT2 and 5-HT3, which increases norepinephrine activity and specific serotonin activity in the brain. Common side effects of mirtaza-pine include drowsiness, increased appetite, and weight gain.

Clinical Emergencies in Diabetes Hypoglycemia

Postprandial or reactive hypoglycemia Alimentary hypoglycemia (gastrectomy, gastrojejunostomy, pyloroplasty or vagotomy) Hyperthyroidism Obesity with hyperinsulinism Early stage of type 2 diabetes, prediabetes or IGT (1) Alimentary hypoglycemia (or alimentary hyperinsulinism) caused by gastrectomy, gastrojejunostomy, pyloroplasty or vagotomy, involving about 5-10 of operated patients and developing 30-120 min after ingestion of carbohydrate-containing meals (due to rapid gastric emptying and glucose absorption which stimulate excessive insulin release, and perhaps also to hypersecretion of enterohormones such as enteroglucagon, secretin, GIP, etc.) it may perhaps also occur in patients with hyperthyroidism, or in obesity with hyperinsulinism. hormones, drugs or alcohol. It is important to have an accurate history of the patient to distinguish between fasting or postprandial hypoglycemia and to relate hypoglycemic episodes and symptoms and signs. The clinical evaluation should refer...

Sedativehypnotics Antianxiety Antimanic Drugs

Ers have the ability to cause psychologic and physical dependence. Uses See individual drugs. Depending on the drug, used as antianxiety agents, hypnotics, anticonvulsants, and muscle relaxants. Contraindications Hypersensitiv-ity, acute narrow-angle glaucoma, psychoses, primary depressive disorder, psychiatric disorders in which anxiety is not a signficiant symptom. Special Concerns Use with caution in impaired hepatic or renal function and in the geriatric or debilitated client. Use during lactation may cause sedation, weight loss, and possibly feeding difficulties in the infant. Geriatric clients may be more sensitive to the effects of ben-zodiazepines symptoms may include oversedation, dizziness, confusion, or ataxia. When used for insomnia, rebound sleep disorders may occur following abrupt withdrawal of certain benzodiazepines. Side Effects CNS Drowsiness, fatigue, confusion, ataxia, sedation, dizziness, vertigo, depression, apathy, lightheadedness, delirium, headache, lethargy,...

Definition Classification and Prevalence

Poor concentration Swelling of extremities Weight gain nervous tension Weight gain, abdominal bloating and tenderness, breast tenderness, swelling of the extremities Premenstrual increased appetite, craving for sweets, fatigue, palpitations, headache Depression, withdrawal, lethargy, forgetfulness, confusion, insomnia, difficulty verbalizing

Pregnancy Category None

Pregnant women who took drugs in unsuccessful suicide attempts were the subjects of a study that tentatively concluded that ergota-mine did not cause congenital malformations, but the researchers felt they needed more data to be sure. Other investigators have noted reports of er-gotamine birth defects consistent with reduced blood flow (a known action of ergot preparations), but those reports have not been scientifically confirmed. Clinical observations have noted that when nursing mothers use ergotamine in the first week after birth, their infants show normal milk consumption and normal weight gain during that week. Ergot passes into human milk, however, and instances have been noted of infants poisoned from ergot in the milk.

Tricyclic antidepressants

Although effective in the treatment of a number of disorders, TCAs are associated with high morbidity and mortality because of their side effects (5,6). These side effects include hypotension, dizziness, and sedation by blocking a1 adrenoreceptors weight gain and sedation through H1 histamine receptors and dry mouth, blurred vision, constipation, and urinary retention through M1 muscarinic receptors. TCAs are known to lower thresholds for seizures. TCAs were the third leading cause of toxic exposures in 2004 after analgesics and sedatives (7).

Appetite Loss and Anorexia

Patients receiving THC for nausea and vomiting associated with cancer chemotherapy have often shown improved appetite after receiving THC, but the effect is unpredictable (Regelson et al., 1976). In a small study comparing THC with diazepam in patients with anorexia nervosa, THC did not improve caloric intake and three of the eleven patients who took the drug developed paranoia (Gross et al., 1980). The Food and Drug Administration approved the use of synthetic THC (dronabinol) for anorexia associated with weight loss in patients with AIDS, based on clinical studies in which the effect of THC was sustained for up to 5 months a placebo-controlled trial involving 139 patients with AIDS in the US and Puerto Rico was carried out for an initial period of 6 weeks. The patients in the active arm of the trial received 2.5 mg THC twice daily before meals. THC produced a significant increase in appetite compared to the placebo but no corresponding increase in weight gain. Side effects...

General Information

The anxiolytic effects of mexazolam have been compared with those of alprazolam in 64 outpatients with generalized anxiety disorder in a multicenter, doubleblind, parallel-group, randomized trial (1). Five mexazo-lam and nine alprazolam recipients reported mild adverse events drowsiness in three patients in each group dizziness in one taking mexazolam and two taking alprazolam blurred vision in one patient taking mexazolam and weight gain, nausea, and insomnia in one patient taking alprazolam. Both drugs were effective anxiolytics and both were well tolerated.

See also Individual agents General Information

There seems to be little difference between SSRIs with respect to frequency and severity of adverse effects. The most common adverse effects are gastrointestinal disturbances (nausea, diarrhea loose stools, constipation incidence 6-37 ), nervous system effects (insomnia, somnolence, tremor, dizziness and headache 11-26 ), and effects on the autonomic nervous system (dryness of the mouth and sweating 9-30 ) (2,10). Weight gain or weight loss have been documented relatively infrequently (2). A high frequency of sexual disturbances has been reported. SSRIs may selectively inhibit hepatic enzymes, causing pharmacokinetic interactions with other drugs that are metabolized by these enzymes a pharmaco-dynamic interaction can also occur when SSRIs are given in combination with other serotonergic drugs, which may give rise to serotonergic hyperstimulation, the serotonin syndrome.'' The SSRIs are safer than the tricyclic antidepressants in overdose.

General adverse effects

Weight gain, gastrointestinal symptoms, hair loss, and tremor are relatively common adverse effects. Sedation, fatigue, dizziness, headache, ataxia, insomnia, and behavioral problems are less frequent than with other anticonvulsants. Hyperammonemia is relatively common, but it is often asymptomatic. Fatal liver failure has an incidence of up to 1 600 in young infants, but is extremely rare in adults. Uncommon effects include parkin-sonism, encephalopathy, pseudoatrophy of the brain, pancreatitis, and disorders of hemostasis (especially thrombocytopenia).

See also Antiepileptic drugs General Information

Vigabatrin is used mainly in the treatment of refractory partial seizures and infantile spasms. Weight gain and mostly transient sedation are its most common adverse effects, but visual field defects are the main cause for concern and severely restrict its use. Vigabatrin has been studied in an open 1-year extension of a randomized, double-blind, placebo-controlled Canadian trial in 97 adults with resistant partial epilepsy (2). There was a mean weight gain of 3.7 kg by the end of the study. Treatment was discontinued in 12 because of adverse effects. Neurological psychiatric adverse effects were the most common reason for withdrawal, including three behavioral reactions attributed to the drug.

Acquired immunodeficiency syndrome

Adderall had earlier been approved and marketed by another company under a different name (Obetrol) as a weight control medication. The manufacturer was taken over by another company, which renamed the product Adderall in 1994. The drug was approved for the treatment of ADHD and reintroduced in 1996 as Adderall.

Psychopharmacological Treatments

Several antidepressant medications and benzodiazepines have been found to be efficacious for panic treatment. Currently, selective serotonin reuptake inhibitors (SSRI's) are considered first-line treatment with regard to issues of safety and tolerability (APA, 1998). Paroxitene (Lydiard et al., 1998), fluvoxamine (Hoehn-Saric et al., 1993), fluox-itene (Michelson et al., 1998), sertraline (Rappaport et al., 1998), and citalopram (Wade et al., 1997) have all been found to be effective in placebo-controlled trials. Of these agents, paroxitene and sertraline are approved by the Food and Drug Administration (FDA) for the treatment of panic disorder. SSRIs were originally thought to have superior efficacy to tricyclic antidepressants, but treatment trials with larger numbers of subjects have suggested they are equivalent (Otto et al., 2001). Despite their overall tol-erability, SSRIs may still have troubling side effects. These include sexual dysfunction, gastrointestinal symptoms...

Cyclic antidepressants

Adverse effects anticholinergic reactions (dry mouth, constipation, blurred vision, prolonged gastric emptying, urinary retention) cardiac effects (tachycardia, T-wave flattening or inversion, prolongation of the PR, QRS, QT intervals) other effects (orthostasis, sedation, extrapyramidal syndromes, weight gain, sexual dysfunction, jaundice, leukopenia, rashes).

Case Reports of Toxicity Caused By Commercially Available Products

Adverse effects associated with feverfew use include dizziness, lightheadedness, nausea, heartburn, indigestion, bloating, gas, constipation, diarrhea, inflammation, and ulceration of the oral mucosa, weight gain, palpitations, heavier menstrual flow, contact dermatitis, and rash (4). Feverfew belongs to the Compositae family (1), and persons allergic to other members of this family such as chamomile, ragweed, asters, chrysanthemums (27), and echinacea could also be allergic to feverfew. Out of 300 feverfew users, 18 of those questioned reported adverse effects, with mouth ulceration reported in 11.3 (7). Feverfew-induced mouth ulceration is not a manifestation of contact dermatitis it is a systemic reaction. In contrast, inflammation of the tongue and oral mucosa accompanied by lip swelling and loss of taste is probably caused by direct contact with feverfew and is not associated with use of feverfew capsules or tablets (28).

Pharmacogenetics Tools Of The Trade

Two epidemiological genetic approaches are often used in human studies to identify genes associated with disease and drug response, the S-TDT (Sib Transmission Disequilibrium Test) (Spielman et al. 1998) and the QTL (Quantitative Trait Loci, Allison 1997) based analysis. The S-TDT involves recruiting an affected proband and an exposed, but unaffected sib. For pharmacogenetics, such an approach is easier, since the frequency of positive familial history for one psychiatric disorder is frequently high (see Table I) and the chance that the relative has also been treated by the same drug (or at least a drug from the same mechanistic class) is also relatively high. Statistical analysis then involves comparing two related subjects discrepant for the phenotype, and testing to see if this phenotypical discrepancy is in accordance with a genotypical discrepancy, i.e. sharing of 0, 1 or 2 alleles with a distribution that is not the one observed by chance only (which is, by definition, 25 , 50...

Which genetic markers to use

Haplotype analysis also provides the opportunity to detect yet unknown functional SNPs. For example, the Cys23Ser (C68G) was the main SNP tested in the 5-HT2C gene in genetic studies of obesity and also pharmacogenetics studies of anti-psychotic-induced weight gain. This SNP was not found to be associated with obesity (Lentes et al. 1997), nor clozapine-induced weight gain (Basile et al. 2001). Several haplotypes for the promoter region of the 5-HT2C receptor gene have now been described and further haplotype analysis has identified a specific haplotype associated with the anti-psychotic-induced weight gain. This association has been attributed to a new T-759C SNP that has a protective effect against pharmacologically induced weight-gain (Reynolds et al. 2002).

Hypertension in Pregnancy and Preeclampsia

Preeclampsia is a pregnancy-induced condition, affecting at least 5-8 of all pregnancies, occurring during the second half of gestation, and rapidly progressive. The main signs of preeclampsia are high blood pressure and protein in the urine. Preeclampsia causes 50-70 of cases of hypertension in pregnancy. Women with preeclampsia may also have swelling (edema) of the hands and feet, sudden weight gain, blurred vision, severe headaches and dizziness. Rarely, preeclampsia may progress to a life-threatening condition called eclampsia, which includes convulsions and sometimes leads to coma and death of the mother and baby. The cause of preeclampsia remains unknown. Low calcium intake has been implicated as a determinant of preeclampsia. Data regarding the role of supplemental calcium in reducing preeclampsia are conflicting. The 'calcium deficiency' hypothesis of gestational hypertension was first proposed by Belizan etal. to explain the surprisingly low incidence of preeclampsia and...

Pharmacology and adverse effects

One of the most common side effects of venlafaxine and duloxetine is nausea. This effect is generally abated with continued use by down-regulation of central and peripheral serotonin receptors. An adverse effect associated with venlafaxine is blood pressure elevation that returns to baseline in approximately 50 percent of patients with continued medication use.

Side Effects And Toxicology

Sertraline has been demonstrated to have a low incidence of anticholinergic, sedative, or cardiovascular effects because of its low affinity for adrenergic, cholinergic, histaminergic, or benzodiazepine receptors. However, sertraline was associated with a number of adverse effects in premarketing evaluation, the most common of which included gastrointestinal disturbance (nausea, 27 diarrhea loose stools, 21 ), sleep disturbance (insomnia, 22 somnolence, 14 ), headache (26 ), dry mouth (15 ), and sexual dysfunction (ejaculation failure, 14 decreased libido, 6 ). Other side effects reported by subjects, described as frequent (i.e., they occurred in at least 1 of 100 subjects) in premarketing pooled data from clinical trials, include impotence, palpitations, chest pain, hypertonia, hypoesthesia, increased appetite, back pain, asthenia, malaise, weight gain, myalgia, yawning, rhinitis, and tinnitus (Zoloft 2001).

Side effects of commonly used drugs in central pain

Gabapentin and pregabalin are structually related compounds and have similar side effect profiles. They are usually well tolerated with no contraindications except for known hypersensitivity to their components and lack drug interactions although additive side effects may be seen. Dose reduction is needed in patients with impaired renal function. The most common adverse reactions are dose-related somnolence, which seems to be higher in the SCI population (41 in the pregabalin group and 9 in the placebo group 23 ) than in peripheral pain trials, and dizziness (occurring in 20 - 40 ). These side effects pose a risk for accidental injury in the elderly. Other adverse reactions include dry mouth, asthenia, blurred vision, ataxia, peripheral edema, and weight gain.

Sertraline hydrochloride

Frequency, micturition disorders, menstrual disorders, dysmenorrhea, dysuria, painful menstruation, intermenstrual bleeding, sexual dysfunction and decreased libido, nocturia, polyuria, dysuria, urinary incontinence. Respiratory Rhinitis, pharyngitis, yawning, bronchospasm, coughing, dyspnea, epistaxis. Ophthalmologic Blurred vision, abnormal vision, abnormal accommodation, conjunctivitis, diplopia, eye pain, xerophthalmia. Otic Tinnitus, earache. Body as a whole Asthenia, fever, chest pain, chills, back pain, weight loss or weight gain, generalized edema, malaise, flushing, hot flashes, rigors, lymphadenopathy, purpura.

Bulimia NervosaDRG 432

Bulimia nervosa (BN) is an eating disorder that is characterized by repeated episodes of binge eating. During binges, the individual rapidly consumes large amounts of high-caloric food (upward of 2000 to 5000 calories), usually in secrecy. The binge is followed by self-deprecating thoughts, guilt, and anxiety over fear of weight gain. Purging is used to relieve these fears. The strict definition used by the Diagnostic and Statistical Manual of Mental Disorders indicates that persons need to have two binge-eating episodes per week for at least 3 months. Most bulimic patients purge by inducing vomiting or using laxatives, but some use excessive exercise and diuretics. The individual is caught in a binge-purge cycle that can recur multiple times each day, several times a week, or at an interval of up to 2 weeks to months. Bulimic patients experience frequent weight fluctuations of 10 pounds or more but are usually able to maintain a near-normal weight.

Somatic Treatments

Side effects with all neuroleptics are common and are the reason that neuroleptics are not used by the majority of individuals with Tourette's disorder. Side effects include those traditionally seen with neuroleptics, such as sedation, acute dystonic reactions, extrapyramidal symptoms including akathisia, weight gain, cognitive dulling, and the common anticholiner-gic side effects. There have also been reports of subtle, difficult-to-recognize side effects with neuroleptics, including clinical depression, separation anxiety, panic attacks, and school avoidance. Olanzapine in low doses does not appear to have the same tic-suppressing power as the typical neuroleptics. The side effects, especially weight gain, have dampened the enthusiasm for the atypicals risperidone, olan-zapine, and quetiapine.

Adverse Effects Of H1 Receptor Antagonists

Specific side effects of first-generation agents include impaired cognition, slowed reaction times, decreased alertness, confusion, dizziness, tinnitus, anorexia, nausea, vomiting, epigastric distress, diarrhea, and constipation. Associated anticholinergic side effects include dry mouth, blurred vision, and urinary retention ( 99). First-generation agents also potentiate the effects of benzodiazepines and alcohol ( 10,9,9). Cyproheptadine, a piperidine, has the unique effect of causing weight gain in some patients (16). The second-generation agents have substantially fewer associated side effects. Sedation and the side effects associated with first-generation agents have been noted to occur, but to no greater extent than with placebo (10,14,101). Astemizole, like cyproheptadine, was associated with increased appetite and weight gain (10). As discussed earlier, terfenadine and astemizole were associated with rare episodes of torsades de pointes leading to cardiac arrest and are no...

Antidepressant Therapy

In clinical trials, the most common side effects were dry mouth and weight gain with mirtazapine (Schatzberg et al., 2002) and nausea vomiting with venlafaxine (Allard et al., 2004). Pooled data from eight RCTs in older patients demonstrated the safety of citalopram, with only increased sweating occurring more often than with placebo (Keller, 2000). SSRI and venlafaxine use have been independently associated with

Genetic and Pharmacogenetics of 5HT2C Receptors in Schizophrenia and Antipsychotic Drug Action

Drug-induced weight gain (Ellingrod et al. 2005 Miller et al. 2005 Reynolds et al. 2002 Ryu et al. 2007)), extrapyramidal side effects of antipsychotic drugs (Gunes et al. 2007) (including tardive dyskinesia Segman et al. 2000), symptomatic improvement following clozapine (Sodhi et al. 1995), and association with major affective disorder (Gutierrez et al. 1996 Lerer et al. 2001) and eating disorders (Hu et al. 2003 Ribases et al. 2008). The Cys23Ser SNP was examined for linkage to schizophrenia in 207 nuclear families using the transmission disequilibrium test. No preferential transmission of the Cys23Ser 5-HT2C receptor alleles in either German or Palestinian-Arab groups alone or combined was found (Murad et al. 2001). A study of 5-HT2C and 5-HT2A receptor SNPs and psychotic symptomatology in late-onset Alzheimer disease showed an association between the 5-HT2C receptor SNPs rs6318 (Cys23Ser) and visual hallucinations and depression, as well as between the 5-HT2A receptor SNP 102T C...

Selective serotonin reuptake inhibitors

Tricyclic antidepressants (TCAs) and SSRIs are equivalent in efficacy for the treatment of depression. Anticholinergic effects, weight gain, sedation, and orthostatic hypotension are most troubling with amitriptyline, clomipramine, doxepin, imipramine, and trimipramine. Amoxapine, desipramine, maprotiline, nortriptyline and protriptyline cause less sedation and fewer anticholinergic effects.

Adverse Effects and Drug Interactions

The most common adverse effect associated with sul-fonylurea administration is hypoglycemia, which may be provoked by inadequate calorie intake (e.g., skipping a meal), or increased caloric needs (e.g., increased physical activity). Collectively, sulfonylureas also tend to cause weight gain, which is undesirable in individuals

Monitoring Complications

During ketogenic diet initiation children are routinely monitored for complications that may arise. Blood glucose levels are checked every 2 h for infants and 4 h for children over the age of one year then reduced to every 4-6 h, respectively, once a child is stable and the diet is being well tolerated. Symptoms of hypoglycemia include dizziness, fatigue, and nausea. If the blood glucose level drops below 50 mg dL, the child is treated with 15-30 cc of apple juice and rechecked in 30-60 min. If the child is unable or refuses to consume the juice orally or enterally, an iv bolus of glucose (0.25 g kg) may be given. Theoretically, children who are very active, very young, or very thin have minimal glycogen stores and thus become hypoglycemic more easily than children who are at or above their ideal weight or who are inactive. Untreated hypoglycemia may result in excessive ketosis. The child's vital signs should be checked every 8 h during ketogenic diet initiation, until they are stable...

Approved Anticonvulsant Drugs

Gabapentin is structurally related to GABA (Figure 2) and is indicated for use as adjunctive therapy for refractory partial seizures in adults. It had modest efficacy as monotherapy. There is considerable interest in its mechanism of action as the majority of prescriptions for gabapentin are for off-label use including neuropathic pain, migraine, and bipolar disorder, markets that are larger than epilepsy (see 6.14 Acute and Neuropathic Pain). Thus second-generation NCEs, like pregbalin (see below) are being aggressively sought. Gabapentin, despite its structural similarity to GABA, has no effect on GABAergic systems despite early reports that it modulated GABAb receptor function.39 Findings that it selectively interacts with the a2S subunit of the Cav2.2 channel remain the subject of debate.40'41 Side effects of gabapentin include transient somnolence, dizziness, fatigue, and modest weight gain, but the compound is generally considered to have a wide margin of human safety....

Drugs used in the treatment of epilepsy

Sedation, weight gain, nystagmus, gastrointestinal distress, tremor and a change in the mood of the patient in that order are the most frequently observed side effects. There is evidence that carbama-zepine can exacerbate atypical absence, tonic and myoclonic seizures. Between 30 and 50 of patients on carbamazepine experience some side effects, although these are generally mild and less than 5 of patients are estimated to withdraw from the drug because of the severity of the side effects. Sodium valproate is useful in the control of most seizure types and has the shortest half-life of the commonly used anticonvulsants (4-15 hours) a slowly absorbed form of the drug, divalproex sodium, is sometimes preferred. Valproate is relatively free from cognitive and behavioural side effects, but alopecia and weight gain frequently occur. The most severe side effect is idiosyncratic hepatotoxicity and pancreatitis, particularly in younger patients. However, these side effects are...

Yang Repletion Excess Conditions

Red complexion, hyperactivity, restlessness, anxiety, loud voice, boisterous laugh, dominating personality, irritability, and tendency to outbursts of anger. Body feels hot, thirst, tendency to get headaches, dizziness, tinnitus (ringing in the ears), headache in the temporal region (shao yang headache due to upbearing liver yang), bitter taste in mouth (liver fire), excessive perspiration, high blood pressure, episodes of voracious appetite with a tendency to weight gain (stomach heat). General causes The majority of yang symptoms are caused by a relative yang surplus and result from a yin vacuity of the affected bowel (zang organ). Emotional strains such as stress, a hectic lifestyle, and suppressed emotions such as rage, anger, and frustration harm the organ network of heart and liver. The longer an emotional imbalance persists, the more the organs are impaired. The liver phase is especially sensitive and can suffer deep-seated damage from protracted stagnation of liver qi when qi...

Cannabinoids Dronabinol

Both drugs are synthetic progestagens that were first used to treat hormone-sensitive tumours 78, 79 . As a result of the observed body weight gain and appetite stimulation, independent of tumour response, in a number of patients receiving such therapy, several trials in the last two Megestrol has shown a dose-related effect on appetite, body weight gain and subjective sensation of well-being with oral dosages ranging from 160 to 1,600 mg day, with an optimal dosage of 480-800 mg day. However, because a dosage of 160 mg day has demonstrated a significant effect, the possible dose-related adverse effects of megestrol and the increased costs of higher dosages, we recommend, in agreement with Gagnon and Bruera

Types of Hypertension

Pregnancy-induced hypertension (PIH) may appear in otherwise healthy women after the twentieth week of pregnancy. It is more likely to occur in women who are overweight or obese. PIH may be mild or severe, and it is accompanied by water retention and protein in the urine. About 5 percent of PIH cases progress to preeclampsia. Preeclampsia is characterized by dizziness, headache, visual disturbance, abdominal pain, facial edema, poor appetite, nausea, and vomiting. Severe preeclampsia affects the mother's blood system, kidneys, brain, and other organs. In rare cases, the woman can die. Preeclampsia is more likely to occur during first pregnancies, multiple fetuses, in women with existing hypertension, and in women younger than twenty-five years old or over thirty-five years old. If convulsions occur with PIH, it is called eclampsia. PIH disappears within a few weeks after birth. protein complex molecule composed of amino acids that performs vital functions in the cell necessary part of...

Reproductive system

Headache, breast tenderness, and less commonly nausea and dizziness have been reported by users of progestogen-only contraceptives, but it is not clear whether progestogen-only contraceptives actually play a causal role. Androgenic adverse effects, such as acne, hirsutism, and weight gain, occur, but rarely.

Treatment Options for Anxiety

Your diet affects the level of glucose in your blood, and, therefore, how much adrenaline you produce. Fasting for more than four hours depletes glucose, causing an increase in adrenaline and the symptoms of anxiety. Eating foods high in sugar, such as candy or sodas, initially cause an elevation in blood sugar. This is quickly followed by a rebound to low blood sugar, however, which increases adrenaline and the symptoms of anxiety. Tricyclic Antidepressants (TCAs) Named for their chemical structure, TCAs are effective for some forms of anxiety. They need to be taken every day and generally take some weeks to work, so they are not effective for acute anxiety. They have been supplanted by other drugs, notably the SSRIs, because of their tendency to cause weight gain, dry mouth, constipation, sweating, and light-headedness due to low blood pressure. Monoamine Oxidase Inhibitors (MAOIs) Named for their action in the brain, MAOIs are also very effective. They too must be taken every day,...

General aspects of allergy and intolerance 1421 Definitions

Wheat contains water, starch, lipids, and the proteins albumin, globulins, and gluten. Gluten consists of gliadin and glutenine. The various proteins in wheat can cause different symptoms. One example is the so-called baker's asthma in bakers allergic to wheat albumin. This reaction shows itself when wheat dust is inhaled. In food allergy, globulins and glutenine are the most important allergens. Allergic reactions can occur following the ingestion of wheat. In celiac disease, an allergy to gliadin plays an important role in the pathogenesis. After exposure to gluten infiltration of eosinophils and neutrophils, edema and an increase in vascular permeability of the mucosa of the small intestine can be observed. If the allergic reaction is chronic, the infiltration consists mainly of lymphocytes and plasma cells. Further, flattening of the mucosal surface is found. The disorder manifests itself typically 6 to 12 months after introduction of gluten into the...

Monosodium glutamate and the Chinese restaurant syndrome

Many foodstuffs, especially seaweed and parmesan cheese which have some of the highest levels, and also tomatoes, mushrooms, and soy sauce. E621 is the sodium salt of glutamic acid, a naturally occurring amino acid which has important functions in the body, especially in the brain. Glu-tamic acid is found both free and as part of protein, and when the latter is broken down and digested in the gut glutamic acid is released (see box). The glutamic acid is released relatively slowly, however, and while excess glutamate can be removed by metabolism it is possible that large amounts may accumulate. Too much free glutamic acid in the diet, which can occur if food that contains naturally high levels is consumed with food to which large amounts have been added, can be toxic, leading to unpleasant symptoms. A variety of studies into the effects of MSG have been carried out, but they have shown conflicting results. In one of the most recent properly conducted, double-blind trials, where the...

Examples of illegal drugs

The amphetamine family includes the stimulants amphetamine, dextroamphetamine, and methamphetamine, which were once freely prescribed for weight control, fatigue, and narcolepsy (a sleeping disorder also known as sleeping sickness). Both amphetamine and metham-phetamine were used during World War II as a stimulant for troops, and after the war they were used by truckers, dieters, and athletes. As abuse spread, the federal government limited the amount of amphetamines that could be manufactured and removed many types from the market. As a result illegal demand for the drug is now supplied primarily by

Semisynthetic progestogens

Adolescents and adults, most commonly for intolerable menstrual cycle changes, and in 6 of all the adults for irregular bleeding the time from insertion to removal was 3-15 months for the adolescents and 1-17 months for the adults. Other problems that led to removal (in 5 of adolescents and 7.5 of adults), apart from a desire to become pregnant, included headache, weight gain, and acne. Megestrol acetate, like medroxyprogesterone acetate, is used for metastatic breast cancer in postmenopausal women. Its commonest adverse effects are typical of the progestogens as a group, but glucocorticoid-like effects are less prominent than with medroxyprogesterone acetate. Typical effects and incidence figures for effective doses in cancer patients (SED-12, 1036) (8,9) have been cited as including weight gain in some 81-88 of cases, mild edema in up to 34 , and hypertension in up to 25 . There are lower but appreciable occurrences of constipation, dyspnea or chest tightness, heartburn,...

Hyperimmunoglobulinemia 239

Are available in various forms by prescription. For most uses, hydrocortisone is applied topically. The side effects of topically administered hydrocortisone are generally mild and may include burning, itching, irritation, dryness, thinning of the skin, slow growth of skin, or secondary infection. The side effects of oral or injectable forms of the drug include dizziness, increased appetite, increased sweating, restlessness, sleep disorders, or weight gain. Serious but rare, side effects include abdominal enlargement, acne, bone or muscle pain, blurred vision, black or tarry stools, convulsions, eye pain, fever, sore throat, headache, slow wound healing, mental depression, mood changes, muscle wasting, nightmares, unusual bleeding, and growth impairment in children.

Limitations of Pharmacotherapy

The primary benefit of treating obese patients with pharmacotherapy is to maximize weight loss and avoid weight regain. The two FDA-approved medications for long-term weight loss and weight maintenance, sibutramine and orlistat, The USPSTF report states that weight regain occurs when patients stop taking medication 2 . Is it possible too much focus in the primary care physician's office for controlling obesity is placed on the impact of the medication and not lifestyle changes If this is the case, then pharmacotherapy is no longer an adjunct to a TLC but replaces it as the primary mode of treatment. The package insert lists numerous adverse reactions as occurring in > 1 in placebo-controlled obesity studies. The list in this chapter includes only those adverse reactions that are two times more frequent than experienced by the placebo group. The adverse reactions are tachycardia, vasodilatation, increase in blood pressure, palpitation, anorexia, increased appetite, rectal disorder,...

Pituitary Disorders and Weight Loss Hypopituitarism

Among the uncommon manifestations of anterior pituitary hormone deficiency, weight loss is associated with corticotropin deficiency. In this case, the loss of weight is less severe and rapid than that in primary adrenal insufficiency. Typical symptoms and signs of hypopituitarism include malaise, loss of energy and libido, reduced muscle mass, and increased fat mass with weight gain, anorexia, postural hypotension, orthostatic dizziness, and sometimes headache 36,38 .

Inhibitors of Monoamine Oxidase

MAOIs have a significant side-effect profile, including dizziness, drowsiness, insomnia, headache, postural hypotension and anticholinergic effects. Asthenia, weight gain and sexual dysfunction can occur during long-term use. A hypertensive reaction (cheese reaction) may follow the ingestion of foods containing tyramine, which must therefore be removed from the diet. Overdose can be fatal due to seizures, cardiac arrhythmias and hypotension. Interactions can occur with sympathomimetics, antihypertensives and most psychoactive drugs, and a washout of 2 weeks is advised when switching from an MAOI to another antidepressant. Moclobemide is better tolerated than MAOIs, although at high doses (> 900 mg daily) dietary restrictions should be observed. The main side-effects are dizziness and insomnia. Overdose toxicity is less, although fatalities have been reported.


In combination with metformin only in obese patients. Hypoglycaemia may occur. Hyperlipidaemia (increased LDL and HDL cholesterol), anaemia (thought to be due to haemodilution), and oedema are well-recognized. Cardiac failure may be precipitated or worsened, although this seems primarily to occur if these agents are used in combination with insulin (the combination is con-traindicated). Weight gain, headache, gastrointestinal symptoms, abnormal vision, arthralgia, dizziness, fatigue, and lactic acidosis may also occur. Women with polycystic ovary syndrome may ovulate as insulin resistance is reduced. Troglitazone, the first thiazolidinedione on the UK market, was withdrawn because of reports of liver damage. Rosiglitazone and pioglitazone may cause hepatic dysfunction and should be stopped if liver enzymes are more than three times the upper limit of normal.

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Replaced with complex carbohydrates (starch, dietary fiber) (2). Chocolate, of course, was restricted because of its high sucrose content (5055 by weight). The terms simple and complex carbohydrates are, in fact, no longer recommended because this chemical distinction means little in clinical terms (3). The assumption that sugars would be more rapidly digested and absorbed than starches, and therefore aggravate high blood glucose levels to a greater degree, was found to be incorrect. Similarly, the reasoning that the large molecular size of starches would render them more slowly digested and absorbed was also wrong in most cases. There is now abundant scientific proof that modern starchy foods have a greater impact on blood glucose and insulin levels than most foods containing sugar, whether naturally occurring or refined (4, 5). While it is now recognised by the experts that the simple-versus-complex carbohydrate distinction has little clinical significance, refined sugars continue...


Regulation of energy homeostasis is critical to the survival of any species. Therefore, intricate behavioral, metabolic, and neuroendocrine mechanisms have evolved to integrate energy intake and dissipation. A delicate balance between intake and expenditure of energy is required to maintain healthy weight. Perhaps for teleological reasons, the mechanisms that regulate energy homeostasis are biased in favor of net positive energy and are geared toward defense of weight loss rather than prevention of obesity. Hence, spontaneous weight loss in the absence of disease is rare and the experience of progressive weight gain in free-living humans is common. The adaptations that defend against weight loss eventually become maladaptive when obesity and its related metabolic and cardiovascular complications supervene, as in the present era (1, 2). At its core, obesity signifies chronic disequilibrium between food consumption and energy expenditure. Total energy expenditure (TEE) comprises basal...


Because the placenta pulls glucose from the mother's blood for use by the fetus, pregnant women more easily develop hypoglycemia, particularly in the morning before breakfast or if meals are skipped during the day. Hypo-glycemia can produce lightheadedness, faint-ness, or headache. Also, skipping meals may increase levels of ketone bodies in the blood that can cross the placenta and adversely affect fetal development. Women should consume regular meals and snacks and avoid long periods of fasting while pregnant.

Eating Disorders

Refusal to maintain body weight at or above a minimally normal weight for age and height (e.g., weight loss leading to maintenance of body weight less than 85 of that expected or failure to make expected weight gain during period of growth, leading to body weight less than 85 of that expected) Eating disorders should be suspected in any adolescent below normal weight ranges or with recent weight loss, but other medical conditions such as intestinal malabsorption, inflammatory bowel disease, and malignancy should also be considered. It is important to realize that most height and weight charts represent cross-sectional population norms, which may not be as sensitive as longitudinal tracking or height velocity of individuals, since puberty occurs at different ages. For example, a 12-year-old who does not gain weight for 6 months may just be entering puberty, or might be severely affected by growth failure due to a malignancy or inflammatory bowel disease.


Gabapentin is a narrow-spectrum drug. It is useful only in patients with partial epilepsy, that is those with simple or complex partial seizures, or partial-onset generalized tonic-clonic convulsions. Gabapentin is felt to be more useful in newly diagnosed patients with mild epilepsy and in the elderly, who benefit from the relatively mild side-effect profile and lack of drug interactions, but less useful in patients with refractory epilepsy. Although gabapentin can be initiated at a therapeutic dose of 1200-2400 mg day, it appears to be better tolerated when titrated 57 . Typically, 300 mg two times a day is well tolerated as a starting dose, but lower starting doses are needed in some patients. Clinical trials have only tested efficacy to 2400 mg day 46 . However, in clinical experience, higher doses can be useful. However, gabapentin displays dose-dependent, saturable absorption. At higher doses, less may be absorbed across the gut, leading to diminishing returns 58 . The amount of...

Systemic Treatment

Doxycycline Before And After Acne

Bone changes, increase of the blood values for neutral lipids (cholesterol, triglycerides) Hormonal contraceptives edemas, thrombosis, increased appetite, weight gain, levels are reduced by the increased SHBG levels, leading to a decrease in sebum production. Oral contraceptives inhibit the ovarian production of androgens by suppressing ovulation. This, in turn, decreases serum androgen levels and reduces sebum production. On the other hand, the progestins administered belong to the families of estranes and gonanes with a variety of drugs in each class. Some progestins can cross react with the androgen receptor or, like the progestins norgestrel and levonorgestrel, reduce SHBG increasing free testosterone, thus leading to increased androgenic effects and aggravating acne, hir-sutism, or androgenic alopecia 67, 68 . They can also cause changes in lipid metabolism and can increase serum glucose, leading to glucose intolerance, as well as possibly interfering with the beneficial effect...


Special Concerns Use with caution in clients with gout and peptic ulcer. Reduced dosage may be required in geriatric clients due to age-related decreases in renal function. Side Effects Oral Stomatitis. GI Nausea, dyspepsia, weight gain, gastritis, vomiting, bloating, flatulence, abdominal distress, loose stools, diarrhea, hepatomegaly, cholelithiasis, gallstones. CNS Headaches, dizziness, fatigue, weakness, drowsiness. CV Changes in blood-clotting time, arrhythmias, increased or decreased angina, intermittent claudication, thromboembolic events, thrombophlebitis, swelling and phlebitis at xanthoma site, pulmonary embolism. Skeletal muscle Asthenia, ar-thralgia, myalgia, weakness, muscle cramps, aches. GU Impotence, dys-uria, hematuria, decreased urine output, decreased libido, proteinu-ria. Hematologic Anemia, leukopenia, eosinophilia. Dermatologic Allergic reactions, including urticaria, skin rash, dry skin, pruritus, dry brittle hair, alopecia. Other Dyspnea, polyphagia, flu-like...


Thalidomide is a highly teratogenic drug with antileprosy and antilupus effects via various mechanisms. Side effects include teratogenicity,fatigue,dizziness,weight gain, constipation, amenorrhea, dry mouth, and a non-dose-related polyneuropathy that is associated with chronic administration (Ludolph and Matz 1982). Because thalido-


Because of the limited information about selenium, it is not clear whether selenium supplementation in MS produces beneficial effects, harmful effects, or no effects at all. It may be most reasonable for people with MS to avoid selenium supplements until more information is available. Selenium may be obtained in the diet from seafood, meat, and whole grains. If supplements are taken, it may be best to take low doses, such as 20 to 55 micrograms or less daily. High doses (greater than 400 micrograms) should be avoided because they may activate the immune system and may produce fatigue, nausea, dizziness, hair loss, tooth decay, and other problems.

Side effects

Common side effects include dry mouth, drowsiness, constipation, and dizziness or lightheadedness when standing. Patients can suck on ice cubes or sugarless hard candy to combat the dry mouth. Increased fiber in the diet and additional fluids may help relieve constipation. Dizziness is usually caused by a drop in blood pressure when suddenly changing position. Patients should slowly rise from a sitting or lying position if dizziness is noticed. Amitriptyline may increase the risk of falls in older adults. Patients should not drive or operate machinery or appliances while under the influence of this drug. Alcohol and other central nervous system depressants can increase drowsiness. Amitriptyline may also produce blurry vision, irregular or fast heartbeat, high or low blood pressure, palpitations, and an increase or decrease in a diabetic patient's blood sugar levels. Patients' skin may become more sensitive to the sun and thus direct sunlight should be avoided by wearing protective...

Pergolide mesylate

CNS Dyskinesia (common), dizziness, dystonia, hallucinations, confusion, insomnia, somnolence, anxiety, tremor, depression, abnormal dreams, psychosis, personality disorder, extrapyramidal syndrome, akathi-sia, paresthesia, incoordination, akine-sia, neuralgia, hypertonia, speech disorders. Musculoskeletal Arthralgia, bursitis, twitching, myalgia. Respiratory Rhinitis, dyspnea, hiccup, epistaxis. Dermatologic Sweating, rash. Ophthalmologic Abnormal vision, double vision, eye disorders. GU UTI, urinary frequency, hematuria. Whole body Pain in chest, abdomen, neck, or back headache, asthenia, flu syndrome, chills, facial edema, infection. Miscellaneous Peripheral edema, anemia, weight gain.


Side effects sedation, weight gain, tremor hair loss, polyuria Low therapeutic index Side effects sedation, weight gain, tremor, hair loss Side effects neurologic (ataxia, vertigo, diplopia) Side effects, differ by individual agent. Risk of tardive dyskinesia May worsen bipolar depression. Greater risk of tardive dyskinesia More difficult to


MONITORING YOUR USE Time to effectiveness The first effects may be noticed within some days, but it may be one to three weeks at the full dose to notice a pronounced change. It may take several months to derive full benefit. A full trial is Four weeks at no less than 80 mg day for adults, and 1.2 mg kg of body weight for children. Half-life of drug and active metabolites 5 hours with no active metabolites. How to monitor dosage The optimal dose is determined by its effectiveness in alleviating the target symptoms. How to monitor safety Pretreat-ment and periodic weight and height measurements should be performed to assess weight gain and growth. If you miss a dose Take a missed dose if it's within an hour or two. Do not try to make up for a missed dose the next day by doubling your dose just continue with your regular dosing schedule.


SIDE EFFECTS Usual (50-100 ) Dry mouth, constipation, blurry vision. Common (10-50 ) Low blood pressure (light-headedness, dizziness), fatigue, ataraxia (zombielike feeling), weight gain, menstrual irregularities, akathisia (restlessness), sexual dysfunction, pseudoparkinsonism (muscular tremor, rigidity, akinesia), and tardive dyskinesia, a form of involuntary muscle movements (see chapter 19 for further details). Less common (1-10 ) Dystonia (muscle spasms, usually of the head and neck, face, and jaw), galactorrhea (milk leaking from breasts) sexual dysfunction. Infrequent (less than 1 ) Cataracts, urinary difficulty jaundice (yellow skin or eyes). Those requiring attention from your physician Symptoms of fever, muscular rigidity, and mental status changes, as you may have neuroleptic malignant syndrome, a potentially severe reaction any abnormal involuntary movements that suggest tardive dyskinesia any other physical or emotional changes not described here.


PRECAUTIONS Warnings Isocarboxazid can cause a hypertensive crisis in which your blood pressure rises to a dangerously high level, putting you at risk for a brain stroke, brain damage, and death. This reaction is unlikely to occur on its own, but is possible if used in combination with foods or medicines that contain tyramine or substances similar to epinephrine. The following medications must be avoided while you are on isocarboxazid and for two weeks following its cessation in order to avoid a hypertensive crisis Prescription medications antiasthmatics that contain epinephrine or epinephrine-like compounds, most antidepressants, antihypertensives, antiparkinsonian agents, barbiturates, buspirone (Buspar), carba-mazepine (Tegretol), disulfiram, diuretics, narcotics, stimulants over-the-counter medications decongestants, dextromethorphan, tryptophan, hay fever medications, sinus medications, appetite suppressants recreational drugs amphetamines, cocaine, hallucinogenics, heroin or...


SIDE EFFECTS Common (10-50 ) Blurry vision, constipation, dizziness, dry mouth, fatigue, headache, insomnia, nausea, sweating, tremor. Less common (1-10 ) Agitation, anxiety, sexual dysfunction. Infrequent (less than 1 ) Confusion, memory impairment, urinary difficulty, weight gain. Those requiring attention from your physician Any physical or emotional changes not listed, such as suicidal thoughts or behavior.


The FDA-approved cessation medications include nicotine replacement therapy (NRT) available in several delivery systems and one non-nicotine drug. Only nicotine gum and nicotine patches are available over-the-counter. Table 9.9 lists smoking cessation medications that are approved for clinical use in the United States. The dose of NRT varies depending on the delivery system and the current usage level of tobacco by the patient. Bupropion therapy is usually started 1 week before quitting smoking as 150-mg slow-release tablets twice a day. The usual length of treatment of smoking cessation therapy is 6-12 weeks. Because all the approved smoking cessation agents are almost equally effective and safe (168), the choice of treatment usually depends on the patient preference. Bupropion is particularly useful for smokers who had unsuccessful attempts with NRT. It is also useful for smokers who are concerned about possible weight gain after quitting. Bupropion was shown to...


Data from short-term clinical trials (6 weeks) suggest that quetiapine may be useful for the management of psychotic disorders in patients who do not tolerate the adverse effects of the typical antipsychotic drugs or clozapine (3). The most common adverse effects of quetiapine were dizziness, hypotension, somnolence, and weight gain. Raised hepatic enzymes have also


SIDE EFFECTS Usual (50-100 ) Dry mouth, constipation, blurry vision. Common (10-50 ) Low blood pressure (light-headedness, dizziness), fatigue, ataraxia (zombielike feeling), weight gain, missed menstrual periods, akathisia (restlessness), sexual dysfunction, pseudoparkinsonism (muscular tremor, rigidity, akinesia), and tardive dyskinesia. Less common (1-10 ) Dystonia (muscle spasms, usually of the head and neck, face, andjaw), galactorrhea (milk leaking from breasts), sexual dysfunction. Infrequent (less than 1 ) Cataracts, urinary difficulty. Those requiring attention from your physician Symptoms of fever, muscular rigidity, and mental status changes, as you may have neuroleptic malignant syndrome, a potentially severe reaction any abnormal involuntary movements that suggest tardive dyskinesia any other physical or emotional changes not described here.


PRECAUTIONS Warnings Tranylcypromine can cause a hypertensive crisis in which your blood pressure rises dangerously high, putting you at risk for a brain stroke, brain damage, and death. This reaction is unlikely to occur on its own, but is possible if used in combination with foods or medicines that contain tyramine or substances similar to epinephrine. The following medications must be avoided while you are on tranylcypromine and for two weeks following its cessation in order to avoid a hypertensive crisis Prescription medications antiasthmatics that contain epinephrine or epinephrine-like compounds, most antidepressants, antihy-pertensives, antiparkinsonian agents, barbiturates, buspirone (Buspar), carba-mazepine (Tegretol), disulfiram, diuretics, narcotics stimulants over-the-counter medications decongestants, dextromethorphan, tryptophan, hay fever medications, sinus medications, appetite suppressants recreational drugs amphetamines, cocaine, hallucinogenics, heroin, or other...


SIDE EFFECTS Usual (50-100 ) Blurry vision, constipation, dizziness, dry mouth, fatigue, increased heart rate, low blood pressure. Common (10-50 ) Agitation, sweating, weight gain. Less common (1-10 ) Insomnia, sexual dysfunction, urinary retention. Those requiring attention from your physician Physical or emotional changes not listed, such as suicidal thoughts or behavior.

Appetite Stimulation

Open studies in cancer patients (Plasse et al. 1991 Nelson et al. 1994) suggested that THC has a positive effect on appetite and weight. In a double-blind study in 54 patients with various cancers, Regelson et al. (1976) found that oral THC (0.10.4 mg kg four times daily) produced a significant (p < 0.05) gain or preservation of weight in comparison with placebo. THC also improved depression and tranquillity scores, but somnolence, dizziness and disassociation were troublesome in a quarter of the patients and led to 9 dropouts. A more recent study (Jatoi et al. 2002) compared dronabinol alone (2.5 mg BD) or in combination with megestrol acetate (MA 800 mg day) with MA alone in 469 patients with advanced cancer who were troubled with recent poor appetite or weight loss of at least 2.268 kg (5 lb). MA alone was significantly superior to dronabinol alone (p 0.0001 for appetite p 0.02 for weight gain), and the addition of dronabinol to MA resulted in no significant improvements in...


Common side effects include headaches, sore throat, dizziness, fainting, chills, sweating, fever, stomach gas, skin rash, lack of coordination, diarrhea, nausea, vomiting, swelling in the legs and feet, a tingling in the hands and feet, difficulty urinating, joint pain and inflammation, spasticity, hyperactivity, nervousness, sinus inflammation, bronchitis, pneumonia, difficulty breathing, convulsions, liver inflammation, conjunctivitis, blood pressure changes, and broken bones. Less common side effects include loss of appetite, changes in taste, drowsiness, eyes that are dry or itching, eye pain, sties, double vision or other vision problems, glaucoma, cataracts, earache, ringing or buzzing in the ears, deafness, infections of the middle or inner ear, a flushing in the face, facial swelling, a sickly appearance, indigestion, insomnia, muscle aches, runny nose, rash, stomach pain, heavy sweating, dehydration, greater chance of tiredness or weakness, and weight gain, heart failure,...


Pramine (Norpramin), and trazodone (Desyrel). A major side effect of these drugs is dry mouth. Other side effects can include constipation, weight gain, changes in sexual desire and ability, dizziness, and fatigue. A side effect of some drugs in this class has been the relief of nerve pain (neuropathy). These drugs, the adjuvant analgesic drugs, specifically nortriptyline and amitriptyline, are used specifically for neuropathy. Usually the amount used for this treatment, however, does not produce all these side effects. Overdose can occur and can cause heart arrhythmias, delirium, and death.


Not only is there no universal means of defining and diagnosing vulvodynia, there is no standard of care for treating this condition (13). Pharmacologic agents, such as tricyclic antidepressants (8,49) and corticosteroids (13), dietary changes, vitamin and mineral supplements (27), physical therapy (50), electromyographic biofeedback therapy (13,21,51,52), and surgery (21,24) have been used to treat vulvodynia with inconsistent success (Tables 1-3) (48). Oral dryness, constipation, weight gain (less common). Occasional neurological symptoms, cardiac arrhythmias, or urinary retention require discontinuation Occasional restlessness, weight gain, fatigue, anorgasma

Histoplasmosis 255

If a parent has high blood pressure, a child is twice as likely to develop the condition as someone with no family history. Children who are overweight usually have higher blood pressure than those who are not. In fact, most children have hypertension for the same reasons as adults family history, obesity, and lack of regular exercise. The most common symptoms are headaches, dizziness, and light-headedness, but these are often so mild that the child ignores them. Many children with high blood pressure have no symptoms at all. Irritability, excessive crying, failure to gain weight, poor feeding, and low-grade fever are the only symptoms in children younger than two or three years.


It is possible to prevent hypoglycemia. Children should not skip meals or snacks, but if a child does not eat appropriately or eats less than usual during the day, blood glucose should be checked more often than usual during the rest of the day. If the blood glucose reading is too low (usually around 70 mg dl), treatment should be given. A middle-of-the-night blood glucose reading should be done if a child has eaten less than usual during the day.


Antihistaminergic Adverse Drug Reactions. Sedation, weight gain. G. MAO inhibitors. The most common adverse drug reaction is hypotension. Patients are also at risk for hypertensive crisis if foods high in tyramine content or sympathomimetic drugs are consumed. Despite the infrequent use of MAO inhibitors because of the dietary restrictions and risk of hypertensive crisis, they remain very important for the treatment of refractory depression. Highly sedating with average of 2 kg weight gain in six weeks. Minimal effect on hepatic enzymes.

Items 106107

A 41-year-old male schoolteacher, a nonsmoker, presents with lightheadedness and increased shortness of breath with lack of stamina and chest pain. On physical examination, vital signs are normal. The patient is overweight with a BMI of 33. CVS exam reveals a left parasternal heave with a harsh grade 3 6 systolic flow murmur and a loud P2 sound. Chest radiographs are shown below in Fig. 60. d. Deconditioning due to obesity


The anxiolytic effects of mexazolam have been compared with those of alprazolam in 64 outpatients with generalized anxiety disorder in a multicenter, double-blind, parallel-group, randomized trial (17C). Five mexazolam and nine alprazolam recipients reported mild adverse events drowsiness in three patients in each group dizziness in one taking mexazolam and two taking alprazolam blurred vision in one patient taking mexazolam and weight gain, nausea, and insomnia in one patient taking al-prazolam. Both drugs were anxiolytic and both were well tolerated.


The pharmacological similarity of pregabalin and gabapentin is confirmed in the frequency of adverse events reported across most clinical trials. Withdrawals range from one-third to one-fifth. The most commonly reported side effects include dizziness, somnolence, peripheral edema, weight gain, vertigo, asthenia, blurred vision, dry mouth, and constipation (see Table 19.2). NNH is reported at 2.5 (95 percent CI 2.0, 3.2).19 I Cognitive problems are highlighted ranging from memory disturbance to confusion. Balance problems are frequent, and the tendency to injury reported in some studies.56, 59 Dose reduction, albeit leading to reduced efficacy, should be considered, especially in the elderly with PHN. NNTs of 5.3-6.3 for 150 mg day and 5.3-5.3 for 300 mg day of pregabalin suggest that there still may be a reasonable response,54 II , 55 II and consideration should only be given to higher doses when tolerability is good.9 I

Feeling Good

If you've been overweight for a long time, you will almost certainly have suffered some of the symptoms in this test. No doubt you thought them a normal part of aging. Isn't it wonderful to see that you can make them go away simply by changing the way you eat Doing Atkins, you'll find that you're cleaning out a lot of metabolic garbage from your life, in addition to excess pounds and junk food. Many of my patients have discovered that instead of a weight loss program, this is for them a rejuvenation program. Now take the test, and see if I'm right

Anticonvulsant Drugs

Valproic acid is commonly used for the treatment of neuropathic SCI pain, but in a controlled trial 600-2400 mg daily was not statistically significantly better than placebo in relieving pain.68 II However, the small number involved in the study means there is a risk of type II error. Valproic acid treatment may be associated with skin reactions, gastrointestinal upset, weight gain, tremor, hair loss, liver dysfunction, and hematologic and teratogenic effects.

Day 12 Monday Tuesday

Where you set calories depends on your goals. If your goal is maximal fat loss, these are the days to really cut calories. As I mentioned last chapter, you should know your normal mixed diet maintenance calorie level. Cutting this value by 50 is the goal (so if your maintenance is normally 3000 calories day, you'd cut that to 1500 cal day). Normally I wouldn't use such a severe deficit but since you're only dieting for 4 days (more or less), this is necessary. With a carbohydrate intake this low, the source won't matter hugely. The reduction in carbs alone will be sufficient to cause all of the effects I described in previous chapters lowered insulin, increased catecholamines, increased blood fatty acid levels, etc. However, choosing lower glycemic index, high-fiber carbs will keep you fuller because they take longer to digest and sit in your stomach longer. Veggies in your morning omelette or a salad at lunch and dinner add considerable bulk to the diet without adding large amounts...


Gabapentin and pregabalin are, generally speaking, well tolerated although there are significant individual variations. The side effect profiles are identical, with dizziness, somnolence, dry mouth, weight gain, peripheral edema, blurred vision and constipation. Also cognitive problems and injuries due to falls are reported in some studies 77-79 .


Side Effects Oral Altered sense of taste. GI N& V, distaste for food, anorexia, diarrhea, abdominal cramps. CV Peripheral edema, superficial phlebitis, deep vein thrombosis, pulmonary embolism, thromboembolic disorders (especially when tamoxifen is combined with other cytotoxic agents). CNS Depression, dizziness, light-headedness, headache, fatigue. Hepatic Rarely, fatty liver, cholestasis, hepatitis, hepatic necrosis. GU Hot flashes, vaginal bleeding and discharge, menstrual irregularities, pruritus vulvae, ovarian cysts, hyper-plasia of the uterus, polyps, uterine carcinoma. Other Skin rash, skin changes, hypercalcemia, musculos-keletal pain, hyperlipidemias, weight gain or loss, increased bone and tumor pain, mild to moderate thrombocytopenia and leukopenia, retinopathy, hair thinning or partial loss, fluid retention, coughing. In men, may be loss of libido and impo-tency. Impotence and loss of libido in males after discontinuing therapy.

Other sideeffects

Clozapine produces a wide range of side-effects. (79> These can generally be managed by dose adjustment and concomitant medications. Clozapine produces hypotension because of its potent a1-adrenoceptor antagonism and must be slowly titrated in most patients. Low-dose glucocorticoid treatment may be helpful in some patients with severe hypotension. Clozapine rarely if ever produces significant extrapyramidal side-effects, although some cases of akathisia and neuroleptic malignant syndrome have been reported. Tardive dyskinesia and especially tardive dystonia are usually improved by clozapine. Major motor seizures are another important side-effect of clozapine. They are dose related, with the incidence being about 2 per cent in patients at low doses and 6 per cent at doses greater than 600 mg day. They are sometimes preceded by myoclonic jerks. Valproic acid and dose reductions are usually effective in preventing the progression of myoclonic jerks or treating major motor seizures....


SIDE EFFECTS Usual (50-100 ) Dry mouth, constipation, blurry vision. Common (10-50 ) Low blood pressure (light-headedness, dizziness), fatigue, ataraxia (zombielike feeling), weight gain, menstrual irregularities, akathisia (restlessness), sexual dysfunction, pseudoparkinsonism (muscular tremor, rigidity, akinesia), and tardive dyskinesia, a form of involuntary muscle movements (see chapter 19 for further details). Less common (1-10 ) Dystonia (muscle spasms, usually of the head and neck, face, and jaw), galactorrhea (milk leaking from breasts), sedation, sexual dysfunction. Infrequent (less than 1 )


Several randomized clinical trials show pregabalin to be superior to placebo in the treatment of neuropathic pain (PHN and DPN) at doses of 300 to 600 mg day. Sleep was improved. Common adverse events included dizziness, peripheral edema, weight gain, and somnolence (271).


SIDE EFFECTS Usual (50-100 ) Sedation, dry mouth, constipation, blurry vision. Common (10-50 ) Low blood pressure (light-headedness, dizziness), fatigue, ataraxia (zombielike feeling), weight gain, menstrual irregularities, akathisia (restlessness), sexual dysfunction, pseudoparkinsonism (muscular tremor, rigidity, akinesia), and tardive dyskinesia. Less common (1-10 ) Dystonia (muscle spasms, usually of the head and neck, face, and jaw), galactorrhea (milk leaking from breasts), sexual dysfunction, cataracts. Infrequent (less than 1 ) Jaundice (yellow eyes and skin, from liver impairment), cataracts, urinary difficulty. Those requiring attention from your physician Symptoms of fever, muscular rigidity, and mental status changes, as you may have neuroleptic malignant syndrome, a potentially severe reaction any abnormal involuntary movements that suggest tardive dyskinesia any irregular heartbeats, as you need an EKG to determine if you are having a dangerous heart rhythm any other...


SIDE EFFECTS Usual (50-100 ) Blurry vision, constipation, dizziness, dry mouth, fatigue, headache, increased heart rate, low blood pressure, sedation, tremor. Common (10-50 ) Anxiety, decreased appetite, insomnia, muscle aches, muscle twitching, nausea, sexual dysfunction, sweating, weight gain. Less common (1-10 ) Cognition impairment, ear ringing, flushing, memory impairment, urinary difficulty. Those requiring attention from your physician Any physical or emotional changes not listed, such as suicidal thoughts or behavior.


SIDE EFFECTS Usual (50-100 ) Blurry vision, constipation, dizziness, dry mouth, fatigue, increased heart rate, low blood pressure. Common (10-50 ) Agitation, sweating, weight gain. Less common (1-10 ) Insomnia, sexual dysfunction, urinary retention. Those requiring attention from your physician Any physical or emotional changes not listed, such as suicidal thoughts or behavior.


SIDE EFFECTS Usual (50-100 ) Dry mouth, constipation, blurry vision. Common (10-50 ) Low blood pressure (light-headedness, dizziness), fatigue, ataraxia (zombielike feeling), weight gain, menstrual irregularities, akathisia (restlessness), pseudoparkinsonism (muscular tremor, rigidity, akinesia), and tardive dyskinesia, a form of involuntary muscle movements (see chapter 19 for further details). Less common (1-10 ) Dystonia (muscle spasms, usually of the head and neck, face, and jaw), galactorrhea (milk leaking from breasts), sedation, sexual dysfunction. Infrequent (less than 1 ) Cataracts. Those requiring attention from your physician Jaundice (yellow eyes or skin) neuroleptic malignant syndrome, a rare but severe and potentially fatal reaction consisting of fever, muscle rigidity, mental status changes, and alterations in pulse and blood pressure (see chapter 19 for further details). Any other physical or emotional changes not described here.


SIDE EFFECTS Usual (50-100 ) Sedation, dry mouth, constipation, blurry vision. Common (10-50 ) Low blood pressure (light-headedness, dizziness), fatigue, ataraxia (zombielike feeling), weight gain, menstrual irregularities, akathisia (restlessness), sexual dysfunction, pseudoparkinsonism (muscular tremor, rigidity, akinesia), and tardive dyskinesia, a form of involuntary muscle movements (see chapter 19 for further details). Less common (1-10 ) Dystonia (muscle spasms, usually of the head and neck, face, and jaw), galactorrhea (milk leaking from breasts), sexual dysfunction. Infrequent (less than 1 ) Urinary difficulty cataracts. Those requiring attention from

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