NAUSEA AND VERTIGO

Nausea and vomiting (also called emesis)

Nausea is an uneasy or unsettled feeling in the stomach together with an urge to vomit. Nausea and vomiting, or throwing up, are not diseases. They can be symptoms of many different conditions. 

Many common problems may cause nausea and vomiting, including:

-food allergies

-infections of the stomach or bowels, such as the "stomach flu" or food poisoning

-leaking of stomach contents (food or liquid) upwards (also called gastro-oesophageal reflux or GORD)

-medicines or medical treatments, such as cancer chemotherapy or radiation treatment

-migraine headaches

-morning sickness during pregnancy

-seasickness or motion sickness

-severe pain, such as with kidney stones

Nausea and vomiting may also be early warning signs of more serious medical problems, such as appendicitis, blockage in the intestines, cancer or a tumor, ingesting a drug or poison (especially by children) or ulcers in the lining of the stomach or small intestine.

Nausea and vomiting are common. Usually, they are not serious. Medical advice should be sought immediately if :

-vomited for longer than 24 hours

-blood in the vomit

-severe abdominal pain

-headache and stiff neck

-signs of dehydration, such as dry mouth, infrequent urination or dark urine.

Vertigo

The most common symptoms of vertigo include a feeling of spinning (you or the room around you), tilting or swaying and feeling off balance. These feelings come and go, and may last seconds, hours, or days. You may feel worse when you move your head, change positions (stand up, roll over), cough, or sneeze. Along with vertigo, you may vomit or feel nauseous, have a headache or be sensitive to light and noise, see double, have trouble speaking or swallowing, feel weak or short of breath or sweaty and have a racing heart beat.

The most common causes of vertigo include:

• Inner ear problems: collections of calcium, inflammation, and certain infections can cause problems in the vestibular system. The vestibular system includes parts of the inner ear and nervous system, which controls balance.
• Benign paroxysmal positional vertigo (BPPV): sometimes called benign positional vertigo, positional vertigo, postural vertigo, or simply vertigo, is a type of vertigo that develops due to collections of calcium in the inner ear. These collections are called canaliths. Moving the canaliths (called canalith repositioning) is a common treatment for BPPV. Vertigo is typically brief in people with BPPV, lasting seconds to minutes. Vertigo can be triggered by moving the head in certain ways.
• Meniere disease:  is a condition that causes repeated spells of vertigo, hearing loss, and ringing in the ears. Spells can last several minutes or hours. It is probably caused by a buildup of fluid in the inner ear. 
• Vestibular neuritis: vestibular neuritis, also known as labyrinthitis, is probably caused by a virus that causes swelling around the balance nerve. People with vestibular neuritis develop sudden, severe vertigo, nausea, vomiting, and difficulty walking or standing up; these problems can last several days. 

• Head injury: head injuries can affect the vestibular system in a variety of ways, and lead to vertigo.
• Medications: rarely, medications can actually damage or affect the function of the inner ear or brain and lead to vertigo.
• Migraines: in a condition called vestibular migraine or migrainous vertigo, vertigo can be caused by a migraine. This type of vertigo usually happens along with a headache.
• Brain problems, such as a stroke or TIA (transient ischemic attack), bleeding in the brain, or multiple sclerosis can also cause vertigo. 

-Drugs used in nausea and vertigo:

• Antihistamines:                                                                         

           -cinnarizine (Stugeron, Arievert)                                                        -cyclizine (Valoid)                                                                    

           -promethazine hydrochloride                                                              -promethiazine teoclate (Avomine).                                                              

• Phenothiazines and related drugs: 

            -chlorpromazine hydrochloride

            -perphenazine

            -prochlorperazine (Stemetil, Buccastem)

            -trifluoperazine.

• Domperidone and metoclopramide:

           -domperidone (Motillium)                                      

           -metoclopramide hydrochloride (Maxolon)

• 5HT3 antagonists:

           -dolasetron mesilate (Anzemet)

           -granisetron (Kytril)

           -ondansetron (Zofran)

           -palonosetron (Aloxi)

• Neurikinin receptor antagonist:

          -aprepitant (Emend)

          -fosaprepitant (Ivemend)

• Cannabinoid: nabilone

• Hyoscine: hyoscine hydrobromide (Joy Rides, Kwells, Scopoderm TTS patches)

• Other drugs for Meniere's disease: betahistine dihydrochloride (Serc).  

Sources:

-https://medlineplus.gov/nauseaandvomiting.html

-http://www.medscape.org/

-https://medlineplus.gov/dizzinessandvertigo.html

-http://www.uptodate.com/contents/dizziness-and-vertigo-beyond-the-basics?view=print

-http://backinmotionfl.com/stop-suffering-vertigo/

-http://www.manxhealthcare.com/products/betahistine.html

-https://www.theindependentpharmacy.co.uk/onlinedoctor/treatment/cyclizine-50mg-tablets100/

ATTENTION DEFICIT HYPERACTIVITY DISORDER

Attention deficit hyperactivity disorder (ADHD) is a problem of not being able to focus, being overactive, not being able control behavior, or a combination of these. For these problems to be diagnosed as ADHD, they must be out of the normal range for a person's age and development.

Causes:

ADHD usually begins in childhood, but may continue into the adult years. It is the most commonly diagnosed behavioral disorder in children. ADHD is diagnosed much more often in boys than in girls.

It is not clear what causes ADHD. A combination of genes and environmental factors likely plays a role in the development of the condition. Imaging studies suggest that the brains of children with ADHD are different from those of children without ADHD.

Symptoms of ADHD fall into three groups:
-Not being able to focus (inattentiveness)
-Being extremely active (hyperactivity)
-Not being able to control behavior (impulsivity).

Some people with ADHD have mainly inattentive symptoms. Some have mainly hyperactive and impulsive symptoms. Others have a combination of different symptom types. Those with mostly inattentive symptoms are sometimes said to have attention deficit disorder (ADD). They tend to be less disruptive and are more likely not to be diagnosed with ADHD.

Inattentive Symptoms
-Fails to give close attention to details or makes careless mistakes in schoolwork
-Has difficulty keeping attention during tasks or play
-Does not seem to listen when spoken to directly
-Does not follow through on instructions and fails to finish schoolwork or chores and tasks
-Has problems organizing tasks and activities
-Avoids or dislikes tasks that require sustained mental effort (such as schoolwork)
-Often loses toys, assignments, pencils, books, or tools needed for tasks or activities
-Is easily distracted
-Is often forgetful in daily activities.

Hyperactivity Symptoms
-Fidgets with hands or feet or squirms in seat
-Leaves seat when remaining seated is expected
-Runs about or climbs in inappropriate situations
-Has problems playing or working quietly
-Is often "on the go," acts as if "driven by a motor"
-Talks excessively.

Impulsivity Symptoms
-Blurts out answers before questions have been completed
-Has difficulty awaiting turn
-Interrupts or intrudes on others (butts into conversations or games).

PHARMACOLOGY
CNS stimulants and drugs used for ADHD:

-Atomoxetine (Strattera).

-Dexamfetamine sulphate (Dexedrine).

-Methylphenidate hydrochloride (Ritalin, Concerta XL, Equasym XL, Medikinet XL).
-Modafinil (Provigil).

Source:
-http://www.nlm.nih.gov/medlineplus/ency/article/001551.htm
-BNF 57

ANTIDEPRESSANT DRUGS

DEPRESSION

Depression may be described as feeling sad, blue, unhappy, miserable, or down in the dumps. Most of us feel this way at one time or another for short periods.

Clinical depression is a mood disorder in which feelings of sadness, loss, anger, or frustration interfere with everyday life for a longer period of time.

Symptoms of depression include:
-Low or irritable mood most of the time
-A loss of pleasure in usual activities
-Trouble sleeping or sleeping too much
-A big change in appetite, often with weight gain or loss
-Tiredness and lack of energy
-Feelings of worthlessness, self-hate, and guilt
-Difficulty concentrating
-Slow or fast movements
-Lack of activity and avoiding usual activities
-Feeling hopeless or helpless
-Repeated thoughts of death or suicide.
Low self-esteem is common with depression. It is also common to have sudden bursts of anger and a lack of pleasure from activities that normally make you happy, including sex.

The main types of depression include:

-Major depression: to be diagnosed with major depression, you must have five or more of the symptoms listed above for at least 2 weeks. Major depression tends to continue for at least 6 months if not treated. (You are said to have minor depression if you have less than five depression symptoms for at least 2 weeks. Minor depression is similar to major depression except it only has two to four symptoms.)

-Atypical depression: occurs in about a third of patients with depression. Symptoms include overeating and oversleeping. You may feel like you are weighed down and get very upset by rejection.

-Dysthymia: a milder form of depression that can last for years, if not treated.

Other common forms of depression include:

Postpartum depression: many women feel down after having a baby, but true postpartum depression is more severe and includes the symptoms of major depression.

Premenstrual dysphoric disorder: symptoms of depression occur 1 week before your menstrual period and disappear after you menstruate.

Seasonal affective disorder (SAD): occurs most often during the fall-winter season and disappears during the spring-summer season. It is most likely due to a lack of sunlight.

Depression may also alternate with mania (known as manic depression or bipolar disorder).

PHARMACOLOGY

1. Tricyclic and related antidepressant drugs:

-Amitriptyline hydrochloride (Triptafen).

-Clomipramine Hydrochloride (Anafranil).

-Dosulepin Hydrochloride (Prothiaden).

-Doxepin (Sinepin).

-Imipramine Hydrochloride.

-Lofepramine.

-Nortriptyline (Allegron).

-Trimipramine (Surmontil).

Related antidepressant drugs: Mianserin Hydrochloride and Trazodone Hydrochloride (Molipaxin).

2. Monoamine-oxidase inhibitors (MAOIs):

-Phenelzine (Nardil).

-Isocarboxazid.

-Tranylcypromine.

-Reversible MAOIs: Moclobemide (Manerix).

3. Selective serotonin re-uptake inhibitors: 

-Citalopram (Cipramil).

-Escitalopram (Cipralex).

-Fluoxetine (Prozac).

-Fluvoxamine maleate (Faverin).

-Paroxetine (Seroxat).

-Sertraline (Lustral).

4. Other antidepressant drugs:

-Duloxetine (Cymbalta, Yentreve).

-Flupentixol (Fluanxol).

-Mirtazapine (Zispin SolTab).

-Reboxetine (Edronax).

-Tryptophan (Optimax).

-Venlafaxine (Efexor).

Sources:

-http://www.nlm.nih.gov/medlineplus/ency/article/003213.htm\

-BNF57

ANTIPSYCHOTIC DRUGS

SCHIZOPHRENIA

Schizophrenia is a serious brain illness. People who have it may hear voices that aren't there. They may think other people are trying to hurt them. Sometimes they don't make sense when they talk. The disorder makes it hard for them to keep a job or take care of themselves.

Symptoms of schizophrenia usually start between ages 16 and 30. Men often develop symptoms at a younger age than women. People usually do not get schizophrenia after age 45. There are three types of symptoms:

-Psychotic symptoms distort a person's thinking. These include hallucinations (hearing or seeing things that are not there), delusions (beliefs that are not true), trouble organizing thoughts, and strange movements.

-"Negative" symptoms make it difficult to show emotions and to function normally. A person may seem depressed and withdrawn.

Cognitive symptoms affect the thought process. These include trouble using information, making decisions, and paying attention.

No one is sure what causes schizophrenia. Your genes, environment, and brain chemistry may play a role.

There is no cure. Medicine can help control many of the symptoms. Additional treatments can help you deal with your illness from day to day. These include therapy, family education, rehabilitation, and skills training.

MANIA

Bipolar disorder is a serious mental illness. People who have it go through unusual mood changes. They go from very happy, "up," and active to very sad and hopeless, "down," and inactive, and then back again. They often have normal moods in between. The up feeling is called mania. The down feeling is depression.

The causes of bipolar disorder aren't always clear. It runs in families. Abnormal brain structure and function may also play a role.

Bipolar disorder often starts in a person's late teen or early adult years. But children and adults can have bipolar disorder too. The illness usually lasts a lifetime.

If not treated, bipolar disorder can lead to damaged relationships, poor job or school performance, and even suicide. However, there are effective treatments to control symptoms: medicine and talk therapy. A combination usually works best.

PHARMACOLOGY

ANTIPSYCHOTICS DRUGS
-Benperidol (Anquil).
-Chlorpromazine Hydrochloride (Largactil).
-Flupentixol (Depixol).
-Haloperidol (Dozic, Haldol, Serenace).
-Levomepromazine (Nozinan).
-Pericyazine (Neulactil).
-Perphenazine (Fentazin).
-Pimozide (Orap).
-Prochlorperazine.
-Promazine Hydrochloride.
-Sulpiride (Dolmatil, Sulpor).
-Trifluoperazine (Stelazine).
-Zuclopenthixol acetate (Clopixol Acuphase).
-Zuclopenthixol (Clopixol).

Atypical antipsychotic drugs:
-Amisulpride (Solian).
-Aripiprazole (Abilify).
-Clozapine (Clozaril, Denzapine, Zaponex).
-Olanzapine (Zyprexa).
-Paliperidone (Invega).
-Quetiapine (Seroquel).
-Risperidone (Risperdal).
-Sertindole (Serdolect).
-Zotepine (Zoleptil).

ANTIPSYCHOTIC DEPOT INJECTIONS
-Flupentixol Decanoate (Depixol).
-Fluphenazine Decanoate (Modecate).
-Haloperidol (Haldol Decanoate).
-Pipotiazine Palmitate (Piportil Depot).
-Risperidone (Risperdal Consta).
-Zuclopenthixol Decanoate (Clopixol).

ANTIMANIC DRUGS
-Benzodiazepines
-Antipsychotic drugs.
-Carbamazepine.
-Valproic acid (Depakote, Convulex).
-Lithium Carbonate (Camcolit, Liskonum, Priadel).
-Lithium Citrate (Li-liquid, Priadel).

Source:
-www.nlm.nih.gov/medlineplus/bipolardisorder.html
-BNF 57 March 2009

HYPNOTICS AND ANXIOLYTICS

INSOMNIA

Insomnia is trouble falling asleep, staying asleep through the night, or waking up too early in the morning. Episodes of insomnia may come and go or be long-lasting.

The quality of your sleep is as important as how much sleep you get.

Causes

Sleep habits we learned as children may affect our sleep behaviors as adults. Poor sleep or lifestyle habits that may cause insomnia or make it worse include:

-Going to bed at different times each night

-Daytime napping

-Poor sleeping environment, such as too much noise or light

-Spending too much time in bed while awake

-Working evenings or night shifts

-Not getting enough exercise

-Using the television, computer, or a mobile device in bed

The use of some medications and drugs may also affect sleep, including:

-Alcohol or other drugs

-Heavy smoking

-Too much caffeine throughout the day or drinking caffeine late in the day

-Getting used to certain types of sleep medicines

-Some cold medicines and diet pills

-Other over-the-counter or prescription medicines, herbs, or supplements

Physical, social, and mental health issues can affect sleep patterns, including:

-Bipolar disorder.

-Overactive thyroid gland.

-Waking up at night to use the bathroom.

-Feeling sad or depressed. (Often, insomnia is the symptom that causes people with depression to seek medical help.)

-Physical pain or discomfort.

-Stress and anxiety, whether it is short-term or long-term. For some people, the stress caused by insomnia makes it even harder to fall asleep.

With age, sleep patterns tend to change. Many people find that aging causes them to have a harder time falling asleep, and that they wake up more often.

Symptoms

The most common complaints or symptoms in people with insomnia are:

-Trouble falling asleep on most nights

-Feeling tired during the day or falling asleep during the day

-Not feeling refreshed when you wake up

-Waking up several times during sleep.

People who have insomnia are sometimes consumed by the thought of getting enough sleep. But the more they try to sleep, the more frustrated and upset they get, and the harder sleep becomes.

Lack of restful sleep can:

-Make you tired and unfocused, so it is hard to do daily activities.

-Put you at risk for auto accidents. If you are driving and feel sleepy, pull over and take a break.

ANXIETY

Fear and anxiety are part of life. You may feel anxious before you take a test or walk down a dark street. This kind of anxiety is useful - it can make you more alert or careful. It usually ends soon after you are out of the situation that caused it. In some people. the anxiety does not go away, and gets worse over time. They may have chest pains or nightmares. They may even be afraid to leave home. These people have anxiety disorders. Types include:

-Panic disorder.

-Obsessive-compulsive disorder.

-Post-traumatic stress disorder.

-Phobias.

-Generalized anxiety disorder.

Treatment can involve medicines, therapy or both.

HYPNOTICS AND ANXIOLYTICS

1. HYPNOTICS:

-Benzodiazepines: Nitrazepam, Flurazepam (Dalmane), Loprazolam, Lormetazepam and Temazepam.

-Zaleplon (Sonata), Zolpidem Tartrate (Stilnoct) and Zoplicone (Zimovane) are non-benzodiazepine hypnotics, but they act at the benzodiazepine receptor.

-Chloral and derivatives: Cholral Hydrate (Chloral mixture/elixir, Welldorm) and Triclofos sodium.

-Clomethiazole (Heminevrin).

-Antihistamines (on sale to the public for occasional insomnia): Promethazine hydrochloride, Sodium oxybate (Xyrem) and Melatonin (Circadin).

2. ANXIOLYTICS:

-Benzodiazepines: Diazepam, Alprazolam, Chlordiazepoxide Hydrochloride, Lorazepam and Oxazepam.

-Buspirone hydrochloride (Buspar).

-Meprobamate.

3. BARBITURATES:

-Barbiturates (Sodium Amytal, Soneryl, Seconal sodium, Tuinal).

Sources:

-http://www.nlm.nih.gov/medlineplus/

-BNF 57 March 2009