Carl M. Pearson
Esmolol is especially effective in treating acute onset atrial fbrillation or futter perioperatively and results in both acute control of the ventricular response and conversion of the arrhythmia back to sinus rhythm erectile dysfunction doctors in massachusetts generic 100/60 mg viagra with fluoxetine with mastercard. It may also be effective against ventricular tachycardia and ventricular fbrillation refractory to other treatment erectile dysfunction medication causes cheap viagra with fluoxetine line. Amiodarone may be effective prophylactically in preventing atrial fbrillation postoperatively prices for erectile dysfunction drugs buy cheap viagra with fluoxetine online. It also can decrease the number of shocks in patients who have implantable cardioverter defbrillators compared with other antiarrhythmic drugs erectile dysfunction drugs natural purchase viagra with fluoxetine overnight delivery. In most patients, refractory ventricular tachycardia is suppressed by acute intravenous use of amiodarone. This effect has been attributed to a selectively increased activity in diseased tissue, as has been seen with lidocaine. Amiodarone also has an adrenergic-receptor (α and β) antagonistic effect produced by a noncompetitive mechanism; the contribution of 8 this effect to the antiarrhythmic action of the drug is not known. Chronic amiodarone therapy is not associated with clinically signifcant depression of ventricular function in patients without left ventricular failure. Hemodynamic deterioration may occur in some patients with compensated congestive heart failure, perhaps because of the antiadrenergic effects of the drug. In acute situations with stable patients, a 150-mg intravenous bolus is followed by a 1. In cardiopulmonary resuscitation, a 300-mg intravenous bolus is given and repeated with multiple boluses as needed if defbrillation is unsuccessful. Despite relatively widespread use of amiodarone, anesthetic complications have infrequently been reported. One of the reports described profound resistance to the vasoconstrictive effects of α-adrenergic agonists. The slow decay of amiodarone in plasma and tissue makes such adverse reactions possible long after discontinuing its administration. Because T3is reported 157 to reverse electrophysiologic effects of amiodarone, T3 could possibly be used to reverse hemodynamic abnormalities, such as those described in these two case reports, although this theory has not been tested. Epinephrine has been shown to be more effective than dobutamine or isoproterenol in reversing amiodarone-induced cardiac depression. Verapamil and Diltiazem Verapamil and diltiazem have been used extensively in the treatment of supraventricular arrhythmias, atrial fbrillation, and atrial futter. The effect on ventricular response is similar to that of the cardiac glycosides, although the onset is more rapid and acutely effective for control of tachycardia in patients. It successfully controlled a variety of supraventricular and ventricular arrhythmias. However, verapamil should be used cautiously intraoperatively because, in conjunction with inhalation anesthetics, signifcant cardiac depression may occur. Because the cardiovascular depressant effects of the inhalation anesthetics involve inhibition of calcium-related intracellular processes, the interaction of verapamil and these anesthetics is synergistic. In addition, the prophylactic use of intravenous diltiazem has been shown to reduce the incidence of postoperative supraventricular arrhythmias after pneumonectomy and cardiac surgery. In an experimental model, diltiazem has been shown to be protective against ventricular fbrillation with acute cocaine toxicity. Digoxin is approximately 25% protein bound, and the therapeutic range of plasma concentrations is 0. Adenosine the important cardiac electrophysiologic effects of adenosine are mediated by the A1-receptor and consist of negative chronotropic, dromotropic, and inotropic actions. For clinical use, adenosine must be administered by a rapid intravenous bolus in a dose of 100 to 200 μg/kg, although continuous intravenous infusions of 150 to 300 μg/kg/min have been used to produce controlled hypotension. For practical purposes, in adults an intravenous dose of 3 to 6 mg is given by bolus followed by a second dose of 6 to 12 mg after 1 minute if the frst dose was not effective. Comparison with verapamil has shown adenosine to be equally effective as an antiarrhythmic agent but with the advantages of fewer adverse hemodynamic effects, a faster onset of action, and a more rapid elimination so that undesired effects are short-lived. Both hypokalemia and hyperkalemia are associated with cardiac arrhythmias; however, hypokalemia is more common perioperatively in cardiac surgical patients and is more commonly associated with arrhythmias. Decreasing extracellular potassium concentration increases the peak negative diastolic potential, which would theoretically appear to decrease the likelihood of spontaneous depolarization. However, because the permeability of the myocardial cell membrane to potassium is directly related to extracellular potassium concentration, hypokalemia decreases cellular permeability to potassium. This prolongs the action potential by slowing repolarization, which in turn slows conduction and increases the dispersion of recovery of excitability and, thus, predisposes 8 to the development of arrhythmias. Treatment of hyperkalemia is based on its magnitude and on the clinical presentation. For life-threatening, hyperkalemia-induced arrhythmias, the principle is rapid reduction of extracellular potassium concentration, a treatment that does not acutely decrease total body potassium content. Calcium chloride, 10 to 20 mg/kg, given by intravenous 159 infusion, will directly antagonize the effects of potassium on the cardiac cell membranes. Sodium bicarbonate, 1 to 2 mEq/kg, or a dose calculated from acid-base measurements to produce moderate alkalinity (pH approximately 7. An intravenous infusion of glucose and insulin has a similar effect; glucose at a dose of 0. Sequential measurement of serum potassium is important with this treatment because marked hypokalemia can result. Hypomagnesemia is associated with a variety of cardiovascular disturbances, including arrhythmias. Sudden death from coronary artery disease, alcoholic cardiomyopathy, and congestive heart failure may involve magnesium defciency. In addition, as with hypokalemia, magnesium defciency predisposes to the development of the arrhythmias produced by cardiac glycosides. Arrhythmias induced by magnesium defciency may be refractory to treatment with antiarrhythmic drugs and either electrical cardioversion or defbrillation. For this reason, adjunctive treatment of refractory arrhythmias with magnesium has been advocated even when magnesium defciency has not been documented. Some studies have shown a beneft and others have not in regard to reducing the incidence of postoperative arrhythmias. The impact of ischemia may be both acute (impending infarction, hemodynamic compromise) and chronic (a marker of previously unknown cardiac disease, a prognostic indicator of poor outcome). Mechanisms of action include coronary vasodilation and favorable alterations in preload and afterload. Favorable hemodynamic changes associated with β-blockade include a blunting of the stress response and reduced heart rate, blood pressure, and contractility. Calcium channel blockers are often administered in the perioperative period for longer-term antianginal symptom control. Current guidelines suggest seeking a target blood pressure of less than 140/85 mm Hg to minimize long-term risk for adverse cardiovascular morbidity and mortality. The signs, symptoms, and treatment of chronic heart failure are as related to the neurohormonal response as they are to the underlying ventricular dysfunction. Physicians must be cautious in administering antiarrhythmic drugs because of the proarrhythmic effects that can increase mortality in certain subgroups of patients. A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients with Unstable Angina). Abrams J: Mechanisms of action of the organic nitrates in the treatment of myocardial ischemia. Giles J, Sear J, Foex P: Effect of chronic beta-blockage on perioperative outcome in patients undergoing noncardiac surgery. Pitt B, Remme W, Zannad F, et al: Eplerenone, a selective aldosterone blocker, in patients with left ventricular dysfunction after myocardial infarction. Lekmann A, Boldt J: New pharmacologic approaches for the perioperative treatment of ischemic cardiogenic shock. Lobato E, Willert J, Looke T, et al: Effects of milrinone versus epinephrine on left ventricular relaxation after cardiopulmonary bypass following myocardial revascularization. Liu P, Konstam M, Force T: Highlights of the 2004 Scientifc Sessions of the Heart Failure Society of America. Dorian P, Cass D, Schwartz G, et al: Amiodarone compared with lidocaine for shock-resistant ventricular fbrillation.
Trials and Tribulations of Treating Target Specifc Oral Anticoagulant Bleeding charge erectile dysfunction treatment in vadodara order viagra with fluoxetine overnight delivery. We ask you to help support ProMedica’s fght against hunger by donating a non-perishable food item to this conference which will be donated to the Seagate Food Bank erectile dysfunction statistics us buy viagra with fluoxetine online pills. Optimize management of diabetes to decrease potential microvascular and macrovascular complications beer causes erectile dysfunction buy viagra with fluoxetine with visa. Expensive Pramlintide: Side Effects Mainly nausea (Dose dependent) Hypoglycemia with insulin Others: fatigue erectile dysfunction in teenage purchase genuine viagra with fluoxetine line, abd pain No Cardiac, Hepatic or Renal toxicity No lipid abnormalities Medical School Revisited? Approved in combination with Metformin and Sulfonylureas No hypoglycemia unless taken with a sulfonylurea. A1C >7, check 2hr postprandials and adjust preprandial Rapid-Insulin Diabetes Care, Vol. Designations used by companies to distinguish their products are often claimed as trademarks. All brand names and product names used in this book are trade names, service marks, trademarks or registered trademarks of their respective owners. The publisher is not associated with any product or vendor mentioned in this book. This publication is designed to provide accurate and authoritative information in regard to the subject matter covered. It is sold on the understanding that the publisher is not engaged in rendering professional services. If professional advice or other expert assistance is required, the services of a competent professional should be sought. The contents of this work are intended to further general scientific research, understanding, and discussion only and are not intended and should not be relied upon as recommending or promoting a specific method, diagnosis, or treatment by physicians for any particular patient. The publisher and the author make no representations or warranties with respect to the accuracy or completeness of the contents of this work and specifically disclaim all warranties, including without limitation any implied warranties of fitness for a particular purpose. In view of ongoing research, equipment modifications, changes in governmental regulations, and the constant flow of information relating to the use of medicines, equipment, and devices, the reader is urged to review and evaluate the information provided in the package insert or instructions for each medicine, equipment, or device for, among other things, any changes in the instructions or indication of usage and for added warnings and precautions. Thefact thatan organization or Website is referred to in this work as a citation and/or a potential source of further information does not mean that the author or the publisher endorses the information the organization or Website may provide or recommendations it may make. Further, readers should be aware that Internet Websites listed in this work may have changed or disappeared between when this work was written and when it is read. No warranty may be created or extended by any promotional statements for this work. Neither the publisher nor the author shall be liable for any damages arising herefrom. Library of Congress Cataloging-in-Publication Data Rapid clinical pharmacology : a student formulary / Andrew Batchelder. Clinical pharmacologyisatopicwithwhichmanystudentsandcliniciansstrugglebecauseofthelarge volumes of factual information that they are required to assimilate. In addition, medical students frequently have difficulty identifying the core learning material. The British Pharmacological Society has recommended that learning be focused on a core list of commonly used drugs and suggests that students create a personal formulary. Rapid Clinical Pharmacology provides a concise structured approach for readers, be they students preparing for pharmacology examinations, junior doctors starting out in clinical practice or members of allied health professions involved in prescribing and dispensing medications. The familiar format of the Rapid series emphasises the key headings for each drug class, directing readers to the main points. Special considerations are also given under the ‘Important points’ heading to highlight features unique to certain drugs or classes. Good prescribing practice requires knowing which drug to use and why; however, it also requires consideration of comorbidities, potential adverse effects and polypharmacy. Emphasising clinically relevant information about the most commonly used medications, this book provides a good foundation of pharmacological knowledge upon which to build. Additionally, it includes useful tips on prescribing in the context of intravenous fluids and blood components. We would like to thank Dr Adrian Stanley for the wealth of time and effort he has dedicated to editing this text; without his invaluable assistance this book would not have been possible. The key pharmacokinetic parameters from a dosing point of view are bioavailability (F), clearance (Cl), volume of distribution (Vd) and elimination half-life (t½). Oralbioavailability variesand isdependenton thedegree ofabsorption,formulation ofsome drugs. If plasma concentration is plotted against time, bioavailability is represented as the area under the curve. Drugs that are lipid insoluble, such as neuromuscular blockers, remain predominantly in the plasma and will have a low Vd. Clinically, the larger the volume of distribution the longer it will take to reach a therapeutic level and, therefore, a loading dose may be necessary. Thetimerequiredtoachieveasteadystateplasmaconcentrationwillbelongifadrug has a long t½ (time taken to reach steady state is approximately 4½ half-lives). Therefore it is desirable to administer a loading dose to attain a therapeutic plasma concentration immediately. In order for a drug to reach a steady state plasma concentration (Cp), the tissues into which the drug distributes must be saturated first. Kis represented by the slope of the line of the log plasma concentration versus time. Elimination rate constant and t½ can be used clinically to estimate the time to reach steady state concentrations after drug initiation or a change in maintenance dose. The rate of elimination is, therefore, proportional to the amount of drug in the body. Many important drugs, such as phenytoin and theophylline, follow zeroorderkineticsathigherdoses. Alcoholalsofollowszero-orderkineticswithadeclineinplasma levels at a constant rate of approximately 15mg/100ml/h. Some of the factors that alter clearance include: degree of protein binding, body surface area, cardiac output, hepatic function and renal function. Inhibit histamineand gastrin-stimulated gastric acid secretion by their action on parietal cells in the stomach. This stimulates intestinal peristalsis (via the stretch reflex) as well as softening faeces. Before prescribing a laxative ensure constipation is not secondary to an underlying pathology such as bowel cancer. It requires at least 2–3 days for osmotic or bulking laxatives to take full effect. Lactulose reduces ammonia-producing organisms and is used in the treatment of hepatic encephalopathy. Inhibition of a1-adrenoceptors in periurethral prostatic stroma results in relaxation of internal urethral sphincter and some relief of obstructive urinary symptoms in males. These agents are rarely used due to infrequent but potentially severe adverse effects (amethyldopamaycausehepatitis). Early specialist cardiology advice is warranted if no response to 12mg of adenosine or if adverse signs are present at any stage. Spironolactone, in particular, also acts on receptors in other tissues, including androgen receptors. Increases plasma levels of warfarin, digoxin and phenytoin (reduce doses accordingly) leading to toxicity. Risk of profound first-dose hypotension with loop diuretics and enhanced hypotensive effect with other antihypertensive agents. Their therapeutic action stems mainly from inhibition of smooth muscle contraction and glandular tissue innervated by postganglionic cholinergic neurones. Inhibitionof prostacyclin is temporary as production by endothelial cells is continuous. Cardioselectivity: atenolol, bisoprolol and nebivolol have less effect on b2 receptors and therefore reduced bronchospasm. Lipid solubility: atenolol and sotalol are most water-soluble therefore less able to cross blood–brain barrier resulting in less sleep disturbance. Dihydropyridines are highly vascular selective and cause peripheral and coronary vasodilatation. Reassure them that strokes in children are diferent to adult stroke and happen for very Tips to help you cope diferent reasons erectile dysfunction signs buy generic viagra with fluoxetine 100/60mg on-line. Write down If they want to help you erectile dysfunction pills images buy viagra with fluoxetine 100/60mg on-line, think of ways that any questions you want to ask the they can ease some of the pressures you nurses and doctors erectile dysfunction medication side effects order viagra with fluoxetine online. They might be able to help you the more you will understand how best with the other children’s routine erectile dysfunction lipitor buy viagra with fluoxetine 100/60 mg with mastercard, food to support your child. Help to wash them, play with rehabilitation exercises and games, but them and feed them. Taking time out is discourage them from talking on behalf essential so you can revitalise yourself of their brother or sister if they have a and come back feeling refreshed. Try invaluable but it can be draining keeping to see it from their perspective and everyone updated. Nominate someone reassure them that they are not in to pass on the news or set up an email list. Try to answer your children’s questions honestly and prepare yourself for answers that can be upsetting or difcult. Your children will be more likely to worry and make up their own explanation for what is happening. If you are visiting the doctor, ask your children to write down any questions that they have. Supports anyone afected by childhood acquired brain injury, from the child or young Stroke Association person to his or her family and professionals. They have community Impaired Children services, grant and beneft information and Helpline: 0845 3 55 55 77 publications. They work for Helpline: 0845 130 7172 their inclusion in society and support parents Website: Great Ormond Street Hospital for Children Tel: 020 7405 9200 Child Stroke Support Site Website: Information and resources to support children and young people with special Study of Outcome in Childhood Stroke educational needs and disability in England. Disclaimer: the Stroke Association provides the details of other organisations for information only. Item code: A01F34 £5 could help us answer a helpline call from a desperately worried person looking for answers about stroke. Peer Review All Medical Advisory Secretariat analyses are subject to external expert peer review. Additionally, the public consultation process is also available to individuals wishing to comment on an analysis prior to finalization. The mandate of the Medical Advisory Secretariat is to provide evidence-based policy advice on the coordinated uptake of health services and new health technologies in Ontario to the Ministry of Health and Long-Term Care and to the healthcare system. The aim is to ensure that residents of Ontario have access to the best available new health technologies that will improve patient outcomes. The Medical Advisory Secretariat conducts systematic reviews of scientific evidence and consultations with experts in the health care services community to produce the Ontario Health Technology Assessment Series. About the Ontario Health Technology Assessment Series To conduct its comprehensive analyses, the Medical Advisory Secretariat systematically reviews available scientific literature, collaborates with partners across relevant government branches, and consults with clinical and other external experts and manufacturers, and solicits any necessary advice to gather information. The Medical Advisory Secretariat makes every effort to ensure that all relevant research, nationally and internationally, is included in the systematic literature reviews conducted. The information gathered is the foundation of the evidence to determine if a technology is effective and safe for use in a particular clinical population or setting. Information is collected to understand how a new technology fits within current practice and treatment alternatives. Details of the technology’s diffusion into current practice and information from practicing medical experts and industry, adds important information to the review of the provision and delivery of the health technology in Ontario. Information concerning the health benefits; economic and human resources; and ethical, regulatory, social and legal issues relating to the technology assist policy makers to make timely and relevant decisions to maximize patient outcomes. The public consultation process is also available to individuals wishing to comment on an analysis prior to publication. It also incorporates, when available, Ontario data, and information provided by experts and applicants to the Medical Advisory Secretariat to inform the analysis. While every effort has been made to do so, this document may not fully reflect all scientific research available. Additionally, other relevant scientific findings may have been reported since completion of the review. Please check the Medical Advisory Secretariat Website for a list of all evidence-based analyses:. Clinical Need Abdominal aortic aneurysm is a localized abnormal dilatation of the aorta greater than 3 cm. Rupture is always life threatening and requires emergency surgical repair of the ruptured aorta. Over one-half of all deaths attributed to a ruptured aneurysm take place before the patient reaches hospital. Review Strategy the Medical Advisory Secretariat used its standard search strategy to retrieve international health technology assessments and English-language journal articles from selected databases to determine the effectiveness of ultrasound screening for abdominal aortic aneurysms. Case reports, letters, editorials, nonsystematic reviews, non-human studies, and comments were excluded. Summary of Findings Population-based ultrasound screening is effective in men aged 65 to 74 years, particularly in those with a history of smoking. Less than 1% of aneurysms will not be visualized on initial screen and a re-screen may be necessary; elective surgical repair is associated with a 6% operative morality rate and about 3% of small aneurysms may rupture during surveillance. It may be classified according to its size: (4) Small aneurysms are smaller than 5 cm in diameter. Symptoms of an Abdominal Aortic Aneurysm Abdominal aortic aneurysms usually do not produce symptoms. The formation of mural thrombi, a type of blood clot, within the aneurysm may predispose people to peripheral embolization, where blood vessels become blocked. Occasionally, an aneurysm may leak into the vessel wall and the periadventitial area, causing pain and local tenderness. More often, acute rupture occurs without any warning, causing acute pain and hypotension. Abdominal aortic aneurysms are found in 4% to 8% of older men aged over 65 years and 0. Additionally, obese people are less likely to be diagnosed due to a lower specificity with diagnosis using manual examination of palpable mass and increased difficulty visualizing the aorta through ultrasound. It is a major operation involving the excision of the dilated area and placement of a sutured woven graft. Ruptured aneurysms are always life threatening and require emergency surgical repair of the abdominal aorta. Possible detection of aneurysms at a size when rupture is unlikely to occur is viable through screening. Reported sensitivities range from 82% to 99%, with sensitivity approaching 100% in some studies and in series of screening patients with a pulsatile mass. However, in a small proportion of patients, visualization of the aorta will be inadequate due to obesity, bowel gas, or periaortic disease. Early intervention at the presymptomatic stage may reduce the frequency of rupture and subsequently decrease mortality and the requirement for emergency hospital treatment. Ultrasound technologists and sonographers, also have the scope of practice to undertake ultrasound screening of the abdomen. However, sonography is not a regulated health profession under the Health Professions Act, and there are no formal uniform requirements for the operation of ultrasound equipment. Regulatory Status There are more than 500 different types of ultrasound devices approved and licensed under Health Canada’s medical devices listing. Ultrasound devices are well-developed technologies that are common tests accounting for the bulk of operating expenditures on diagnostic imaging. Methods Search Strategy the Medical Advisory Secretariat completed a computer-aided search limited to human studies. Case reports, letters, editorials, nonsystematic reviews, and comments were excluded. An in-depth quality assessment of each study included in this health technology policy assessment was performed. However a high grade will remain high) Very strong evidence of association-significant relative risk of > 5 (< 0. Further research is unlikely to without reservation change our confidence in the estimate of benefit and risk. Generic 100/60mg viagra with fluoxetine visa. Best Impotence Massage Oil to Get Stronger Penis Erection Naturally.
Syndromes
In most cases it is dull erectile dysfunction juice effective viagra with fluoxetine 100/60mg, diffuse impotence antonym cheap 100/60 mg viagra with fluoxetine fast delivery, continuous and manner that constitutes overuse even though no of moderate to severe intensity erectile dysfunction pills in store discount 100/60mg viagra with fluoxetine fast delivery. Patients who are clearly overusing multiple drugs tion-misuse headache; rebound headache erectile dysfunction protocol amazon purchase viagra with fluoxetine australia. Description: Headache occurring on 15 or more days/ Tension-type headache (or both); only a small minority month in a patient with a pre-existing primary have other primary headache disorders such as 3. Epidemiological eviusually, but not invariably, resolves after the overuse dence from many countries indicates that more than is stopped. Clinical Diagnostic criteria: evidence shows that the majority of patients with this disorder improve after discontinuation of the overused A. Regular intake of one or more triptans, in any In the criteria below for the various subtypes, the formulation, on! The triptan(s) will usually be specified in based studies estimating the prevalence of 8. Medication-overuse headache can record the coexistence in participants of headache on! Description: Headache occurring on 15 or more days/ month in a patient with a pre-existing primary headComments: A patient who fulfils criteria for more ache and developing as a consequence of regular use of than one of the subforms of 8. The term combination-analgesic is used specifically for formulations combining drugs of two or more Diagnostic criteria: classes, each with analgesic effect. They tend to be widely used by people with headache, Diagnostic criteria: and are very commonly implicated in 8. Regular intake of a non-opioid analgesic other sics combine non-opioid analgesics with opioids, butalthan paracetamol or non-steroidal anti-inflammabital and/or caffeine. Regular intake of any combination of ergotamine, 1 overuse headache triptans, non-opioid analgesics and/or opioids on 1 B. The drugs or drug classes should be specified in Description: Headache developing within 24 hours after parenthesis. Without overuse of any single drug or drug class alone for more than two weeks, which has been interrupted. Caffeine consumption of >200 mg/day for >2 Diagnostic criteria: weeks, which has been interrupted or delayed C. Comment: Patients who are clearly overusing multiple medications for acute or symptomatic treatment of 8. While a prospective diary record over several daily consumption of opioid(s) for more than three weeks might provide the information, it would also months, which has been interrupted. International Headache Society 2018 126 Cephalalgia 38(1) contraception or following a course of replacement or Bibliography supplementary oestrogen). It resolves spontaneously within three days in the absence of further consumption. Headache or migraine fulfilling criterion C induced spasm of cerebral blood vessels. Evidence of causation demonstrated by both of induced headache in patients with chronic tensionthe following: type headache. Medical complications of ruption in chronic use of or exposure to a medication or cocaine abuse. Headache in the use and withdrawal of opiates and other associated Diagnostic criteria: substances of abuse. Increase in plasma calcitonin gene-related peptide from the extraComments: It has been suggested, but without sufficient cerebral circulation during nitroglycerin-induced clusevidence, that withdrawal from chronic use of the folter headache attack. Unmasking continuous intravenous infusion of histamine, clinlatent dysnociception in healthy subjects. Safety of a tertiary headache centre — clinical characteristics long-term doses of aspartame. Analgesicagent m-chlorophenylpiperazine induced migraine induced chronic headache: long-term results of withattacks: a controlled study. The confirmation ergotamine overuse and drug-induced headache: a of a biochemical marker for women’s hormonal clinicoepidemiologic study. The effects of pathways and national distribution of painkillers norethisterone in postmenopausal women on oesin a descriptive, multinational, multicenter study. Inappropriate primary headaches during hormone replacement use of sumatriptan: population based register and therapy. International Headache Society 2018 128 Cephalalgia 38(1) heroin, cocaine and amphetamine users. Comparative with medication overuse: the Akershus study of abuse liability of codeine and naratriptan. Caffeine Brief intervention for medication-overuse headache as an analgesic adjuvant. J Neurol Neurosurg Psychiatry 2015; 86: 505– of a biochemical marker for women’s hormonal 512. Withdrawal tion-overuse headache, follow-up after 6 months: a syndrome after the double-blind cessation of cafpragmatic cluster-randomised controlled trial. The role of estradiol withdrawal in the Limmroth V, Katsarava Z, Fritsche G, et al. Analgesic kers switched from ordinary to decaffeinated coffee: rebound headache in clinical practice: data from a a 12 week double blind trial. When a pre-existing headache with the characterismeningitis or meningoencephalitis tics of a primary headache disorder becomes 9. Headache attributed to infection (or one of its parasitic infection types or subtypes) should be given, provided that 9. The purpose is to distinguish and keep tions of the head (such as ear, eye and sinus infections) separate two probably different causative mechanisms are coded as types or subtypes of 11. More rarely, it may accompany other systhe triad of headache, fever and nausea/vomiting is temic infections. In intracranial infections, headache is usually the the probability is increased when lethargy or convulfirst and the most frequently encountered symptom. International Headache Society 2018 130 Cephalalgia 38(1) and associated with focal neurological signs and/or B. Bacterial meningitis or meningoencephalitis has altered mental state and a general feeling of illness been diagnosed and/or fever should direct attention towards an intraC. Evidence of causation demonstrated by at least cranial infection even in the absence of neck stiffness. An infection, or sequela of an infection, known to a) holocranial be able to cause headache has been diagnosed b) located in the nuchal area and associated C. Evidence of causation demonstrated by at least with neck stiffness two of the following: D. It may A variety of bacteria may cause meningitis and/or develop in a context of mild flu-like symptoms. It is encephalitis, including Streptococcus pneumoniae, typically acute and associated with neck stiffness, Neisseria meningitidis and Listeria monocytogenes. The nausea, fever and changes in mental state and/or immunologic background is very important because other neurological symptoms and/or signs. Direct stimulation of the sensory terminals located Diagnostic criteria: in the meninges by the bacterial infection causes the onset of headache. Headache of any duration fulfilling criterion C iators of inflammation such as bradykinin, prostaglandins and cytokines and other agents released by! Bacterial meningitis or meningoencephalitis has induce pain sensitization and neuropeptide release. Headache has persisted for >3 months after may also play a role in causing headache. Viral meningitis or encephalitis has been attributed to bacterial meningitis or meningoencediagnosed phalitis, and criterion B below C. Bacterial meningitis or meningoencephalitis b) located in the nuchal area and associated 1 remains active or has resolved within the last three with neck stiffness months D. Intracranial fungal or other parasitic infection has Diagnostic criteria: been diagnosed C. Neuroimaging shows enhancement of the leptoto the onset of the intracranial fungal or other meninges exclusively. There may also be associated leptomeningeal parallel with the level of immunosuppression. |
