Medical Drugs

Sleep Disorders and Medical Drugs Treatment

2009-02-27T16:34:00.002+08:00

Introduction

The light from the moon casts long shadows across your bedroom wall. Your spouse breathes softly beside you. You are wide awake once again at four a.m. Your frustration grows the longer you lie awake. You wonder how you will be able to function at work tomorrow with so little rest.

What is it?

Sleep disorders can be temporary or long-term problems and can affect the quantity or quality of sleep achieved. There are four recognized types of sleeping disorders:

Extrinsic sleep disorders, caused by something outside of the body such as drug use or a poor sleep environment
Intrinsic sleep disorders, caused by something within the body such as a physical or psychological ailment
Dyssomnias, characterized by an abnormality in the amount, quality, or timing of sleep. For example, insomnia, narcolepsy, breathing-related sleep disorders, and circadian rhythm sleep disorders, which are disruptions in your regular daily biological clock such as jet lag or work shift changes
Parasomnias, characterized by unusual physical occurrences during sleep such as sleepwalking, grinding teeth or bed-wetting

Insomnia, is defined as difficulty falling asleep, difficulty maintaining sleep or sleeping but not feeling rested. Insomnia can be caused by any one of the four types of sleep disorders mentioned above.

The National Institutes of Mental Health has identified three broad categories of insomnia. These include:

Transient - insomnia lasting fewer than three days
Short-term - lasting three days to three weeks
Chronic - lasting more than three weeks

What causes it?

There are many elements about the mechanisms of sleep and wakefulness that scientists do not understand. What is known is that sleep is primarily controlled by two systems in the brain: one that induces sleep and sleep-related processes, and one that regulates sleep within a 24-hour cycle. This cycle, which corresponds to periods of light and darkness, is known as the circadian rhythm cycle. Researchers are discovering that this cycle is a process controlled by genes that are found in living creatures ranging from the lowly fruit fly to human beings.

Researchers know that as human beings we go through a variety of stages of sleep that can be measured by brain wave patterns. Sleep is divided into two phases: non-rapid eye movement (NREM) sleep and rapid eye movement (REM) sleep. There are many cycles of NREM and REM sleep, each lasting between 70 and 120 minutes. Sleep disorders result from either internal abnormalities or external disturbances to these cycles. The feeling of having had enough sleep, or sleep satiety, is related to whether one has gone through all of the cycles of sleep, including both dreamless and REM sleep. We typically cycle through these stages multiple times per night.

The ongoing study of sleep disorders spans many medical fields, including neuroscience, genetics, physiology and psychology. Some of the mechanisms that play a role in sleep disorders are the subject of study at The National Center for Sleep Disorders Research. This center is situated within the National Heart, Lung, and Blood Institute - part of the National Institutes of Health (NIH) in Bethesda, Maryland. Research includes the study of the genes that play a role in narcolepsy (a condition characterized by brief attacks of deep sleep), how sleep disturbances affect the immune system, and the role of sleep/wake cycles in triggering heart attacks.

Who has it?

About 40 million people in the U.S. suffer from sleep problems every year. Insomnia is the most prevalent sleep complaint among adults in America. Insomnia is more common among the elderly and women.

Sleep apnea, a disruption of breathing during sleep, affects nearly 18 million people in the U.S. More than one billion dollars are spent each year on sleep medications in the United States.

What are the risk factors?

Most short-term sleep disorders are caused by one or more of the following factors:

lifestyle changes, such as marriage, retirement, or unemployment
stressful situations, such as the death of a loved one or job pressure
physical disorders
environment

Chronic sleep disorders have numerous possible causes. These include:

medical conditions - especially those producing pain
psychiatric conditions such as depression
drug use (including alcohol, nicotine, or caffeine)
environments that are not conducive to sleep

Many conditions that cause sleep disorders are associated with the elderly, which could explain why insomnia is 1.5 times more common in people older than age 65. In addition to physical conditions that disrupt sleep, elderly people tend to experience changes in sleep patterns leading to fewer hours of quality sleep per night.

Women, especially those who are postmenopausal, are more likely to suffer from sleep disorders than men. However, laboratory studies show that men are more likely to experience disrupted sleep patterns than women.

What are the symptoms?

The symptoms of sleep disorders include:

difficulty or inability to fall asleep
awaking early from sleep
easy disruption of sleep
fatigue or sleepiness
anxiety
lack of concentration
irritability

How is it treated?

Lifestyle changes and proper sleep hygiene (click on the Helping Yourself box) may be helpful for short-term management of insomnia. Medications may also help relieve insomnia and re-establish regular sleep patterns. Management of chronic insomnia requires careful assessment of the underlying cause for the insomnia, as well as nonpharmacologic therapy and less frequent use of sedative-hypnotics to prevent tolerance and dependence.

Over-the-counter sleep aids that contain diphenhydramine (Benadryl), an antihistamine, may be helpful for short-term bouts of insomnia. Because the body can grow accustomed to antihistamine sleep aids, they often lose their effectiveness the more you take them. If you experience continued bouts of insomnia you should talk to your doctor to see if prescription medications are needed. Benzodiazepines are commonly used for the management of sleep disorders. Short-acting benzodiazepines are less likely than long-acting benzodiazepines to be associated with drowsiness or sluggishness the next morning. Benzodiazepines are only available with a prescription. They are controlled substances and do carry a potential for addiction if used inappropriately.

Other drugs used in the management of insomnia include unique agents called non-benzodiazepine sedative hypnotics. Examples include Ambien (zolpidem), Sonata (zaleplon), and Lunesta (eszopiclone).

Drug classes also considered sedative hypnotics are barbiturates and sedating antihistamines. The non-benzodiazepines and barbiturates are also controlled substances due to the potential for addiction.

A newer class of sedative hypnotics is also available. Rozerem (ramelteon), a melatonin receptor agonist, mimics the body's natural sleep promoting hormone, melatonin. This drug class is unique because it works with the body's natural circadian rhythm to promote sleep. These melatonin receptor agonists are not controlled substances and do not carry an addiction potential.

Natural remedies have been used for years to treat sleep disorders. One of the most popular "natural" remedies for insomnia has been melatonin, which can be obtained at most pharmacies and health food stores. Melatonin is a hormone that is known to be involved in the regulation of sleep and wakefulness. It has been shown that the ingestion of melatonin prior to bedtime will help individuals fall asleep. However, scientific data have failed to confirm that melatonin is useful in maintaining sleep.

Herbal products such as valerian, chamomile, kava kava, and others have also been promoted as natural remedies for insomnia. However, these herbals are not regulated by the Food and Drug Administration (FDA) and the effectiveness and safety of these products has not been documented in large clinical trials.

Drug classes used to treat Sleep Disorders

Barbiturates
Benzodiazepines
Miscellaneous Sedatives and Hypnotics

Stroke and Medical Drugs Treatment

2009-02-20T16:29:00.000+08:00

Introduction

Although death rates from stroke have declined over the recent years, it remains the third leading cause of death in the United States. On average, someone in the United States has a stroke every 40 seconds. And, every 3 to 4 minutes, someone dies of a stroke. Strokes can occur at any time, regardless of age, gender or race. Most stroke symptoms are not associated with pain, causing people to delay medical treatment. Signs and symptoms of stroke can range from difficulty with speech to sudden numbness or weakness in the face or limbs. During a stroke, two million brain cells die every minute, increasing the risk for permanent brain damage, disability and death. Therefore, it is important to recognize signs and symptoms of a stroke in order to seek immediate medical attention.

What is it?

There are two main types of strokes:

An ischemic stroke occurs when there is a decrease in the amount of blood and oxygen delivered to the brain as a result of blood clots or build up of fat in the blood vessels.
A hemorrhagic stroke occurs when a blood vessel ruptures, causing blood to leak into the brain.

About 87% of all strokes are ischemic in nature, with hemorrhagic stroke occurring only 13% of the time. Ischemic strokes are more common because there are more causes or risk factors associated with ischemic strokes, such as high cholesterol, heart disease, other heart conditions (such as heart failure), and high blood pressure. On the other hand, hemorrhagic strokes may occur when there is trauma to the head or high blood pressure, causing a rupture in a blood vessel.

Transient ischemic attacks (TIAs) are "mini strokes" that have stroke-like symptoms with no lasting damage. It occurs when the blood supply to the brain is temporarily interrupted. TIA symptoms, which usually occur suddenly, are similar to those of a full-blown ischemic stroke, but they do not last as long. Symptoms of a TIA may last for several minutes to 24 hours without leaving permanent effects. It is possible to have more than one TIA, and the recurrent signs and symptoms may be similar or different. People who have had a TIA are more likely to have a stroke than those who have not had a previous TIA.

TIAs occur before an ischemic stroke in about 15% of cases. After a TIA, the 90-day risk of experiencing a stroke is approximately 3% to 17%, but the risk is the highest within the first 30 days. Within one year of a TIA, up to one-fourth of people who have an ischemic or hemorrhagic stroke die.

What causes it?

Ischemic Strokes

There are two main causes of ischemic strokes:

Cerebral thrombosis: Thrombosis is the formation of a blood clot (or thrombus) at the blocked portion of a blood vessel. Atherosclerosis (hardening of the blood vessels as a result of fatty buildup and cholesterol plaques on the vessel wall) causes blood vessels to narrow and restrict blood flow, which can lead to the formation of a blood clot. If a blood clot develops in a blood vessel that supplies blood to the brain, the blood and oxygen supply to the brain can be diminished or completely blocked leading to an ischemic stroke.
Cerebral embolism: An embolism is a dislodged blood clot that forms at another site in the circulatory system, usually in the heart or in the large arteries in the upper chest and neck. The blood clot then traveles through the blood vessels and becomes wedged in an artery. In about 15% of all strokes, the emboli are blood clots that originally formed in the heart as a result of a rhythm disorder known as atrial fibrillation -- a rapid, irregular beat in the upper chambers of the heart (the atria). As a result of the irregular pumping, some blood may pool in the heart chamber and form a clot, which can then break off and travel to the brain as an emboli, causing an ischemic stroke.

Hemorrhagic Stroke

A hemorrhagic stroke occurs when a blood vessel that is weakened ruptures, causing blood to leak into the surrounding areas of the brain. Blood vessels usually rupture as a result of high blood pressure combined with arteriosclerosis (hardening of the blood vessels due to fatty buildup and cholesterol plaques on the vessel wall), which can place too much pressure on the blood vessel walls. The blood can accumulate and increase the pressure surrounding the brain tissue.

The two types of hemorrhagic strokes are:

An intracerebral hemorrhage occurs when a faulty blood vessel in the brain bursts, flooding the nearby areas of the brain. The most common sites are the basal ganglia (an area in the brain responsible for controlling voluntary movements and establishing postures), the cerebellum (an area in the brain that provides coordination of finely executed complex movements, including speech) the thalamus (an area in the brain that is the center of pain, touch, and temperature) and the pons (an area in the brain that acts as a relay station for messages in the brain and is important centers for regulating breathing).
A subarachnoid hemorrhage occurs when a blood vessel in the brain bursts, causing sudden bleeding into the space between the middle lining of the brain (the arachnoid membrane) and the brain itself. A subarachnoid hemorrhage causes sudden, severe pain in the head; a person may describe it as "the worst headache I have ever had."

Who has it?

As mentioned previously, stroke is the third leading cause of death in the United States and a leading cause of long-term disability. In 2006, the American Stroke Association estimated that in the United States nearly 157,000 people die from a stroke each year, and that cumulatively 4.6 million people survived a stroke. Each year, it is estimated that 795,000 people will experience a new or recurrent stroke.

Strokes can occur in both women and men and in all ethnic groups although certain groups are at higher risk for dying from strokes (see "What are the risk factors?"). African Americans have almost twice the risk of an initial stroke as compared with Caucasians. The incidences of strokes in males are greater than in women at younger ages, but not at older ages. In 2004, women accounted for 61% of U.S. stroke deaths.

What are the risk factors?

Risk factors are characteristics that may increase your chance for developing a condition. For ischemic and hemorrhagic stroke, risk factors include the following:

Risk factors that can not be changed or controlled:

Age -- The risk for stroke doubles each decade after the age of 55.
Gender -- Men have about a 30% higher risk for stroke than women do until the age of 55 years. After the age of 55 years, the risk is the same for men and women.
Race -- Higher death rates from stroke occur in African Americans, Asian-Pacific Islanders, and Hispanics than in whites as a result of increased incidence of high blood pressure.
Heredity -- The risk for stroke is greater if a parent, brother, or sister has a stroke or transient ischemic attack.

Risk factors that can be changed or that can be controlled:

High blood pressure
Heart disease
TIAs
Diabetes
High cholesterol
Atrial fibrillation
Cigarette smoking
Alcohol
Illicit drug use
Lifestyle factors - inactivity, obesity, poor diet and stress
High estrogen oral contraceptives, especially in women over 35 years who smoke and women over 40 years who have hypertension or diabetes
Sickle cell disease

What are the symptoms?

Ischemic stroke

General symptoms of an ischemic stroke include a sudden onset of the following:

Numbness, weakness, or inability to move (paralysis) of face, arm, or leg, usually on one side of the body
Trouble seeing in one or both eyes (such as dimness, blurring, double vision, or loss of vision)
Confusion, trouble speaking or understanding
Trouble walking, dizziness, loss of balance or coordination
Severe headache with no known cause

Symptoms can develop suddenly (within minutes) and may also progress over hours to days. Symptoms of an ischemic stroke may be so minor that they often get ignored or go unnoticed, but medical attention should not be delayed.

TIA

General symptoms of TIA include sudden onset of the following:

Numbness or weakness in the face or limbs
Dimming or loss of vision in one eye
Unexpected falls
Unexplained dizziness
Nausea
Double vision
Drowsiness

The difference between a TIA and an ischemic or hemorrhagic stroke is the duration of the symptoms; TIA symptoms usually disappear after 10 to 20 minutes and last no longer than 24 hours. For instance, a person experiencing a TIA may experience temporary numbness in the limbs, loss of vision or unexplained dizziness for a few minutes, or even up to 24 hours, but will likely recover the next day. On the other hand, a person who has an ischemic stroke may have numbness on one side of the body, loss of vision, headache or confusion, which will not disappear the next day. This would also apply to a person having a hemorrhagic stroke; they may experience a severe headache, changes in mental status or dizziness that will not disappear after 24 hours.

Hemorrhagic stroke

General symptoms of a hemorrhagic stroke include sudden onset of the following:

Headache (severe and in a specific area)
Nausea and vomiting
Neck stiffness
Dizziness
Seizures
Changes in mental state, such as irritability, confusion, and possibly, unconsciousness

Hemorrhagic strokes often occur during the daytime and during physical activity, but this is not always true. Symptoms of a hemorrhagic stroke typically begin suddenly (within seconds) and progress over several hours.

People with very high, uncontrolled blood pressure may have one or more symptoms before they have a hemorrhagic stroke, including the following:

Severe headache in the back of the head or top of the neck
Dizziness or fainting
Tingling or numbness in an arm or leg, or an inability to move an arm or leg that comes and goes

How is it treated?

Strokes can be treated and 80% of strokes are preventable. At the moment, no treatment can cure a stroke, and most people will have some form of residual damage, which will vary from person to person. Residual damage can range from a slight limp to paralysis on one side of the body. Prevention will be the key to avoid further damage and subsequent strokes.

Prevention:

Antihypertensive agents: Reducing even mild to moderate blood pressure has been shown to lower the risk of stroke.

Cholesterol lowering agents: These agents -- "statins" like Zocor, Lipitor, Crestor, Lescol, Mevacor and Pravachol -- reduce the risk of stroke in people with existing coronary artery disease.

Treatment of Atrial Fibrillation (irregular heartbeat): The main goal of treatment for atrial fibrillation is to prevent blood clots from forming by first restoring and then maintaining normal heart rhythm.

Treatment for ischemic stroke:

Acute Treatment:

An acute ischemic stroke is usually treated with a thrombolytic agent, which is considered to be a first-line treatment. Thrombolytics, sometimes called "clot busters," dissolve the blood clot that is blocking the flow of blood through the blood vessel. The use of thrombolytics may however, increase the risk of an intracranial hemorrhage (bleeding in the brain). Due to this increased risk for bleeding, there are several specific criteria that a person must meet before thrombolytic therapy can be given. One of the key criteria is that thrombolytics need to be administered within a certain time frame after stroke symptoms are initially recognized. Therefore, it is extremely important for the person or family members to recognize the symptoms of stroke and to seek medical attention immediately - - at the very least within 3 hours of the onset of stroke symptoms to qualify for thrombolytic therapy. Call 911 if you witness anyone having a stroke because time is of the essence.
Aspirin is another important agent in the treatment of an acute ischemic stroke. Aspirin should be given more than 24 hours after the thrombolytic, but within 48 hours of symptoms. Early aspirin use has been shown to decrease long-term death and disability in stroke patients.

Chronic Treatment:

After hospitalization, most patients will need to be placed on an antiplatelet or an anticoagulant, as well as other medications to control blood pressure and lower cholesterol to prevent another stroke. Anti-platelets and anticoagulants are important after a stroke because they interfere with the blood's ability to clot; this can prevent blood clots that may form in the heart or in the blood vessels, which will help reduce your chances of another stroke.
Medications that prevent blood from clotting are also used in people who have had a TIA and are at risk for stroke.
Carotid endarterectomy is a surgical procedure used to treat and prevent an acute ischemic stroke. This is an effective procedure in protecting against a first stroke in patients with severe stenosis (constriction or narrowing of a blood vessel by 70%-99%) of the main blood vessel in the brain.
Angioplasty and stenting are common procedures used in some individuals to help widen the arteries. During the procedure, a catheter (a long, hollow tube) is inserted in an artery near the groin until it reaches the artery that is narrowed. A tiny balloon at the end of the catheter is inflated to flatten the fatty buildup against the wall of the artery. Afterwards, a wire mesh stent (small mesh tube) is placed in order to keep the artery open and prevent it from narrowing.

Treatment for hemorrhagic stroke:

A cerebral hemorrhage is associated with extremely high death rates. It can be treated with either surgery or medical intervention and there is currently no medical consensus as to which treatment is best.
Surgical treatment involves removing the large clot from the area. The blood clot (referred to as a hematoma) size and level of consciousness of the patient are critical. Patients who are awake and have small hematomas (less than 3 centimeters diameter or less than 20 mls) will usually improve without surgery, whereas comatose patients with large hematomas (greater than 6 centimeters diameter or greater than 80 mls) will usually do very poorly, regardless of management. The best candidates for surgery may be patients with moderate to large hematomas who are still awake or conscious.
Medical treatment involves monitoring blood pressure while providing adequate blood flow to the brain. If increased pressure is suspected treatment with intravenous mannitol (which reduces the pressure and excess fluids by reducing the clot) with or without furosemide (a diuretic that reduces pressure and removes excess water) may be helpful.
A subarachnoid hemorrhage can be treated with either surgery or medical treatment. Surgical treatment involves not only finding the site of the bleeding, but also stopping the bleeding in the brain. Currently, surgery in all patients in good neurological condition (meaning there are no other complications affecting the nervous system) would be the treatment of choice, if the site is surgically easy to get to and there are no other medical complications present. Medical treatment involves normalizing blood pressure, bedrest, analgesics (acetaminophen) to relieve headache and nimodipine (Nimotop) (to reduce pressure and decrease brain cell loss). Nimodipine has been shown to reduce death and hospitalizations.

Drug classes used to treat Stroke

Antiplatelets
Oral Anticoagulants
Salicylates
Thrombolytic Agents

What is on the horizon?

New therapy for prevention of TIAs and stroke includes a number of new and emerging interventions. Different strategies that restore blood flow to the brain, including longer-acting thrombolytics, anti-platelets and laser-guided clot removal are being researched. Therapies that help reverse the effects of an acute stroke are also being investigated. Researchers are also investigating the possibility of extending the time frame for administering thrombolytic therapy.

Smoking Cessation and Medical Drug Treatment

2009-02-13T16:25:00.000+08:00

Introduction

Every day, more than 3,500 teenagers (<>

What is it?

Smoking is an addiction that currently affects approximately 47 million people in the United States. It has been identified by the American Lung Association as the most important source of preventable morbidity and early mortality worldwide. In the U.S., smoking is responsible for 1 in 5 deaths. Smoking costs the U.S. economy over $193 billion in health care costs and lost productivity each year.

A person who smokes often feels the compulsive need to light up that next cigarette. Many smokers cannot wait until their next cigarette to make the nicotine craving go away.

Tobacco smoke contains many compounds that are harmful to the body. Over 4,000 chemicals, including 60 that have been shown to cause cancer, have been found in tobacco and tobacco smoke. Smoking causes approximately one-third of all cancers, including 90% of all lung cancers. Other chemicals in the smoke cause lung and heart disease.

The following are just a few of the chemicals surprisingly found in cigarette smoke:

Cyanide
Benzene
Formaldehyde
Methanol (wood alcohol)
Acetylene (fuel used in welding torches)
Ammonia
Poisonous gases including nitrous oxide and carbon monoxide

These chemicals inhaled by a smoker or nonsmoker (via second hand smoke?see below) are known to either cause or worsen the following health problems:

Cancers: lung, oral, larynx (throat), esophageal, kidney, bladder, pancreas, stomach, colon
Chronic Obstructive Pulmonary Disease (emphysema and chronic bronchitis)
Chronic "smoker's cough"
Asthma
High blood pressure
Heart disease
Stroke
Peptic ulcer disease
Gastric Esophageal Reflux Disease (GERD or heartburn)
Diabetes

Secondhand smoke, also called environmental tobacco smoke (ETS), is smoke inhaled by a person who is in an environment where tobacco smoke is being produced by another person. Secondhand smoke contains the same amount of cancer-causing chemicals as smoke inhaled directly by a smoker. In 1993, the U.S. Environmental Protection Agency determined that there is sufficient evidence that secondhand smoke causes cancer in humans. However, researchers are unsure at this time what amount of secondhand smoke exposure is needed to cause cancer. The current Surgeon General's Report concluded that scientific evidence indicates there is no risk-free level of exposure to secondhand smoke.

Additionally, a study was recently published that coined the term "third-hand smoke." The term is being used to describe the invisible yet toxic brew of gases and particles that cling to smokers' hair and clothing, even furniture cushions and carpeting that lingers long after second-hand smoke has cleared. Researchers have found that eleven of the compounds found in third-hand smoke are highly carcinogenic (may cause cancer). The study shows that increasing awareness of how third-hand smoke harms the health of children may encourage home smoking bans.

According to the Centers for Disease Control and Prevention (CDC), approximately 38,000 deaths occur each year among nonsmokers in the United States as a result of exposure to secondhand smoke. It has also been shown that persons living in a home with smokers are at the highest risk of developing cancer from secondhand smoke. According to the American Cancer Society, sitting in a nonsmoking section of a restaurant for two hours is equal to smoking one and a half cigarettes. In addition, a nonsmoker sitting behind a smoker in a bar for two hours breathes in the equivalent of four cigarettes.

What causes it?

Addiction to smoking is actually caused by the body's addiction to the primary ingredient in cigarette smoke, known as nicotine. Nicotine causes an addiction to smoking in three ways. First, small amounts of nicotine make a person feel pleasant and satisfied, causing the person to want to smoke even more. Secondly, nicotine affects the mood and behavior of a smoker by altering chemicals in the brain. Long-term brain changes induced by continued nicotine exposure result in addiction. Lastly, and often most importantly, withdrawal symptoms, such as nervousness, headaches, irritability, increased appetite, and difficulty sleeping, occur when a person refrains from smoking for a given period of time (usually about 24 hours).

Who has it?

Since tobacco use is an addiction that is self-initiated, anyone could become addicted to tobacco products. However, there are certain groups of people that are more prone to becoming addicted to nicotine. According to the most recent National Health Interview Survey from the Centers for Disease Control and Prevention and the National Center for Health Statistics, in the United States, an estimated 25.9 million men (23.9%) and 20.7 million women (18.1%) are smokers. Smoking is least prevalent among persons older than age 65 (10.0%) and most prevalent among persons 18 to 24 years of age (23.7%), although the prevalence for those 25 to 44 years of age is only just slightly lower (23.2%). Studies have shown that the prevalence of smoking is higher among persons with 9 to 11 years of education (32.6%) compared with persons with more than 16 years of education (7.1%).

Unfortunately, teenage smoking is on the rise. In 2003, approximately 3.6 million Americans 12 to 17 years of age smoked regularly. In 2007, 20% of high school students reported that they were current smokers. On a positive note, in recent years, the percentage of 8th grade students who admitted to smoking has declined from 21% (in 2002) to 9% (in 2003).

What are the risk factors?

Surveys have shown that young adults age 18 to 25 years have the greatest incidence of starting to use tobacco products. The younger you are when you begin smoking, the more likely you are to be an adult smoker. Almost 90% of adult smokers started at or before the age of 19. Teenage use of tobacco products is most often initiated by the need to be accepted by their peers who smoke and the need to feel like they fit in. Some teens have also reported that they began using tobacco products in order to rebel against their parents. Recent research has also shown that teenagers are the most resistant to antismoking messages and campaigns, because they do not fully understand the complications that smoking tobacco can initiate.

The pleasant feeling associated with nicotine use is often helpful to people who want to decrease their stress levels. Consequently, people who have high-stress work environments or difficult family situations may be more likely to use nicotine, at least on an occasional basis.

A few small studies have shown that persons are more likely to begin smoking if a parent smoked. Parents, the most influential role models in children, often dictate the positive and negative behaviors of their children.

What are the symptoms?

Symptoms of high nicotine addiction include but are not limited to:

Nicotine craving within the first hour of waking
Having difficulty refraining from smoking in places where it is forbidden
Smoking more than ten cigarettes per day (although any nicotine use is unhealthy)
Smoking even when very ill and unable to go to work or get out of bed

Nicotine withdrawal often occurs within 24 hours of refraining from nicotine use. Signs of nicotine withdrawal include:

Depressed or elevated mood
Insomnia
Irritability, frustration, or anger
Anxiety
Difficulty concentrating
Restlessness
Decreased heart rate
Increased cravings
Increased appetite or weight gain

The presence of at least four signs of withdrawal is needed to be diagnosed with nicotine withdrawal. It is important to continually self-monitor for these signs.

Why should you quit?

The US Surgeon General's Report of 1990 detailed a timeline as to how cessation from nicotine improves a person's health status. While this report is somewhat dated, it still holds true today.

20 minutes after the last cigarette: heart rate drops
12 hours after the last cigarette: the carbon monoxide level in the blood drops back to normal
2 weeks to 3 months after the last cigarette: circulation improves and lung function increases
1 to 9 months after the last cigarette: coughing and shortness of breath decrease; cilia (tiny hair-like structures that move mucus out of the lungs) begin to function normally again, increasing the ability to clean out the lungs and thus reduce the risk for lung infection
1 year after the last cigarette: risk of heart disease is decreased in half compared to a continuing smoker's risk
5 years after the last cigarette: risk for having a stroke is the same as a person who never smoked
10 years after the last cigarette: lung cancer death rate is about half of a continuing smoker. The risk of cancer of the mouth, throat, esophagus, bladder, cervix, and pancreas decrease as well.
15 years after the last cigarette: the risk of heart disease is the same as a person who never smoked.

Five stages of smoking cessation

There are five stages of smoking cessation. These stages can help a person determine how much further he/she must go in order to achieve complete smoking cessation.

Pre-contemplation: the person has no desire to quit
Contemplation: the person has a desire to quit but no quitting plan
Preparation: the person has a desire to quit within one month and has a quitting plan
Action: the person has quit for one day to six months
Maintenance: the person has quit for at least six months

Successful treatment of nicotine addiction is a continual process. An addiction is not like an infection where you take a medication and the infection completely resolves in a short amount of time. On average, a person tries to quit smoking eleven different times before becoming successful. Quitting "cold turkey" with no additional help is often only successful in persons who smoke infrequently. People who smoke greater than ten cigarettes per day often require medication and psychological therapy to aid them in successfully refraining from smoking on a permanent basis.

Multiple products are available to help you quit smoking including nicotine replacement aids (e.g. gums, patches) and medications such as Zyban, Chantix, and antidepressant medications. For individuals who are highly addicted to nicotine or who have smoked for many years, combination therapy (eg. nicotine patch plus Zyban) can be tried. However, it's best to try one therapy first and if that therapy fails, then proceed to combination therapy. Therapy needs to be tailored to the individual. Click on the drug class links below to learn more.

Additionally, non-drug therapy is the key to success with smoking cessation. Click on our "Helping Yourself" link above to learn helpful tips to stop smoking.

Finally, some people have found success with alternative therapies such as hypnosis.

Drug classes used to treat Smoking Cessation

Alpha 4 Beta 2 Nicotinic Acetylcholine Receptor Agonist
Alpha-2 Agonists
Nicotine Replacement Therapy
Tricyclic Antidepressants
Zyban

What is on the horizon?

An experimental vaccine to help people quit smoking is currently being researched. This vaccine stimulates the body to produce nicotine antibodies that bind to any nicotine that enters a person's blood when he/she smokes. This nicotine/antibody complex is then too large to enter a person's brain, thus preventing the addictive effects of the nicotine from occurring. Small studies so far have reported the vaccine to be safe and well tolerated. However, the effectiveness of the vaccine in helping people to stop smoking has not yet been established. A recent study was just completed that evaluated the safety and efficacy of various dosing levels and dosing frequencies of a nicotine vaccine named NicVAX. The results have yet to be published. There are also two more studies in progress that are studying NicVAX. The vaccine will most likely be used in combination with other smoking cessation drug therapies. It is being considered as a smoking prevention vaccine for people who have never smoked before. The vaccine for the use in smoking prevention has yet to be studied. Once clinical studies of the vaccine for smoking cessation purposes are completed, FDA approval will be needed before manufacture of this vaccine can occur.

Research has pinpointed a specific molecule, the b2 subunit, of the nicotine receptor in the body as a critical component of nicotine addiction. This discovery identifies a potential site for targeting future drug therapy in smoking cessation.

Other recent research has shown that persons with decreased function of the liver enzyme CYP2A6 have a less likely chance of becoming addicted to nicotine. The creation of new medications that decrease function of this enzyme may promote improved smoking cessation.

Many smokers report that they miss the sensory aspects of smoking. Studies using sensory replacement therapy in these patients have shown some promise. Inhalation therapies containing ascorbic acid or citric acid have been tested, both increasing short-term rates of smoking cessation. Further studies of sensory replacement therapy in combination with FDA-approved smoking cessation drug therapy is warranted but has yet to be initiated.

Menopause and Medical Drugs Treatment

2009-01-09T16:19:00.001+08:00

Introduction

As women reach their late forties or early fifties, their menstrual periods generally become much less frequent and then stop. Sometimes called the "change of life" or the "climacteric," menopause is the time when menstrual periods end. Some women see menopause as a time for celebration while others dread the physical signs of aging. Most women treat it as a normal stage of life.

What is it?

Menopause simply means the end of menstruation. Usually defined as not having had a menstrual period for 12 months in a row, menopause may be natural or it may occur after a hysterectomy (surgical removal of the uterus). In the United States, the average age of natural menopause is 51 years, but it may occur naturally at any time between the ages of about 45 and 55 years.

Menopause results from decreased production of the female sex hormones, estrogen and progesterone. After menopause, few eggs remain in the ovaries. As a result, both estrogen and progesterone levels fall. The extreme decline in hormone production is a major cause of symptoms, such as hot flashes and mood disorders, which frequently accompany the start of menopause. Lowered estrogen and progesterone levels also contribute to an increased risk for certain health problems, such as heart disease, osteoporosis, and urinary incontinence (the inability to control urine flow). When levels of both hormones decline, menstruation stops and fertility essentially ends, as well.

Perimenopause is the time just before and after the onset of menopause. It averages 4 years in length, but it may be much shorter or longer for individual women. Because women may still release eggs during perimenopause, they can still get pregnant. Common symptoms that may begin in perimenopause include:

Changes in menstrual periods
Hot flashes
Insomnia
Mood changes
Night sweats

Postmenopause refers to the time after menopause. This is the time when some of the distress from the changes from menopause will start to fade. The symptoms described above may become milder, while energy levels and emotions stabilize.

What causes it?

Menopause is a natural part of the aging process for women. Each girl is born with a limited number of immature eggs in her ovaries. A complex balance of female hormones promotes the maturation and release of the eggs by the ovaries. With each menstrual period, some of the eggs are lost. As the number of eggs in the ovaries decreases, less estrogen is produced and menstrual periods usually become irregular before they stop completely. For most women, the process is gradual, but some women experience abrupt physical and emotional changes. For unknown reasons, some young women undergo menopause many years before expected. Women of any age enter menopause if the ovaries are removed surgically or if they are damaged (for example, by chemotherapy or radiation). In menopause caused by ovarian surgery or damage, the production of estrogen and progesterone drops suddenly.

Who has it?

All women will experience menopause. The average age is in the early fifties, but some women undergo menopausal changes much earlier or later in life. Emotional stress, certain illnesses, some medications, or excessive exercise can cause even very young women to stop menstruating temporarily. In rare cases, temporary cessation of the menstrual cycle may become permanent if the underlying cause is not corrected. Women who smoke cigarettes generally enter menopause a few years earlier than non-smokers.

What are the risk factors?

Risk factors are characteristics that make individuals more likely to develop a disease or condition. For menopause, the only risk factors are being female and approaching 50 years of age. However, younger women with certain risk factors can experience menopause earlier in life. For example, women who undergo surgical treatments such as hysterectomy (removal of the uterus), have genetic disorders that affect the ovaries, or who use certain types of cancer therapies may experience menopause at a younger age.

Menopause increases risk factors for other health conditions. When a woman stops producing female hormones naturally, she loses the protective effects of those hormones. For example, her rate of bone loss speeds up, making the development of osteoporosis causing broken bones more likely. Her risk of heart disease also increases, partly due to higher cholesterol levels that occur after the production of female hormones stops. Estrogen and progesterone were formerly prescribed widely to help prevent heart disease among postmenopausal women. However, the results of large studies have found they not only do not protect against heart disease, they may actually increase heart disease risk for some women. The American Heart Association (AHA) now recommends against the use of estrogen and progesterone if they are taken only to prevent heart disease. If hormones are taken to relieve the symptoms of menopause, some guidelines now suggest they be used no longer than needed - 5 years, at the most.

What are the symptoms?

Menopause is usually associated with distinctive symptoms. Although many women have very little trouble dealing with menopausal symptoms, about 40% of American women report symptoms that disrupt their normal functioning to some extent. Approximately 85% of women experience vasomotor symptoms - most often hot flashes. Vasomotor refers to the interactions of muscles and nerves that cause blood vessels to shrink and expand. Although the exact causes of vasomotor menopausal symptoms are not yet known, they are associated with disruption of the body's temperature regulation by changing hormone levels. Hot flashes are sudden, unprovoked feelings of heat, usually on the face, head, neck, and chest. They may be accompanied by rapid heartbeats, reddened skin, and/or heavy sweating. Typically beginning a year or more before menopause, individual hot flashes may last for a few seconds or for several minutes. They may occur singly or in groups. Only a few may occur per day or they may occur frequently. Hot flashes may happen at any time of the day or night, and they may persist for several years. Generally, both the length and the number of hot flashes decrease gradually until they eventually disappear for most women.

Other symptoms of menopause may include:

Decreased interest in sexual intercourse
Difficulty in concentrating
Dry, thin, easily bruised skin
Inability to control urine
Insomnia
Mood changes (such as anxiety, depression, and/or irritability)
Night sweats
Spotting (small amounts of blood from the vagina) and/or abnormal vaginal bleeding
Thinning or lost hair
Vaginal dryness
Urinary Tract Infections
Vaginal infections
Waking up earlier than usual

How is it treated?

For nearly 50 years, the standard treatment for menopausal symptoms was replacing one or both of the major female hormones, estrogen and progesterone. Hormone replacement therapy, often abbreviated as "HRT," restores both estrogen and progesterone. Since estrogen alone may increase the risk of uterine cancer, HRT is prescribed for menopausal women who have not had surgery to remove the uterus. Progesterone decreases the risk of endometrial cancer and so, is said to "oppose" the uterine cancer-promoting side effects of the estrogen. Progesterone also regulates fluid balance, restores libido, and helps to build bone. Replacement of estrogen alone (estrogen replacement therapy or ERT) is often used for women who have had a hysterectomy (surgical removal of the uterus) since they no longer are at risk for uterine cancer. Therapy aimed at decreasing symptoms of menopause is usually given only for a short period of time. If hormone replacement therapy is used for prevention of osteoporosis, the therapy must be taken for longer. Although still used today, it is now known that in addition to the benefits of this therapy, there are risks involved. Based on the results of several trials, both the risks and benefits of hormone replacement must be weighed to determine if it is the best option for an individual. For some women, symptoms of menopause can be managed by making lifestyle changes. Read the section on Helping Yourself.

Two large, long-term studies and several smaller ones concentrated on defining the risks and benefits associated with ERT and HRT. In 1998, results from the Heart and Estrogen-Progestin Replacement Study (HERS) found no heart disease prevention benefit from HRT. Those findings were confirmed in a follow-up study (HERS II) that concluded in 2002. The good news, however, is this study showed that after an initial treatment period of 2 years with hormones, the risk of blood clots declined to a non-significant difference. Therefore, long-term there seems to be no increased risk of blood clots. The HERS II study also demonstrated that there were no differences between the hormone group and the placebo (inactive pill) group in the incidence of any types of cancer.

An even larger study, the Women's Health Initiative (WHI) sponsored by the National Heart, Lung and Blood Institute of the U.S. National Institutes of Health also examined the use of both ERT and HRT by thousands of women. The part of WHI that concerned HRT began in 1993 and ended in 2002 before the planned end date. It was stopped when higher rates of breast cancer, heart disease, stroke, and blood clots in the lungs were found in women who were taking HRT than in women taking a placebo. The study did find a decrease in hip fractures and colon cancer for those women taking HRT.

The estrogen-only part of the WHI, scheduled to end in 2005, was also stopped early (in February 2004) after results showed that estrogen apparently increased the risk of both stroke and dementia (decreased mental functioning). Benefits from treatment in this study included a reduction in fractures, conferring protection from osteoporosis. Neither part of WHI found any benefit for ERT or HRT in preventing heart disease.

The Women's International Study of Long Duration Oestrogen After Menopause (WISDOM) was a study performed in the United Kingdom, Australia, and New Zealand. The study was designed similarly to the Women's Health Initiative study. The trial was stopped early following the publication of results from the Women's Health Initiative study. Reports of results from the portion of the WISDOM study that was completed were consistent with those from the Women's Health Initiative. Older women beginning HRT many years after the start of menopause were at greater risk for cardiovascular events and blood clots. The investigators suggested that research is needed to assess the long-term risks and benefits of starting HRT in younger women, who may have different effects than older women starting HRT.

To investigate this issue, a substudy of the estrogen-only part of the Women's Health Initiative was recently undertaken. The results of this substudy demonstrated that younger postmenopausal women who had had a hysterectomy and who took ERT had significantly less buildup of calcium plaque in their arteries compared to those who did not take hormone therapy. This is good news for younger women who have had a hysterectomy and want to use short-term estrogen therapy to relieve the symptoms of menopause. However, more studies in this age group are needed, and it should be noted that these findings do not alter the previous recommendation that hormone therapy should not be used to prevent heart disease.

For those taking HRT or ERT, the lowest dose that is effective should be taken. Taking HRT or ERT may not be a good decision for some women, however. Other types of treatment may be more appropriate for women who:

Have or have had breast cancer
Have mothers or sisters who have or have had breast cancer or ovarian cancer
Experience abnormal bleeding from the uterus
Receive active treatment for blood clots in the legs

Another option for women who are at risk for certain types of cancer or have failed treatment with prescription estrogens and progesterone is bioidentical hormones. The terms "natural" or "bioidentical" hormone therapy are used to describe hormone treatment with individually compounded recipes of certain hormones in various dosage forms. Based on the results of a person's salivary or blood hormone levels, the final composition of the compounded dosage form is individualized to that specific person. It is important to consider that saliva testing has not been proven accurate or reliable, and blood testing only provides hormone levels present in the blood at the time of testing. This may be a problem because blood hormone levels can vary throughout the day. Also, the desired levels of these hormones in the blood and saliva are unknown.

Proponents claim that natural hormone therapy is better tolerated than manufactured products. Most manufactured oral hormone products require metabolism by the body to be broken down into a form that the body can use. Metabolites are left behind that your body does not use and are the likely culprits of causing side effects. Bioidentical hormones are chemically identical to the hormones which your body produces and do not require metabolism. However, there is no approved preparation method for these compounded products, and methods will differ from one pharmacist or pharmacy to another. This can result in patients receiving inconsistent amounts of medication. Currently this treatment option is not recommended over FDA-approved prescription products.

Drug classes used to treat Menopause

Androgen and Estrogen Combinations
Estrogens
Estrogens - Vaginal
Progestins
Topical Estrogens

What is on the horizon?

The National Center for Complimentary and Alternative Medicine (NCCAM), a division of the U.S. National Institutes of Health, is currently conducting several clinical trials investigating the effectiveness and safety of natural menopause treatments. Black cohosh, soy and other isoflavones, and red clover are the primary agents being studied. However, clinical studies to date have failed to demonstrate positive results with these natural products.

Some evidence suggests that antidepressant drugs may help to control hot flashes. In small studies involving women with hot flashes, drugs known as selective-serotonin reuptake inhibitors (SSRIs), such as fluoxetine, sertraline, and paroxetine, relieved hot flashes up to twice as well as placebo. Another type of antidepressant, venlafaxine, has also shown effectiveness. Possible side effects from antidepressants include constipation or diarrhea, dry mouth, insomnia, nausea, and sexual dysfunction. In addition, antidepressant drugs may interfere with the effectiveness of tamoxifen, a drug used to treat breast cancer.

Gabapentin, a drug used to control epileptic seizures and some types of pain, has also shown some promise for controlling hot flashes. A recent study has demonstrated that gabapentin appears to be as effective as estrogen in treating menopausal hot flashes. The exact mechanism of action in menopause is not completely understood, but it may help to normalize the body's temperature. In clinical and case studies of its use, women taking gabapentin reported reductions in other menopausal symptoms, such as mood changes and muscle aches, as well. Side effects, mainly dizziness, tiredness, and swelling in the hands or feet, were generally mild and appeared to be similar to those experienced by women taking estrogen only. Usually, side effects lessened after a few days of therapy. Gabapentin does not interfere with tamoxifen therapy for women who have breast cancer.

Also under study is the drug clonidine, which is commonly used to treat high blood pressure. Like gabapentin, clonidine can be used at the same time that tamoxifen is being taken. In case reports, clonidine relieved the length, number, and severity of hot flashes, at least mildly, for many women who were taking it. However the effects of clonidine on hot flashes wore off more quickly than anti-depressants or gabapentin. In addition to oral tablets, clonidine is available as a transdermal patch, which may be easier for some women to use. However, women taking clonidine experienced more problems with sleeping than women who were taking a placebo.

Hypertension (High Blood Pressure) and Medical Drugs Treatment

2008-08-29T16:10:00.002+08:00

Introduction

You can't feel it. You can't see it. Nevertheless, your blood pressure may be high. If it is, you have hypertension, commonly called "the silent killer." You cannot afford to ignore it.

What is it?

In hypertension, also known as high blood pressure, blood is forced through the heart and vessels throughout the body with a greater force than is necessary. Over time, hypertension damages the heart and blood vessels. Eventually, untreated hypertension can lead to life-threatening health problems such as heart disease and strokes.

When your blood pressure is checked, two measurements--systolic and diastolic--are taken.

Systolic blood pressure represents the peak pumping pressure of your heart when it is fully contracted during a heartbeat.

Diastolic blood pressure represents the pressure in the heart when it is at rest between heartbeats. You may be diagnosed with hypertension if your systolic pressure is 140 or higher, and your diastolic is 90 or higher.

Normal blood pressure is defined as a systolic less than 120 and a diastolic less than 80 (or "less than 120 over 80"). "Pre-hypertension" is a new classification that impacts approximately 45 million American adults and is defined as a systolic of 120 to 139 and a diastolic of 80 to 89. Individuals who have pre-hypertension are on the brink of developing full blown hypertension.

Hypertension is defined as a systolic pressure of 140 or higher and/or a diastolic of 90 or higher. Hypertension is further classified by stages - stage 1 and stage 2 - depending on the systolic and diastolic pressure readings (see table below).

Hypertension is diagnosed when either the systolic or diastolic pressure is high or if both the systolic and diastolic pressures are high. To be diagnosed with hypertension, two or more properly measured blood pressure readings must be taken on each of two or more doctor's office visits and then the readings are averaged. This means it takes more than just one elevated blood pressure reading to be diagnosed with hypertension.

When the two blood pressure measurements fall into separate stages--for example a Stage 2 systolic reading, but a diastolic pressure in the normal range, the higher of the two is used for the classification. The higher part of the blood pressure measurement along with your personal risk for hypertension and other health conditions you may have, help your doctor determine the best treatment options for you. The table below lists the stages or classifications of hypertension.

	Systolic	Diastolic
Normal	Less than 120	Less than 80
Pre-hypertension	120 to 139	80 to 89
Stage 1	140 to 159	90 to 99
Stage 2	160 or higher	100 or higher

The higher the blood pressure, the more likely you are to experience a heart attack, stroke, heart failure or kidney disease.

What causes it?

Two main types of hypertension are recognized. By far the most common is Essential Hypertension, sometimes called Primary Hypertension. This is hypertension in which there is no identifiable cause. Ninety-five percent of all persons living with hypertension have essential hypertension. Although researchers have been unable to pinpoint its specific causes, several risk factors definitely increase an individual's chance of developing essential hypertension. Some of these risk factors are controllable. They include:

Obesity
High Salt Intake
Smoking
Lack of Exercise
Emotional and/or Physical Stress

Risk factors that cannot be controlled are:

Gender--Males are at a higher risk for hypertension at earlier ages than females.
Age--The risk goes up for older women; more than half of women over the age of 60 have high blood pressure.
Race--Hypertension and its complications are more common among people of African ancestry than among members of other ethnic groups. Not only does hypertension typically begin earlier among African-Americans; its complications are more frequent, and it leads to death more often.
Family History of Hypertension--Risk is higher in people whose parents also have high blood pressure.

The other major type of hypertension, termed Secondary Hypertension, has an identifiable cause. It is due to disease. For example, kidney (renal) hypertension is due to high blood pressure within the arteries that supply blood to the kidneys. The underlying cause is kidney disease or conditions like atherosclerosis, which narrow or block the renal arteries. Secondary hypertension may also result from hormonal imbalances, particularly in the kidney's adrenal glands. Cushing's syndrome and pheochromocytoma (pronounced: "fee-oh-chrome-oh-sigh-toe-ma"), which is a tumor of the adrenal glands, are two of the conditions that can disrupt adrenal hormones and lead to secondary hypertension. Other causes of secondary hypertension include pregnancy, thyroid disease, and the use of some medications such as oral contraceptives and non-steroidal anti-inflammatory medications (NSAIDs).

Who has it?

According to estimates based on the Third National Health and Nutrition Examination Survey and on U.S. Census information, one-fourth of the general adult population in America has some degree of high blood pressure--a total of about 50 million people. Approximately 1 billion people worldwide have hypertension. Today it's estimated that there is a 19.3% prevalence of hypertension among white women, 24.4% among white men, 34.2% among black women, 35% among black men, 22% among Mexican-American women, and 25.2% among Mexican-American men.

Older persons also develop hypertension more often than younger individuals. Today it's estimated that in the older population (greater than 60 years of age), the prevalence of hypertension is 60%. As the population continues to age, it is expected that these numbers will also continue to increase. For unexplained reasons, people who live in the Southeastern part of the U.S. also seem to have higher rates of hypertension.

Approximately 45 million Americans have "prehypertension." These individuals are at increased risk for going on to develop hypertension.

What are the risk factors?

Risk factors are characteristics that may increase your chance for developing a condition. The more risk factors you have, the more likely you are to develop the condition. You are at increased risk for developing hypertension if you:

Are 60 years of age or older
Have a family history of hypertension
Are of African-American descent
Are overweight or obese
Are a smoker
Lack exercise or don't get enough physical activity
Consume excessive amounts of alcohol (on a regular basis - defined as 3 or more drinks/day for a man or 2 or more drinks/day for a woman)
Use oral contraceptives (birth control)
Have a high salt intake and low potassium intake in your diet

What are the symptoms?

Hypertension (high blood pressure) usually has no symptoms. That is why it is termed "the silent killer." However, it can be accompanied by the following, especially if blood pressure gets very high:

Headache
Confusion
Numbness or tingling in the hands and feet
Severe shortness of breath

How is it treated?

The overall goal in treating hypertension is to prevent other health-related complications and death from hypertension-related complications. Treating and controlling your hypertension can help prevent damage to your heart, brain, kidneys, blood vessels, and eyes. For individuals who don't have other medical or health conditions such as diabetes or heart failure, typically the goal is to lower systolic blood pressure to less than 140 and the diastolic blood pressure to less than 90 ("less than 140 over 90"). For individuals with other medical conditions, blood pressure goals are lower and are determined by your doctor. For instance, the blood pressure goal for most people with diabetes is a systolic less than 130 and a diastolic less than 80 ("less than 130 over 80").

For individuals who have pre-hypertension, it is critical to adopt a healthy lifestyle to prevent high blood pressure. These lifestyle modifications include weight reduction, eating a healthy diet (called the "DASH" eating plan), increasing your amount of physical activity, and limiting alcoholic beverages. You can get more information about lifestyle modifications in the Helping Yourself section above.

For individuals with hypertension, lifestyle modifications as mentioned above are important but many times, medications will also be needed to adequately manage blood pressure. Many types of drugs are used to lower blood pressure. The initial drug choice is determined by your stage of hypertension (or how high your blood pressure is) and whether you have other health conditions that would affect the drug choice. (See the table below titled, "Options for Individualizing Antihypertensive Therapy" for more information.)

Options for Individualizing Antihypertensive Drug Therapy
If you have:	Then your doctor may prescribe one of the following:
Diabetes mellitus	ACE Inhibitors, ARBs, Diuretics, Beta Blockers, Calcium Channel Blockers
Heart failure	Diuretics, Beta Blockers, ACE Inhibitors, ARBs, spironolactone
Heart attack	Beta Blockers, ACE Inhibitors, spironolactone
Isolated systolic hypertension (elevated systolic only)	Diuretics, certain Long-acting Calcium Channel Blockers
Kidney Disease	ACE Inhibitors, ARBs
Recurrent Stroke Prevention	Diuretics, ACE Inhibitors

For hypertension that isn't controlled by diet and exercise, new treatment guidelines for hypertension recommend that most patients be started on a thiazide-type diuretic, unless there is a compelling need for a different class of medications.

Thiazide diuretics are useful in achieving blood pressure control. They have been proven to enhance effectiveness of other antihypertensive medications when used in combination, and are typically more affordable than other antihypertensive medications.

Patients with Stage 1 hypertension are generally started on a thiazide-type diuretic, but ACE Inhibitors, angiotensin II receptor blockers (ARBs), beta blockers, calcium channel blockers, or combinations of different classes can also be considered. Patients diagnosed with Stage 2 hypertension typically need a combination of two drugs usually consisting of a thiazide diuretic along with an ACE Inhibitor, an ARB, a beta blocker or a calcium channel blocker to adequately lower their blood pressure. However, the treatment guidelines are meant only to be a guide. Your healthcare provider is in the best position to design a drug therapy regimen to manage your hypertension.

If the initial drug regimen does not achieve the goal blood pressure, your healthcare provider may change your regimen by increasing your dosage or by adding additional antihypertensive medications until your goal blood pressure is achieved. Many patients eventually require two or more drugs to effectively control their blood pressure. Some patients may even require four or five medications to control their blood pressure.

It is important to remember that everyone can respond to antihypertensive medications differently. What works for others may not work for you and vice versa. It is sometimes necessary for a doctor to prescribe different antihypertensive medications until the best regimen for you is found.

More severe hypertension may require the use of drugs called "vasodilators", which widen arteries, allowing blood to flow more easily and thus, lowering blood pressure. Oral vasodilators, such as hydralazine and minoxidil, are often used together with diuretics and other drugs that reduce fluid retention. Clonidine, another type of antihypertensive, may also be utilized.

Hypertension is typically a lifelong condition. However, some patients-- especially those who have made lifestyle modifications such as losing weight-- may be able to modify their antihypertensive medication regimen after hypertension has been controlled for at least one year. In so-called "Step-Down" therapy the number of drugs being used, their dosages, or both are gradually reduced to see if blood pressure remains controlled. The goal is to maintain blood pressure control using the lowest dosage of the least number of medications possible. The key though is to keep blood pressure at or under goal. Not all patients are able to "Step Down" from their antihypertensive therapy.

Drug classes used to treat Hypertension (High Blood Pressure)

ACE-Inhibitor and Calcium Channel Blocker Combination
ACE-Inhibitor and Diuretic Combination
ACE-Inhibitors
Alpha Blockers
Alpha-2 Agonists
Angiotensin II Receptor Blocker and Diuretic Combinations
Angiotensin II Receptor Blockers
Beta Blockers
Calcium Channel Blockers
Combined Alpha and Beta Blockers
Diuretics
Renin Inhibitors

What is on the horizon?

Research is ongoing to better understand hypertension and how it develops. Researchers performed a study on newborns and found that healthy babies who had a "preferential response" to salt taste and who had at least one grandparent with a history of high blood pressure had blood pressures that averaged 5 millimeters of mercury (mmHg) or more higher than babies who had an aversive or neutral response to salt. Hypertension experts have long known that salt intake is linked to high blood pressure in some adults, especially those who are considered salt-sensitive, meaning that even low levels of salt trigger increases in blood pressure. While it is premature to suggest that neonatal testing can identify individuals at risk for adult hypertension, this research has spawned further investigation.

Researchers have also found that treating high blood pressure with medications not only lowers blood pressure but also makes the heart work better.

Researchers are also investigating a new class of drugs called vasopeptidase inhibitors. An investigational drug in this class called omapatrilat, was shown in one study to reduce blood pressure better than the well-known ACE inhibitors and appears to reverse some of the blood vessel stiffness thought to be an inevitable part of aging and a contributing factor to hypertension. Research continues on this drug class.

Researchers are also looking for a vaccine that would protect individuals against essential hypertension.

Hormonal Contraception/Birth Control and Medical Drugs Treatment♦

2008-08-15T15:39:00.003+08:00

Introduction

Contraception (preventing pregnancy) has been attempted for thousands of years. Over the centuries, contraceptive methods have varied greatly from ways we would consider bizarre to methods quite similar to what we use today. For example, in ancient Egypt, crocodile dung and honey were put in the vagina to prevent conception. In some African countries, women used okra pods as vaginal pouches similar to the female condoms now in use. From dung to seedpods, the effectiveness of traditional contraceptive methods is quite questionable. Although today's methods of birth control can be more complicated to use, they are undeniably more reliable and certainly more appealing.

Over the next 25 years, the world's population is estimated to exceed 8 billion individuals. At more than 40%, this increase represents the largest population growth ever seen over such a short time period. Governments as well as individuals are taking action to keep a huge growth in population from overwhelming resources. Without using some form of family planning, however, approximately 80% of women age 35 to 39 and 91% of women age 20 to 24 would become pregnant at least once during a 5-year period. Even more significant to overall population growth, one out of ten women age 15 to 19 will become pregnant each year, despite a consistent decline in the teen birth rate. Far more likely to live in poverty, babies born to teen-aged mothers are often low in birth weight, which contributes not only to higher infant death rates, but also to greater risk of lifelong health problems. Although estimates vary over a large range, as many as 60% of all pregnancies are believed to be unplanned. Worldwide, unplanned children are more likely to die before the age of one year.

Efforts to control population growth take many forms from governmental limits on the number of children per family to individual decisions about contraceptive methods. Hormonal contraception is just one method of birth control now used to help keep population growth in check and minimize the number of unwanted pregnancies. By far, the most popular method of limiting family size in the United States is oral hormonal contraception taken by the female partner. Since the U.S. Food and Drug Administration (FDA) approved the first modern contraceptive, Enovid 10, in 1960, major advances have been made in hormonal contraception. Available in several different dosage forms, today's hormonal contraceptives are formulated to reduce side effects and increase convenience while maintaining effectiveness.

Important Note: Hormonal contraceptives, in any form, do not provide protection against the spread of sexually transmitted infections (STIs), such as AIDS, gonorrhea, or syphilis (just to name a few).

What is it?

Hormonal contraception is one approach to birth control. It may be accomplished through various methods, which all involve interference with normal sex hormone function in the body. Hormonal contraception for men is under study, but existing hormonal contraception is used almost exclusively by women. Currently-available hormonal contraceptives disrupt the normal menstrual cycle by altering the levels of the female hormones, mainly estrogen and/or progesterone. By changing the amounts of estrogen, progesterone, or both; hormonal contraceptives interfere with the release, fertilization, and/or implantation of human eggs.

Combination contraceptives contain both a synthetic estrogen (usually one known as ethinyl estradiol) and any one of several progestins (synthetic progesterones). Typically, they are taken or used for 3 weeks per month usually being discontinued during the week of the menstrual period. Among the general types of hormonal contraceptives that contain both an estrogen and a progestin are:

Combined oral contraceptive pills (COCs - also known as birth-control pills, OCs, or the "pill") Usually packaged in a compact-like case that holds a one-month supply (either 21 pills that contain active hormones or 21 active pills and 7 inactive placebo "sugar pills"), COCs may be:
monophasic (all the pills contain the same amounts of both estrogen and progestin)
biphasic (two different dose levels of the hormones are taken during separate parts of the menstrual cycle)
triphasic (three different amounts of hormones are used in an effort to better match the normal menstrual cycle and minimize side effects)

Contraceptive patches - adhesive bandage-like squares that stick to the skin and release hormones for one week

Injectable estrogen and progestin combinations (no longer available in the US) - continuous hormone release from once-monthly injections

Vaginal rings - soft circles of vinyl that are saturated with estrogen and a progestin. Inserted once a month into the vagina, they release hormones for 3 weeks before being removed.

Progestin-only contraceptives work mainly by keeping sperm from reaching an egg. They include the following kinds of products:

Injectable progestins - usually oil-based products that release a progestin gradually over one to 3 months after a single injection

Intrauterine devices (IUDs) - certain brands contain reserves of a progestin that releases slowly as long as the IUD is in place

Progestin-only pills (also called POPs or "minipills") - tablets taken orally every day

Progestin implants (not currently available in the United States) -progestin-filled rubber or plastic tubes that release a progestin slowly for much longer times (up to 5 years) after being inserted under the skin

What causes it?

Although preventing pregnancy is usually not considered to be a health condition, hormonal contraceptives do represent one of the few drug classes that are widely used by healthy individuals.

How Does Hormonal Contraception Work?

Hormonal contraception upsets normal female hormonal cycles in the human body. Generally, additional amounts of one or two female hormones are used to disrupt the balance of hormones that is needed for pregnancy to occur.

Estrogens:

prevent ovulation (the release of eggs from the ovaries)
affect the time needed for an egg to travel through the fallopian tubes, thus interfering with precise timing needed for fertilization
interfere with the implantation of a fertilized egg on the wall of the uterus

Progestins:

prevent ovulation (the release of eggs from the ovaries)
affect the time needed for an egg to travel through the fallopian tubes, thus interfering with precise timing needed for fertilization
increase the amount and thickness of mucus at the cervix (the opening of the uterus), thereby decreasing sperm entry to and passage through the vagina
decrease the ability of sperm to fertilize an egg
interfere with the implantation of a fertilized egg on the wall of the uterus

Who has it?

Currently, all forms of hormonal contraceptives are for use only by women, although several non-hormonal contraceptives (such as condoms) exist for use by men and women.

What are the risk factors?

Certain conditions require careful attention by a healthcare provider when hormonal contraceptives are used. Click on the links below to read about contraindications (reasons not to use certain kinds of hormonal contraceptives) and precautions (reasons to be careful when using certain kinds of hormonal contraceptives) associated with each hormonal contraceptive. Women who have any of the following conditions should discuss the use of hormonal contraception with a doctor before beginning to use it.

Injectable Estrogen and Progestin Combination (No longer available in the US)
Contraceptive Patch
Injectable Progestin
Progestin-only Pill
Combination Oral Contraceptive (COC)
Vagina Ring
Progestin Implant (not currently available in the US)
Intrauterine Device (IUD)

What are the symptoms?

Since hormonal contraception is not a health condition, it has no symptoms. It is not absolutely foolproof, however. Pregnancy may occur even when hormonal contraceptives are used correctly and consistently. Women who are using a contraceptive, but who think they may be pregnant, should contact a doctor right away. Hormonal contraceptives should NOT be used during pregnancy. Common signs and symptoms of pregnancy may include:

Amenorrhea (absence of menstruation)
Breast tenderness and enlargement
Darkened nipples
Frequent urination
Increased appetite
Morning sickness (nausea and vomiting, typically early in the day)
Weight gain

How is it treated?

Many types of hormonal and non-hormonal contraceptives are available.

What are the advantages and disadvantages of non-hormonal contraceptive methods?

Non-hormonal Contraceptive Methods Comparison

Method	Advantages	Disadvantages
Abstinence	No cost No side effects Acceptable for individuals who cannot use other forms of contraception Fertility is not affected	Advance planning required Commitment from both partners required
Cervical Cap	Relatively inexpensive Can be inserted several hours before intercourse Only small amounts of spermicide are required Protects for up to 48 hours Fertility is not affected	Prescription required Advance planning required Must be fitted by a doctor Comes in limited sizes-may not fit all women May be difficult to insert and/or remove Latex may cause allergic reactions May move during intercourse Should not be removed for 6 to 8 hours after intercourse Effectiveness reduced after childbirth Cannot be used during menstrual periods
Condom, Female	Relatively inexpensive Non-prescription, relatively easy to obtain Can be inserted just before intercourse or up to 8 hours in advance Protects against STIs (including HIV/AIDS) Provides protection for 48 hours Polyurethane is non-allergic Can be used with oil-based lubricants Fertility is not affected	More expensive than male condoms High failure rate, may break during use Awkward to use One time use
Condom, Male	Inexpensive Non-prescription, easy to obtain Latex type helps to protect against STIs including HIV/AIDS Fertility is not affected	Poor acceptance Relatively high failure rate, may break during use Cannot be applied in advance Can interrupt intercourse One-time use Latex type may cause allergic reactions Lamb-skin type does not protect against STIs Effectiveness reduced by oil-based lubricants
Diaphragm with Spermicide	Relatively inexpensive Can be inserted up to 6 hours before intercourse Helps to protect against STIs, including HIV/AIDS Fertility is not affected	Prescription required Must be fitted by a doctor Must be refitted if weight changes more than 10 pounds Effectiveness reduced by: frequent intercourse oil-based lubricants Increases risk for: toxic shock syndrome (TSS) urinary tract infections vaginal yeast infections
Natural Methods*	No cost No side effects Acceptable for individuals who cannot use other forms of contraception Fertility is not affected	High failure rate Advance planning required No protection against STIs May be complicated and time-consuming Commitment from both partners required
Spermicides Alone	Inexpensive Non-prescription, easy to obtain May offer some protection against certain STIs Fertility is not affected	High failure rate Cannot be applied in advance One-time use - must reapply before each act of intercourse No protection against HIV/AIDS Messy Possibly irritating to either partner
Sponge	Inexpensive Non-prescription Easy to insert and remove Fertility is not affected	No protection against STIs Fairly high failure rate when used alone
Tubal Ligation	Very low failure rate	Expensive Outpatient surgery required No protection against STIs Permanent
Vasectomy	Very low failure rate	Expensive In-office surgery required No protection against STIs Fertility difficult or impossible to restore
Withdrawal	No cost No side effects Acceptable for individuals who cannot use other forms of contraception Fertility is not affected	High failure rate Advance planning required No protection against STIs Commitment from both partners required

*Natural Methods include measuring body temperature, tracking menstrual cycles on the calendar, or determining the thickness of cervical mucus

How do hormonal contraceptives compare in cost?

General Cost of Hormonal Contraceptives
(All costs are based on retail prices that were in effect on July 1, 2007)

TABLE KEY:

$ = $0 to $50

$$ = $51 to $100

$$$ = $101 to $150

$$$$ = $151 to $200

$$$$$ = $201+

	Type of Contraceptive	Average Cost Range per Month
Combined Estrogen and Progestin	COC-monophasic*	$
	COC-biphasic*	$
	COC-triphasic*	$
	COC-91-day*	$ to $$$ (3-month supply)
	Contraceptive patch	$$
	Injectable estrogen and progestin combination	No longer available in U.S.
	Vaginal ring	$
Progestin Only	Injectable progestin*	$$ (3-month supply)
	Progestin-containing IUD **	$$$$$
	Progestin-only Pill*	$ to $$
	Progestin Implant	Not currently available in the U.S.

* A generic form may be available.
**The IUD must be inserted by a physician and additional fees for this service may apply and will vary according to physician.

What are the types of non-hormonal contraceptives?

Abstinence (not having sexual intercourse)

Cervical Cap (a small, cup-shaped latex device that is fitted into the entrance of the vagina to block the passage of sperm)

Condom, Female (a thin, stretchy pouch that fits inside the vagina and keeps sperm from entering the uterus)

Condom, Male (a thin, but strong covering that fits over the penis to prevent sperm from entering the vagina)

Copper IUD (a small T-shaped device wrapped in a copper wire that is inserted into the uterus and may be effective for up to 10 years depending on the device).

Diaphragm (a flexible, rubber device that is held against the opening of the uterus by a spring to prevent sperm from getting into the uterus)

Natural methods (such as measuring body temperature, tracking menstrual cycles on the calendar, or determining the thickness of cervical mucus)

Spermicide (vaginally-inserted chemicals that inactivate sperm - often used in combination with other forms of contraception such as cervical caps, condoms, diaphragms, sponges, and withdrawal)

Sponge (a thick, soft cushion of polyurethane foam that is inserted into the vagina to block the passage of sperm into the uterus)

Tubal ligation or female sterilization (commonly known as tied tubes - a permanent surgical procedure in which the fallopian tubes are cut or blocked so that eggs cannot enter the fallopian tubes and sperm cannot reach the eggs to fertilize them)

Vasectomy or male sterilization (a surgical procedure in which the vas deferens, which are the tubes through which sperm travel, are cut or blocked, so that sperm cannot leave the male body)

Withdrawal (also called coitus interruptus or pulling out taking the penis out of the vagina before sperm is released)

What is Emergency Contraception?

Whether it is the result of a broken condom or a sexual assault, unprotected (without contraception) sexual intercourse may occur. To avoid a possible unwanted pregnancy, emergency contraception may be utilized. Although emergency contraception is often called the ?morning after? pill, it is not a method to use routinely. It should be restricted to just what the name indicates - emergencies.

Currently several methods are used for emergency contraception. The most common methods work by preventing conception. Another way is to force the elimination of a fertilized egg.

In 1999, the FDA approved for use in the United States a contraceptive that is used only to prevent conception in an emergency situation. Under the brand name Plan B, the product has 2 tablets containing the progestin, levonorgestrel. Depending on the time of the woman?s cycle when it is taken, it prevents conception by interfering with ovulation, fertilization, and/or implantation. To use it, the first dose should be taken as soon as possible. A second dose is then taken 12 hours after the first dose. According to study results, Plan B may be up to 95% effective, if the first dose is taken within the first 24 hours and the second dose is taken on time. If the first dose is delayed until 72 hours, effectiveness decreases to about 89%. After 72 hours, effectiveness decreases significantly. In August 2006, the FDA made Plan B a non-prescription product for women who are 18 years old or older. Because it is still a prescription drug for younger women, Plan B will be kept behind the pharmacy counter.

Taking high doses of certain regular COCs may also prevent conception after unprotected sex. Like Plan B, however, this method also loses effectiveness if it is not started quickly. Each dose consists of 2 to 4 tablets of certain COC brands. A woman who needs to use this method, which may also be called the Yuzpe Method (pronounced Yoo-zep-ee), should check with a physician or pharmacist for recommendations on the brand of COC to use and the number of tablets to take. As with Plan B, the first dose of the COC should be taken as soon as possible within 72 hours. A second dose is then taken 12 hours after the first dose.

Common side effects from either Plan B or high doses of COCs may include breast tenderness, headache, nausea, pain in the abdomen, and tiredness. Because many women using Plan B or high dose COC also experience vomiting, an anti-nausea drug may be recommended before taking the first dose. If vomiting occurs within one hour of taking the COC, the dose should be repeated. Neither Plan B nor high doses of a COC can end a pregnancy if a fertilized egg has already implanted in the uterus.

For emergency use, a copper IUD can also prevent fertilization and/or implantation if it is inserted no later than 5 to 7 days after the incident. It is left in place at least until the start of the next menstrual period, but it may be left in place for 5 years or longer, if it is chosen as continuing contraception. With pregnancy prevention nearing 100%, inserting an IUD is more effective for emergency situations than taking oral forms of emergency contraception. IUDs are much more expensive, though, and they have to be inserted, checked, and removed by a doctor. They are not recommended for women who may have or who may have been exposed to an STI. IUDs may cause abdominal cramping and vaginal bleeding in the first few days or weeks after their insertion.

Another method of emergency contraception ends a pregnancy. Sometimes known as a "medical abortion", this method requires that two different drugs be taken. First, one 600 mg dose of mifepristone (Mifeprex) is taken as soon as possible within 49 days of the missed menstrual period. Two days later, one 400 microgram dose of misoprostol (Cytotec) must be taken. Mifepristone, commonly known as RU-486, blocks the effects of progesterone, which is necessary to maintain a pregnancy. Misoprostol belongs to a group of drugs known as prostaglandins, which cause the uterus to tighten. Usually, uterine contents (such as a fertilized egg) are forced out of the uterus. Women who use this form of emergency contraception must follow-up with a physician 14 days after taking misoprostol to determine whether the treatment was effective. Mifepristone/misoprostol is available only through specific physicians who must be able to perform abortive surgery if the treatment is ineffective.

Women with an IUD in place, those taking medications to prevent blood clotting, and those who have taken certain steroid medications for long periods of time cannot use mifepristone/misoprostol. This method also should not be used for women who have or have ever had:

Adrenal gland dysfunction
Allergic reactions to mifepristone or misoprostol
Bleeding disorders
Ectopic pregnancy (a fertilized egg that has implanted outside the uterus)
Tubal pregnancy (a fertilized egg that has implanted inside the fallopian tube)

Between 80% and 90% of women who use mifepristone/misoprostol experience abdominal cramps and/or heavy vaginal bleeding. Other common side effects from mifepristone/misoprostol include diarrhea, dizziness, headaches, nausea, and tiredness.

What are the types of hormonal contraception?

Combination oral contraceptives (COCs) contain both an estrogen (usually one called ethinyl estradiol) and a progestin. Different brands may have varying amounts of estrogen and the progestin may be different. In general, lower doses of estrogen cause fewer side effects, so most currently-available COCs contain smaller amounts of estrogen than earlier versions. In addition, the products may have constant or varying amounts of the progestin component - making the pills either monophasic, biphasic, or triphasic. Monophasic COCs have the same amount of the estrogen and the same amount of the progestin in each pill throughout the cycle. Biphasic pills have the same amount of the estrogen, but have two different doses of the progestin at different parts of the menstrual cycle. Triphasic COCs, which are made to mimic the natural changes in hormone levels, have a constant dose of the estrogen with three different amounts of the progestin. Most COCs are prepackaged in compact-like cases that contain either 21 or 28 pills. Women who use the 21-day packs do not take a pill during their menstrual periods. The 28-day packs contain 21 active pills and seven inactive placebo (sugar) pills that are included as reminders so that the individual taking the pills does not forget to start a new pack on time.

A newly-approved COC (Seasonale) introduces a new dosing schedule that is more convenient for women using it. Intended to be taken daily for 12 weeks, the "extended-cycle" COC is then discontinued for one week. As a result, the user has only four periods a year instead of one a month.

Another newly approved COC (Yaz) is taken for 24 days instead of 21 days. This is done to help shorten menstruation as well as possibly decrease side effects due to decreased hormonal fluctuation.

Estrogen containing drugs may increase your chances of developing heart disease. This is especially true if you are a smoker, have diabetes, high cholesterol, or a history of heart disease in your family. A recent study found that even low dose estrogen containing oral contraceptives can increase a woman's risk for a heart attack or stroke. You should always talk with your physician to see if a particular form of birth control is right for you.

Contraceptive patches release hormones through the skin. One patch is applied by the user each week for 3 weeks every month, skipping the fourth week usually the week that menstruation occurs. They are convenient for women who cannot remember to take pills.

Injectable estrogen and progestin combinations are given into a muscle of the arm, thigh, or buttock by a qualified health care professional. They must be injected once a month between days one and 5 of the menstrual cycle. Injectable combination hormonal contraception offers another effective alternative for women who may have difficulty remembering to take pills. Unfortunately, injectable estrogen and progestin combinations are no longer available in the U.S.

Vaginal rings are inserted by the user. After releasing hormones for 3 weeks, they are removed and discarded. A new vaginal ring is then inserted possibly during the menstrual period. Similar to hormonal injections or patches, vaginal rings provide an alternative for women who have difficulty remembering to take pills.

Injectable progestin has been used for contraception since the 1960's, even though it was not FDA-approved for contraception until 1992. Given by injection into an arm or buttock muscle, it must be administered by a health care professional. It is given once every 3 months between days one and 5 of the menstrual cycle. A very effective long-term contraceptive, progestin injection may be an especially good choice for women who are breast-feeding, who have a history of seizures, who should avoid estrogens, who may forget to take pills, or who do not want to use other methods.

Intrauterine devices (IUDs) are small "T"-shaped devices, which may be filled with a progestin. In addition to releasing a progestin, IUDs are believed to cause minor uterine inflammation, change the chemical environment of the uterus, and ? possibly ? interfere with sperm movement. All these effects may destroy the egg or sperm and they may also prevent implantation. IUDs are inserted through the vagina by a qualified health professional. Good candidates for an IUD are women who have a history of seizures, who should avoid estrogens, who have trouble remembering to take pills, who do not want to use other methods, or who want long-term contraception that is not permanent. However, women who use IUDs may have higher risk for both pelvic inflammatory disease (PID) and ectopic pregnancy (a fertilized egg that has implanted outside the uterus).

Progestin-only pills, also called "POPs" or "minipills" offer an alternative to COCs for women who are breast-feeding, smokers over the age of 35, women who have or who have had breast cancer, and other women who cannot take estrogens. They must be taken every day with no breaks during periods. To be as effective as possible, progestin-only pills need to be taken at the same time each day.

Progestin-only implants are not currently available in the United States, although they are used commonly in other parts of the world. They consist of up to six small tubes that contain a progestin. Inserted under the skin on the inside part of the upper arm, the tubes release a constant amount of medication. Their insertion and removal are minor surgical procedures that must be done by a doctor with special training. Insertion is usually done between days one and 7 of the menstrual cycle or after a negative pregnancy test. Progestin-only implants may be removed at any time over a period of one to 5 years depending on the brand and the number of tubes that are inserted.

How effective are various methods of contraception?

Except for total abstinence (never having sex at all), no form of contraception is 100% effective even if it is used perfectly. Failure rates (the percentage of pregnancies that occur among women who are using each type of contraception) are typically higher during the first year that an individual uses a particular type of contraceptive. Additionally, effectiveness may be influenced by social or economic factors, such as body weight, ethnicity, income level, location, marital status, and frequency of sexual intercourse. For comparison, about 85% of fertile (able to become pregnant) women who do not use any form of contraception may be expected to become pregnant in any one year.

Contraceptive Effectiveness Comparison

Method	Failure Rate
Hormonal Methods
COC	0.1% to 3%
Contraceptive Patch	0.3% to 1%
Injectable Estrogen and Progestin (no longer available in U.S.)	Less than 1%
Vaginal Ring	0.3% to 1%
Injectable Progestin	0.3% to 3%
IUD	1% to 4%
Progestin-only Pill	0.5% to 5%
Progestin Implant (not currently available in the U.S.)	1.5% to 9.3%
Non-hormonal Methods
Abstinence (Continual)	0
Abstinence (Occasional)	Up to 25%
Cervical cap	8% to18%*
Condom, Female	3% to 12%
Condom, Male	3% to 21%
Diaphragm (with spermicide)	2% to 18%
Natural Methods**	1% to 25%
Spermicide Alone	15% to 29%
Sponge	14% to 28%
Tubal Ligation	0.5% to 0.6%
Vasectomy	0.1% to 0.2%
Withdrawal	4% to 27%

*Failure rates for the cervical cap may reach 30% for women who have had children
**Natural Methods include measuring body temperature, tracking menstrual cycles on the calendar, or determining the thickness of cervical mucus

What is on the horizon?

Currently, several pharmaceutical companies are developing other new combinations, dosing schedules, and formulations of estrogen and/or progestin pills. Generally, the proposed new products are intended to lower the chance of side effects. New progestins that may provide both contraception and additional benefits, such as helping to lower high cholesterol levels, are also being investigated. Potentially, some of these newer contraceptives may be appropriate for women with irregular periods and other women who cannot use COCs that are currently on the market. Other research focuses on completely new delivery methods, such as an estrogen/progestin nasal spray, that would give women more options for combination hormonal contraception.

Other investigation centers on hormonal contraceptives for men. In much the same way that hormonal contraception works for women, changing normal amounts of androgens (male hormones) disrupts a man's fertility. For example, increasing amounts of the male hormone, testosterone; introducing a progestin (a female hormone); or both drastically decreases the production of sperm and/or causes the sperm that are produced to be unable to fertilize an egg. Injections, implants, or pills are the dosage forms most studied for male contraception.

Non-hormonal contraceptives in development include:

Immunocontraception (contraceptive vaccines) By stimulating the body's immune system to produce antibodies against cells or chemicals that are essential to fertilization, various stages of conception may be prevented. Antibodies are natural proteins that are produced by the immune system to attack specific foreign substances in the body. Among the potential antibody targets that have been studied as immunocontraception are sperm, female and male hormones, and the zona pellucida (a membrane that surrounds human eggs). In studies of humans, antibody response has not been consistent, however, and producing enough antibodies to be effective may take a long time. How long the vaccine will remain effective is not clear, and once antibodies are produced, restoring fertility may be difficult or impossible.

N-butyldeoxygalactonojirimycin (NB-DNJ) A drug already being used to treat a genetic disease, NB-DNJ also blocks the production of sperm. In laboratory studies, male mice that were given NB-DNJ stopped producing sperm, eventually becoming sterile after their pre-existing sperm supplies were exhausted. Men taking NB-DNJ also stopped making new sperm. Their inability to fertilize an egg continued for as long as the drug was administered; but gradually returned to normal after the drug was stopped - over about three weeks for mice; about six weeks for humans.

Spermicide/Anti-infectant Combinations Chemicals that kill or disable sperm and also eliminate bacteria, viruses, and other agents that cause sexually-transmitted infections would not only provide contraception, they would also help to control the spread of diseases such as AIDS and other sexually transmitted infections.

Contraceptive Gel In very early stages of testing is a gel that hardens into a permanent, but possibly removable barrier after being inserted into the fallopian tubes. It forms a solid plug that prevents eggs from entering the uterus and sperm from reaching eggs. In animal studies, it has been effective and easy to insert. However, no human studies have been conducted, yet.

Erectile Dysfunction and Medical Drugs Treatment

2008-08-08T15:33:00.002+08:00

Introduction

In the past few years, there has been an increase in the number of advertisements regarding erectile dysfunction. You've probably seen former Presidential candidate Bob Dole or Baltimore Oriole Rafael Palmeiro in television commercials informing viewers of erectile dysfunction and the use of Viagra. Former professional football player and coach Mike Ditka has also been seen educating viewers about the once taboo subject of erectile dysfunction. With heightened awareness of this disorder, the attitudes of the public and healthcare professionals are changing with more individuals seeking help with the disorder.

What is it?

Erectile dysfunction (ED), sometimes called "impotence", is the inability to achieve or maintain an erection for sexual intercourse. Impotence can involve three aspects of erection development: the time to develop an erection, the strength of the erection, or the amount of stimulation needed to achieve an erection. Erectile dysfunction may be a result of a variety of factors, ranging from chronic diseases, medications, to psychological factors.

What causes it?

Before discussing the causes of erectile dysfunction, it is important to understand how an erection develops and how an erection is sustained. The penis is made of a mass of tissue composed of several structures of spongy networks that contain blood vessels and smooth muscle tissue. Normal nerve function and blood supply to these areas is essential to experience and maintain an erection. When sexual arousal takes place (whether it be a result of visual stimuli, touches, smells, or thoughts), the brain responds by communicating the arousal to the body's nervous system, which activates blood flow to the penis. As blood flow increases in the penile area, blood vessels supplying the penis dilate so the body of erectile tissue becomes engorged. When the erectile tissue engorges, an erection develops.

If something affects any of the factors responsible for an erection, erectile dysfunction may result. Psychological factors or nonphysical factors may also contribute to erectile dysfunction. Such factors may include depression, stress, anxiety, negative feelings toward a sexual partner, or even feelings of dissatisfaction with sexual function.

Although psychological and nonphysical causes are possible, there are several physical causes that may contribute to erectile dysfunction. Common diseases such as diabetes, high blood pressure, atherosclerosis (hardening of the arteries), thyroid problems, and alcoholism may also cause erectile dysfunction. Spinal cord injury, multiple sclerosis, or other diseases that may affect nerve conduction to the penile area can decrease the likelihood of achieving or maintaining an erection. Low hormone levels (for example, low levels of testosterone or prolactin) may also be a cause of erectile dysfunction, although the incidence of this cause is thought to be much less than the common diseases such as diabetes. Studies have even shown that the pressure obtained from riding a bike, which comes from sitting on a bicycle seat with a nose extension, restricts blood flow to the penis.

Certain prescription medications and illicit drugs may cause erectile dysfunction. Up to 25% of cases of erectile dysfunction result from medication side effects. Examples of prescription medications that may lead to erectile dysfunction include certain antidepressants, medications for high blood pressure, antipsychotics, medications used for anxiety disorders, anticholinergics (e.g. diphenhydramine, benztropine, and atropine), cimetidine, digoxin, and substances of abuse (e.g. alcohol, cocaine, and marijuana). Check with your doctor or pharmacist if you suspect that a medication you are taking may be the cause of erectile dysfunction.

Who has it?

Erectile dysfunction can affect all age groups. It has been estimated that 18 to 30 million American men suffer from erectile dysfunction. This number has increased significantly as awareness of the disorder has heightened. Researchers and health care professionals now have a better understanding of what causes erectile dysfunction and the effective medications used to treat the condition.

What are the risk factors?

Numerous physical and emotional risk factors may contribute to erectile dysfunction. Many of these risk factors are similar to the causes of the disorder. Risk factors may include the following:

Physical diseases, disorders, or conditions - Chronic diseases such as diabetes, high blood pressure, atherosclerosis (hardening of the arteries), thyroid diseases and disorders affecting the nerves are risk factors for developing erectile dysfunction. Also, men greater than the age of 40 are at risk for developing erectile dysfunction.
Surgery or trauma- surgeries to treat the bladder, rectum, or prostate can also result in erectile dysfunction; erectile dysfunction can also result from injury to the pelvic area or spinal cord.
Prescription medications - Certain antidepressants, antipsychotics, medications used to treat anxiety disorders and high blood pressure, anticholinergics (e.g. diphenhydramine, benztropine, and atropine), cimetidine, and digoxin have been shown to contribute to erectile dysfunction. If you are experiencing erectile dysfunction, talk to your doctor or pharmacist to see if any of your medications may be the cause.
Nonphysical disorders - Stress, depression, anxiety, or even negative feelings toward a sexual partner can cause erectile dysfunction.
Substance abuse - Alcohol, anabolic steroids, heroin, cocaine, and marijuana have also been shown to lead to erectile dysfunction.

What are the symptoms?

The inability to achieve or maintain an erection is the main symptom of erectile dysfunction. The inability to develop an erection may or may not occur every time an individual becomes aroused. If you consistently experience erectile dysfunction for longer than 2 months, contact your doctor so the cause of the dysfunction may be determined.

How is it treated?

The first step in the treatment of erectile dysfunction is a physical examination. This is done to rule out disorders such as diabetes, high blood pressure, high cholesterol, kidney disease, alcoholism, or multiple sclerosis, which can cause erectile dysfunction. It is estimated that physical diseases or conditions are the cause of erectile dysfunction approximately 70% of the time.

An important part of the evaluation should be a detailed patient history, which can give the doctor valuable clues about the patient's condition and the degree of severity of the condition. Usually, the doctor will ask about sexual activity and carefully discuss all of the patient's symptoms, which may help determine if the patient is having problems with erection, ejaculation, orgasm, or sexual desire. The treatment of erectile dysfunction is tailored to the individual, with the severity and cause of the erectile dysfunction taken into account.

Prescription medications like Viagra (sildenafil), Levitra (vardenafil), and Cialis (tadalafil) are frequently prescribed, but vacuum devices, penile implants, and vascular surgery are also options for the treatment of ED. It may also be helpful for some patients to receive psychological therapy as well.

Drug Therapy

First-line medications for the treatment of ED are phosphodiesterase inhibitors which include Viagra, Cialis, and Levitra. These medications work by preventing the breakdown of nitric oxide, causing relaxation of the muscles in the penis. This allows more blood to flow into the penis improving an erection. In order for these medications to work, sexual stimulation is needed. One advantage to Cialis is that it has been shown to improve erectile function for up to 36 hours following a dose while Viagra lasts for 4 hours and Levitra lasts for 5 hours. Cialis also has a faster onset of action of 15 minutes compared to Viagra and Levitra which have an onset of action of 30 minutes. This allows for more flexibility in planning sexual intercourse.

Although not first-line, several other drug classes are available. One of these is the prostaglandin E analogs which includes alprostadil. Alprostadil is a hormone that causes relaxation of the muscle tissue in the penis allowing for an erection. Alprostadil is available in two forms. With the injectable form (Caverject, Edex), a fine needle is used to inject the hormone into the penis. With the intraurethral form (Muse), a tiny suppository is inserted into the tip of the penis. Yohimbine, an alkaloid, is also sometimes used to treat ED. It is not thought to be effective for most men, but may be helpful to men whose ED is due to nonphysical causes such as stress or anxiety. Testosterone may also be helpful in treating ED in men who have a testosterone deficiency.

Vacuum Devices

Vacuum devices are non-drug options for treating erectile dysfunction. The device creates a vacuum around the penis, which draws blood into the penis and allows it to engorge, hence causing an erection. The devices are made up of three parts: a plastic cylinder that is placed over the penis; a pump which draws air out of the cylinder; and an elastic band which is placed around the base of the penis to maintain erection after the cylinder is removed and during intercourse to keep the penis engorged with blood.

Penile Prosthesis & Implants

Penile prosthesis/implants are another non-drug option for treating erectile dysfunction. A penile implant or inflatable prosthesis can be surgically embedded into the penis. With an inflatable prosthesis, fluid is pumped from a holding chamber in the abdomen into hollow cylinders placed within the corpora cavernosa (the 2 chambers inside the penis). The inflation and deflation of the hollow cylinders can be done by the patient as desired. An easy way to think about it is that penile implants function similarly to putting water into a latex balloon. As water is put into a balloon, the balloon expands (much like pumping fluid into the hollow cylinders of the penile implant makes the penis become erect). As water is let out of the balloon, the balloon deflates (much like deflating the fluid from the penile implants then makes the penis become flaccid again). Penile implants have a high satisfaction rate with patients. However, complications of the penile implant include infections, which can lead to the removal of the prosthesis. The cost of treating an infected prosthesis can actually exceed the cost of the original implant.

Surgery

Vascular surgery is another non-drug option for this disorder. Surgery can be performed to restore blood flow to the penile area if the vasculature (blood vessels) to the area is compromised. These types of surgeries have fallen out of favor in recent years due to the possible risk of infection associated with such invasive procedures. As a result, prescription medications have become the treatment of choice for erectile dysfunction.

Psychological Therapy

Psychological therapy and behavior modifications are other options to treat erectile dysfunction. This method targets any anxiety that may be associated with sexual intercourse. If your doctor feels this is an issue for you, a visit to a psychologist or psychiatrist may be warranted.

Drug classes used to treat Erectile Dysfunction

Alkaloids for erectile dysfunction
Phosphodiesterase Enzyme Inhibitors
Prostoglandin E Analogs
Testosterone for erectile dysfunction

What is on the horizon?

A new regular dosing schedule for sildenafil (Viagra) and the other phosphodiesterase enzyme inhibitors like tadalafil (Cialis) and vardenafil (Levitra) may restore erectile function more effectively than an "as needed" dosing schedule. According to a recent study, Viagra taken every night may provide more nocturnal erections which may benefit patients with erectile dysfunction. The significance of the benefit, however, has yet to be determined by larger, more conclusive studies. The safety of an "every day" treatment pattern has also not been determined and is therefore discouraged at this time.

Because of the success and wide spread use with sildenafil (Viagra) for erectile dysfunction, researchers are focusing on other noninvasive treatment options to treat erectile dysfunction. Currently, a form of phentolamine to be taken by mouth is being studied to determine its effectiveness in treating erectile dysfunction. Another study is looking at the use of radiation treatments to improve erections.

There was a study conducted in patients taking sildenafil (Viagra) to see if this medication is still effective 8 hours after taking the dose. The study measured if patients with mild to moderate erectile dysfunction will have difficulty obtaining an erection 8 hours after the first dose of Viagra. This study is most likely being carried out to make Viagra more competitive with Cialis, which works up to 36 hours after the dose is taken. The study has been completed, however the results have not yet been reported.

Researchers think they may have found a way to help men avoid impotence caused by nerve damage. While they haven't tried their approach on humans yet, the researchers say tests on rats suggest that a type of gene therapy may bring back the ability to have an erection. Individuals with diabetes and/or whom have had their prostate removed are at risk for nerve damage.

Headache and Medical Drugs Treatment

2008-08-01T15:22:00.002+08:00

Introduction

Do you have chronic headaches? You are not alone -- the National Headache Foundation estimates that about 45 million Americans suffer from recurring headaches. Many different types of headaches have many different causes, however, and individuals respond differently to treatment options, which range from meditation to drug therapy. Trying to find the best treatment is no simple matter. Patience and the willingness to try several different methods may be necessary to find what works best for you.

What is it?

Tension Headache

The most common type of headache, tension headache pain is usually described as feeling like a tight band that puts constant pressure on both sides of the head. Pain may extend into the neck or shoulders. Generally, tension headaches are mild to moderate in severity and they do not usually interfere with routine activity. An occasional inconvenience for most individuals, tension headaches often have a specific cause such as fatigue or stress. However, some individuals may have frequent or even daily tension headaches that may be severe enough to limit regular activity. Chronic tension headaches may have no apparent cause or they may be associated with other conditions such as anxiety, depression, or insomnia. About equal numbers of men and women have tension headaches and individuals of any age may experience them, although they most commonly occur between the ages of 20 and 40 years.

Migraine Headache

Migraine headaches are often described as intense throbbing or pounding pain on one or both sides of the head. Nausea and the inability to tolerate light, smells, or sounds may accompany the pain of a migraine. Up to a third of individuals who have migraines may have a warning(or ?aura?) that a migraine is about to start. These individuals may experience an aura that may include visual changes (such as dimmed or blinking lights) or unusual sensations (such as tingling in their hands, feet, or face). Generally, migraines are infrequent, although they may be chronic for some individuals. Migraines can last for days, often leaving patients feeling exhausted and lethargic(lacking energy). While the exact causes of migraine headaches are unknown, individuals who have recurring migraines may be able to identify physical factors that ?trigger? their migraines. For example, some migraines are attributed to stress; others may occur in response to environmental changes, such as very cold weather; certain foods may contribute to other migraines. About three times as many women as men suffer from migraines, with many women experiencing migraines around their menstrual periods.

Cluster Headache

Much less common than migraines or tension headaches, cluster headaches usually occur in groups (clusters) that may continue for a few days up to several weeks. Most often cluster headaches involve sudden attacks of extreme pain lasting from a few minutes to several hours and often involving only one side of the head. Affecting many more men than women, cluster headaches may be associated with irritation of the eye and nose. Individuals who smoke and drink alcohol may be more prone to having cluster headaches. This type of headache is more common in people who have the following: eye problems, runny noses, or facial sweating.

Other Types of Headaches

Organic Headache

Organic headaches are relatively rare, but they need immediate medical attention because they have serious physical causes such as blood clots, brain tumors, brain infections, or bleeding into the brain. Sometimes becoming intensely severe over a few hours or days, they may be associated with weakness, confusion, or unconsciousness.

Sinus Headache

Usually, sinus headache pain is due to swelling in the sinus cavities around the nose and eyes. Often caused by allergies or infections, sinus headaches may be accompanied by fever, a stuffy nose, or toothaches. Leaning forward or lying down may increase sinus headache pain.

Rebound Headache

Ironically, rebound headaches result from overuse of headache medications. Individuals who take more headache medication than recommended, take it continually for long periods of time, or consume large amounts of caffeine may need more and more medication to control headache pain. When the effects of the medication start to decrease, the headache is even worse and more medication is needed. Eventually, the medication doesn?t work anymore. Individuals who have ten or more headaches a month may be experiencing rebound headaches.

Hormonal Headache

Headaches of the hormonal type often result from fluctuation of hormones in the female body, especially in relation to the menstrual cycle.

What causes it?

Almost all headaches involve changes in the nerves and blood vessels of the head. For many years, the narrowing and widening of blood vessels was believed to cause headaches, but recent evidence does not support that theory totally. Another popular theory is that severe headaches and other types of chronic pain may be associated with low levels of brain chemicals known as endorphins. Produced in the pituitary and hypothalamus glands, endorphins are known to play roles in regulating pain.

Many headaches have no identifiable triggers (something that makes the headache start), but others may be associated with certain physical or emotional factors. Headache triggers are many and varied.

Physical factors such as prolonged sitting in an uncomfortable position may prompt a tension headache for some individuals. Other tension headaches may result from dust, noise, or poor lighting. Emotional issues, including anger, depression, and grief, may also contribute to tension headaches.

Several triggers have been identified for migraines. They include hormonal changes, stress, caffeine, poor diet, light, alcohol, smoking, lack of sleep, or illness.

Cluster headaches may be started by drinking alcohol, being exposed to glaring lights, experiencing heat or cold, or eating certain foods such as citrus fruits or chocolate. Food additives such as monosodium glutamate (MSG commonly found in Chinese foods) and aspartame (an artificial sweetener) may bring on headaches for some individuals. Some medications -- including both prescription and over-the-counter medications that are used to treat headaches -- can actually cause headaches, if they are taken improperly.

Sinus headaches represent a common example of headaches that result from a specific condition. Brain abnormalities (such as meningitis an infection in the brain or spinal chord, blood clots, or brain tumors) are examples of rare, but extremely dangerous illnesses that may also produce headache pain.

Who has it?

Headaches are among the most common complaints that health care practitioners encounter. Up to 90% of the population of the United States will have at least one headache per year, with an estimated 45 million Americans suffering chronically from headaches. Migraines also have had an impact economically due to the increasing cost of the medications for their treatments.

What are the risk factors?

Risk factors are characteristics that may make individuals more likely to develop a condition. Common risk factors for headaches include the following:

Tension Headache
- Female gender
Migraine Headache
- Female gender
- Family history
- Less advantaged socioeconomic groups
Cluster Headache
- Male gender
Rebound Headache
- Overuse of headache medicines

What are the symptoms?

Tension Headache

Almost 90% of tension headaches result from tightness in the scalp and neck. The pain of a tension headache is usually described as a constant pressure that feels like a vise or a tight band squeezing on both sides of the head. Pain may spread to the scalp, face, neck, and shoulders. Often the neck or shoulder muscles tighten, giving this type of headache the alternate name of muscle contraction headache. Not usually associated with additional symptoms, tension headaches are classified according to frequency. Chronic tension headaches occur daily or almost every day. Tension headaches that occur only a few times a year are called episodic tension headaches.

Migraine Headache

Migraine headaches are characterized as intense pounding pain, which may affect one or both sides of the head lasting anywhere from 4 to 72 hours. The two main forms of migraine are:

Migraine with Aura (formerly called classic migraine) An aura is a neurological (meaning, related to the nervous system) disturbance experienced by about one-fourth to one-third of all individuals who have migraines. About 10% of all migraine sufferers will have an aura on a consistent basis. Usually consisting of visual changes that may include seeing colored or flashing lights or squiggly lines, an aura may also involve physical symptoms such as numbness or tingling sensations in the face, fingers, or toes. Some individuals may experience temporary or loss of vision when experiencing a pre-migraine aura. Typically, an aura begins approximately 10 to 30 minutes before the onset of the headache.
Migraine without Aura (formerly called common migraine). Individuals with this type of migraine have little or no warning that a migraine is about to occur.

Other symptoms that may be associated with migraines include:

Cold, clammy, or sweaty skin
Confusion
Fatigue
Depressed mood
Fluid retention
Muscle pain
Food cravings
Numbness or a sensation of pins and needles
Inability to tolerate light, noise, or smells
Light-headedness
Nausea
Vomiting

Cluster Headache

Cluster headaches generally start suddenly and they often affect only one side of the head. A single cluster headache is usually brief lasting from a few minutes to about 4 hours, then decreasing or disappearing. Occurring repeatedly at roughly the same times of day, however, cluster headaches typically extend over a period of 4 to 12 weeks, followed by a period of remission. This on and off sequence may last for a few months or it may occur chronically over many years. Other symptoms of a cluster headache may include nasal congestion, facial sweating, runny nose, drooping eyelids, and irritated, teary eyes. Men are 4 to 7 times more likely to suffer from cluster headaches than women.

Other Headaches

Organic Headache

An organic or secondary headache is the result of a brain tumor, a brain infection, bleeding into the brain, or other severe illness. Accounting for less than 5% of all headaches, organic headaches may occur as sudden, sharp, extremely severe pain. Symptoms that frequently accompany organic headaches may include confusion, seizures, sudden loss of balance, or difficulty with speech. Because organic headaches are indications of a more serious illness, individuals experiencing any of these symptoms should receive emergency medical care.

Sinus Headache

Sinus headache pain usually results from pressure exerted by swollen, inflamed tissue in sinus passages. Generally, due to infections, sinus headache pain is localized in the forehead, above the cheekbones, and behind the bridge of the nose. Pain, which may vary from dull aches to moderately intense pain, may extend to the teeth or jaw. Other symptoms of a sinus headache may include:

Chills
Fever
Greenish or yellow nasal secretions
Nasal congestion
Swollen face

Rebound Headache

Taking headache medications on a regular basis may create a need to increase the dose for the medication to be effective. As the dose increases, the headache pain may get worse, and the dose may need to be increased even more. The medication (or doses of it that are no longer strong enough) actually may begin to cause a headache.

Hormonal Headache

Changes in estrogen levels due to menstrual periods may trigger headaches for some women. Usually beginning a few days before the start of a menstrual period, hormonal headaches may be associated with other symptoms of premenstrual syndrome (PMS) such as bloating, breast tenderness, fatigue, irritability, and joint pain. Pregnancy, menopause, or oral contraceptive use may also cause hormonal fluctuations that may lead to headaches.

How is it treated?

Appropriate treatment for headaches is highly specialized depending on the type of headache, individual response to therapy, and any associated health conditions the person may also have. Lifestyle changes may be enough to resolve some headaches. For example, avoiding the foods that are known to trigger migraines may prevent migraine occurrence for certain individuals. In addition, numerous prescription and non-prescription medications are available treat and prevent headaches. Several medications or combinations of medications may have to be tried to find the best treatment.

In general, medications for headaches focus on two areas:

Abortive therapy -- to stop a headache that has already started, and
Prophylactic or preventive therapy -- to keep headaches from occurring.

Treatment Options

Cluster Headache
Non-prescription drugs typically do not relieve cluster headaches. Therefore, treatment usually requires a prescription medication taken under a doctor's supervision.

Abortive therapy

The drugs of choice for cluster headache are oxygen and sumatriptan. These can either be given alone, or in combination. Inhaling pure oxygen may provide almost immediate relief for up to 80% of cluster headache attacks. Other initial treatment choices include prescription medications -- ergot derivatives or a triptan. For rapid relief of a cluster headache, an ergot derivative in a dosage form that is either quickly dissolved under the tongue (Ergomar), or injected (dihydroergotamine mesylate, DHE-45) is the second choice. Injected sumatriptan (Imitrex) may also be an effective treatment for cluster headaches in patients that don't respond well to oxygen and sumatriptan. Zolmitriptan (Zomig) may be considered over sumatriptan when given orally because 60% of patients experience relief at 30 minutes whereas sumatriptan may take longer to deliver relief.

Prophylactic/Preventive therapy

Calcium channel blockers, such as verapamil (Calan, Isoptin, Verelan) and diltiazem (Cardizem, Cartia, Dilacor, Diltia, Taztia, Tiazac), are also commonly used to prevent cluster headaches. Generally well tolerated, calcium channel blockers may cause constipation or swelling in the legs for some individuals who take them. Another well-tolerated medication is indomethacin, the only NSAID shown to be effective in preventing chronic cluster headaches. Possible side effects of indomethacin include dizziness, rash, stomach upset, and loss of appetite. The choice to begin taking indomethacin regularly should be carefully considered by a physician. Continued use of NSAIDs may lead to severe stomach irritation and result in ulcers (which must then be treated with more medications). Also patients with high blood pressure, heart failure, and kidney disease should know that taking NSAIDs may worsen these conditions. Always consult a physician before beginning long-term use of NSAIDs.

Other prescription medications that may be used to prevent cluster headaches may have more serious side effects, so they usually require close monitoring by a healthcare provider. Corticosteroids, such as prednisone (Deltasone, Orasone), may work well for preventing both episodic and chronic cluster headaches. They may cause insomnia, mood changes, upset stomach, and weight gain, however; and long-term therapy can affect thyroid function, cholesterol levels, blood pressure, and blood sugar levels.

Two other drugs used to treat cluster headaches are methysergide maleate (Sansert) and lithium (Eskalith, Lithobid). Methysergide maleate has been discontinued in the United States, but it may be available in other countries. Side effects from either methysergide maleate or lithium can be significant and treatment with either of them needs to be monitored closely by a healthcare provider.
Organic Headache
Because organic headaches are caused by serious illnesses, any individual experiencing an unusually sudden or extremely severe headache should seek medical attention as soon as possible. Headaches that are accompanied by vision disturbances, numbness and/or weakness on one side of the body may be emergencies that also need immediate attention. Treatment may not be possible for organic headaches, but the condition causing the pain may be treatable.
Tension Headache
Many different medication options are available for tension headaches. Ideal treatment for tension headaches is the medication that is most effective at the lowest dose and has the fewest potential side effects. If headaches are not relieved, the dose may be increased or another type of drug can be tried.
Abortive Therapy

Initial abortive therapies for tension headaches include non-prescription pain medications (also called analgesics) such as aspirin and acetaminophen (Tylenol). Usually medications like these are well tolerated, although some individuals may experience upset stomach when taking aspirin. Continually taking non-prescription analgesics daily for more than 2 weeks or taking higher than recommended doses can lead to rebound headaches. If an analgesic is being used with increasing frequency and less relief is occurring, other treatment options should be tried.

When aspirin or acetaminophen is not effective, a non-steroidal anti-inflammatory drug (NSAID) such as ibuprofen (Advil, Motrin) or naproxen (Aleve, Naprosyn) is usually the next step for pain relief. Some NSAIDs are available both without a prescription (usually in lower doses) and with a prescription (usually in higher doses). Common side effects include stomach irritation, which may be minimized if the medication is taken with food. Because individuals with kidney problems may be at increased risk for side effects, they should not begin taking an NSAID before discussing its use with a healthcare provider.

Other prescription treatments include muscle relaxants, such as carisoprodol (Soma) and cyclobenzaprine (Flexeril), and certain antidepressants (however, there is no evidence to support the effectiveness of these agents as abortive therapy). Both of these types of medications may cause drowsiness, however. A combination medication that includes isometheptene mucate, dichloralphenazone, and acetaminophen (Midrin, Duradrin) may also be used as abortive treatment for tension headaches. Caution should be used if it is taken because it may be habit-forming.

Prophylactic/Preventive Therapy

To prevent tension headaches, many different antidepressants may be effective for individuals with and without depressive symptoms. The antidepressant needs to be taken continually. Side effects depend on the individual drug, but they are usually mild. They may include constipation, dizziness, drowsiness, dry mouth, nausea, and weight gain.

In the case of tension headaches, psychophysiologic therapies such as stress management, relaxation training and biofeedback training may significantly reduce headache activity.
Migraine Headache
Abortive Therapy

Initial abortive therapy for mild to moderate migraine headaches includes non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil or Motrin) and naproxen (Aleve or Naprosyn), and other non-prescription pain medications (also known as analgesics) such as aspirin and acetaminophen (Tylenol). Another medication available, without a prescription, that some find effective is a combination of aspirin, acetaminophen, and caffeine (Exedrine or Exedrine Migraine).

If non-prescription medications are not effective, several prescription medications are available to relieve migraines. Among the most commonly prescribed are selective serotonin agonists, commonly known as "triptans". Designed specifically for migraine treatment, seven triptans are available in the United States. They are almotriptan (Axert), eletriptan (Relpax), frovatriptan (Frova), naratriptan (Amerge), rizatriptan (Maxalt), sumatriptan (Imitrex), and zolmitriptan (Zomig). Triptans are generally prescribed for moderate to severe migraines with or without auras, and they also may work when other previous treatments have failed. They come in several different dosage forms that may include injections and nasal spray, as well as traditional tablets to take by mouth. In addition, rizatriptan and zolmitriptan are available in rapidly-dissolving tablets that melt quickly for fast absorption when placed on the tongue. Although triptans work in similar ways, one may be more effective than another for certain individuals. Therefore, individuals who do not find relief from one triptan may want to consider trying another triptan before switching to a completely different drug class. Triptans should not be used by individuals with heart disease or uncontrolled high blood pressure. And, as with other headache medications, overuse of triptans may lead to rebound headaches.

Ergot derivatives are a second-line prescription option for treating moderate to severe migraine headaches that do not respond to non-prescription treatment or triptans. Ergot derivatives are most effective in dosage forms that reach the bloodstream quickly. Sublingual tablets that dissolve quickly under the tongue (Ergomar), injections (dihydroergotamine mesylate, DHE-45), and nasal sprays (dihydroergotamine, Migranal) are rapidly-acting ergot derivatives. Although they are effective for many individuals, taking ergot derivatives usually requires close monitoring by a healthcare provider. They may be habit-forming and they may cause numerous side effects, including abdominal cramps, dizziness, dry mouth, and nausea. Individuals who experience potentially serious side effects such as leg cramps or coldness, numbness or pain in the hands or feet while taking an ergot derivative should contact a doctor immediately.

Combinations of isometheptene mucate, dichloralphenazone, and acetaminophen (Midrin, Duradrin) or combinations of aspirin or acetaminophen with butalbital, codeine, or both (Fiorinal, Fioricet) may also be used as abortive treatment for migraine headaches. Caution should be used because of the potential for dependence associated with these drugs.

Many individuals who suffer from migraines also have nausea, and some evidence suggests that stomach contents are poorly absorbed into the body during a migraine attack. Consequently, taking medications by mouth may not be as effective as using other routes of administration, such as rectal suppositories or injected medications.

Prophylactic/Preventive Therapy

One possible way to prevent migraines is to avoid triggers. Eating regular, healthy meals, limiting caffeine, eliminating other food triggers, and getting plenty of exercise may help to prevent migraines from occurring. Keeping a headache diary may facilitate identification of triggers (see the Helping Yourself section to learn more about headache diaries). If medication is needed, it usually has to be taken regularly. Only certain individuals are candidates for prophylactic therapy with medication. These are individuals whose migraines cause severe disruptions in normal activity despite treatment, and those who have frequent migraines requiring prescription medication (at least twice weekly) which puts them at risk for developing rebound headaches. For these persons, several prescription options are available.

Tricyclic antidepressants (TCAs), such as amitriptyline, may be effective migraine prevention for some individuals, especially those with underlying depression, insomnia, or tension headaches. Although amitriptyline is generally accepted to be the most effective TCA for prevention of headaches, other TCAs such as doxepin (Sinequan), imipramine (Tofranil), nortriptyline (Pamelor), and protriptyline (Vivactil) have also shown some effectiveness. TCAs should be taken at night because they can cause sedation. Other possible side effects from TCAs may include an unpleasant taste in the mouth, and dry eyes, mouth, and skin. Individuals with glaucoma or an enlarged prostate should use caution when taking TCAs due to the increased risk of side effects.

Other prescription medications commonly used for migraine prevention include oral beta-blockers, such as atenolol (Tenormin), metoprolol (Lopressor), propranolol (Inderal), and timolol (Blocadren); and calcium channel blockers, such as verapamil (Calan, Isoptin, Verelan). Common side effects of beta-blockers may include decreased blood pressure, depression, impotence, and lethargy. Common side effects of calcium channel blockers are decreased blood pressure, constipation, and leg swelling.

Some medications used primarily to treat epilepsy may also decrease the frequency, duration, and/or severity of migraine headaches. Valproic acid (Depakene), divalproex sodium (Depakote), and topiramate (Topamax) are anti-epileptics that are also approved for migraine prophylaxis. Tremor, weight gain, and hair loss are common side effects of these drugs. Rarely, they may cause liver damage. Therefore, symptoms of nausea, vomiting, and yellowing of eyes or skin should be brought to the attention of a doctor immediately. To decrease the risk of liver damage, blood tests should be performed periodically as long as anti-epileptic medications are taken.

Another drug occasionally used to prevent migraine headaches is methysergide maleate (Sansert). Methysergide maleate has been discontinued in the United States, but it may still be available in other countries. Its use must be limited due to the relatively high number of side effects that are associated with taking it. Dizziness, drowsiness, flushing, heartburn, insomnia, and stomach upset may all be caused by methysergide maleate. Long-term use may result in heart or lung changes. Methysergide maleate should be taken no longer than 6 months at a time, doses should be decreased gradually, and at least 3 to 4 weeks must be allowed before starting it again. Individuals taking methysergide maleate need to be supervised closely by a healthcare professional that is familiar with its use.

Non-drug Therapy

Resting in a cool, dark, quiet room is effective treatment for some migraine sufferers. Others find relief from an ice pack or cool water on their foreheads.
Rebound Headache
The best way to treat headaches that result from taking too much headache medication is to stop the medication. Some individuals may stop all at once, while others need to stop more gradually. A health professional may need to determine the best way for each individual to stop over-using headache medication. Additional treatments for rebound headaches may include behavior modification therapy and the use of non-analgesic medications to help control headache pain until the headache medications are stopped.
Sinus Headache
Since sinus headaches generally result from a sinus condition, the best approach is to treat that underlying condition. Non-prescription medications for sinus headaches commonly contain a pain reliever such as acetaminophen, as well as antihistamines for allergic conditions and/or decongestants for nasal congestion. If sinus pressure and pain is not relieved after a day or two of treatment with a non-prescription product, an infection may be present. A prescription antibiotic may be needed to treat a bacterial infection. If the sinus infection is caused by a virus, however, antibiotics will not be effective.
Hormonal Headache
Hormonal headaches may be triggered by hormonal changes in the body. Most usually occurring as women begin their periods each month, hormonal changes also occur as young girls reach puberty, as women become pregnant, and as older women reach menopause. Taking oral contraceptives (birth control pills) may also cause hormonal headaches for some women especially when the pills are first started.

Women who have hormonal headaches may start headache medication about 2 days before the period starts and continue taking the headache medication until the period has ended. Commonly effective headache medications include non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin) and naproxen (Aleve, Naprosyn). Prescription treatment options may have more serious side effects that require close monitoring by a healthcare provider. These medications should be used only if NSAIDs do not provide adequate relief. Ergot derivatives in oral tablets or suppositories can be used; however, individuals should be aware that ergot derivatives might be habit forming. Their common side effects include abdominal cramping, nausea, dizziness, and dry mouth. Patients should report muscle pains, numbness, coldness, or loss of color in their hands or feet to their physician immediately. Methysergide maleate (Sansert) was another potential treatment. However, methysergide mesylate has been discontinued for sale in the United States. While it may still be available in other countries, its side effects can be significant. If methysergide maleate is taken, its use must be supervised closely by a doctor who is familiar with its use.

Cluster Headache

Non-prescription drugs typically do not relieve cluster headaches. Therefore, treatment usually requires a prescription medication taken under a doctor's supervision.

Abortive therapy

The drugs of choice for cluster headache are oxygen and sumatriptan. These can either be given alone, or in combination. Inhaling pure oxygen may provide almost immediate relief for up to 80% of cluster headache attacks. Other initial treatment choices include prescription medications -- ergot derivatives or a triptan. For rapid relief of a cluster headache, an ergot derivative in a dosage form that is either quickly dissolved under the tongue (Ergomar), or injected (dihydroergotamine mesylate, DHE-45) is the second choice. Injected sumatriptan (Imitrex) may also be an effective treatment for cluster headaches in patients that don't respond well to oxygen and sumatriptan. Zolmitriptan (Zomig) may be considered over sumatriptan when given orally because 60% of patients experience relief at 30 minutes whereas sumatriptan may take longer to deliver relief.

Prophylactic/Preventive therapy

Calcium channel blockers, such as verapamil (Calan, Isoptin, Verelan) and diltiazem (Cardizem, Cartia, Dilacor, Diltia, Taztia, Tiazac), are also commonly used to prevent cluster headaches. Generally well tolerated, calcium channel blockers may cause constipation or swelling in the legs for some individuals who take them. Another well-tolerated medication is indomethacin, the only NSAID shown to be effective in preventing chronic cluster headaches. Possible side effects of indomethacin include dizziness, rash, stomach upset, and loss of appetite. The choice to begin taking indomethacin regularly should be carefully considered by a physician. Continued use of NSAIDs may lead to severe stomach irritation and result in ulcers (which must then be treated with more medications). Also patients with high blood pressure, heart failure, and kidney disease should know that taking NSAIDs may worsen these conditions. Always consult a physician before beginning long-term use of NSAIDs.

Other prescription medications that may be used to prevent cluster headaches may have more serious side effects, so they usually require close monitoring by a healthcare provider. Corticosteroids, such as prednisone (Deltasone, Orasone), may work well for preventing both episodic and chronic cluster headaches. They may cause insomnia, mood changes, upset stomach, and weight gain, however; and long-term therapy can affect thyroid function, cholesterol levels, blood pressure, and blood sugar levels.

Two other drugs used to treat cluster headaches are methysergide maleate (Sansert) and lithium (Eskalith, Lithobid). Methysergide maleate has been discontinued in the United States, but it may be available in other countries. Side effects from either methysergide maleate or lithium can be significant and treatment with either of them needs to be monitored closely by a healthcare provider.

Organic Headache

Because organic headaches are caused by serious illnesses, any individual experiencing an unusually sudden or extremely severe headache should seek medical attention as soon as possible. Headaches that are accompanied by vision disturbances, numbness and/or weakness on one side of the body may be emergencies that also need immediate attention. Treatment may not be possible for organic headaches, but the condition causing the pain may be treatable.

Tension Headache

Many different medication options are available for tension headaches. Ideal treatment for tension headaches is the medication that is most effective at the lowest dose and has the fewest potential side effects. If headaches are not relieved, the dose may be increased or another type of drug can be tried.

Abortive Therapy

Initial abortive therapies for tension headaches include non-prescription pain medications (also called analgesics) such as aspirin and acetaminophen (Tylenol). Usually medications like these are well tolerated, although some individuals may experience upset stomach when taking aspirin. Continually taking non-prescription analgesics daily for more than 2 weeks or taking higher than recommended doses can lead to rebound headaches. If an analgesic is being used with increasing frequency and less relief is occurring, other treatment options should be tried.

When aspirin or acetaminophen is not effective, a non-steroidal anti-inflammatory drug (NSAID) such as ibuprofen (Advil, Motrin) or naproxen (Aleve, Naprosyn) is usually the next step for pain relief. Some NSAIDs are available both without a prescription (usually in lower doses) and with a prescription (usually in higher doses). Common side effects include stomach irritation, which may be minimized if the medication is taken with food. Because individuals with kidney problems may be at increased risk for side effects, they should not begin taking an NSAID before discussing its use with a healthcare provider.

Other prescription treatments include muscle relaxants, such as carisoprodol (Soma) and cyclobenzaprine (Flexeril), and certain antidepressants (however, there is no evidence to support the effectiveness of these agents as abortive therapy). Both of these types of medications may cause drowsiness, however. A combination medication that includes isometheptene mucate, dichloralphenazone, and acetaminophen (Midrin, Duradrin) may also be used as abortive treatment for tension headaches. Caution should be used if it is taken because it may be habit-forming.

Prophylactic/Preventive Therapy

To prevent tension headaches, many different antidepressants may be effective for individuals with and without depressive symptoms. The antidepressant needs to be taken continually. Side effects depend on the individual drug, but they are usually mild. They may include constipation, dizziness, drowsiness, dry mouth, nausea, and weight gain.

In the case of tension headaches, psychophysiologic therapies such as stress management, relaxation training and biofeedback training may significantly reduce headache activity.

Migraine Headache

Abortive Therapy

Initial abortive therapy for mild to moderate migraine headaches includes non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil or Motrin) and naproxen (Aleve or Naprosyn), and other non-prescription pain medications (also known as analgesics) such as aspirin and acetaminophen (Tylenol). Another medication available, without a prescription, that some find effective is a combination of aspirin, acetaminophen, and caffeine (Exedrine or Exedrine Migraine).

If non-prescription medications are not effective, several prescription medications are available to relieve migraines. Among the most commonly prescribed are selective serotonin agonists, commonly known as "triptans". Designed specifically for migraine treatment, seven triptans are available in the United States. They are almotriptan (Axert), eletriptan (Relpax), frovatriptan (Frova), naratriptan (Amerge), rizatriptan (Maxalt), sumatriptan (Imitrex), and zolmitriptan (Zomig). Triptans are generally prescribed for moderate to severe migraines with or without auras, and they also may work when other previous treatments have failed. They come in several different dosage forms that may include injections and nasal spray, as well as traditional tablets to take by mouth. In addition, rizatriptan and zolmitriptan are available in rapidly-dissolving tablets that melt quickly for fast absorption when placed on the tongue. Although triptans work in similar ways, one may be more effective than another for certain individuals. Therefore, individuals who do not find relief from one triptan may want to consider trying another triptan before switching to a completely different drug class. Triptans should not be used by individuals with heart disease or uncontrolled high blood pressure. And, as with other headache medications, overuse of triptans may lead to rebound headaches.

Ergot derivatives are a second-line prescription option for treating moderate to severe migraine headaches that do not respond to non-prescription treatment or triptans. Ergot derivatives are most effective in dosage forms that reach the bloodstream quickly. Sublingual tablets that dissolve quickly under the tongue (Ergomar), injections (dihydroergotamine mesylate, DHE-45), and nasal sprays (dihydroergotamine, Migranal) are rapidly-acting ergot derivatives. Although they are effective for many individuals, taking ergot derivatives usually requires close monitoring by a healthcare provider. They may be habit-forming and they may cause numerous side effects, including abdominal cramps, dizziness, dry mouth, and nausea. Individuals who experience potentially serious side effects such as leg cramps or coldness, numbness or pain in the hands or feet while taking an ergot derivative should contact a doctor immediately.

Combinations of isometheptene mucate, dichloralphenazone, and acetaminophen (Midrin, Duradrin) or combinations of aspirin or acetaminophen with butalbital, codeine, or both (Fiorinal, Fioricet) may also be used as abortive treatment for migraine headaches. Caution should be used because of the potential for dependence associated with these drugs.

Many individuals who suffer from migraines also have nausea, and some evidence suggests that stomach contents are poorly absorbed into the body during a migraine attack. Consequently, taking medications by mouth may not be as effective as using other routes of administration, such as rectal suppositories or injected medications.

Prophylactic/Preventive Therapy

One possible way to prevent migraines is to avoid triggers. Eating regular, healthy meals, limiting caffeine, eliminating other food triggers, and getting plenty of exercise may help to prevent migraines from occurring. Keeping a headache diary may facilitate identification of triggers (see the Helping Yourself section to learn more about headache diaries). If medication is needed, it usually has to be taken regularly. Only certain individuals are candidates for prophylactic therapy with medication. These are individuals whose migraines cause severe disruptions in normal activity despite treatment, and those who have frequent migraines requiring prescription medication (at least twice weekly) which puts them at risk for developing rebound headaches. For these persons, several prescription options are available.

Tricyclic antidepressants (TCAs), such as amitriptyline, may be effective migraine prevention for some individuals, especially those with underlying depression, insomnia, or tension headaches. Although amitriptyline is generally accepted to be the most effective TCA for prevention of headaches, other TCAs such as doxepin (Sinequan), imipramine (Tofranil), nortriptyline (Pamelor), and protriptyline (Vivactil) have also shown some effectiveness. TCAs should be taken at night because they can cause sedation. Other possible side effects from TCAs may include an unpleasant taste in the mouth, and dry eyes, mouth, and skin. Individuals with glaucoma or an enlarged prostate should use caution when taking TCAs due to the increased risk of side effects.

Other prescription medications commonly used for migraine prevention include oral beta-blockers, such as atenolol (Tenormin), metoprolol (Lopressor), propranolol (Inderal), and timolol (Blocadren); and calcium channel blockers, such as verapamil (Calan, Isoptin, Verelan). Common side effects of beta-blockers may include decreased blood pressure, depression, impotence, and lethargy. Common side effects of calcium channel blockers are decreased blood pressure, constipation, and leg swelling.

Some medications used primarily to treat epilepsy may also decrease the frequency, duration, and/or severity of migraine headaches. Valproic acid (Depakene), divalproex sodium (Depakote), and topiramate (Topamax) are anti-epileptics that are also approved for migraine prophylaxis. Tremor, weight gain, and hair loss are common side effects of these drugs. Rarely, they may cause liver damage. Therefore, symptoms of nausea, vomiting, and yellowing of eyes or skin should be brought to the attention of a doctor immediately. To decrease the risk of liver damage, blood tests should be performed periodically as long as anti-epileptic medications are taken.

Another drug occasionally used to prevent migraine headaches is methysergide maleate (Sansert). Methysergide maleate has been discontinued in the United States, but it may still be available in other countries. Its use must be limited due to the relatively high number of side effects that are associated with taking it. Dizziness, drowsiness, flushing, heartburn, insomnia, and stomach upset may all be caused by methysergide maleate. Long-term use may result in heart or lung changes. Methysergide maleate should be taken no longer than 6 months at a time, doses should be decreased gradually, and at least 3 to 4 weeks must be allowed before starting it again. Individuals taking methysergide maleate need to be supervised closely by a healthcare professional that is familiar with its use.

Non-drug Therapy

Resting in a cool, dark, quiet room is effective treatment for some migraine sufferers. Others find relief from an ice pack or cool water on their foreheads.

Rebound Headache

The best way to treat headaches that result from taking too much headache medication is to stop the medication. Some individuals may stop all at once, while others need to stop more gradually. A health professional may need to determine the best way for each individual to stop over-using headache medication. Additional treatments for rebound headaches may include behavior modification therapy and the use of non-analgesic medications to help control headache pain until the headache medications are stopped.

Sinus Headache

Since sinus headaches generally result from a sinus condition, the best approach is to treat that underlying condition. Non-prescription medications for sinus headaches commonly contain a pain reliever such as acetaminophen, as well as antihistamines for allergic conditions and/or decongestants for nasal congestion. If sinus pressure and pain is not relieved after a day or two of treatment with a non-prescription product, an infection may be present. A prescription antibiotic may be needed to treat a bacterial infection. If the sinus infection is caused by a virus, however, antibiotics will not be effective.

Hormonal Headache

Hormonal headaches may be triggered by hormonal changes in the body. Most usually occurring as women begin their periods each month, hormonal changes also occur as young girls reach puberty, as women become pregnant, and as older women reach menopause. Taking oral contraceptives (birth control pills) may also cause hormonal headaches for some women especially when the pills are first started.

Women who have hormonal headaches may start headache medication about 2 days before the period starts and continue taking the headache medication until the period has ended. Commonly effective headache medications include non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin) and naproxen (Aleve, Naprosyn). Prescription treatment options may have more serious side effects that require close monitoring by a healthcare provider. These medications should be used only if NSAIDs do not provide adequate relief. Ergot derivatives in oral tablets or suppositories can be used; however, individuals should be aware that ergot derivatives might be habit forming. Their common side effects include abdominal cramping, nausea, dizziness, and dry mouth. Patients should report muscle pains, numbness, coldness, or loss of color in their hands or feet to their physician immediately. Methysergide maleate (Sansert) was another potential treatment. However, methysergide mesylate has been discontinued for sale in the United States. While it may still be available in other countries, its side effects can be significant. If methysergide maleate is taken, its use must be supervised closely by a doctor who is familiar with its use.

Drug classes used to treat Headache

Ergot Derivatives
Miscellaneous Analgesics and Antipyretics
Narcotic Combinations
Non-steroidal Anti-inflammatory drugs
Salicylates
Serotonin Receptor Agonists (Triptans)

What is on the horizon?

While headaches are not unbearable for most individuals, research on potential headache treatments will continue to be very active simply because so many individuals do have occasional headaches. The resulting loss of productivity reaches several million hours per year. Both medications and non-medication treatments are under study.

Recently, the National Headache Foundation announced clinical trials evaluating current headache medicines being delivered in potentially more efficient ways - such as through the skin, nasal passages, or even the lungs. The following are some new delivery methods of headache medications that are currently being studied:

The skin patch, Actyve(TM) by Vyteris, will release zolmitriptan by low electrical energy in the patch.
DHE Nasal Powder by Britannia Pharmaceuticals with Novartis Pharmaceuticals, sprays powdered dihydroergotamine into the sinuses for faster absorption.
Nasal capsaicin spray is proposed to help block the brain from knowing that there is pain. Capsaicin is usually found in topical creams over the counter to help with pain from cuts, scratches, burns, and other minor skin injuries that are causing discomfort.
Another type of inhalation device using heat propels the drug prochlorperazine into the lungs for a faster rate of absorption into the body.
Maybe the most interesting new medical idea is the carbon dioxide inhaler to be used for sinus headaches. This device will send carbon dioxide gas into one nostril simply to open up the nasal passageway.

Other medications that currently treat health conditions not associated with migraines are now being looked at to help relieve headaches. Some of these are oxcarbazepine, doxepin, donepezil, diclofenac, potassium, propofol injections, and calcitonin.

There is also a new migraine research study focusing on implanting a medical device into the migraine sufferer and stimulating major nerves thought to be associated with headache. Precision(TM), Genesis(TM), Medronic Synergy(TM), etc. are a few of the devices, some of these have been approved for other pain conditions however, none has been approved for treating migraines.

Finally, an experimental technique called thermography, which is used for diagnosing headache, is another area of intense investigation. In thermography, an infrared camera converts skin temperature into a color picture, or thermogram, with different degrees of heat appearing as different colors. Researchers have found that thermograms of headache patients show heat patterns that differ from those of people who never or rarely get headaches. Ways to change heat patterns may help to relieve headaches.

Heart Failure and Medical Drugs Treatment

2008-07-25T15:18:00.000+08:00

Introduction

Once thought of as a terminal condition, patients today are living for years even decades with heart failure, thanks in large part to medications. Nonetheless, prevention remains the key.

What is it?

Heart failure, also called left ventricular dysfunction, is a condition in which the heart muscle does not pump adequately. As a result, blood is not dispersed adequately to the body and fluid backs up into the lungs, causing "congestion.

In some patients, heart failure occurs suddenly, while in other cases it develops gradually. As heart function deteriorates over the years, the strength of muscle contractions may be reduced. In other cases, mechanical problems may affect the ability of heart chambers to fill with blood, so that less blood is pumped out to tissues in the body. In other cases, the pumping chambers enlarge and fill with too much blood. The weakened heart muscle may not be strong enough to pump out all of the blood it receives. There are also cases where the heart enlargement affects the functioning of the valves that usually stop blood from flowing backwards into the heart chamber it just left. This condition, called regurgitation, may make the heart failure even worse.

When the heart cannot efficiently pump blood into the arteries, the blood backs up into the lungs and the resulting fluid collection is responsible for the congestion and breathing difficulties. Blood may also collect in veins, especially in the lower extremities, and cannot circulate into tissues.

In most patients, heart failure is controllable. With appropriate care, people may live for many years after the diagnosis is made.

What causes it?

Heart failure (HF) is often the direct result of the heart muscle's inability to contract with enough force to pump blood efficiently. Among the causes of HF are heart valve disease, scar tissue left from a previous heart attack, and high blood pressure which has been uncontrolled for long periods.

Coronary artery disease, in which the coronary arteries supplying the heart muscle are narrowed by plaques (usually from high cholesterol), is the most common cause of HF accounting for 60% of people with the disease. Although coronary artery disease often starts at an early age, HF occurs most often in the elderly. The majority of these patients are women. Researchers theorize that this is probably because men are more likely to die from coronary artery disease before it progresses to HF.

HF is also associated with alcohol abuse and drug abuse, particularly cocaine and amphetamines, which affect heart rate. Among other disorders that can cause HF are hyperthyroidism (or an overactive thyroid), HIV/AIDS, treatment of cancer (such as radiation and certain chemotherapy agents), and various abnormalities of the heart valves. In addition, viral infection or inflammation of the heart, known as myocarditis, or a heart muscle disease called cardiomyopathy can cause HF. There are also rare cases where HF is caused by extreme vitamin deficiencies.

Who has it?

Over 5 million Americans have chronic HF, with 550,000 new cases occurring each year. HF results in almost 1 million hospitalizations each year and is the most common diagnosis among patients between the ages of 55 to 65 years discharged from hospitals.

Forty four percent of patients with HF have diabetes, 30% have kidney problems, 52% are women, and atrial fibrillation (irregular heart rhythm) accounts for approximately 31% of heart failure patients. These numbers are expected to continue to increase as the population of elderly Americans rises.

What are the risk factors?

Risk factors are characteristics that may increase your chance for developing a condition. If you have conditions such as coronary artery disease, valvular heart disease, diabetes or high blood pressure, then you are at risk for developing heart failure (HF). Coronary artery disease, high blood pressure, and diabetes are the leading causes of heart failure. Other factors that increase your chance of having or developing HF include:

Age - Older people are more likely to develop HF than younger people.
Male gender - Before age 60 or 70, men are more likely than women to develop coronary disease.
Family history of heart disease
Cigarette smoking
High blood pressure
Diabetes
Alcohol abuse
Coronary artery disease
Chronic kidney disease
Atrial fibrillation
High cholesterol
COPD (lung disease) or asthma
Race:African Americans are more likely to develop heart failure than Caucasians

What are the symptoms?

Due to the complexity of trying to determine whether or not a symptom is caused by the inadequate forward flow of blood or the backward buildup of blood, the following list of symptoms are all attributed to heart failure.

Common symptoms include:

Exercise intolerance (diminished ability to perform physical tasks)
Cough
Fatigue
Nocturia (having to go to the bathroom frequently during the night)
Abdominal pain
Loss of appetite
Nausea
Bloating
Mental status change such as confusion
Shortness of breath (that may even occur at rest)
Cool or pale extremities (legs, feet, hands, fingers)
Edema (or swelling), particularly in the lower legs, ankles, and feet
Chest pain

How is it treated?

The management of heart failure (HF) depends on its cause and clinical course. Since high blood pressure, coronary artery disease, high cholesterol, and valvular heart disease are common causes of HF, aggressive management of these conditions is essential. Treatment goals include:

Improve the individual's quality of life and symptoms
Prevent the heart failure from worsening
Prolong the individual?s life span
Treat the underlying cause of the heart failure.

When a person is diagnosed with HF, both non-drug (described in "Helping Yourself") and drug therapy is recommended. All patients with chronic HF due to left ventricle systolic dysfunction (means the heart muscle itself is weakened and not able to pump blood out of the heart as effectively as before) should receive an angiotensin-converting enzyme inhibitor (ACE-Inhibitor), unless the person is intolerant to or has a contraindication to the use of this class of drugs. ACE-Inhibitors are "vasodilators," which cause the peripheral blood vessels to dilate, or open up. This reduces the work of the heart by making it easier for blood to flow.

ACE-Inhibitors should even be used in HF patients who do not yet have symptoms of HF because these drugs have been shown in clinical studies to reduce the risk of disease progression and improve patient survival. In patients with fluid retention, ACE-Inhibitors are typically combined with diuretics.

Diuretics (aka, "water pills"), available since the 1950s, are used to help the kidneys get rid of excess water and sodium, thereby reducing blood volume and the heart's workload. These drugs can help alleviate HF symptoms like shortness of breath and lower extremity edema (fluid collection in the feet, ankles, & lower legs).

Patients who cannot tolerate ACE-Inhibitors should be treated with angiotensin II receptor blockers (ARBs). ARBs have been shown to improve survival in persons who have HF.

There may be special situations when a combination of an ACE-Inhibitor and ARB may be used. However, the role of this combination is not well-defined and is somewhat controversial.

Other "vasodilators" such as a combination of hydralazine plus nitrate therapy may be used if patients cannot tolerate either ACE-Inhibitors or ARBs. The hydralazine and nitrate combination is considered a second-line therapy and should not be used for the treatment of HF in patients who have not been previously treated with an ACE-Inhibitor. A newer drug called BiDil combines hydralazine and isosorbide dinitrate into one tablet. BiDil was shown in one study to improve survival in African American persons who have HF.

Beta-blockers are also a first-line recommendation for HF patients. These drugs decrease the heart rate as well as the overall work of the heart through vasodilation. Certain beta-blockers have been shown in clinical studies to reduce the risk of death associated with HF. All persons with stable, mild-to-moderate or moderate-to-severe HF due to left ventricular dysfunction (who do not have intolerance or contraindications) should have a beta-blocker (either bisoprolol, carvedilol, or metoprolol succinate) added to a regimen of an ACE-Inhibitor and a diuretic as early as possible.

Some clinicians recommend using digitalis (digoxin), a drug that has been used since the 18th century, to strengthen the heart's pumping action. Other clinicians contend that digitalis has not been shown to affect the normal course of HF. They recommend that it should be reserved for patients who still have symptoms of HF after being treated with an ACE-Inhibitor, diuretic, and a beta-blocker or for those patients who also have atrial fibrillation. While digoxin has not been adequately shown in clinical studies to reduce death from HF, it has been shown to improve HF symptoms and patient quality of life. Patients taking both diuretics and digitalis may need to supplement their levels of potassium.

In patients with severe heart failure, another type of diuretic can be added to treatment regimens consisting of an ACE-Inhibitor, diuretic, beta-blocker, and digoxin. Spironolactone (brand name: Aldactone), a potassium-sparing diuretic, has been shown in clinical studies to reduce mortality in patients with severe heart failure and thus, may be considered for use in these patients. Spironolactone blocks the action of aldosterone, a hormone that may exert adverse effects on the heart muscle and peripheral blood vessels. Spironolactone not only may improve fluid balance but may also decrease the risk of progression of HF. For patients with more severe forms of HF, spironolactone has been shown in clinical studies to reduce hospitalizations and death from heart failure. Spironolactone's efficacy and safety in patients with mild to moderate HF remains unknown.

Most recently, eplerenone (Inspra) received FDA approval for the treatment of heart failure that occurs following a heart attack. Eplerenone is a selective aldosterone receptor blocker, the first drug in this class. Individuals may be candidates for eplerenone therapy if they have documented heart failure proceeding a heart attack. For more information on the use of eplerenone following a heart attack, talk to your doctor or primary health care provider.

Sometimes, surgery proves effective. When HF is due to disease of the heart valves, surgery to repair the valve or implant an artificial heart valve may be helpful. Surgery is also used to correct congenital heart defects that can lead to HF. When HF is caused by partial or complete blockage of the coronary arteries, coronary bypass surgery or angioplasty may be used.

Heart transplants are a last resort in treating severe HF caused by diseased heart muscle. Although the success rate of heart transplants has significantly improved, the cost of the operation and shortage of donor organs makes it impractical except as a last resort.

Drug classes used to treat Heart Failure

ACE-Inhibitors
Aldosterone Receptor Blockers
Angiotensin II Receptor Blockers
Beta Blockers
Cardiac Glycosides
Diuretics
Nitrate and Peripheral Vasodilator Combination
Nitrates
Peripheral Vasodilators
Selective Aldosterone Receptor Antagonist

What is on the horizon?

Heart transplantation has become a widely used treatment of end-stage congestive heart failure. While the goal of treatment of HF is to avoid the need for transplantation, advances in the care of patients with heart transplants will make this a viable option for more people in the future.

Many drugs are being developed for heart failure. These drugs are currently undergoing clinical trials to see how effective they will be for heart failure, including carvedilol controlled-release.

Conivaptan and tolvaptan are two new drugs currently being studied for use in heart failure. These are vasopressin antagonists that may help rid the body of excess fluid to help relieve the "congestion" commonly seen in HF.

A new drug Bystolic, generic name is nebivolol, is being studied for a possible indication for heart failure. It is a beta-1 specific blocker. Similar to other beta blockers it works to reduce the force and rate of the heartbeat and decrease muscular tone in blood vessels. Also like other beta blockers, it can produce nitric oxide which will cause vasodilation thereby allowing blood to flow more freely. It is being studied because unlike other beta blockers it retains its beta specific action at higher doses which would equate to less side effects. A clinical trial comparing nebivolol to other beta blockers that are approved for the treatment of heart failure is currently underway.

Natriuretic peptides are being studied to see if they help urine output when combined with a commonly used diuretic called furosemide. The benefit will be that these two medications will be able to remove more fluid from the body resulting in less "congestion" which can make heart failure worse. Clinical studies are being performed to evaluate the effects of these medications together.

A process known as cardiac resynchronization is currently being studied for patients with heart failure. This process uses electrical stimulation to get the heart to pump better with a pacemaker. The long term effects are not yet known, but it is currently being evaluated to see if this process will be useful to heart failure patients.

Another process known as ultra-filtration is being studied to see if this process will help reduce fluid overload, thus reducing future hospitalizations and emergency room visits. This process is also known as kidney (renal) replacement therapy and is used experimentally in those individuals who have severe heart failure.

Eating Disorders and Medical Drugs Treatment

2008-07-18T15:12:00.001+08:00

Introduction

Even as Americans are becoming heavier than ever before, our society continues to place value on thinness and almost everyone worries about their weight at least occasionally. However, people with eating disorders take those weight concerns to extremes, developing abnormal eating habits that threaten their well-being and even their lives.

Simply put, eating disorders can be deadly. Self-starvation, binging and purging, or overly-excessive exercise because of an irrational fear of becoming fat may not just be a "fad" that one will easily outgrow. Many times, eating disorders are lifelong battles.

What is it?

An eating disorder is defined as a continual disturbance of eating or eating-related behavior that results in the altered consumption or absorption of food, significantly impairing physical health or psychological and social functioning.

Eating disorders are often long-term problems, which can cause immeasurable suffering for victims and their families. There are generally two recognized types of eating disorders:

Anorexia Nervosa (AN) - This disorder's name means "loss of appetite." In reality, the person has not actually lost their appetite, but chooses to deny the hunger because of an unreasonable fear of becoming fat. If left untreated, anorexia nervosa can be fatal, with an estimated fatality rate of 6% in serious cases.

Individuals with anorexia nervosa can be further categorized based on their eating behaviors.

Restrictive Type: Individuals with this specific type of anorexia nervosa limit the amount of food they eat, typically eliminating foods that contain fat. These individuals also tend to exercise excessively to assist in weight loss.
Binge Eating/Purging Type: These individuals are first diagnosed with the restrictive type of anorexia nervosa and then begin to regularly engage in the binge eating and purging behaviors that are more commonly linked with bulimia nervosa. (For definitions of binge eating and purging, see the section on bulimia nervosa.)

Bulimia Nervosa (BN) - This eating disorder is described by repeated episodes of binge eating, during which large amounts of food are consumed in a short period of time (sometimes as many as 20,000 calories). To be diagnosed with bulimia nervosa, binge eating needs to occur at least twice every week for a 3-month period. As a result of the repeated binge eating, the person often feels depressed and guilty.

Individuals with bulimia nervosa can be further categorized based on their purging behaviors.

Purging Type: Individuals with this specific type of bulimia nervosa will have an episode of binge eating followed by self-induced vomiting, abuse of laxatives and/or diuretics (water-pills) to avoid gaining weight from the binge.
Non-Purging Type: Individuals with this specific type of bulimia nervosa will have an episode of binge eating and then use other behaviors to offset the behavior, such as fasting or excessive exercise. Individuals with this type of bulimia nervosa do not regularly engage in self-induced vomiting or the misuse of laxatives and/or diuretics.

Many times it is difficult to differentiate between anorexia nervosa and bulimia nervosa. Every individual who resorts to binge eating and purging may not be classified as bulimic because of the subgroup of patients diagnosed with anorexia nervosa who may also display these behaviors. Furthermore, a large percentage of individuals may have both eating disorders at the same time. It has been estimated that 50% of anorexics will develop bulimia nervosa and that 30% to 40% of bulimics will develop anorexia nervosa.

Binge Eating Disorder (BED) - This eating disorder is characterized by recurrent consumption of large amounts of food without purging, fasting, or excessive exercise. The difference between binge eating disorder and non-purging type bulimia nervosa is the behavior that takes place after binge eating. In non-purging type bulimia nervosa after binge eating the individual will try to offset their calorie consumption by fasting or excessive exercise. In binge eating disorder the individual does nothing to offset the calorie consumption. The person eats to a point of uncomfortable fullness. Binge eaters focus less on their body image than people with anorexia nervosa and bulimia nervosa. A binge eater often eats alone and has feelings of shame or guilt after binging. Consequences of binge eating include death (approximately 300,000 deaths per year), obesity, and depression.

What causes it?

The exact cause of eating disorders is unknown; however, physical, psychological, personal, and social issues have been associated with triggering eating disorders.

The social pressure to be thin affects everyone to some extent. Society is flooded with messages on TV, in the movies, in magazines, on billboards, and on the Internet that thinness brings beauty, success, and happiness. These messages can also come from an individual's family structure, culture, and way of life. Social and cultural pressures along with a low self-esteem are thought to be the major causes for the development of anorexia nervosa and bulimia nervosa.

No one factor causes an eating disorder, but a few or a combination of factors may increase the risk. Here are some common psychological factors that may contribute to developing eating disorders:

For anorexia:

fear of growing up
inability to separate from the family
need to please or be liked
perfectionism
need to control
need for attention
lack of self esteem
high family expectations
parental dieting
family discord
temperament - often described as the "perfect child"
teasing about weight and body shape

For bulimia:

difficulty regulating mood
more impulsive - sometimes with shoplifting, substance abuse, etc.
sexual abuse
family dysfunction
If individuals are at risk of developing an eating disorder, sometimes all it takes to put the ball in motion is a trigger event that the individual does not know how to handle. A trigger could be something as seemingly harmless as teasing or as devastating as rape. Triggers often happen at a time in an individual's life when there is an increased demand on the resources of an individual who is already unsure of his or her ability to meet expectations. Such triggers may include puberty, starting a new school, beginning a new job, death of a friend or loved one, divorce in the family, marriage, family problems, or the breakup of an important relationship.
However, the most common trigger of eating disorders is dieting. When individuals who are at risk of developing an eating disorder excessively diet, making themselves constantly hungry, they may respond by overeating. These individuals then become panicky about the possibility of weight gain and then vomit, exercise excessively, or otherwise purge to get rid of the calories. Feeling guilty and perhaps horrified at what they have done, they swear to "be good." This usually means more dieting, which leads to more hunger, and repeats the cycle.

Who has it?

Currently, it is estimated that 7 million women and 1 million men suffer from an eating disorder. Eating disorders have reached epidemic levels in America in all segments of society; however, eating disorders are most common in individuals who have a higher social or economic background. This may be due to the fact that these individuals are continually striving to achieve the social standards of thinness in order to be accepted into their chosen career or lifestyle.

Almost all (86%) anorexics and bulimics begin their eating disorder related behaviors by the age of 20; however, reports that eating disorders are occurring in children 8 to 11 years of age are on the rise. Also, adults are not immune to eating disorders. A significant number of newly diagnosed anorexics and bulimics are in their upper 20s, 30s, and 40s.

It is estimated that about 6% of persons with serious cases of eating disorders die and only 50% report being cured. Therefore, it is a debilitating disease that has consequences if it is not realized (by the individual or people around them) and treated correctly.

What are the risk factors?

Risk factors are characteristics that can make you more likely to develop a condition. The risks associated with developing an eating disorder are related to the following:

Family history of anorexia nervosa or bulimia nervosa
Less than 20 years of age
Female gender
Participating in activities that focus on weight, appearance, and lean body mass (for example, ballet, modeling, gymnastics, acting, figure skating, running, diving)
Existing psychiatric illness such as obsessive-compulsive disorder (a type of anxiety distinguished by patterns of repetitive thoughts and behaviors) or depression.
Presence of personality traits such as being a perfectionist (having the best or expecting the best at all times) and low self-esteem

What are the symptoms?

The main symptom of anorexia nervosa is self-induced starvation. The main symptom of bulimia nervosa is binge eating with purging. The main symptom of binge eating is out of control eating without purging. These disorders may become a compulsive addiction such as alcoholism. Most patients with anorexia nervosa, bulimia nervosa, and binge eating disorder report psychological impairments (mainly depression), shame, guilt, and withdrawal from social events.

Because many people are concerned about their weight, most people diet at least once in a while; however, it may be difficult to distinguish between normal dieting behaviors and abnormal dieting behaviors that could develop into a serious eating disorder. Not every individual will show all of the characteristics listed below for anorexia nervosa and bulimia nervosa, but people with eating disorders may clearly show several of them.

Signs of anorexia nervosa may include the following:

Intentional self-starvation associated with weight loss
Intense, persistent fear of gaining weight
Refusal to eat, except tiny portions
Pretending to eat and trying to hide that you are not eating from others
Continuous dieting
Excessive facial/body hair due to inadequate protein in diet (malnutrition)
Abnormal, rapid weight loss
Hair loss - mainly on the head
Dry, cracked, or discolored skin
Sensitivity to cold temperatures
Absent or irregular menstruation

Signs of bulimia nervosa may include the following:

Constantly thinking about food
Binge eating, usually in secret
Vomiting after binging
Abuse of laxatives, diuretics, diet pills
Denial of hunger
Denial of induced vomiting
Swollen salivary glands

Anorexia nervosa and bulimia nervosa are closely related and several characteristics of the two eating disorders often overlap.

Signs associated with both anorexia nervosa and bulimia nervosa may include the following:

Poor body image (constant thoughts of thinness)
Malnutrition
Anxiety
Lethargy (sluggish, inactive, or slow moving)
Decreased concentration
Abdominal pain
Constipation/diarrhea
Bloating
Compulsive exercise (a person feels compelled to exercise and struggles with guilt and anxiety if she or he doesn't exercise)

If continued, the starving, binge eating, and purging can lead to irreversible physical damage and even death. Eating disorders can affect every cell, tissue, and organ in the body. The following is a list of some of the physical and medical dangers associated with anorexia nervosa and bulimia nervosa.

Malnutrition (can lead to loss of muscle and bone density [osteoporosis] resulting in dry, brittle bones)
Severe dehydration, which can result in kidney failure and chemical imbalances (can lead to seizures, irregular heartbeats and possibly heart failure and death)
Tearing of the esophagus from excessive vomiting
Chronic irregular bowel movements and constipation as a result of laxative abuse
Potential for a ruptured stomach during periods of binge eating
Tooth decay and gum erosion from stomach acids released during frequent vomiting
Irregular menses or absence of menstruation
Abnormally low blood pressure

How is it treated?

There are many factors that contribute to the development of an eating disorder, and because each individual's situation is different, the "best treatment" must be tailored for that individual. The process begins with an evaluation by a physician or psychiatrist. From there, a variety of approaches are used to treat individuals with anorexia nervosa and bulimia nervosa.

The intensity of the treatment required and the need for outpatient (appointments with a doctor at an office) or inpatient (hospitalization) therapy should be determined based on the severity of the individual's disease. Determining the seriousness of the associated medical complications and psychological problems will lead to the evaluation of disease severity.

Hospitalization may be needed for those individuals who exhibit the following:

A significant weight loss (more than 30% less than normal weight); particularly if the weight loss has been recent and rapid
Medical complications such as seizures, heart failure, or irregular heart rhythms
Chemical imbalances or dehydration
An overriding psychiatric problem such as depression or thoughts of suicide
No response to outpatient treatment after 3 to 4 months

The goals of outpatient treatment of eating disorders are nutritional rehabilitation (balanced diets), weight restoration, stopping weight loss behaviors, improvement in eating behaviors, and improvement of psychological and emotional states. The goals for hospitalized individuals are the same as outpatient management but with increased intensity. If a patient is admitted to the hospital for treatment, resolving medical complications and stabilizing nutritional status are the first and most important goals. If severe weight loss and malnutrition are apparent, intravenous feeding (receiving nutrition through one's veins) will be needed.

Psychotherapy

Once the malnutrition has been corrected and the individual begins to experience weight gain, psychotherapy can be used to help individuals overcome low self-esteem and address distorted thought and behavior patterns. Psychotherapy is a form of behavioral therapy that focuses on the individual's emotional and psychological well-being. Forms of psychotherapy include psychodynamic, cognitive, family, and group therapy.

Psychodynamic therapy is a general name for approaches that attempt to get the individual to surface his or her true feelings and then to understand those feelings. This therapy focuses on the basic assumption that everyone has an unconscious mind (sometimes called the subconscious) and that feelings held in the unconscious mind are often too painful to be faced. Psychodynamic therapy helps the individual to deal with subconscious feelings.
Cognitive therapy focuses on changing negative thoughts and behaviors and recognizing what triggers them. Cognitive therapy may focus on weight restoration with meal planning, assistance with developing regular eating patterns, and discouraging the use of dieting. This type of behavioral therapy provides a structured, safe, and supportive environment to discuss the foods the individual fears most.
Family therapy is important for patients who live at home because family dynamics play an important role in eating disorders. Parents and siblings can be deeply affected by the presence of an eating disorder within the family and need an outlet to understand the disease and recovery process. Family therapy provides a meeting place to communicate concerns and needs between the family and the patient.
Group therapy, when the individual is ready, this can be an important source for peer support. Goals of group therapy typically include the following: (1) exploring underlying emotional conflicts that may be expressed by eating behaviors, (2) sharing problem solving and effective coping strategies, (3) developing realistic weight goals and a healthy relationship with food, and (4) improving interpersonal communications. These groups often focus on exploring the roots and influences of negative body image on the individual and work towards body acceptance.

Nutritional Therapy

A professional nutritionist or dietician can help patients learn how to manage their weight effectively. Individualized guidance and a meal plan that provides a framework for meals and food choices (but not a rigid diet) are helpful for most individuals. Nutritionists can also help individuals better understand how their eating disorders can create serious medical problems.

Drug Therapy

Drug therapy in the treatment of anorexia nervosa and bulimia nervosa should be used in combination with psychotherapy and nutritional therapy.

For anorexia nervosa, medications are used most frequently after weight and normal eating behaviors have been restored. Medications including certain antidepressants, antipsychotics, and gastrointestinal stimulants are used to treat psychiatric and gastrointestinal symptoms that may coincide with eating disorders. Also calcium plus vitamin D supplementation is recommended for people with low bone mineral density (BMD) because of their high risk of developing bone loss and/or osteoporosis.

For bulimia nervosa, medications are used to reduce the frequency of disturbed eating behaviors such as binge eating and vomiting. Medications are often used to improve symptoms that may accompany depression, anxiety, or obsessive behaviors. The medications used in the treatment of bulimia nervosa include antidepressants, the antipsychotic drug lithium, and the anticonvulsant drug topiramate (brand name: Topamax). Although lithium is now falling out of favor due to ineffectiveness in bulimia nervosa, its side effect of weight gain, and need of frequent blood monitoring to avoid toxic drug levels. The long-term benefits of using antidepressants for bulimia nervosa are unclear, as relapse rates are high with up to 80% of patients relapsing.

For binge-eating, medications are used to reduce the frequency of binging and also to cause weight loss in binge eaters who are obese. The medications used in the treatment of binge-eating include antidepressants, anticonvulsants topiramate and zonisamide, and the appetite-suppressant sibutramine (brand name: Meridia).

To learn more about the drugs used to treat eating disorders, click on the drug class links below.

Although eating disorders are treatable and many people recover from them, recovery is a complex process that can take several months or even years. Some individuals do better than others - the success often depends on the individual's drive to seek help and reach out to their support system. Seeking treatment from physicians and psychiatrists typically offers the greatest success in the recovery process.

Drug classes used to treat Eating Disorders

Anticonvulsants
Atypical Antipsychotics
Miscellaneous Antidepressants
Noradrenergic/Serotonergic Agent
Promotility Agents
Selective Serotonin Reuptake Inhibitors
Typical Antipsychotics

Anxiety and Medical Drugs Treatment

2008-07-11T15:04:00.002+08:00

Introduction

Most of us have experienced symptoms of anxiety at some point in our lives. A pounding heart, tense muscles, rapid breathing, perfuse sweating, or an upset stomach characterize a few of the many symptoms associated with the condition. Perhaps you have felt anxious when you have given a speech, taken a test, or driven in heavy traffic. While this kind of tension may have felt uncomfortable, it also helped you cope. You had a reason to be anxious, and the tension it caused kept you aware and ready to react. Now imagine feeling anxious for no apparent reason.

What is it?

Generally, anxiety is a complex, a normal emotional state that occurs when an individual senses an unclear danger. When anxiety ceases being a protective response, the person suffering from an anxiety disorder. Anxiety disorders may arise from an individual's brain chemistry, genetics, personality, and life events. Within the brain, cells communicate with one another through the intake and discharge of chemical substances known as neurotransmitters. Imbalances in neurotransmitter production may produce the severe symptoms that accompany anxiety disorders. The neurotransmitters that are associated with anxiety disorders are norepinephrine, serotonin, and gamma-aminobutyric acid (GABA).

There are five general types of anxiety:

Obsessive-Compulsive Disorder
Generalized Anxiety Disorder
Exaggerated Fears (Phobias)
Panic Disorder
Post-Traumatic Stress Disorder

What causes it?

There are several theories about what causes anxiety disorders. They include the following:

Family history
Drug use or withdrawal
Traumatic events
Severe or long-lasting stress
Medical or psychiatric illnesses

Who has it?

According to the National Institutes of Mental Health, 40 million Americans 18 years and older suffer from anxiety disorders every year. Of those 40 million, 6.8 million suffer from Generalized Anxiety Disorder, GAD, while 6 million American adults suffer from panic disorder. GAD and panic disorder affect twice as many women as men.

Specific phobias, which are intense and irrational fears of specific things or situations, affect 19.2 million American adults. Specific phobias are twice as common in women as men. Social phobia affects approximately 15 million American adults per year, whereas agoraphobia (fear and anxiety of any place or situation where escape might be difficult) affects 1.8 million American adults per year.

Obsessive-compulsive disorder affects both genders equally and is seen in about 2.2 million American adults. Though it is seen in about 7.7 million American adults, Post-Traumatic Stress Disorder, PTSD, can occur at any age and affects more women than men.

What are the risk factors?

Risk factors are characteristics that increase the likelihood that you will develop a particular condition. Common risk factors for anxiety disorders are:

a family history of anxiety disorders
past negative experiences (e.g. family conflict or sexual abuse)
buildup of stress
medical illness, such as heart or respiratory ailments
psychiatric illness, such as depression or dementia
medication use or discontinuation
withdrawal after discontinuing certain substances, such as alcohol
drug abuse

What are the symptoms?

Physical symptoms include blushing, sweating, dizziness, abdominal discomfort, sleep disturbances, shortness of breath, heart palpitations (a sensation of rapid or pounding heartbeats), chest pain, and fatigue.

Mental symptoms include poor concentration, feeling out of control, sense of fear or dread, and feelings of panic.

Behavioral symptoms include inability to be still or calm, avoidance of stressful situations, and poor coping skills.

How is it treated?

Anxiety disorders are treated with specific types of psychotherapy, medications, or a combination of both. A number of different medication classes are used to treat anxiety disorders, but will not cure them. Certain drug classes have greater effectiveness on specific anxiety disorders than others. For an acute anxiety attack, short-term treatment with benzodiazepines is generally used first. To help prevent episodes of anxiety, selective serotonin reuptake inhibitors, serotonin norepinephrine reuptake inhibitors, or buspirone are generally tried first. Other choices may include tricyclic antidepressants, beta-blockers, and, rarely, monoamine oxidase inhibitors. Some of these drugs may be used together if needed to control anxiety.

Each drug class has their benefits and risks. For instance, elderly individuals may have to take different doses compared to younger individuals due to changes in how the body metabolizes medications. Some medications may have dietary restrictions, while other medications may have important drug interactions that the patient needs to be aware of. In addition, there are sometimes side effects with the use of anti-anxiety medications. With all of these precautions, doctors must carefully evaluate the individual's condition before prescribing an anti-anxiety medication. Additionally, because treatment may take several weeks to work best, the doctor should closely monitor the individual's condition and treatment strategy for effectiveness, side effects, and toxicity.

Drug classes used to treat Anxiety

Benzodiazepines
Beta Blockers
Miscellaneous Anxiolytics
Monoamine Oxidase Inhibitors
Selective Serotonin Reuptake Inhibitors
Selective Serotonin and Norepinephrine Reuptake Inhibitors (SNRI)
Tricyclic Antidepressants

What is on the horizon?

A new study funded by the National Institute for Mental Health is investigating the cost and benefits of excluding benzodiazepines, a common class of drugs used in anxiety, from the new Medicare Part D plans. When Medicare Part D formularies were developed, benzodiazepines were excluded from coverage because it was felt that they contributed to worsening overall health in the elderly by increasing falls and fractures and worsening conditions such as emphysema and depression. This research aims to uncover how the exclusion of benzodiazepines has affected overall health, as well as the treatment of anxiety disorders, in older adults. It is not clear at this time whether the results of this study could change the formulary decisions for Medicare Part D.

Today, SSRIs are usually the 1st line medications for most anxiety disorders. Current research focuses on developing new drugs that will correct imbalances in the chemistry of the brain causing anxiety disorders. Around 50% of persons with anxiety can be treated with an SSRI. The question remains, how should the others be treated? Many drugs are being tested for their use in anxiety. Strattera is a drug that has been used for Attention Deficit Hyperactivity Disorder (ADHD), and is currently being studied for the possible treatment of anxiety. Seroquel, an antipsychotic is also being studied for its potential benefits for major depression and generalized anxiety disorder. For alcoholics who suffer from anxiety, levetiracetam (Keppra), an anti-seizure medication, is also being tested.

New drugs such as AZD7325 is in phase II trials for generalized anxiety; AA21004 is in phase III trials for mood and anxiety disorders.

Researchers have also found that there may be a potential link between anxiety and balance problems in children. Although not all children with anxiety have balance problems, but the ones with balance problems do exhibit symptoms of anxiety. The study found that through a 12 week sensory-motor intervention, children were able to improve their balance skills and also helped to reduce anxiety to normal levels; they also found that as their balance and anxiety issues improved, their self-esteem also increased. Cognitive therapy is more difficult with children due to maturity levels and lack of operational thinking; therefore, researchers are exploring the role of occupational therapy in these children.

Conjunctivitis "Pink Eye" and Medical Drugs Treatment

2008-07-04T12:35:00.002+08:00

Introduction

Bothered by red, itchy eyes that feel puffy and seem to be draining constantly? It might be a case of conjunctivitis, and you may benefit dramatically by consulting your personal health care provider to evaluate treatment options.

What is it?

Conjunctivitis (often referred to as "pink eye") is a general term to describe an inflammation or infection of the conjunctiva. The conjunctiva is a thin, colorless membrane that lines the eyelid and a portion of the eyeball. Once irritation occurs, the lining then becomes red and swollen. Pink eye is a common eye disease; however, it may be contagious and easily spread. There are several types and causes of conjunctivitis.

What causes it?

Conjunctivitis may result from allergic, bacterial, and viral irritants; however, viral causes tend to be the most common cause of conjunctivitis.

Seasonal allergic conjunctivitis usually stems from an air-born irritant such as ragweed, pollen, or mold. Allergic conjunctivitis can also occur due to an allergic reaction to smoke, chlorine in swimming pools, or other products that come in contact with the eyes. When the conjunctiva is exposed to the irritant, a chain of events leads to the swelling, itching, and redness, which are often associated with this form of conjunctivitis. First, the irritant is detected and marked by the body's immune system as foreign, unlike other cells. Then the target is marked for elimination. Combatant cells, called mast cells, arrive on the scene to remove the foreign attacker and cause the release of various inflammatory substances such as histamines. Histamines cause the uncomfortable symptoms associated with allergic conjunctivitis such as red, watery, itchy eyes. Allergic conjunctivitis is not contagious or infectious.

A similar chain of events occur when the conjunctiva is exposed to bacterial or viral irritants. Bacterial and viral conjunctivitis are usually associated with a cold and both usually produce a discharge from the eye. Bacterial and viral conjunctivitis can be extremely contagious, and treatment should be sought immediately to prevent the spread to others. Practicing good hygiene (such as frequent hand washing) can also help prevent the spread of pink eye.

Who has it?

Conjunctivitis is a worldwide ailment and affects all ages, races, and both genders. It is commonly self-referred, that is, patients recognize the symptoms and report them to their healthcare provider. It is espically common among children.

Bacterial conjunctivitis seems to be more prevalent in children and in newborns when the cause may be an incompletely open or blocked tear duct.

What are the risk factors?

The risk factors associated with conjunctivitis are dependent on the cause of the infection or inflammation and, in some cases, age.

The most common seasonal allergic conjunctivitis risk factor is exposure to an environmental irritant. Specific environment irritants change with the seasons.

In the case of bacterial conjunctivitis the risks vary with age. For new born infants, bacteria may be transferred from the mother during vaginal delivery. The factor that increases the risk of infection in the infant is less than adequate prenatal care for the mother. For infants and children the bacteria may be spread by exposure to an infected individual or by chronic ear infections. Adults may contract bacterial conjunctivitis from contact, tear deficiency, poor hygiene, or trauma.

Risk for viral conjunctivitis may be increased if one is exposed to an infected individual or if there is a history of sinus infections and congestion.

If the form of conjunctivitis is contagious, it is important to take steps to reduce the chance of spreading it by limiting direct contact and practicing good hygiene. This includes:

Avoid touching or rubbing the infected eye(s).
Wash hands with soap and water frequently.
Avoid sharing and re-using towels or other items that come into contact with the hands or eyes.
Properly clean contact lenses.
Do not use anyone else's eye cosmetics (i.e. mascara) or personal eye-care items.

Persons with viral or bacterial conjunctivitis may stay contagious for 1 to 2 weeks after signs and symptoms first appear.

What are the symptoms?

When the conjunctiva becomes irritated or inflamed, the blood vessels around the eyes dilate (become larger) and become more noticeable, making the eye(s) appear red.

Seasonal Allergic Conjunctivitis

Red and itchy eyes
Watery or mild mucous (milky) discharge
Generally occurs in both eyes

Bacterial

Red and itchy eyes
Watery or milky discharge or pus-like discharge
Can occur in one or both eyes
Can exhibit slight or marked swelling around the eye

Viral

Red and itchy eyes
Watery discharge
Can occur in one or both eyes
May be present only for a very short time
May be associated with a respiratory infection or sore throat

How is it treated?

Appropriate therapy for conjunctivitis is varied and depends on the diagnosis and severity of the symptoms the person is experiencing. To get suitable treatment, a thorough evaluation from a qualified healthcare provider is recommended. The healthcare provider may assess the condition in a variety of ways including: evaluating the symptoms reported, examining the affected area, or taking bacterial cultures for analysis.

According to the American Optometric Association, the goals of treatment include:

To increase comfort
To reduce or lessen the course of infection or inflammation
To prevent the spread of conjunctivitis

Below are explanations of some the treatment options grouped according to type of conjunctivitis. The best option for your condition will be determined by your healthcare provider based on diagnosis, severity and symptoms.

Seasonal Allergic Conjunctivitis

Allergic conjunctivitis may disappear completely when the allergy is managed appropriately. Being aware of and removing allergic trigger(s) may help to avert the symptoms associated with this type of conjunctivitis.

Multiple eye drops or ointments (ophthalmic products) are available to treat the symptoms of allergic conjunctivitis. Oral antihistamines may be used if allergy symptoms involve more than just the eyes.

Applying cool compressess and artificial tears may aid in reducing discomfort in mild cases.

Bacterial

Although this type of conjunctivitis, if mild, may resolve without treatment, it is best to have a healthcare practitioner evaluate the appropriate management. Severe bacterial conjunctivitis is characterized by thick pus-like discharge, pain, and marked inflammation of the eye. Your doctor will likely prescribe an ophthalmic antibiotic for treatment of this condition.

Viral

There are no specific treatment options to treat this type of conjunctivitis. Like the common cold, the virus has to run its course, which may take up to several weeks. In this situation your provider will educate you on how to reduce symptoms and prevent spreading the infection to the other eye or to other people.

Your doctor may also suggest ophthalmic steroids to reduce discomfort from the swelling. Artificial tears and cold compresses may be used ease pain and dryness. Alternatively, the physician may choose to thoroughly rinse the eye with a saline solution. This rinsing will help the eye shed the viral particles causing the infection. These treatments may help relieve symptoms, but will not shorten the course of the infection.

Finally, if the symptoms do not improve within 3 to 5 days, return to the doctor for follow-up. It may mean that your condition is more severe than first thought or that the initial treatment is not working sufficiently to improve symptoms.

Drug classes used to treat Conjunctivitis "Pink Eye"

Ophthalmic Antibiotics
Ophthalmic Antihistamine and Mast Cell Stabilizer Combinations
Ophthalmic Antihistamines
Ophthalmic Mast Cell Stabilizers
Ophthalmic Steroids
Ophthalmic non-steroidal anti-inflammatory drugs

What is on the horizon?

Treatment options for allergic seasonal conjunctivitis have expanded in recent years. Most notable are the oral antihistamines, such as loratidine and cetirizine, which are both now available over-the-counter. These oral antihistamines can be helpful in preventing allergic conjunctivitis when used appropriately prior to the presentation of symptoms. However, be aware that these medications may cause side effects such as drowsiness, dryness, and irritability.

Recently, an ophthalmic drop that is an antihistamine and a mast cell stabilizer was approved for over-the-counter use as a long-term treatment for patients with allergic conjunctivitis. This product, Zaditor, with the active ingredient ketotifen, is the first available over-the-counter product for long-term treatment of allergic conjunctivitis since past over-the-counter products containing other ingredients such as decongestants are not safe for more than short-term use.

Newer antibiotics are being evaluated for their effectiveness in the treatment of bacterial conjunctivitis. These new developments will provide physicians with more options for treatment. It is probable that the newer antibiotics will have less side effects and a shorter duration of treatment time for patients with this condition.

One example is the newer antibiotic ophthalmic drop, AzaSite, which contains the macrolide antibiotic azithromycin. This product's advantage is that it stays on the eye surface longer so it can be dosed less frewuently. It can be administered twice daily for the first two days of therapy and then once daily for the remainder of the therapy. Other antibiotic drops require administration between three and four times daily, sometimes more which can decrease compliance.

Depression and Medical Drugs Treatment

2008-06-27T12:19:00.002+08:00

Introduction

Sadness is a natural reaction to a disappointing event. Usually after something happens that makes us sad, we rebound. But sometimes, we don't. When sadness exists over a steady period of time and seems to occur for no apparent reason, it may be called "clinical depression." It's important to realize that this type of depression is a medical illness - not a sign of weakness. It cannot be "willed away" nor is it "all in your head." The good news is that in most cases, it can be successfully treated.

What is it?

Depression is an illness that can cause noticeable changes in your moods, your perceptions of yourself and your environment. There are several types of depression, each varying in the number, severity and length of symptoms.

In real life, depression does not always fall into neat categories. It is sometimes hard to know when depression crosses the line from being a normal reaction to a difficult life situation to being a depressive illness. Friends, relatives, and busy family doctors often miss the symptoms of a major depression, particularly in the case of an elderly person who may have other medical concerns. Depression in an adolescent or teenager may be mistaken for the normal mood swings that seem to happen at this age. This is one of the reasons why clinical depression if often not diagnosed and treated.

Post-Partum Depression
Adjustment Disorder with Depressed Mood
Mild Depression (Dysthymia)
Normal Depressed Mood and Grief
Major Depression
Bipolar disorders
Seasonal Affective Disorder (SAD)
Atypical Depression

What causes it?

Depression is thought to be due to a combination of mental and physical factors; although it may also occur (or reoccur) at any time for no obvious reason. Some individuals appear to be genetically predisposed to depression and may, therefore, have a family history of it. Other factors involved in the development of clinical depression can be related to:

extreme stress
trauma
physical illness
environmental conditions

Clinical depression also can occur if some of the chemicals in your brain are not functioning effectively. A decrease in the amount of the following chemicals in your brain can affect your mood:

dopamine
norepinephrine
serotonin

Who has it?

The true prevalence of depression in the United States is unknown. According to the National Institute of Mental Health, in 2003, 35 million Americans (more than 16% of the population) suffer from depression severe enough to warrant treatment at some time in their lives. In addition, one out of every four adults experiences depression at some point in life with about 7% of Americans living with depression in a given year. Depression is two to three times as frequent in women as in men; although anyone, including children, can develop depression. According to the World Health Organization in their 2002 report, depression (including complications of depression) was the fourth leading cause of premature death and disability worldwide in 2000 and will be the second greatest cause of this by the year 2020.

While there is help for depression, nearly two-thirds of depressed people do not seek or receive appropriate treatment.

Authorities estimate that depression costs the nation $43 billion a year for medications, professional care, and time lost from school and work. Of that figure, the direct cost of medication and treatment is estimated at $12 billion. However, these figures do not reflect the toll that depressive illness takes on the lives of family members and loved ones. There is also an economic cost for the premature deaths of individuals whose depression impacts on their health, as well as for deaths by suicide. Each year, tens of thousands of depressed people attempt suicide and, sadly, about 16,000 succeed.

What are the risk factors?

Risk factors for depression include the following:

Family history of depression (3 times greater risk)
Age (highest incidence between 20-40 years old)
Postpartum (greater risk 6 months following delivery for women)
Marital status (associated more with married and divorced individuals. Single individuals that have never been married have the least risk).
Major stresses at home or work
Medications such as some drugs used for high blood pressure, sleeping pills, heartburn, or birth control pills
The loss of a loved one
Reaching your senior years
Having an overall negative attitude
An inability to handle stress
Medical conditions such as heart disease, stroke, diabetes, cancer or Alzheimer's disease, Parkinsons disease, Multiple sclerosis, certain infections, and thyroid disorders.
Eating disorders
Abuse of drugs or alcohol

What are the symptoms?

Depression is frequently overlooked, because it can present itself in a range of signs and symptoms that are not necessarily obvious, particularly because there may be no clear cause, or triggering event. The condition often manifests itself in physical symptoms like headaches, back pain, and chronic fatigue. There are also non-physical symptoms of depression that are sometimes harder to identify or separate from everyday behavior and can last weeks, months or even years if not treated, these symptoms include:

A persistent feeling of worthlessness or sadness
A numb or empty feeling or the absence of any feelings at all
An inability to experience pleasure in hobbies and activities that were once enjoyed
Irritability
Restlessness
Insomnia, early-morning awakening, or oversleeping
Abrupt changes in eating habits; decreased appetite and/or weight loss or overeating and weight gain
Difficulty concentrating
Decreased ability to perform normal daily tasks
Recurrent thoughts of death or suicide

Depression can also be associated with other disorders, such as alcoholism, anorexia, anxiety, and obsessive-compulsive disorders. This can make it hard to correctly diagnose a patient with depression.

Diagnosis of Depression
Symptoms of Bipolar Disorder
Depression in Adolescents
Depression in the elderly

How is it treated?

Severe depression is a complex illness that should be treated by professionals who are familiar with all of its manifestations. A complete clinical evaluation will include a physical examination, a medical and psychiatric history, and a mental status examination.

The first step in the treatment of depression is a physical examination. This is done to rule out disorders like thyroid disease, anemia or a recent viral infection, which can produce symptoms similar to those found in a depressive illness. In an estimated 20 to 25 % of major depressive episodes, the cause is an underlying factor such as a particular medication or a medical condition.

A neurological examination should also be done to rule out the possibility that the depressive symptoms are being caused by a neurological disorder.

An important part of the evaluation should be a detailed case history, which can give the family practitioner or mental health specialist valuable clues about the person's condition. Usually, the doctor will ask about the reasons for the visit and carefully discuss all of the person's symptoms. This will permit the doctor to evaluate whether specific events in the person's life could be contributing to their depression or whether the depression appears to have occurred for no obvious reason. The doctor will probably also inquire whether other family members have suffered from depression. A vital element of this examination is to assess the severity of the depression, particularly whether there is any danger that the patient will attempt suicide. In cases such as this, the individual may be hospitalized until the danger passes.

The treatment of depression is tailored to the individual, with the severity and cause of the depressive episode taken into account. Antidepressant medications are frequently prescribed, but it is usually helpful for depressed individuals to receive some form of psychotherapy as well.

The two most common types of antidepressants used are selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs). With these medications, it may take up to eight weeks before an improvement in depressive symptoms is seen. Since it can take several weeks for the symptoms of depression to improve after treatment has begun, it is helpful for friends and family to encourage the depressed person to continue taking his or her medication. In some cases, different types of antidepressants will need to be tried to find the right match. Antidepressants may cause significant side effects, so drugs and dosages must be monitored closely by a doctor. SSRIs are associated with fewer side effects than TCAs or monoamine oxidase inhibitors (MAOIs). Treatment is usually evaluated six weeks after starting an antidepressant medication. It is then generally re-evaluated after 12 weeks. If the person improves somewhat on a particular medication, treatment can appropriately be continued with dosage adjustments. If there is no improvement, however, treatment should be augmented or changed.

Usually, by the twelfth week of treatment, the most suitable medication for the person has been established. If the individual clearly appears to be benefiting from the medication, it should be continued for four to nine months. After this time, maintenance therapy may be considered.

Studies are ongoing to establish the optimal length of time that antidepressant medications should be taken. Most mental health professionals now recommend that persons who suffer from recurring episodes of major depression and those with bipolar, or manic-depressive disorders stay on maintenance therapy.

Treatment Overview of Depression

Treating Adolescent Depression
An estimated 2-10% of children and adolescents in the U.S. have depression. In light of this, it is important to try and find the best therapy for this younger population with the fewest side effects. However, in recent years, several antidepressant medications have been in the news due to reports of increased suicide risk among adolescent users. Because of these reports, beginning in 2004, the U.S. Food and Drug Administration (FDA) now requires manufacturers to add a black-box warning to the labeling of antidepressant medications to inform healthcare providers and the public of the increased risk of suicidal tendencies in adolescents who use antidepressants. This warning was extended by the FDA in May 2007 to include young adults aged 18-24 years who are just starting antidepressant therapy (usually the first 1-2 months of antidepressant therapy). A medication guide has also been developed to be distributed at the pharmacy with each new or refilled prescription for antidepressants. This doesn't mean that antidepressants shouldn't be used to treat younger depressed persons; however, more caution needs to be exercised to determine if the benefits of the antidepressant truly outweigh the potential risks.
Treatment Options
First-line treatment options for depression in adolescents include Cognitive Behavioral Therapy (CBT), interpersonal psychotherapy, antidepressants, psychosocial intervention, or a combination of the above. Non-drug options should be generally considered before starting a medication for depression.
The only antidepressant medication officially approved by the FDA for children 8 years of age or older is fluoxetine (brand name: Prozac). This generally should be the first medication considered. Other antidepressant options that are available but with less evidence to support their use in children and adolescents include sertraline (brand name: Zoloft) and paroxetine (brand name: Paxil).
If antidepressant medication is used in a child or adolescent, he or she should be monitored closely due to the potential increased risk for suicidality (thoughts or attempts of suicide). All pediatric patients being treated with antidepressants for any indication should be observed closely for clinical worsening of their depression, suicidality, and unusual changes in behavior, especially during the initial few months of therapy, or any time the antidepressant dose is changed. Monitoring should include at least weekly face-to-face contact with the child or adolescent or their family members or caregivers during the first 4 weeks of treatment, then every other week visits for the next 4 weeks, then at 12 weeks, and as clinically indicated beyond 12 weeks. Additional contact by telephone may be appropriate between face-to-face visits.

Drug classes used to treat Depression

Miscellaneous Antidepressants
Monoamine Oxidase Inhibitors
Selective Serotonin Reuptake Inhibitors
Selective Serotonin and Norepinephrine Reuptake Inhibitors (SNRI)
Tricyclic Antidepressant & Benzodiazepine Combination
Tricyclic Antidepressants

What is on the horizon?

Because the newer antidepressants are effective and widely used, most current research focuses on compounds that work like the drugs that are already on the market.

Other drug research involves products that affect dopamine or serotonin and dopamine together. Researchers are also studying a different type of drug called an alpha-1 adrenergic blocker. Drugs developed from these studies may improve mood, energy and alertness. Among the non-drug therapies being studied is one that uses the magnetic stimulation of the brain as an alternative to conventional shock treatment. Investigators are also studying the benefits of light therapy to treat seasonal depression, which can be a problem during winter months.

Because of the high public interest in herbal remedies for minor depression, the National Institute of Mental Health has launched a study to determine the safety and effectiveness of St. John's Wort, a common herbal supplement, and citalopram, a prescription antidepressant, compared to placebo. This study started in Februrary 2003 and is still ongoing. Once finished, researchers will assess the changes in a patient's symptoms, functioning, and quality of life.

A current research question is how best to maintain the benefits of electroconvulsive therapy (ECT) over time. Although ECT can be very effective for relieving acute depression, there is a high rate of relapse when the ECT treatments are discontinued. One study has compared maintenance medication therapy to maintenance ECT. This study found high relapse rates with both medication and ECT and neither was superior to the other. However, the medication regimen used included nortriptyline and lithium, which may have more side effects and may be less effective than SSRIs (another widely used antidepressant drug class). Because of this, a study comparing SSRIs to ECT or one that includes both medication plus ECT to avoid relapses may be warranted in the future.

Research continues in the quest to more clearly identify the causes of depression. Studies that are underway are examining genetic and environmental factors that may have a role in depression. A possible relationship between the substances released from the body when inflammation occurs and the onset of depression in healthy men has just recently been discovered. A study showed that men with depression had higher levels of inflammatory substances in their blood circulation than men without depression.

Another study showed that the drug, ketamine (a drug more commonly used for anesthesia during surgery), demonstrated rapid antidepressant effects. These effects were seen within hours as opposed to weeks or months for current therapy. Ketamine probably would not be the drug of choice for depression because it is used as an anesthetic and has been abused recently as a "party drug." Therefore, research has shifted to other drugs.

A study done in 2006 used Namenda (memantine), a medication currently approved to treat Alzheimer's disease, for persons with major depression. The trial was ended early because no effect was noticed; but low doses of the drug were used. Therefore, higher doses of memantine should be evaluated for major depression. Once the causes of depression are better identified, new treatments and techniques for prevention can be developed.

Breast Cancer and Medical Drugs Treatment

2008-06-20T12:09:00.002+08:00

Introduction

It has become a popular fashion statement to support different charities or organizations by wearing ribbons or the even more popular wrist bands. Perhaps the most notable are the yellow wrist bands started by Lance Armstrong to support his charity. However, if you take a close look you will see that many people are showing their support for breast cancer by wearing pink ribbons and bracelets. Breast cancer has unfortunately become so widespread that nearly everyone knows someone that has suffered from this terrible form of cancer.

What is it?

Each month, a woman's breast goes through changes associated with menstruation that can cause a lump to form. While the majority of these lumps are benign (or non-cancerous), each lump should be examined. Lumps are most commonly formed in breast tissue lobules, (small sacs that produce milk), or the ducts that carry milk to the nipple. However, lumps can also form in other breast tissue.

When a lump is found to be malignant, breast cancer is diagnosed. Breast cancer is divided into two main categories: lobular and ductal carcinomas. Breast cancer is also categorizes as non-invasive or invasive.

Breast cancer typically starts with the formation of a small confined tumor. Some tumors are benign, thus not invading other tissue; other are malignant or cancerous. These malignant tumors have the ability to metastasize, which means they spread to other tissues or regions in the body. The larger a tumor grows, the more likely it is that small pieces or cells will break off and spread to other parts of the body through the bloodstream or lymph system. Different types of breast cancer grow and spread at different rates; some may take years, while others may grow and spread much more quickly.

Four Main Types of Breast Cancer Exist:

Invasive Ductal Carcinoma (IDC): Invasive ductal carcinoma (also known as IDC) is the most common form of invasive breast cancer accounting for 75 percent of all invasive breast cancers. These tumors commonly spread to lymph nodes in the armpits. IDC is typically an aggressive cancer and has an increased risk of death compared to other types of invasive breast cancers. IDC metastasizes commonly to different areas of the body including bone, the liver, lung or brain

Invasive Lobular Carcinoma (ILC): Another type of invasive breast cancer is known as invasive lobular carcinoma (or ILC), which accounts for 5 to 10% of breast tumors. ILC more commonly spreads or metastasizes to unusual sites such as the layers that cover the brain and surfaces that cover organs.

Ductal Carcinomna In Situ (DCIS): A form of breast cancer that is non-invasive is known as ductal carcinoma in situ (DCIS). DCIS is the most common type of non-invasive breast cancer and is diagnosed when cancerous cells line the ducts in the breast. "In situ" means that the cancer cells have not spread beyond the ducts. However DCIS can progress and become invasive, especially if not detected early. Most cases of DCIS cannot be felt as lumps or masses but will show up on mammograms?one reason why regular mammograms are a must.

Lobular Carcinoma In Situ (LCIS): Lobular carcinoma in situ (or LCIS) is another form of non-invasive breast cancer. LCIS is a benign tumor that consists of abnormal cells in the lining of the lobule. "In situ" means that the abnormal cells have not spread beyond the lobules. LCIS is not actually considered cancer?it is generally thought to be a 'pre-cancer." LCIS will typically not show up on a mammogram. The only means of detecting LCIS is by taking sample of the suspected tissue and examining it in a lab. It is currently unclear whether or not LCIS progresses to cancer.

Breast cancers, just like other cancers are also categorized or "staged" based on the following system called the "TNM" rating:

A "T" refers to the size of the tumor. Tumors are graded on a scale of one to four, with four being the most advanced.
An "N" refers to how much the cancer has affected the lymph nodes, which exist throughout the body. Lymph node involvement is graded on a scale of zero to three, with three having the most lymph node involvement.
An "M" rating is used to identify if the cancer has spread, which is referred to as "metastasized." Metastases are assigned a zero if the tumor has not spread or a one if it has.

Once the cancer begins to spread, getting rid of it completely is more difficult, although treatment can often control the disease for years. Improved screening procedures and treatment options mean that at least seven out of 10 women with breast cancer will survive more than five years after initial diagnosis, and half will survive more than 10 years.

Fortunately, breast cancer is very treatable if detected early. Localized tumors can usually be treated successfully before the cancer spreads; and in nine in 10 cases, the woman will live at least another five years. Experts usually consider a five-year survival to be a cure.

What causes it?

Although the exact cause of breast cancer is unknown, we do know the main risk factors that put people at risk. Most current evidence indicates that hypersensitivity of estrogen and/or progesterone-specific receptors within breast tissue are responsible for the majority of breast cancer cases. It is believed that these two hormones may be responsible for proliferation of breast cells and resultant tumor formation. For example, estrogen tells cells to divide; the more the cells divide, the more likely they are going to become abnormal in some way and possible cancerous.

Additionally, the mutations of two abnormal hereditary genes, BRCA1 and BRCA2, have been found to play an important role in the development of breast cancer. It is estimated that about 1 in 200 women carries these genes and are therefore at a substantial greater risk for developing breast cancer.

Who has it?

Among women, breast cancer is the most common cancer and the second leading cause of cancer death, only second to lung cancer. Nearly 200,000 women in the United States will be diagnosed with invasive breast cancer in 2007. It is also estimated that there will be over 40,000 deaths due to breast cancer in 2007. This mortality rate may seem high, but mortality rates have been decreasing every year since 1989. This decline is thought to be due to improvement in cancer treatments and improvement in prevention and early detection techniques.

The incidence of breast cancer begins in early adulthood, with a sharp rise in incidence to the time of menopause. After menopause, the incidence of cancer decreases significantly.

If eight women were to live to be at least 85, one of them would be expected to develop the disease at some point during her life. Two-thirds of women with breast cancer are over 50, and most of the rest are between 39 and 49.

Breast cancer is not a disease that affects only women. One percent of all breast cancers occur in men. According to the American Cancer Society, over 2000 men in the United States will be diagnosed with breast cancer in 2007.

What are the risk factors?

Several risk factors have been identified as having a potential relationship to the development of breast cancer. These include:

Advanced age
Personal or family history of breast cancer
Menstrual periods beginning at an early age (before age 12)
Abnormal BRCA1 and BRCA2 genes (genetic testing can identify if you carry these genes)
Late menopause (after age 55)
Never having children
Having first child after age 30
Obesity (especially noted in postmenopausal women)
Long term use of postmenopausal hormone replacement therapy (greater than 5 years)
Benign breast disease
Oral contraceptive use(however recent studies have shown this to not be as significant as once thought)
Alcohol consumption
Having received radiation before age 40

Since most of these risk factors are not easily modified, early detection is very important. The American Cancer Society recommends a breast self examination (BSE) monthly for all women older than 20, a Clinical Breast Exam (performed by a healthcare professional) every 3 years (from ages 20-39), and a Mammogram annually for women older than 40.

What are the symptoms?

Symptoms of breast cancer can vary based on the severity of the disease. The most common initial sign of breast cancer is abnormalities on mammograms. These abnormalities can often show long before a woman or her doctor detects any physical changes in the breast.

There are specific factors that should raise suspicion of disease. These include:

A lump noted on breast self-examination (BSE)
A thickening or swelling of the breast or nipple
A discharge from the nipple
Swelling in the armpit
More advance stages will show a change in contour, texture, size, or warmth of the breast

How is it treated?

The most important treatment for breast cancer is early detection. Starting around age 20, women should perform monthly self breast examines to check for any new masses or lumps. Contact your doctor immediately if you detect a lump or mass or your breast(s) is painful or abnormally shaped. Also, contact your doctor if you notice any swelling in your armpits, which could also be associated with cancer.

The type of treatment that is chosen for a person with breast cancer is based on several factors, and the individual should work closely with the health care provider to determine the best treatment approach. The decision for treatment is made based on the size and location of the mass in the breast, lab tests performed on the cancer cells, and the stage or extent of the disease. The care given may consist of chemotherapy, radiation therapy, surgery, and hormone therapy or a combination of treatments.

Most individuals with breast cancer will have some type of surgery. Surgery for breast cancer includes either a mastectomy, full removal of the breast, or lumpectomy, which preserves the breast and only removes the lump. Each of these procedures can also be done with or without removal of lymph nodes. Treatment regimens may be used to prevent the spread of breast cancer to the opposite breast and to reduce the incidence of breast cancer.

The U.S. Preventive Services Task Force is urging health professionals to recommend tamoxifen or raloxifene to women at high risk for developing breast cancer to prevent the disease (chemoprevention). This agency is also advising that women at low or average breast cancer risk should not take these medications for chemoprevention due to adverse effects.

Drug classes used to treat Breast Cancer

Anti-estrogens
Aromatase Inhibitor
Monoclonal Antibodies
Progestins

What is on the horizon?

The FDA recently approved Avastin (also known as bevacizumab) to be used in combination with Taxol (also known as paclitaxel) to treat women with advanced breast cancer who have not started chemotherapy. Studies showed that this combination increased the time that breast cancer did not progress. Avastin is a new class of drugs that block the formation of blood vessels that supply the cancerous tumors, thus eliminating the source of nutrition for the cancer cells.

The American Cancer Society has funded more than 184 research projects relating to breast cancer. A few areas of research include:

Anti-angiogenesis drugs - These drugs are theorized to block the supply of new blood vessels to breast tumors.
New molecular targets for anticancer drugs
Gene therapy - an area of interest to many researchers. The idea here would be to replace the defective genes in cancer cells with normal, healthy genes, thereby correcting the cells' overactive replication problem. The challenge is finding a way to get the healthy genes into the cancer cells.
The effect of presurgery hypnosis on side effects, recovery, and cost of breast cancer treatment
How a woman's genetic makeup determines her response to treatment
Causes of breast cancer - The Sister Study is following 50,000 women ages 35-74 whose sisters (not themselves) have had breast cancer for 10 years to try to identify causes of breast cancer.
Immunotherapy - vaccines containing specific antigens (particles that generate an immune response) located on the surface of the breast are currently being studied.

There are currently more and more studies that are examining the effects of lifestyle factors and habits that can alter breast cancer risk. Many studies are looking into the effects of exercise, weight gain or loss, and diet on the risk. With the sequencing of the human genome, the advances in breast cancer prevention and treatment related to genes will continue to accelerate.

Cancer and Medical Drugs Treatment

2008-06-13T11:57:00.001+08:00

Introduction

In 1971, President Richard Nixon signed the National Cancer Act, committing federal resources to finding a cure for cancer. More than 35 years later, cancer is still the second leading cause of death in the United States. According to the American Cancer Society, 7.6 million people have died in the world from cancer since cancer was discovered. Currently cancer accounts for 1 out 4 deaths in America. Nevertheless there is good news to report. The rate of cancer-related deaths has been significantly reduced, according to the National Cancer Institute. And, new treatments are being introduced all the time.

What is it?

Cancer is a group of diseases characterized by uncontrolled growth or spread of abnormal cells. The abnormal cells can form a mass, or a tumor. Tumors can either be "benign" (not harmful) or "malignant" (cancerous). If the cells grow out of control but are not able to invade other tissues, the tumor is benign. Cells that grow out of control, invade other tissues, and spread to other parts of the body represent malignant tumors (cancer). Malignant tumors can spread to other parts of the body by shedding cells into the blood or lymph system.

Cancers are classified according to their origin and the type of tissue involved. Types of cancers include:

Carcinomas, which begin in tissues like the skin, mucous membranes, stomach, or intestines.This group includes the most common forms of cancer such as breast, prostate, colon, and lung cancers.
Sarcomas, which originate in muscle or connective tissues such as bone, cartilage, and fat.
Leukemias, which involve blood cells.
Lymphomas, which affect lymph nodes throughout the body.
Blastomas, which originate from immature embryonic cells

Malignant tumors are usually named using -carcinoma, -sarcoma or -blastoma added to the end of the Latin or Greek word for the organ of origin as the root. For instance, adeno- is the Greek word that relates to glandular tissue, therefore a malignant cancer of a glandular tissue is adenocarcinoma. From this you can see that the beginning portion of the word is adeno- and the ending portion is carcinoma.

Benign tumors are also named adding -oma to the end of the Latin or Greek word for with the organ involved. For instance, a benign tumor of the glandular tissue is an adenoma.

What causes it?

The cause of cancer is not clearly known. However, at its most basic level, cancer is a disease of the genes. Genes are the blueprints for our growth and development. Every cell in our body contains our genes, or genetic material. These genes program the cell to divide at a certain rate. When changes to the gene occur, it is called a genetic mutation. These mutations lead to inappropriate growth and division of the cell, which can sometimes cause cancer.

Genetic mutations, or faulty genes, can be inherited or the result of an exposure to carcinogens, substances that can cause genetic mutations. Carcinogens may include:

certain medications
chemicals
hormones
viruses and other infectious angents
ultraviolet light
tobacco smoke
radiation

Who has it?

The National Cancer Institute estimates that approximately 10.8 million Americans have cancer or a history of cancer. One-half of American men and one-third of American women will develop cancer during their lifetimes. More than 1.4 million new cases of cancer will be diagnosed this year, which does not account for the nearly 1 million new cases of basal skin cancer that will also be diagnosed this year.

Cancer is the second leading cause of death in the U.S. with almost 560,000 deaths annually--more than 1,500 people a day. Cancer causes one in four deaths in this country. Cancer rates are approximately 16 percent higher among African-American men than Caucasian men. Death rates from all cancers combined peaked in 1990 for men and in 1991 for females. Between 1990 and 2003 death rates from cancer decreased by 16.3 percent for men and between 1991 and 2003 death rates have decreased by 8.5% for females.

What are the risk factors?

Risk factors are characteristics that increase your chance for developing a condition. Exposure to certain substances in the environment may increase the risk of cancer. In fact, many cancers can be prevented by:

not using any tobacco products
eating a proper diet
avoiding the overexposure to the sun or ultraviolet light (as also found in tanning beds)

Cigarette smoke is directly responsible for 30% of all cancer deaths in the United States. The Surgeon General and Centers for Disease Control and Prevention estimates that smoking accounts for about 400,000 deaths per year. While smoking is most often associated with lung cancer, it is also a cause of cancers of the:

mouth
pharynx
larynx
esophagus

pancreas
uterus
kidneys
bladder

Other risk factors are those that were discussed previously as contributing to the cause of cancer. Other risk factors that cannot be controlled include increasing age and family history. For example, women with a mother, sister, or daughter who has had breast cancer have a higher risk of getting the disease. Prostate cancer also appears to have a hereditary link.

What are the symptoms?

Symptoms vary greatly with the location and type of cancer. If you notice one of the early warning signs, consult your doctor immediately. Many cancers can be cured if caught early.

Some of the early warning signs in adults include:

a change in bowel or bladder habits
a sore throat that does not heal
unusual bleeding or discharge
thickening or a lump in the breast or other part of the body
indigestion or difficulty swallowing
an obvious change in an existing wart or mole
a nagging cough or hoarseness
unexplained weight loss
persistent fever, chills, or night sweats

Some early warning signs in children include:

continued, unexplained weight loss
headaches with vomiting in the morning
increased swelling or persistent pain in bones or joints
lump or mass in abdomen, neck, or elsewhere
development of whitish appearance in the pupil of the eye
recurrent fevers not caused by infections
excessive bruising or bleeding
noticeable paleness or prolonged tiredness

Early Detection Plays a Crucial Role:

Fortunately, screening tests can detect more than one-half of all new cancers. These include cancers that affect the:

breasts
tongue
mouth
colon
rectum

cervix
prostate
testes
skin
uterus

Early detection means early treatment, and early treatment means increased survival rates. For example, 100 percent of women who are diagnosed with breast cancer at an early stage live at least five years after remission. If breast cancer is detected after it has spread, the rate decreases to only 20 percent.

If all Americans participated in regular detection programs, the survival rate of many cancers could reach 95 percent, according to the American Cancer Society.

Once you are diagnosed with cancer, your doctor will use a staging system to determine how advanced the cancer is at the time of diagnosis. He/She will measure the cancer's development through a course of treatment. Staging systems can differ according to the type of cancer.

One type of staging involves a "TNM" rating:

A "T" refers to the size of the tumor. Tumors are graded on a scale of one to four, with four being the most advanced.
An "N" refers to how much the cancer has affected the lymph nodes, which exist throughout the body. Lymph node involvement is graded on a scale of zero to three, with three having the most lymph node involvement.
An "M" rating is used to identify if the cancer has spread, which is referred to as "metastasized." Metastases are assigned a zero if the tumor has not spread or a one if it has.

An adittional staging system uses the Roman numerals I to IV. Stage I cancers are usually small and curable and stage IV cancers are the most advanced and most difficult to successfully treat.

How is it treated?

Treatment may provide a cure, relieve discomfort, or serve as a preventive measure against recurring tumors. There are three types of treatments most commonly used for cancer. Sometimes these treatments are used individually and other times they are used in combination.

Surgery - the oldest and most commonly used method of treatment for solid tumors. The concept is simple: cut the cancer out of the body. Surgery also has an important role in making a diagnosis and determining the severity of the disease.In theory, any cancer not involving the blood could be cured if entirely surgically removed, however this is not always possible. When cancers metastasize to other regions of the body their complete removal by surgery is nearly impossible. Examples of surgery include mastectomy for breast cancer and prostatectomy for prostate cancer. The goal of the surgery may be removal of the entire organ or just the tumor. However, a single cancer cell is invisible to the naked eye and has the ability to re-grow an entire tumor, a process call recurrence.
Radiation - the use of high-energy X-rays and gamma rays to destroy tumors. Therapeutic doses of radiation are normally built up through a series of treatments that take place over several weeks or by having radioactive implants placed directly in the tumor. Radiation can destroy cells that were not visible to the surgeon when a tumor was removed.Radiation can also be used to slow the spread of cancer and to offer relief from pain in conditions such as bone cancer.Although radiation can damage both tumor cells and normal cells, most normal cells can recover from the effects of radiation and function properly. The goal of radiation is to harm as many tumor cells as possible while limiting the negative effects to healthy tissue.
Chemotherapy - the use of chemicals or medications to treat cancer. The drugs used in chemotherapy interfere with cancer cells' ability to divide and reproduce. While the ultimate goal of chemotherapy is to destroy malignant cells without harming normal cells, selectivity is difficult because only subtle differences exist between normal and cancerous cells. Treatment may be deemed successful if normal cells are able to recover, and tumor cells are destroyed. Chemotherapy is the main treatment for metastatic cancer.Chemotherapy often works well on metastatic cancers because they are growing rapidly. Therefore, by inhibiting division and reproduction of the tumor cells, chemotherapy can oftentimes be the treatment of choice to provide a successful outcome.

Your doctor will recommend the best option for you depending on the following:

your type of cancer
the stage of your cancer
your age
medical history
general health

Drug classes used to treat Cancer

Alkylating Agents
Anti-estrogens
Antimetabolites
Antineoplastic Antibiotics
Antineoplastic Hormones
Interleukins
Mitotic Inhibitators

What is on the horizon?

Researchers are currently studying more than 300 new drugs for treating or preventing cancer and thousands of trials are ongoing that involve other cancer related issues. Moreover, several drugs that are used today for other health conditions are currently being studied for their potential role in the prevention and treatment of certain cancers.

In addition to new drugs, the following therapies are under study:

Gene therapy - an area of interest to many researchers. The idea here would be to replace the defective genes in cancer cells with normal, healthy genes, thereby correcting the cells' overactive replication problem. The challenge is finding a way to get the healthy genes into the cancer cells.
Cancer vaccines - to treat existing cancers by teaching the body's immune system to target and destroy cancer cells.
Antiangiogenic therapy - Angiogenesis is the rapid formation of new capillaries for transporting blood to the tissues. Under normal circumstances, this process is rare and lasts only a short time. Tumors have been known to stimulate angiogenesis when they spread into tissues other than the ones where they originated. By preventing the formation of new capillaries, scientists hope to deprive the tumor of its blood supply, and therefore, its ability to spread.
Laser therapy- Lasers are small beams of concentrated light. They are currently being used for the treatment of small cancers on the skin. Lasers can be used alone or in combination with other treatments. Advances in this technology may lead to further uses.

2008-06-07T13:36:00.004+08:00

Headache and Drug Medical Treatment

Introduction

What is it?

Tension Headache

Migraine Headache

Cluster Headache

Other Types of Headaches

Organic Headache

Sinus Headache

Rebound Headache

Hormonal Headache

Headaches of the hormonal type often result from fluctuation of hormones in the female body, especially in relation to the menstrual cycle.

What causes it?

Many headaches have no identifiable triggers (something that makes the headache start), but others may be associated with certain physical or emotional factors. Headache triggers are many and varied.

Several triggers have been identified for migraines. They include hormonal changes, stress, caffeine, poor diet, light, alcohol, smoking, lack of sleep, or illness.

Cluster headaches may be started by drinking alcohol, being exposed to glaring lights, experiencing heat or cold, or eating certain foods such as citrus fruits or chocolate. Food additives such as monosodium glutamate (MSG?commonly found in Chinese foods) and aspartame(an artificial sweetener) may bring on headaches for some individuals. Some medications -- including both prescription and over-the-counter medications that are used to treat headaches -- can actually cause headaches, if they are taken improperly.

Sinus headaches represent a common example of headaches that result from a specific condition. Brain abnormalities (such as meningitis?an infection in the brain or spinal chord, blood clots, or brain tumors) are examples of rare, but extremely dangerous illnesses that may also produce headache pain.

Who has it?

What are the risk factors?

Risk factors are characteristics that may make individuals more likely to develop a condition. Common risk factors for headaches include the following:

Tension Headache
- Female gender
Migraine Headache
- Female gender
- Family history
- Less advantaged socioeconomic groups
Cluster Headache
- Male gender
Rebound Headache
- Overuse of headache medicines

What are the symptoms?

Tension Headache

Migraine Headache

Migraine headaches are characterized as intense pounding pain, which may affect one or both sides of the head. The two main forms of migraine are:

Migraine with Aura (formerly called classic migraine) An aura is a neurological(meaning, related to the nervous system) disturbance experienced by about one-fourth to one-third of all individuals who have migraines. Usually consisting of visual changes that may include seeing colored or flashing lights or squiggly lines, an aura may also involve physical symptoms such as numbness or tingling sensations in the face, fingers, or toes. Some individuals may experience temporary or loss of vision when experiencing a pre-migraine aura. Typically, an aura begins approximately 10 to 30 minutes before the onset of the headache.
Migraine without Aura (formerly called common migraine). Individuals with this type of migraine have little or no warning that a migraine is about to occur.

Other symptoms that may be associated with migraines include:

Cold, clammy, or sweaty skin
Confusion
Fatigue
Inability to tolerate light, noise, or smells
Light-headedness
Nausea
Vomiting

Cluster Headache

Cluster headaches generally start suddenly and they often affect only one side of the head. A single cluster headache is usually brief ? lasting from a few minutes to about 4 hours, then decreasing or disappearing. Occurring repeatedly at roughly the same times of day, however, cluster headaches typically extend over a period of 4 to 12 weeks, followed by a period of remission. This ?on and off? sequence may last for a few months or it may occur chronically over many years. Other symptoms of a cluster headache may include nasal congestion, drooping eyelids, and irritated, teary eyes.

Other Headaches

Organic Headache

Sinus Headache

Chills
Fever
Greenish or yellow nasal secretions
Nasal congestion
Swollen face

Rebound Headache

Hormonal Headache

How is it treated?

In general, medications for headaches focus on two areas:

Abortive therapy -- to stop a headache that has already started, and
Prophylactic or preventive therapy -- to keep headaches from occurring.

Treatment Options

Migraine Headache

Abortive Therapy

Initial abortive therapy for mild to moderate migraine headaches may include non-prescription pain medications (also known as analgesics) such as aspirin or acetaminophen (Tylenol). Another medication available, without a prescription, that some find effective is a combination of aspirin, acetaminophen, and caffeine (Exedrine or Exedrine Migraine). For more severe pain or pain that does not respond to aspirin or other analgesics, non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen may be recommended.

If non-prescription medications are not effective, several prescription medications are available to relieve migraines. Among the most prescribed are selective serotonin agonists, commonly known as ?triptans.? Designed specifically for migraine treatment, seven triptans are available in the United States. They are almotriptan (Axert), eletriptan (Relpax), frovatriptan (Frova), naratriptan (Amerge), rizatriptan (Maxalt), sumatriptan (Imitrex), and zolmitriptan (Zomig). Triptans may be effective for migraines with or without auras, and they may work when previous treatments have failed. They come in several different dosage forms that may include injections and nasal spray, as well as traditional tablets to take by mouth. In addition, rizatriptan and zolmitriptan are available in rapidly-dissolving tablets that melt quickly for fast absorption when placed on the tongue. Although triptans work in similar ways, one may be more effective than another for certain individuals. Therefore, individuals who do not find relief from one triptan may want to consider trying another triptan before switching to a completely different drug class. Triptans should not be used by individuals with heart disease or uncontrolled high blood pressure. ?And, as with other headache medications, overuse of triptans may lead to ?rebound? headaches.

Ergot derivatives are a second-line prescription option for treating migraine headaches that do not respond to non-prescription treatment or triptans. Ergot derivatives are most effective in dosage forms that reach the bloodstream quickly. Sublingual tablets that dissolve quickly under the tongue (Ergomar), injections (dihydroergotamine mesylate, DHE-45), and nasal sprays (dihydroergotamine, Migranal) are rapidly-acting ergot derivatives. Although they are effective for many individuals, taking ergot derivatives usually requires close monitoring by a healthcare provider. They may be habit-forming and they may cause numerous side effects, including abdominal cramps, dizziness, dry mouth, and nausea. Individuals who experience potentially serious side effects such as leg cramps or coldness, numbness or pain in the hands or feet while taking an ergot derivative should contact a doctor immediately.

Combinations of isometheptene mucate, dichloralphenazone, and acetaminophen (Midrin, Duradrin) or combinations of aspirin or acetaminophen with butalbital, codeine, or both (Fiorinal, Fioricet) may also be used as abortive treatment for migraine headaches. Caution should be used because of the potential for dependence associated with these drugs.

Many individuals who suffer from migraines also have nausea, and some evidence suggests that stomach contents are poorly absorbed into the body during a migraine attack. Consequently, taking medications by mouth may not be as effective as using other routes of administration, such as rectal suppositories or injected medications.

Prophylactic Therapy

One possible way to prevent migraines is to avoid triggers. Eating regular, healthy meals, limiting caffeine, eliminating other food triggers, and getting plenty of exercise may help to prevent migraines from occurring. Keeping a headache diary may facilitate identification of triggers (see the ?Helping Yourself? section to learn more about headache diaries). If medication is needed, it usually has to be taken regularly. Only certain individuals are candidates for prophylactic therapy with medication. These are individuals whose migraines cause severe disruptions in normal activity despite treatment, and those who have frequent migraines requiring prescription medication (at least twice weekly) which puts them at risk for developing rebound headaches. For these persons, several prescription options are available.

Tricyclic antidepressants (TCAs), such as amitriptyline, may be effective migraine prevention for some individuals, especially those with underlying depression, insomnia, or tension headaches. Although amitriptyline is generally accepted to be the most effective TCA for prevention of headaches, other TCAs such as doxepin (Sinequan), imipramine (Tofranil), nortriptyline (Pamelor), and protriptyline (Vivactil) have also shown some effectiveness. TCAs should be taken at night because they can cause sedation. Other possible side effects from TCAs may include an unpleasant taste in the mouth, and dry eyes, mouth, and skin. Individuals with glaucoma or an enlarged prostate should use caution when taking TCAs due to the increased risk of side effects.

Other prescription medications commonly used for migraine prevention include oral beta-blockers, such as atenolol (Tenormin), metoprolol (Lopressor), propranolol (Inderal), and timolol (Blocadren); and calcium channel blockers, such as verapamil (Calan, Isoptin, Verelan). Common side effects of beta-blockers may include decreased blood pressure, depression, impotence, and lethargy. Common side effects of calcium channel blockers are decreased blood pressure, constipation, and leg swelling.

Some medications used primarily to treat epilepsy may also decrease the frequency, duration, and/or severity of migraine headaches. Valproic acid (Depakene), divalproex sodium (Depakote), and topiramate (Topamax) are anti-epileptics that are also approved for migraine prophylaxis. Tremor, weight gain, and hair loss are common side effects of these drugs. Rarely, they may cause liver damage. Therefore, symptoms of nausea, vomiting, and yellowing of eyes or skin should be brought to the attention of a doctor immediately. To decrease the risk of liver damage, blood tests should be performed periodically as long as anti-epileptic medications are taken.

Another drug occasionally used to prevent migraine headaches is methysergide maleate (Sansert). Methysergide maleate has been discontinued in the United States, but it may still be available from other countries. Its use must be limited due to the relatively high number of side effects that are associated with taking it. Dizziness, drowsiness, flushing, heartburn, insomnia, and stomach upset may all be caused by methysergide maleate. Long-term use may result in heart or lung changes. Methysergide maleate should be taken no longer than 6 months at a time, doses should be decreased gradually, and at least 3 to 4 weeks must be allowed before starting it again. Individuals taking methysergide maleate need to be supervised closely by a healthcare professional who is familiar with its use.

Non-drug Therapy

Resting in a cool, dark, quiet room is effective treatment for some migraine sufferers. Others find relief from an ice pack or cool water on their foreheads.

Tension Headache

Many different medication options are available for tension headaches. Ideal treatment for tension headaches is the medication that is most effective at the lowest dose and has the fewest potential side effects. If headaches are not relieved, the dose may be increased or another type of drug can be tried.
Abortive Therapy

Initial abortive therapies for tension headaches include non-prescription pain medications (also called analgesics) such as aspirin and acetaminophen (Tylenol). Usually medications like these are well tolerated, although some individuals may experience upset stomach when taking aspirin. Continually taking non-prescription analgesics daily for more than 3 weeks or taking higher than recommended doses can lead to rebound headaches. If an analgesic is being used with increasing frequency and less relief is occurring, other treatment options should be tried.

When aspirin or acetaminophen is not effective, a non-steroidal anti-inflammatory drug (NSAID) such as ibuprofen (Advil, Motrin) or naproxen (Aleve, Naprosyn) is usually the next step for pain relief. Some NSAIDs are available both without a prescription (usually in lower doses) and with a prescription (usually in higher doses). Common side effects include stomach irritation, which may be minimized if the medication is taken with food. Because individuals with kidney problems may be at increased risk for side effects, they should not begin taking an NSAID before discussing its use with a healthcare provider.

Other prescription treatments include muscle relaxants, such as carisoprodol (Soma) and cyclobenzaprine (Flexeril), and certain antidepressants(however, there is no evidence to support the effectiveness of these agents as abortive therapy). Both of these types of medications may cause drowsiness, however. A combination medication that includes isometheptene mucate, dichloralphenazone, and acetaminophen (Midrin, Duradrin) may also be used as abortive treatment for tension headaches. Caution should be used if it is taken because it may be habit-forming.

Prophylactic Therapy

To prevent tension headaches, many different antidepressants may be effective for individuals with and without depressive symptoms. The antidepressant needs to be taken continually. Side effects depend on the individual drug, but they are usually mild. They may include constipation, dizziness, drowsiness, dry mouth, nausea, and weight gain.

In the case of tension headaches, psychophysiologic therapies such as stress management, relaxation training and biofeedback training may significantly reduce headache activity.

Sinus Headache

Since sinus headaches generally result from a sinus condition, the best approach is to treat that underlying condition. Non-prescription medications for sinus headaches commonly contain a pain reliever such as acetaminophen, as well as antihistamines for allergic conditions and/or decongestants for nasal congestion. If sinus pressure and pain is not relieved after a day or two of treatment with a non-prescription product, an infection may be present. A prescription antibiotic may be needed to treat a bacterial infection. If the sinus infection is caused by a virus, however, antibiotics will not be effective.

Cluster Headache

Non-prescription drugs typically do not relieve cluster headaches. Therefore, treatment usually requires a prescription medication taken under a doctor?s supervision.

Abortive therapy

The drugs of choice for cluster headache are oxygen and sumatriptan. These can either be given alone, or in combination. Inhaling pure oxygen may provide almost immediate relief for up to 80% of cluster headache attacks. Other initial treatment choices include prescription medications -- ergot derivatives and a triptan. For rapid relief of a cluster headache, an ergot derivative in a dosage form that is either quickly dissolved under the tongue (Ergomar), or injected (dihydroergotamine mesylate, DHE-45) is the second choice. Injected sumatriptan (Imitrex) may also be an effective treatment for cluster headaches in patients that don?t respond well to oxygen and sumatriptan. Zolmitriptan (Zomig) may be considered over sumatriptan when given orally because 60% of patients experience relief at 30 minutes whereas sumatriptan may take longer to deliver relief.

Prophylactic therapy

Calcium channel blockers, such as verapamil (Calan, Isoptin, Verelan) and diltiazem (Cardizem, Cartia, Dilacor, Diltia, Taztia, Tiazac), are also commonly used to prevent cluster headaches. Generally well tolerated, calcium channel blockers may cause constipation or swelling in the legs for some individuals who take them. Another well-tolerated medication is indomethacin, the only NSAID shown to be effective in preventing chronic cluster headaches. Possible side effects of indomethacin include dizziness, rash, stomach upset, and loss of appetite. The choice to begin taking indomethacin regularly should be carefully considered by a physician. Continued use of NSAIDs may lead to severe stomach irritation and result in ulcers (which must then be treated with more medications). Also patients with high blood pressure, heart failure, and kidney disease should know that taking NSAIDs may worsen these conditions. Always consult a physician before beginning long-term use of NSAIDs.

Other prescription medications that may be used to prevent cluster headaches may have more serious side effects, so they usually require close monitoring by a healthcare provider. Corticosteroids, such as prednisone (Deltasone, Orasone), may work well for preventing both episodic and chronic cluster headaches. They may cause insomnia, mood changes, upset stomach, and weight gain, however; and long-term therapy can affect thyroid function, cholesterol levels, blood pressure, and blood sugar levels.

Two other drugs used to treat cluster headaches are methysergide maleate (Sansert) and lithium (Eskalith, Lithobid). Methysergide maleate has been discontinued in the United States, but it may be available from other countries. Side effects from either methysergide maleate or lithium can be significant and treatment with either of them needs to be monitored closely by a healthcare provider.

Organic Headache

Because organic headaches are caused by serious illnesses, any individual experiencing an unusually sudden or extremely severe headache should seek medical attention as soon as possible. Headaches that are accompanied by vision disturbances, numbness and/or weakness on one side of the body may be emergencies that also need immediate attention. Treatment may not be possible for organic headaches, but the condition causing the pain may be treatable.

Rebound Headache

The best way to treat headaches that result from taking too much headache medication is to stop the medication. Some individuals may stop all at once, while others need to stop more gradually. A health professional may need to determine the best way for each individual to stop over-using headache medication. Additional treatments for rebound headaches may include behavior modification therapy and the use of non-analgesic medications to help control headache pain until the headache medications are stopped.

Hormonal Headache

Hormonal headaches may be triggered by hormonal changes in the body. Most usually occurring as women begin their periods each month, hormonal changes also occur as young girls reach puberty, as women become pregnant, and as older women reach menopause. Taking oral contraceptives (birth control pills) may also cause hormonal headaches for some women ? especially when the pills are first started.

Women who have hormonal headaches may start headache medication about 2 days before the period starts and continue taking the headache medication until the period has ended. Commonly effective headache medications include non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin) and naproxen (Aleve, Naprosyn). Prescription treatment options may have more serious side effects that require close monitoring by a healthcare provider. These medications should be used only if NSAIDs do not provide adequate relief. Ergot derivatives in oral tablets or suppositories can be used; however, individuals should be aware that ergot derivatives might be habit forming. Their common side effects include abdominal cramping, nausea, dizziness, and dry mouth. Patients should report muscle pains, numbness, coldness, or loss of color in their hands or feet to their physician immediately. Methysergide maleate (Sansert) was another potential treatment. However, methysergide mesylate has been discontinued for sale in the United States. While it may still be available in other countries, its side effects can be significant. If methysergide maleate is taken, its use must be supervised closely by a doctor who is familiar with its use.

Drug classes used to treat Headache

Ergot Derivatives

Ergot Derivatives are an option for headaches that do not respond to aspirin, acetaminophen, NSAIDs, or triptans. Ergot derivatives are made in several different dosage forms such as quickly dissolving tablets, injections, and a nasal spray. Ergot derivatives have more serious side effects and require close monitoring by a healthcare provider. Patients should be aware that this drug may be habit forming. Side effects include abdominal cramping, nausea, dizziness, and dry mouth. Patients should report muscle pains, numbness, coldness, or loss of color in their hands or feet to their doctor immediately.
Drugs in the class

Ergotamine Tartrate and Caffeine (Cafatine PB, Cafergot, Ercaf, Ergo-Caff, Migergot, Wigraine)
Dihydroergotamine Nasal Spray (Migranal)
Dihydroergotamine Injection (D.H.E. 45 Injection)

Miscellaneous Analgesics and Antipyretics

Acetaminophen suppresses your body's production of the chemicals that cause pain.
Drugs in the class

Acetaminophen, Butalbital, and Caffeine (Alagesic, Amaphen, Americet, Anolor, Anoquan, Arcet, Butace, Endolor, Esgic, Esgic Plus, Ezol, Fioricet, Medigesic, Pacaps, Repan, Tencet, Zebutal)
Acetaminophen Suppositories (Acephen Suppositories, Feverall Suppositories, Neopap Suppositories)
Acetaminophen (Aspirin Free Anacin, Datril, Genapap, Genebs, Panadol, Tempra, Tylenol, Valorin)
Acetaminophen Oral Suspension or Syrup (Genapap Children, Infantaire, Liquiprin, Mapap Children's, Panadol Infants, Tylenol Liquid)

Narcotic Combinations

These agents combine a simple analgesic--usually acetaminophen or aspirin--with a narcotic.
Narcotics raise your pain threshold and blunt your brain's perception of pain.
Simple analgesics work by suppressing your body's production of certain chemicals that cause inflammation and pain.
Drugs in the class

Aspirin, Butalbital, and Caffeine (Axotal, B-A-C, Butalbital Compound, Fiorgen PF, Fiorinal, Fiortal, Fortabs, Isollyl Improved, Lanorinal, Marnal)

Non-steroidal Anti-inflammatory Drugs

NSAIDs work by suppressing the production of fatty acids called prostaglandins that cause the inflammation and pain of arthritis. They do this by blocking the action of an enzyme, cyclooxygenase (COX). This enzyme is responsible for converting precursor acids into prostaglandins.
While NSAIDs are effective headache pain reducers, continued use of NSAIDs may lead to severe stomach irritation and result in ulcers (which must then be treated with more medications). Also patients with high blood pressure, heart failure, and kidney disease should know that taking NSAIDs may worsen these conditions. Always consult a physician before beginning long-term use of NSAIDs.
Drugs in the class

Piroxicam (Feldene)
Diclofenac (Voltaren)
Tolmetin (Tolectin, Tolectin DS)
Diclofenac Potassium (Cataflam)
Etodolac (Lodine)
Flurbiprofen Oral (Ansaid)
Ketoprofen (Orudis, Oruvail)
Meloxicam (Mobic)
Fenoprofen (Nalfon)
Nabumetone (Relafen)
Naproxen (Aleve, Anaprox, Anaprox DS, EC-Naprosyn, Naprelan, Naprosyn)
Etodolac ER (Lodine XL)
Indomethacin SR (Indocin SR)
Oxaprozin (Daypro)
Diclofenac XR (Voltaren XR)
Sulindac (Clinoril)
Ibuprofen (Advil, Advil Liqui-Gels, Advil Migraine, Genpril, Haltran, Junior Strength Advil, Junior Strength Motrin, Menadol, Midol Maximum Strength Cramp Formula, Motrin, Motrin IB, Motrin Migrain Pain, Nuprin, Rufen)
Indomethacin (Indocin)
Meclofenamate (Meclomen)

Salicylates

Salicylates reduce pain and swelling by blocking the body's production of chemicals that cause inflammation.
Drugs in the class

Diflunisal (Dolobid)
Aspirin Gum (Aspergum)
Aspirin (ASA, Acetylsalicylic acid, Acuprin, Alka-Seltzer, Ascriptin A/D, Bayer, Bufferin, Easprin, Ecotrin, Empirin, Zorprin)
Salsalate (Amigesic, Argesic-SA, Artha-G, Disalcid, Marthritic, Monogesic, Salflex, Salgesic, Salsitab)
Aspirin Rectal

Serotonin Receptor Agonists (Triptans)

Serotonin Receptor Agonists also known as "triptans" are the newest class of medications used to treat migraine and cluster headaches. Some are available in different dosage forms including; tablets, quickly dissolving tablets that can be taken without water, nasal sprays and injections. They help relieve headaches by constricting blood vessels and moderating chemical reactions in the brain.
Drugs in the class

Sumatriptan Oral (Imitrex)
Naratriptan (Amerge)
Zolmitriptan Nasal Spray (Zomig Nasal Spray)
Rizatriptan Disintegrating Tablets (Maxalt MLT)
Almotriptan (Axert)
Sumatriptan Injection (Imitrex Injection)
Zolmitriptan (Zomig)
Sumatriptan Nasal Spray (Imitrex Nasal Spray)
Rizatriptan (Maxalt)
Eletriptan (Relpax)

2008-05-30T12:59:00.004+08:00

Sexually Transmitted Infections (STIs) and Drug Medical Treatment

Introduction

Sometimes called the nation's "hidden epidemic," sexually transmitted infections, or STIs (also known as sexually transmitted diseases or STDs), frequently exhibit no symptoms. The United States has the highest rates of STIs in the industrialized world. According to the Center of Disease Control (CDC), the United States alone has an estimated 15 million new cases of STIs reported each year. Women suffer more frequent and more serious complications from STIs than men. Despite their common occurrence, STIs continue to be one of the least discussed health issues. Sexually transmitted infections can have serious health consequences ranging from pain and discomfort to infertility or complications in pregnancy.

Five of the most commonly encountered STIs are chlamydia, gonorrhea, syphilis, genital herpes, and trichomoniasis.

*Keep in mind that HIV is one of the most frequently occurring STI, but it is covered in depth in its own section here.

What is it?

An STI is any disease transmitted by sexual intercourse or sexual contact. Sexually transmitted infections can affect men and women from all backgrounds and economic levels, with approximately two-thirds of cases occurring in individuals less than 25 years of age. Sexually transmitted infections are one of the most common infectious diseases in the United States with more than 20 different types identified and an estimated 15 million new cases reported each year.

The 5 most commonly occurring STIs; chlamydia, gonorrhea, syphilis, genital herpes, and trichomoniasis.

Chlamydia is the most frequently reported STI. An estimated 2.8 million Americans get chlamydia each year, but not even half get reported. Chlamydia infections are spread by sexual contact through oral, vaginal, or anal routes with an infected partner.

Gonorrhea is a STI that you can get if you have oral, anal, or vaginal sex with someone who has gonorrhea. Gonorrhea infections are spread by sexual intercourse or contact through oral, vaginal, or anal routes with an infected partner.

Syphilis is an STI that has often been called "the great imitator" because so many of the signs and symptoms are indistinguishable from those of other diseases. Syphilis is also spread by sexual contact through oral, vaginal, or anal routes with an infected partner. Syphilis is not spread by contact with toilet seats, doorknobs, swimming pools, hot tubs, bathtubs, shared clothing, or eating utensils.

Trichomoniasis, also called "trick," is a common STI that affects both women and men, although symptoms are more common in women. This disease is spread through sexual activity.

Genital Herpes is a STI that spreads from person to person through sexual contact. Individuals who get this disease may have only minimal signs or symptoms from the infection. When signs do occur, they typically appear as one or more blisters on or around the genitals or rectum. The blisters break, leaving tender ulcers (sores) that may take two to four weeks to heal the first time they occur.

Complications of Chlamydia and Gonorrhea

Potential Complications in Women:

1. Salpingitis, or inflammation of the fallopian tubes. The fallopian tubes are the connection between the ovaries and the uterus. The symptoms of salpingitis include pain in the lower chest, especially when you move or walk, pain during a vaginal exam, fever, and an increase in the need to urinate.

2. Infertility, or the inability to conceive.

3. Pelvic Inflammatory Disease (PID), an infection in the female reproductive organs (fallopian tubes, uterus, and ovaries). Normally, the cervix prevents bacteria that normally live in the vagina from migrating into the reproductive organs; however, if the cervix becomes infected with unfamiliar bacteria such as chlamydia or gonorrhea, the unfamiliar bacteria can travel up through to other organs. The reproductive organs can then become infected and inflamed, which can potentially lead to infertility. The symptoms of PID may differ among women, and some women may not experience symptoms. Symptoms of PID include the following:

Stomach ache, or dull pains in the stomach
Tenderness of the stomach area
Vaginal discharge (yellow or green in color that may have an unusual odor)
Irregular menstruation (extra long periods, spotting or cramps throughout menstrual cycles)
Chills
High fever
Nausea
Vomiting
Pain during sexual intercourse

4. Ectopic pregnancy is a pregnancy that takes place outside of the uterus, where pregnancy normally takes place. The most common site of an ectopic pregnancy is in one of the fallopian tubes; however, the pregnancy can develop in the ovary, abdominal cavity or cervix. Ectopic pregnancies are usually diagnosed within the first 2 months of pregnancy, possibly before a woman realizes that she is pregnant. The symptoms may be mild such as a missed period, abnormal vaginal bleeding, and pain in the lower abdomen or pelvis, or there could be symptoms similar to pregnancy such as breast tenderness or morning sickness. More serious and life-threatening symptoms are associated with a rupture of an ectopic pregnancy and may include a sudden increase in pain in the abdomen or pelvic area, pale skin, fast heart rate, and dizziness with possible fainting.

If you notice that you are experiencing any of these symptoms, it is important that you contact your doctor as soon as possible. Ectopic pregnancies will eventually rupture and can be life threatening.

5. Conjunctivitis is another complication of chlamydia and gonorrhea. Conjunctivitis is the inflammation of the lining of the eye. When this occurs, the eye becomes red, swollen, and produces a watery or pus-like discharge. It is not considered to sight-threatening condition. It can become chronic, although most cases resolve spontaneously after a few months if not treated.

Potential Complications in Men:

1. Epididymitis, or inflammation of the epididymides. The epididymides are the tubes that are connected to the testes. When sperm is released from the testes, sperm pass through the epididymides into the vas deferens to urethra upon ejaculation. The symptoms of epididymitis are pain, swelling, and redness of the scrotum.

2. Infertility, or the inability to produce conception.

3. Conjunctivitis is inflammation of the lining of the eye. The eye becomes red, swollen, and produces a watery or pus containing discharge. It is not considered a sight-threatening condition. It can be chronic, but most cases resolve spontaneously after a few months.

Complications of Syphilis

Potential Complications for Men, Women, and Children/Newborns:

1. Neurosyphilis is syphilis that affects the nervous system - the brain, spinal chord, and nerves. There are four types of neurosyphilis that range from a patient being asymptomatic (showing no symptoms) to experiencing symptoms such as headaches, incontinence (inability to control passage of urine, memory loss, delusions, and muscle paralysis. Neurosyphilis occurs in about 8% of individuals who go untreated. It can appear at any time, from 5 to 35 years after the onset of primary syphilis. Neurosyphilis affects men more frequently than women and Caucasians more than African-Americans.

2. Cardiovascular syphilis can lead to a heart attack, scarring of the valves in the heart, heart failure, or the formation of an aortic aneurysm (an abnormal blood-filled expansion of a blood vessel resulting from disease of the vessel wall). Cardiovascular syphilis usually begins within 5 to 10 years after initial infection, but it may not occur until 20 to 30 years after the initial syphilis infection.

3. Benign Late Syphilis begins 3 to 10 years after the initial infection and is characterized by the development of gummas. Gummas are rubbery tumor-like growths that are most likely to involve the skin or long bones but may also develop in the eyes, throat, liver, or stomach.

4. Periosteal inflammation or inflammation of the membrane surrounding the bone. Individuals may experience pain due to the inflammation. This inflammation leads to thickening of the bone. This thickening is most often seen on the skull, leg bones, breastbone, and ribs.

5. Skin damage including scaling of the skin and alopecia (loss of or thinning of the hair, eyebrows and beard).

Complications of Trichomoniasis

Low birth weight and immaturity of infant--trichomoniasis in pregnant women may cause premature rupture of membranes and preterm delivery.
Urinary tract infections can also occur in women with trichomoniasis infections.
High risk of HIV exposure -The genital inflammation caused by trichomoniasis can increase a woman's susceptibility to HIV infection if she is exposed to the virus. Having trichomoniasis may increase the chance that an HIV-infected woman passes HIV to her sex partner(s).

Complications of Genital Herpes

Recurrent painful genital sores can frequently occur.
Mother-infant transmission - a fetus can acquire herpes in utero, and herpes can be passed to a baby during birth. The risk is greatest if the mother's first outbreak was during pregnancy. Later outbreaks still pose some risk to the fetus.
Premature birth - a fetus with herpes is often delivered early.
Neonatal complications - a newborn may have various health problems; some newborns with herpes have a poor prognosis leading to neonatal death.
HIV exposure - Herpes may play a role in the spread of HIV, the virus that causes AIDS. Herpes can make individuals more susceptible to HIV infection, and it can make HIV-infected individuals more infectious.

What causes it?

Chlamydia
Chlamydia is caused by the bacterium, Chlamydia trachomatis. This bacterium may infect men, women, and newborns. If symptoms occur, they usually appear approximately 7 to 21 days after infection. Chlamydia can also be passed from an infected mother to her newborn child during childbirth. If symptoms occur in a newborn, they usually appear 7 to 14 days after delivery and pneumonia may result when the infant is 2 to 3 weeks old.

Gonorrhea

Gonorrhea is caused by the bacterium, Neisseria gonorrhoeae. The bacterium may infect men, women, children and newborns. The bacteria can grow in moist areas of the reproductive tract, including the cervix (opening to the uterus), uterus, and fallopian tubes (fallopian tubes connect the ovaries to the uterus) in females and in the urethra (the canal through which urine passes to the outside of the body) in both males and females. The bacteria can also grow in the eyes, mouth, throat, and anus. Gonorrhea can also be passed from an infected mother to her newborn child during childbirth.

Syphilis

Syphilis is caused by the bacterium, Treponema pallidum. This bacterium may infect men, women, children, and newborns. Symptoms of infection generally occur between 10 and 90 days after contact with an infected partner. Syphilis can also be passed from an infected mother to her newborn infant during childbirth.

Trichomoniasis

Trichomoniasis is caused by the single-celled protozoan parasite called Trichomonas vaginalis. It is caused by a parasite that can be passed from one person to another. The parasite is sexually transmitted through penis-to-vagina intercourse or vulva-to-vulva contact with an infected partner. The vulva is the genital area outside the vagina. Women can get the disease from infected men or women.

While trichomoniasis is usually passed sexually, it may be picked up from contact with damp or moist objects such as towels, wet clothing, or a toilet seat, if the genital area gets in contact with these damp or moist objects. The vagina is the most common site of infection in women, and the urethra is the most common site of infection in men.

Herpes

Genital herpes is almost always sexually transmitted. It is an infection caused by the herpes simplex virus, one of the same family of viruses that causes chicken pox, cold sores, and mononucleosis. Two different types of herpes simplex viruses can cause herpes.

Herpes simplex virus type 1 (HSV-1) usually causes oral herpes (cold sores or fever blisters) on the face and mouth. HSV-1 infection of the genitals can be caused by oral-genital or genital-genital contact with a person who has HSV-1 infection. Genital HSV-1 outbreaks recur less regularly than genital HSV-2 outbreaks.

Herpes simplex virus type 2 (HSV-2) usually causes genital herpes. Genital HSV-2 infection is more common in women (approximately one out of four women) than in men (almost one out of five). This may be due to male-to-female transmissions being more likely than female-to-male transmission.

Who has it?

Chlamydia
Chlamydia is the most frequently reported infectious disease in the United States. The U.S. Centers for Disease Control and Prevention (CDC) reported 783,424 cases of chlamydia in 2001. In 2004, the number jumped to 929,462 cases of chlamydial infections. Based on CDC data, the number of reported cases of chlamydia has more than doubled in the past 10 years. Of those cases reported, 4 out of every 5 occurred in individuals under 25 years of age. Among teenagers, approximately 15% of sexually active girls and 5% to 10% of sexually active boys have chlamydial infections.

Gonorrhea

Gonorrhea is the second most frequently reported STI in the United States, following chlamydia. According to the CDC, 361,705 gonorrhea cases were reported in 2001 but was decreased to 330,132 cases in 2004. Although this trend seems favorable, gonorrhea still remains prevalent in the Southwestern states, especially among minorities and adolescents of racial and ethic groups. The highest rates of gonorrhea infection are seen in blacks, Hispanic, and Native American populations, with Asian/Pacific being the lowest (less than 100 cases per 100,000 people). The highest rates of infection are usually found in women 15 to 19 years of age and men age 20 to 24 years.

Syphilis

In 2004, primary and secondary syphilis cases reported to CDC increased to 7,980 from 7,177 in 2003, an increase of 11.2%.More cases probably occur each year than what is actually reported to health officials. Syphilis occurs primarily in individuals aged 20 to 39 years, and the reported rate in men was 1.5 times greater than the rate in women. The incidence of syphilis was highest in women aged 20 to 29 years and in men 30 to 39 years of age.

Trichomoniasis

Any sexually active person can be infected with trichomoniasis. According to the CDC, 221,000 cases were reported, an increase of 23 percent from 2003. About 5 million Americans develop trichomoniasis every year. It has been found in:

5%-15% of women at gynecology clinics
50%-75% of prostitutes in the United States

It is often diagnosed in patients who are already infected with other STIs such as gonorrhea.

Genital Herpes

According to the CDC, 269,000 cases were reported in 2004, an increase of 32 percent from 2003. About 45 million Americans, age 12 and older have had genital herpes in their lifetime. It?s estimated that up to one million people become infected each year. Genital herpes (HSV-2) is more common in women than men.

What are the risk factors?

Risk factors are characteristics that may increase your chance for developing a condition. The more risk factors you have, the more likely you are to develop the condition. Any of the following may increase your risk for contracting chlamydia, gonorrhea, or syphilis, genital herpes, and trichomoniasis:

Age less than 25 years (individuals at greatest risk are women between the ages of 15 and 20 years and men younger than 25 years)
Sexual intercourse or sexual contact with an infected partner (whether protected or not)
Having other STIs such as genital herpes (having one STI increases the risk for contracting other STIs)
Injection drug users (sharing needles with an infected person)

Using safe sex measures may help decrease your risk but will not completely void the risk. Some safe sex measures include:

Know your partner. Before having sex, first establish a committed relationship that allows trust and open communication.
Properly use latex condoms to avoid contact with semen, vaginal fluids, or blood. Both male and female condoms dramatically reduce the chance you will get or spread an STI.
Stay sober. Alcohol and drugs impair your judgment, communication abilities, and ability to properly use condoms or lubricants.
Be responsible. If you have an STI, like syphilis or herpes, advise any prospective sexual partner. Allow him or her to decide what to do. If you mutually agree on engaging in sexual activity, use latex condoms and other measures to protect the partner.
If pregnant, take precautions. If you have an STI, learn about the risk to the infant before becoming pregnant. Ask your provider how to prevent the fetus from becoming infected.

What are the symptoms?

Symptoms of STIs vary depending on the specific sexually transmitted infection. Learn more about the specific symptoms that can accompany each STI:

Symptoms of Chlamydia

Chlamydia is known as a "silent" disease because 75 percent of infected women and at least half of infected men have no symptoms. Since symptoms are rare, it often goes untreated and undetected until complications occur. If symptoms do occur, they tend to appear within 7 to 21 days of exposure.

Symptoms that may occur in women include the following:

Mucus or pus-like vaginal discharge
Burning sensation when urinating
Lower abdominal pain
Low back pain
Nausea
Fever
Pain during sexual intercourse
Bleeding between menstrual periods

Symptoms that may occur in men include the following:

White or clear discharge from the penis
Burning sensation when urinating
Burning or itching around the opening of the penis
Pain and swelling in the testicles

Symptoms that may occur in newborns (if transmitted during birth) include the following:

Conjunctivitis (inflammation of the lining of the eye) along with redness of the eye and a discharge containing pus
Pneumonia

Symptoms of Gonorrhea

The symptoms of gonorrhea depend on the age and sex of the infected person. The symptoms of gonorrhea are often mild and start to develop within 10 to 24 days after exposure. Gonorrhea infections among newborns often develop within 2 to 5 days after birth.

Symptoms that may occur in women include the following:

Thick, yellow vaginal discharge
Burning pain when urinating
Bleeding or spotting between menstrual periods
Heavy menstrual periods
Abdominal pain
Pain during sexual intercourse
Fever
Pharyngitis (inflammation of the throat)
Urethritis (inflammation of the urethra, the canal through which urine passes to the outside of the body)

Symptoms that may occur in men include the following:

Thick, yellow discharge from the penis
Burning sensation when urinating
Urge to urinate often
Discharge from the penis (thick, yellow)
Painful or swollen testicles
Pharyngitis (inflammation of the throat)
Urethritis (inflammation of the urethra, the canal through which urine passes to the outside of the body)

Symptoms that may occur in newborns (if transmitted during birth) include the following:

Conjunctivitis (inflammation of the lining of the eye)
Uveitis (inflammation of the iris which is the color part of the eye)
Scalp lesions

Symptoms of Syphilis

There are four stages of syphilis, each of which is associated with distinct symptoms.

1. Primary syphilis is the stage of the bacteria's entry into the body.

The classic sign of primary syphilis is a chancre (pronounced 'kang ker'). A chancre is a red, painless although sometime tender, skin lesion that appears at the location where the bacteria enter the body. The chancre develops approximately 14 to 21 days after a patient has been infected. The base of the chancre is usually smooth, and the borders are raised and firm. The chancre is usually a single lesion but multiple chancres can occur, especially in people infected with human immunodeficiency virus (HIV). Chancres occur in up to 60% of patients infected with syphilis and are usually seen in the genital, anal, or oral areas; however, any part of the body may be affected. If untreated, the chancre will heal typically on it's own within 3 to 8 weeks.
During primary syphilis individuals are infectious. Being infectious means that you may pass the disease to other individuals through sexual contact or contact with a chancre.

2. Secondary syphilis results when the bacteria actually enter the bloodstream. It occurs approximately 4 to 10 weeks after the initial appearance of the primary chancre. Sometimes, secondary syphilis may occur at the same time as primary syphilis. During secondary syphilis patients are infectious, meaning that the disease can be transmitted to other individuals through sexual contact. Signs and symptoms of secondary syphilis may include the following:

Skin rash is typically the first symptom of secondary syphilis. The rash is red or reddish-brown in color, and usually involves the trunk, legs, and palm of the hands and soles of the feet. The rash is usually scaly in appearance but sometimes appears smooth and can be mistaken as psoriasis.
Increased or decreased skin color
Circular lesions which appear mainly on the face of dark-skinned individuals and are described as looking like "clean-cut ham" or having a coppery tint color
Swelling of all lymph nodes
"Condyloma latum" which are one or more large, raised, whitish or gray warty-like lesions usually found in warm, moist areas such as around the vulva (opening of the vagina) or anus
Loss or thinning of hair, eyebrows or beard
Flu-like symptoms such as fever, weight loss, headache, muscle aches, or sore throat

3. Latent syphilis is the hidden (or latent) stage of syphilis.

It generally begins when the secondary symptoms spontaneously resolve after a period of 3 to 12 weeks, leaving an individual free of symptoms. Even though the secondary symptoms resolve, the bacteria remain in the body and may begin to damage the brain, nerves, eyes, heart, blood vessels, liver, bones, and joints. This damage may not appear until many years later, until the late or tertiary stage of syphilis. Damage that may occur during the latent stage though may be serious enough to cause death.
Individuals are infectious during latent syphilis, meaning that the disease can be transmitted to other individuals through sexual contact.

4. Tertiary Syphilis, is the last stage, " the destructive stage," of the disease.

Symptoms of tertiary syphilis may develop 2 or more years following the latent period. Late stage signs and symptoms include not being able to coordinate muscle movements, paralysis, numbness, gradual blindness and dementia. Complications (such as neurosyphilis, cardiovascular syphilis, late benign syphilis, periosteal inflammation, or skin damage) of syphilis typically occur in this stage. These complications can be serious and even life threatening. To learn more about the complications from syphilis, read the What is it? section concerning the complications of syphilis.
Individuals are not infectious during tertiary syphilis.

Symptoms of Trichomoniasis

Many people with trichomoniasis experience no symptoms. The symptoms differ between women and men.

Symptoms for women are:

Itching
Burning
Vaginal or vulval redness
Unusual vaginal discharge
Frequent and/or painful urination
Discomfort during intercourse
Abdominal pain

Symptoms tend to worsen after menstruation. Symptoms usually appear within 5 to 28 days of exposure in women.

Symptoms for men are:

Unusual penile discharge
Painful urination
Tingling inside the penis

*An interesting point to note is that 70 - 90 percent of women and 40 ? 50 percent of men who have an STI have NO noticeable symptoms.

Symptoms of Genital Herpes

The symptoms of genital herpes may include:

A rash, bumps, blisters, cuts, or sores in or around the genital area (vagina, vulva, anus, penis, or scrotum)
Itching, burning, tingling, or swelling in or around the genital area
Aches or pains in or around the genital area
Discharge from the penis or vagina
Burning and/or pain when urinating
Flu-like symptoms such as headache, fever, and swollen glands (lymph nodes) in the groin
Not everyone has symptoms during every outbreak

How is it treated?

Chlamydia, gonorrhea, syphilis, and trichomoniasis are bacterial infections and are treated and cured with antibiotics (medications used to treat infections caused by bacteria). Treatment is crucial to prevent the spread of these STIs. The treatment of all sexual partners (past and present) helps prevent re-infection and further spread of the disease. It is also important to treat pregnant women to prevent transmission to infants during birth. Since most people infected with gonorrhea are often also infected with chlamydia, it is now recommended that all patients being treated for gonorrhea also be treated for chlamydia.

The selection of an antibiotic to treat an STI will depend on several factors. These include the following:

The actual bacteria causing the infection
Allergies you have to various antibiotics
Severity of the infection
Resistance to antibiotics that you may have because of past treatment

Treating Chlamydia

For most cases of uncomplicated chlamydial infections, doxycycline 100mg orally twice a day for 7 days or azithromycin 1,000mg orally one time is the treatment of choice. For patients who can not take these medications, or in cases where complications are apparent, oral antibiotics including erythromycin, ofloxacin, amoxicillin, and sulfisoxazole may be used. Another alternative is ceftriaxone, which is given by injection into a muscle as a one time dose.

Treating Gonorrhea

Most cases of uncomplicated gonorrheal infections can be effectively treated with ceftriaxone 125mg given by injection into a muscle as a one time dose, or cefixime 400 mg orally in a single dose. Each of these treatment regimens should be accompanied by a treatment regimen for chlamydia (those treatments are discussed above). Ongoing data from the CDC demonstrate that gonorrheal infections have become resistant to fluoroquinolone antibiotics, such as ciprofloxacin and ofloxacin. As a consequence, as of 2007 this class of antibiotics is no longer recommended for the treatment of gonorrhea in the United States.

Treating Syphilis

Penicillin, given either as an injection into the muscle (intramuscular - IM) or as an injection directly into a vein (intravenous - IV) is the treatment of choice for all stages of syphilis. For patients who cannot take penicillin, oral antibiotics such as doxycycline, tetracycline, or erythromycin may be used.

Treating Trichomoniasis

The usual treatment is a single large dose of oral metronidazole, or split doses over the course of a week. Sexual partners of an infected individual must also be treated, to prevent the infection being passed back and forth. Treatment is important because studies suggest that trichomoniasis may increase a pregnant woman?s risk of premature delivery and may also increase the risk of HIV transmission.

Women who are taking antibiotics for other illnesses should speak to their health care provider about the possible effects of the medication(s) on the balance of organisms in their vagina. There are a certain amount of ?good? bacteria that live in the vagina, and the more metronidazole or other antibiotics you take the more the chance your ?good? bacteria is abolished leaving your vaginal area vulnerable to other infections.

Regardless of the chosen antibiotic, it is important to remember to take the entire course of antibiotics prescribed by your physician. Many individuals take their medication only until they feel better, and this can allow an infection to return with even greater severity in the near future. Not finishing the full course of treatment may also prevent that antibiotic from working well in the treatment of other individuals. To learn more about the different types of antibiotics used to treat chlamydia, gonorrhea, and syphilis, click on the drug class links below.

Treating Genital Herpes

There is no treatment that can cure genital herpes; the virus will always be in your body. Certain drugs such as acyclovir, valacyclovir, and famciclovir can shorten outbreaks and make them less severe, or stop them from occurring. Depending on your needs, your doctor can give you drugs to take right after getting outbreak symptoms or drugs that you can take on a regular basis to try to stop outbreaks from occurring. When used along with safe sex practices, valacyclovir can also help prevent you from passing the infection to someone else. Talk to your doctor about which treatment plan is best for you.

During outbreaks, these steps can speed healing and prevent spreading of the infection to other sites of the body or to other people.

Keep the infected area clean and dry.
Try not to touch the sores.
Wash hands after contact.
Avoid sexual contact from the time the symptoms are first noticed until the sores have healed.

2008-05-23T13:13:00.004+08:00

HIV and AIDS Drug Medical Treatment

Introduction

Barely 25 years ago few people knew what the words AIDS and HIV meant. Now not only are red ribbons the standard attire on guests at television awards shows, but there are specific lines of clothing and cell phones dedicated to raise money and awareness of this deadly virus.

What is it?

AIDS stands for Acquired Immune Deficiency Syndrome. People with AIDS are infected with the human immunodeficiency virus (HIV), a virus that damages the immune system. Since the immune system protects the body from illness, people with AIDS are more susceptible to all sorts of other health problems. Currently, AIDS cannot be cured. However, AIDS has evolved from a relatively untreatable, almost always fatal disease into a complex, long-term illness for which patients and their caregivers have numerous treatment options. Therapies have been developed to treat both the virus itself and its associated complications.

What causes it?

Acquired Immune Deficiency Syndrome, or AIDS, is caused by an infection with a specific virus - human immunodeficiency virus (HIV). AIDS is the last stage of the HIV infection. When HIV enters the body, it attacks special white blood cells that are part of your body's immune system. These cells, called CD4 cells or T cells, play an important role in fighting infections as well as in directing other cells to find and destroy disease-causing organisms. After invading a cell, HIV releases an enzyme called reverse transcriptase that helps it grow and multiply inside the CD4 cell. HIV then uses another enzyme, protease, to make pieces of virus to spread throughout the body. As HIV disables and kills more and more CD4 cells, the body's ability to fight infection weakens.

AIDS is diagnosed when CD4 cell count drops below 200 cells per cubic millimeter of blood. (Healthy adults usually have CD4 counts of 1000 or more). A diagnosis of AIDS is also given when one or more of the 26 clinical conditions that often affect people with advanced HIV disease are present. Most of these conditions are infections that generally do not affect healthy people. In individuals with AIDS, these infections are often severe and sometimes fatal because the immune system is so weakened by HIV that the body cannot fight off certain bacteria, viruses, fungi, other microbes,and even certain cancers.

Who has it?

AIDS can strike individuals in all ethnic groups, ages, sexes, and sexual orientations. According to the World Health Organization (WHO), as of November, 2007, 33.2 million people worldwide were living with HIV/AIDS, with approximately 68% (22.5 million) of these people live in Sub-Saharan Africa and 50% being of the male gender. In the year 2006, 4.3 million individuals were diagnosed with HIV, which means that roughly 14,000 individuals were diagnosed each day. Approximately 95% of those new infections are occurring in developing countries such as: Bangladesh, Pakistan, Indonesia, Papua New Guinea, and Vietnam. Also, in the year 2006, there was an estimated 2.9 million deaths associated with HIV/AIDS.HIV continues to be one of the major causes of death globally, and it is the number one cause of death in sub-Sahara Africa.

As of March 2008, in the United States, it is estimated that 1.2 million residents are living with HIV/AIDS, 25% of whom are unaware that they are infected. Approximately 40,000 new cases are diagnosed each year, with 70% being males and 50% being individuals under the age of 25.

What are the risk factors?

HIV infection is spread by the transmission of body fluids from a person who is infected with HIV. Anybody, regardless of age, geographic location, gender, or sexual preference is at risk for HIV. For example, any of the following are ways of contracting HIV:

Having unprotected sex, including vaginal, oral, and anal (without a latex condom) with a person who is infected with HIV whether they are heterosexual, homosexual, or bisexual.
Having STI?s (sexually transmitted infections) such as syphilis, herpes, chlamydia, or gonorrhea.
Sharing a needle or syringe with an HIV-positive individual.
Receiving an HIV-contaminated blood transfusion or any blood product prior to 1985.
Being born to or breastfeeding from an un-medicated HIV-positive woman.
Breaking the skin with an injury from medical equipment that has been in contact with HIV-infected fluids. (eg. accidentally pricking the finger with a needle that was used in an HIV-positive patient)
Receiving an HIV-contaminated organ transplant (very rare).
Undergoing dental procedures done with improper sanitation of dental equipment that has been in contact with HIV (very rare).
Getting a tattoo or body piercing with equipment that was not sanitized properly, or with needles that have been reused.

Within the past 15 years, many efforts have been made to reduce the risk of being infected with HIV. For instance, since 1985 the American blood supply has been tested for HIV, making infections through blood transfusions very rare. HIV infection is NOT spread by:

Air
Food
Water
Insects (including mosquitoes and bedbugs)
Animals
Non-infected people wanting to donate blood
Everyday, casual contact with people who are HIV-positive (eg. sharing food, utensils, towels, bedding, telephones, toilet seats, swimming pools, and hand shaking)
Saliva from kissing, sweat, tears, urine, feces

What are the symptoms?

A person who has been infected with HIV is usually referred to as being "HIV-positive". The time between a diagnosis of HIV and the onset of AIDS can vary greatly. Whereas many HIV-positive individuals remain symptom-free for several years, most will develop at least some AIDS-related condition within 10 years.

Many people do not develop any symptoms when they first become infected with HIV. Others may suffer a brief flu-like illness, with symptoms that may include the following:

Fever
Headaches
Tiredness
Sore throat
Swollen glands
Muscle and joint pain

As the immune system loses its ability to fight infection, serious illnesses, called opportunistic infections, may appear. Opportunistic infections result when microorganisms that do not ordinarily cause problems in healthy people take advantage of a weakened immune system and attack the body. Common sites for some of these infections are the following:

Esophagus
Lungs
Brain or spinal cord
Retina (an organ located behind the eye that is ultimately responsible for vision)

Symptoms of opportunistic infections can include the following:

Upset stomach
Vomiting
Diarrhea
Stomach cramps
Coughing
Fever
Headaches
Vision loss
Weight loss
Tiredness, lack of energy
Painful swallowing
Mental symptoms including confusion and forgetfulness
Seizures, lack of coordination

How is it treated?

AIDS has no cure and there are currently no FDA-approved vaccines to protect against HIV, but there are vaccines that are currently being studied. However, medications can slow the progress of the disease, which allows patients to stay healthier and live longer. The drugs used to treat HIV infection are called antiretrovirals, because they fight HIV, which is a type of "retrovirus."

The goals of therapy are to:

Suppress viral load (or the amount of HIV in a sample of blood)
Restore or preserve immune function
Improve quality of life
Reduce morbidity (the occurrence of opportunistic infections or number of hospitalizations) and mortality (death)
Reduce the transmission of HIV/AIDS

The six types of currently FDA-approved antiretroviral medications used to treat HIV and AIDS are:

Nucleoside Reverse Transcriptase Inhibitors (NRTIs), which includes Nucleotide Analogs
Non-nucleoside Reverse Transcriptase Inhibitors (NNRTIs)
Protease Inhibitors
Fusion Inhibitors, sometimes also referred to as Entry Inhibitors
CCR5 Entry Inhibitors, sometimes also referred to as CCR5 Co-receptor Antagonist
Integrase Inhibitors

How These Drugs Work:

Antiretroviral drugs inhibit the growth and replication of HIV at various stages of its life cycle. NRTIs interrupt an early stage of the virus replication process (or interrupt the virus from making copies of itself). NRTIs help to slow the spread of HIV in the body and delay the start of other opportunistic infections. NNRTIs keep the enzyme called "reverse transcriptase" from working so viral cells cannot reproduce. Protease Inhibitors interrupt virus replication at a later step in the HIV life cycle. Nucleotide Analogs prevent the HIV cells from producing new virus and decrease the amount of HIV in the body. Fusion Inhibitors bind to HIV and prevent the virus from infecting healthy cells in the body. CCR5 Entry Inhibitors work by binding to CD4 cells and prevent the HIV virus from entering CD4 cells. Integrase Inhibitors work by stopping viral genetic material from being integrated into healthy host cell genetic material.

Recommended Treatment Options:

According to the guidelines for the use of antiretroviral agents,

treatment is typically not started in individuals who have a CD4+ T cell count of greater than 350 cells/mm3 and plasma HIV RNA levels of less than 100,000 copies/mL.
clinicians may consider starting therapy for individuals who have a CD4+ count of more than 350 cells/mm3 and a plasma HIV RNA level of more than 100,000 copies/mL and are not showing signs or symptoms of HIV, whereas some clinicians may choose to delay starting therapy.
individuals who have a CD4+ count of 201to 350 cells/mm3 and any level of plasma HIV RNA are offered the option to start treatment, but it is up to the individual.
treatment is recommended in those individuals who have a CD4+ count of less than 200 cells/mm3 even if they are not showing signs or symptoms of HIV/AIDS.
treatment is recommended in those individuals who have severe symptoms of HIV infection or who have a history of AIDS-defining illnesses (such as multiple/recurrent bacterial infections, recent pneumonia, fungal infection in the esophagus, herpes simplex virus, kaposi's sarcoma-a type of skin cancer, burkitt's lymphoma-a type of cancer, invasive cervical cancer, as well as any other opportunistic infections just to name a few) no matter what their CD4+ count is.

Highly Active Anti-Retroviral Therapy (HAART) is a combination of different classes of drugs that are used to treat HIV/AIDS. This therapy focuses on maximizing suppression of the individual's symptoms of HIV and prolonging the development of opportunistic infections. The treatment guidelines recommend two different types of regimens for those individuals who have not been placed on HAART before. Both regimens include the use of 2 NRTIs as the basis of therapy. One of the regimens recommends the additional use of 1 NNRTI agent (so, 2 NRTIs plus 1 NNRTI) while the other recommends the additional use of 1 to 2 PIs (so, 2 NNRTIs plus 1 to 2 PIs). Studies have shown that the combination of zidovudine, lamivudine (both are NRTIs ), and efavirenz (an NNRTI) is a regimen that is superior over other regimens for initial therapy.Fusion inhibitors, CCR5 Co-Receptor Antagonists, and Integrase Inhibitors are typically used in place of protease inhibitors, NRTIs, or NNRTI in cases of resistant HIV.

Unfortunately, the HIV/AIDS virus typically becomes resistant to medications due to viral mutations or changes. Also, over time, individuals may become intolerant to the medication or the medication?s side effects which can be very unpleasant. With resistance developing or if medication intolerance occurs, 1 to 2 medications might have to changed at some point during therapy.

Combination Medications:

Due to the need of a large number of medications used to treat HIV, drug companies have started to create combination medications. Some of these combination medications contain up to three different HIV medication ingredients to help reduce the number of pills taken per day and to help individuals remember to take all medications. Here is a list of all currently available combination medications: Trizivir, Epzicom, Truvada, Combivir, and Atripla. Some of the combination medications contain drugs from the same class, but not all of them.

Resistance Testing:

When individuals who are infected with HIV become resistant to a particular treatment regimen, a new regimen should be tried. But how do doctors know if the new treatment will work? Persons who fail a certain combination of antiretroviral drugs can undergo resistance testing (sometimes called genotype testing) before starting a new treatment regimen. This type of testing may help health care providers find the most effective treatment regimen for the resistant infection. Also, since resistant HIV can be transmitted to others, some newly diagnosed patients who have not been on antiretroviral drugs previously may also undergo resistance testing to find the most appropriate drugs even before beginning treatment.

The treatment guidelines provide recommendations on when an individual should have resistance testing done. Resistance testing should be performed in those individuals who:

have an acute HIV infection and therapy is going to be started (often times an acute infection goes unrecognized as it presents with similar symptoms to the flu and other illnesses, symptoms include: fever, rash, headache, nausea/vomiting, weight loss. HIV RNA tests are done to then confirm diagnosis.)
have a chronic HIV infection and therapy is going to be started
have suboptimal viral load reduction

Resistance testing should be considered in those individuals who have an acute HIV infection, but therapy is going to be started at a later time. However, resistance testing may not be beneficial for all patients with HIV/AIDS. Your doctor can decide if resistance testing is right for you.

Finally, it is important to note that individuals who are infected with HIV should seek medical care from doctors who are specially trained and have expertise in treating HIV/AIDS. We are learning more and more about HIV/AIDS on a daily basis. Research into new drug therapies and treatments is ongoing. Seeking medical care from an HIV/AIDS specialist will help you ensure that you are receiving the most cutting-edge therapy and care. An HIV/AIDS specialist will best be able to determine when to start HIV treatment and what HAART regimen is best.

Drug classes used to treat HIV and AIDS

Combination Antiretroviral Medications

Combination antiretroviral medications have been developed to help reduce the number of pills that HIV/AIDS individuals need to take. This development will hopefully help HIV/AIDS individuals be compliant with their medications and to help reduce the development of drug resistance. Some combination medications contain drugs in the same class, whereas others combine two different classes together.

Drugs in the class

Emtricitabine and Tenofovir (Truvada)

Abacavir, Zidovudine and Lamivudine (Trizivir)

Lamivudine and Zidovudine (3TC and AZT, 3TC and ZDV, Combivir)

Abacavir and Lamivudine (Abacavir and 3TC, Epzicom)

Efavirenz; emtricitabine; tenofovir tablets (Atripla)

2. Fusion Inhibitors

Fusion Inhibitors bind to HIV and prevent the virus from infecting healthy cells in the body. They are used along with other antiretroviral medications to treat HIV.

Drugs in the class

Enfuvirtide (Fuzeon)

3. Non-Nucleoside Reverse Transcriptase Inhibitors

NNRTIs keep the enzyme reverse transcriptase from working so viral cells cannot reproduce.

Drugs in the class

Delavirdine (Rescriptor)
Nevirapine (Viramune)
Efavirenz (Sustiva)

4. Nucleoside Reverse Transcriptase Inhibitors (NRTIs)

By taking the place of essential viral parts during division, NRTIs prevent viral cells from copying properly. This allows NRTIs to block the replication of viruses and slow the progression of viral infections such as HIV and hepatitis B.

Drugs in the class

Zalcitabine (Hivid, ddC, dideoxycytidine)
Stavudine Oral Solution (Zerit Oral Solution, d4T Oral Solution)
Abacavir tablets (Ziagen)
Emtricitabine capsules (Emtriva capsules)
Stavudine (Zerit, d4T)
Zidovudine Injection (AZT Injection, Azidothymidine Injection, Compound S, Retrovir Injection)
Didanosine (DDI, Videx)
Lamivudine (3TC, Epivir, Epivir-HBV)

5. Nucleotide Analogs

Drugs in the class

Tenofovir (PMPA, TDF, Tenofovir Disoproxil Fumarate, Viread)

6. Protease Inhibitors

Protease inhibitors are a newer class of antiretroviral drugs. They interrupt virus replication at a later step in the HIV life cycle. HIV can still divide to make copies of itself, but the new viral particles are unable to infect additional CD4 cells. Protease inhibitors can reduce the amount of virus in the blood and increase CD4 cell counts, helping to preserve or even restore immune system function. The chance of getting opportunistic infections is less, too.
Most of the protease inhibitors interact with other medications, so they require careful monitoring to avoid serious complications. A unique adverse effect of the protease inhibitors is called lipodystrophy?the redistribution of body fat from the face, arms, and legs to the stomach, breasts, and upper back. Although it is not dangerous, lipodystrophy can be annoying or embarrassing enough to make some HIV/AIDS patients stop taking protease inhibitors. Another complication of these drugs is extremely high cholesterol that occurs in some patients and can lead to serious health complications, including heart disease. Researchers are not sure why this occurs but some evidence points to genetics. Future research may include testing to determine which patients would be at increased risk for developing this complication.

Drugs in the class

Atazanavir (Reyataz)
Amprenavir (Agenerase)
Indinavir (Crixivan)
Ritonavir (Norvir)
Amprenavir Oral Solution (Agenerase Oral Solution)
Lopinavir and Ritonavir (Kaletra)
Ritonavir Oral Solution (Norvir Oral Solution)
Nelfinavir (Viracept)
Fosamprenavir Calcium (Lexiva)
Tipranavir (Aptivus)
Saquinavir (Invirase)
Darunavir tablets (Prezista)

2008-05-09T12:40:00.000+08:00

Sleep Disorders and Drug Medical Treatment

Introduction

What is it?

Sleep disorders can be temporary or long-term problems and can affect the quantity or quality of sleep achieved. There are four recognized types of sleeping disorders:

Extrinsic sleep disorders, caused by something outside of the body such as drug use or a poor sleep environment
Intrinsic sleep disorders, caused by something within the body such as a physical or psychological ailment
Circadian rhythm sleep disorders, which are disruptions in your regular daily biological clock such as jet lag or work shift changes
Parasomnias, characterized by unusual physical occurrences during sleep such as sleepwalking, grinding teeth or bed-wetting

Insomnia, or difficulty falling asleep, can be caused by any one of the four types of sleep disorders mentioned above.

The National Institutes of Mental Health has identified three broad categories of insomnia. These include:

Transient - insomnia lasting fewer than three days
Short-term - lasting three days to three weeks
Chronic - lasting more than three weeks

What causes it?

There are many elements about the mechanisms of sleep and wakefulness that scientists do not understand. What is known is that sleep is primarily controlled by two systems in the brain: one that induces sleep, and sleep-related processes, and one that regulates sleep within a 24-hour cycle. This cycle, which corresponds to periods of light and darkness, is known as the circadian rhythm cycle. Researchers are discovering that this cycle a process controlled by genes that are found in living creatures ranging from the lowly fruit fly to human beings.

Researchers know that as human beings we go through a variety of stages that can be measured by brain wave patterns. This includes a stage in which our eyes move rapidly, where it is assumed we are dreaming. This stage of sleep is therefore known as rapid eye movement (REM) sleep. Sleep disorders result from either internal abnormalities or external disturbances to these cycles. The feeling of having had enough sleep, or sleep satiety, is related to whether one has gone through all of the cycles of sleep, including both dreamless and REM sleep. We cycle through these stages multiple times per night.

Who has it?

Insomnia is the most prevalent sleep complaint among adults in America. Sleep apnea, a disruption of breathing during sleep, affects nearly 12 million people in the U.S. More than one billion dollars are spent each year on sleep medications in the United States.

What are the risk factors?

Most short-term sleep disorders are caused by one or more of the following factors:

lifestyle changes, such as marriage or retirement
stressful situations, such as the death of a loved one or job pressure
physical disorders
environment

Chronic sleep disorders have numerous possible causes. These include:

medical conditions - especially those producing pain
psychiatric conditions such as depression
drug use (including alcohol, nicotine, or caffeine)
environments that are not conducive to sleep

What are the symptoms?

The symptoms of sleep disorders include:

difficulty or inability to fall asleep
awaking early from sleep
easy disruption of sleep
fatigue or sleepiness
anxiety
lack of concentration
irritability

How is it treated?

Drug therapy in combination with good sleep hygiene (click on the Helping Yourself box) may be helpful for short-term management of insomnia.

Other drugs used in the management of insomnia include unique agents called non-benzodiazepine sedative hypnotics. Examples include Ambien (zolpidem), Sonata (zaleplon), and Lunesta (eszopiclone).

A new class of sedative hypnotics has recently been introduced to the market. Rozerem (ramelteon),is a melatonin receptor agonist which mimics the body?s natural sleep promoting hormone, melatonin. This drug class is unique because it works with the body?s natural circadian rhythm to promote sleep. These melatonin receptor agonists do not carry an addiction potential.

Herbal products such as valerian, chamomile, kava kava, and others have also been promoted as natural remedies for insomnia. However, the effectiveness and safety of these products has not been documented in large clinical trials.

Drug classes used to treat Sleep Disorders

Barbiturates

Barbiturates are a class of drugs sometimes used to treat sleep disorders. Drugs in this class produce drowsiness and prolong sleep duration by slowing the body's central nervous system functioning. Barbiturates can also cause mild sedation and a hypnotic state. At higher doses, these drugs are even used as anesthetics. Barbiturates can be habit-forming and should be carefully prescribed and monitored by a physician. When used for treating sleep disorders, barbiturates should be used only short-term, usually a period of no more than 2 weeks, since patients tend to develop tolerance to their effects.

Benzodiazepines

Benzodiazepines ("benz - o - di - as - ip - eens") are commonly used for the management of sleep disorders because of their ability to hasten sleep onset, reduce the number of awakenings, and increase total sleep duration. Benzodiazepines should not be discontinued abruptly because rebound insomnia (i.e. worsening of insomnia) may result.

Miscellaneous Sedatives and Hypnotics

Many drugs used to treat sleep disorders are difficult to group together with other drugs based on their mechanism of action because the exact mechanism may be unknown or no other medication works in the same manner. These drugs are thus listed as miscellaneous sedatives and hypnotics.

2008-05-02T10:02:00.003+08:00

Acne and Drug Medical Treatment

Introduction

You may have been told that if you wash your face several times each day to keep it clean, that will help keep acne away. Is this true or just an old wives-tale? Though it may be difficult to believe, washing your face that often can actually make your acne worse! If you want to learn more about acne and ways that you can help yourself treat this skin condition, read on!

What is it?

Acne, also called acne vulgaris, is a common inflammatory skin condition that is characterized by pimples, blackheads, and red, swollen bumps on the skin (usually the face, neck, shoulders, or back). The term acne is used to describe the condition when a person has between 5 to 10 pimples, blackheads, or red and swollen bumps on his or her body at the same time. Acne is typically thought to occur in adolescence, but it can also occur in adulthood. While not a life-threatening condition, acne can have a significant psychological and physical impact on a person's life, causing poor self-image, anxiety, depression, and permanent scarring of the skin.

What causes it?

Acne is thought to be the result of several different factors occurring either separately or at the same time. Most commonly, acne develops because of excess sebum (oil) production by the sebaceous glands (oil glands) in the skin. Excess oil production is typically triggered by an increase in androgen hormones ("masculine hormones") such as testosterone or androsterone. Both males and females produce androgen hormones, and their production normally increases during adolescence to help the body mature. Increases in androgen hormone levels lead to increased sebum production, which in turn increases the likelihood for developing acne.

Along with excess sebum production, skin cells can plug a pore and allow normally-occurring bacteria to flourish. A bacterium called Propionibacterium acnes or P. acnes is normally found on the skin, but if it gets trapped inside hair follicles, it can trigger acne. All of these processes can result in inflammation.

Certain medications can also cause acne. Specifically, hormone medications like contraceptive agents [medroxyprogesterone injections (Depo-Provera) and older oral contraceptives--newer birth control pills such as Ortho Tri-Cyclen and Estrostep can actually improve acne], testosterone, corticosteroids [prednisone, methylprednisone, dexamethasone, prednisolone, betamethasone, cortisone, hydrocortisone, and triamcinolone], and anabolic steroids [danocrine (Danazol) and stanozolol (Stomba)] can all make acne worse. Other medications known to exacerbate acne include certain antidepressants, drugs used to treat tuberculosis, anti-seizure medications, and cyclosporine (Neoral, Sandimmune).

Oftentimes, it is difficult for doctors to determine the exact cause of acne for a particular patient. Because of this, it may take time and multiple trials of medication to find the medication most effective for the treatment of your acne.

Disregard the Myths

You've heard your mother say, "Don't eat that chocolate! It will cause your face to break out!" But is this really true or merely a misperception? There are numerous myths regarding the causes of acne. Read below to learn more about these common misperceptions.

Acne is caused by not washing your face often enough. This is not true! Some people think they must vigorously scrub their face numerous times a day to avoid acne breakouts. However, acne is not caused by dirt, dead skin cells, or oils on the skin surface. Actually, if you wash your face too often and too hard, you may make acne worse. Most dermatologists recommend gently washing your face twice daily with a mild soap and the use of appropriate acne medications if needed.
Acne is caused by the foods you eat. This myth has been around for a long time, but contains no truth. A considerable amount of research has been performed to determine if certain foods, for example, chocolate, pizza, and french fries, may cause acne or make it worse. Research has shown there is no connection between what you eat and the development of acne. If you still think that certain foods cause you to breakout then you can simply avoid those foods. Typically, if your acne is being treated appropriately, there is no need to worry about what foods you eat.
Acne is caused by stress. Again, this is a misperception. No evidence exists to support this claim. Normal day-to-day stress does not cause acne. However, if you are taking medications to treat stress, anxiety, or depression, the medication may contribute to or worsen acne check with your pharmacist or doctor if you think any of your medications could be contributing to acne breakouts.

Who has it?

Acne is the most common skin disease in the United States affecting between 40 and 50 million people. Many teenagers regardless of race or ethnicity develop acne. Acne affects approximately 80% of people who are between the ages of 12 to 25 years old. Although a large majority of teens are affected by acne, it can also occur in adults. Acne is relatively common in women in their 20s to 30s due changes in hormone levels associated with the menstrual cycle and pregnancy. Acne is more common in males than in females during adolescence, but more common in females than in males during adulthood.

What are the risk factors?

Risk factors are characteristics that predispose people to develop a condition. Common risk factors for acne include the following:

Family history of acne: Some dermatologists believe that the type, pattern, duration, and severity of acne that you may experience is related to the experiences of your parents. However, it is impossible to predict which type you will develop. While studies have been highly suggestive of a hereditary link for acne, no "acne gene" has been discovered yet.
Hormone levels: Higher levels of sex hormones (like testosterone and androsterone) stimulate oil production by the glands surrounding hair follicles. This excess oil clogs these follicles or pores, thus causing a pimple.

Along with risk factors for developing acne, certain factors can aggravate acne. These aggravating factors include the following:

Environment: Individuals living in humid areas may develop more severe acne breakouts.
Cosmetics: Certain ingredients within cosmetics may worsen acne. These ingredients include lanolin, petrolatum, vegetable oils, butyl stearate, lauryl alcohol, and oleic acid. These ingredients may be contained in moisturizers, foundations, and pomades.
Petroleum oils: Individuals who work in fast food restaurants and those exposed to motor oil regularly may be more prone to acne break-outs. This occurs because the grease or oil in the air causes the skin to become irritated.
Pressure from wearing headbands or chinstraps: People who wear helmets or sporting equipment should continue to do so for safety reasons. However, oils can collect on headbands, chinstraps, and helmets and lead to acne breakouts. Thus, it is important to clean and thoroughly rinse these items after wearing them.

What are the symptoms?

Most dermatologists consider an outbreak of more than 5 to 10 lesions in one area at one time to be acne. Different types of lesions can occur. A person may even experience more than one type of lesion at the same time. Below is a list and a description of the different types of lesions.

Noninflammatory Lesions

Blackheads or open comedones. Blackheads result when sebum (oil) and skin cells become clogged in the sebaceous hair follicle. They appear to be black in color.
Whiteheads or closed comedones. Whiteheads result when the sebaceous follicle is completely clogged with sebum and skin cells. They appear to be either white or skin colored, hence the name "whiteheads." Whiteheads can form as small bumps on top of the skin or under the skin.

Inflammatory Lesions

Papules are small, firm, red-colored lesions. Although they may contain pus, is not easily seen because of the redness. Papules often continue to grow in size and become pustules.
Pustules are small papules but they are round, red, swollen, and contain pus. Although they contain pus, they generally don't have a lot of bacteria inside.
Nodules also referred to as cysts. Oftentimes, nodules are very red, swollen, and contain a large amount of pus. They develop deep in the skin and may be painful. Unlike the other types of lesions, upon healing, nodules generally leave scars.

Based on the type and number of lesions present, a doctor or dermatologist can classify acne as mild, moderate or severe.

You should see your doctor or dermatologist if any of the following apply to you:

A lesion or nodule becomes infected, turns purple in color, increases in size, becomes painful, or does not get better with self treatment
A scar develops following healing
Acne interferes with your normal daily routine or makes you feel embarrassed or depressed
Acne leads to dark patches on the skin (this is more common in people with dark skin)

How is it treated?

There are several treatment options for acne. Most options reduce or prevent new lesions and take at least 8 weeks to produce results. An important goal of acne treatment is to prevent or minimize scarring. Specific treatment regimens will vary from person to person, depending on acne severity and tolerance to the medication. Generally, mild acne is treated with topical products, including topical retinoids, antimicrobials (benzoyl peroxide, clindamycin, or erythromycin), salicylic acid or azelaic acid. Moderate acne can be managed with topical retinoids in combination with oral antibiotics and possibly benzoyl peroxide. Severe acne that is not responsive to conventional treatments may require treatment with oral isotretinoin (Accutane).

Below is a list of commonly used medications. They are divided into topical medications and oral medications. Remember, if you have any questions about which products to use, talk with your doctor, dermatologist, or pharmacist.

Topical Acne Products
Oral Acne Products

Topical Acne Products

Benzoyl Peroxide

Benzoyl peroxide if often used to treat mild to moderate acne, and can produce a response in as few as five days. It is available in several strengths, some of which are only available by prescription. Benzoyl peroxide is available in soaps, lotions, washes, gels, and creams. Gel formulations are typically the most potent. Care should be taken when applying products containing benzoyl peroxide to avoid bleaching hair, sheets, towels and clothing. A common side effect of benzoyl peroxide is dryness and irritation of the skin. To help avoid this side effect, start with a lower potency formulation (2.5%) and increase the strength (5% to 10%) as needed for acne control. You can also start by applying every other day then work up to a maximum of twice daily applications. Applying benzoyl peroxide products to cool, clean, dry skin will also decrease irritation. If you have sensitive skin, benzoyl peroxide and other topical acne treatments may be applied as a spot treatment to pimples only, reducing irritation to the skin surrounding acne lesions.

Azelaic Acid

Azelaic Acid is a cream used in the treatment of mild to moderate acne. It has antibacterial effects and may help with skin inflammation. Azelaic acid is generally well tolerated with a low incidence of temporary side effects such as skin redness, itching, and burning. Darker complexions may develop hypopigmentation during treatment. Azelaic acid should be applied to clean, dry skin.

Sulfur, Sodium Sulfacetamide and Salicylic Acid

Sulfur, sodium sulfacetamide, and salicylic acid products are not considered as effective as benzoyl peroxide but may be tried for treating mild acne. Many of these products are available without a prescription. These products are less irritating than benzoyl peroxide, but some have a strong smell and may cause the skin to turn brown.

Topical Antibiotics

Topical antibiotics are used to treat moderate to severe acne when acne is resultant from bacteria. Topical antibiotics include clindamycin and erythromycin. These antibiotics are available in lotions, solutions, gels, and disposable pads, and are typically applied twice daily. Topical clindamycin and erythromycin are most effective when they are combined with other acne medications (such as benzoyl peroxide). The combination also helps decrease the risk of the bacteria becoming resistant to the antibiotic. Topical antibiotics, while effective, can cause occasional skin irritation and stinging upon applications.

Tretinoin

Tretinoin is a topical retinoid available in various strengths and forms (creams, gels, solutions, a microsphere gel, and liquid polymer). It works by preventing the formation of microcomedones and has anti- inflammatory actions. For mild acne, weaker strengths are typically used first and increased as needed for moderately severe forms of acne. A "flare" of acne may occur after starting tretinoin, but clears after about 8 to 12 weeks of therapy. Tretinoin works well for moderate to severe acne when combined with benzoyl peroxide, topical antibiotics, and oral antibiotics. Tretinoin can cause skin irritation, redness, and peeling which are usually noticed within the first week of use but can be minimized by slowly increasing application frequency. The doctor may recommend you use it every other day and, over a period of time, increase to a maximum of twice daily. Tretinoin can also increase sensitivity to sun, wind and cold.

Adapalene

Adapalene is a topical retinoid available as a gel, cream or solution and is used to treat mild to moderate acne. Adapalene is typically used as an alternative to tretinoin in patients who cannot tolerate tretinoin. It can also be used in combination with topical and oral antibiotics. Improvement is generally seen by 12 weeks of therapy. Some patients may notice redness of the skin and peeling. It is recommended that patients avoid contact with mucus membranes, including the eyes, mouth, and nostrils. Patients should also try to avoid UV ray exposure through sunlight and tanning because drying of skin, scaling, redness, burning, and itching may occur after exposure.

Tazarotene

Tazarotene is a topical retinoid, available as a gel or cream, and used to treat mild to moderate acne. Although it is effective for acne, it can cause skin irritation, itching, burning, and redness (similar to tretinoin). It is recommended that patients avoid other medications or cosmetic products that have strong drying effects as these could further irritate the skin.

Oral Acne Products

Oral Antibiotics

As discussed earlier, bacteria may reside in acne lesions. Oral antibiotics (tetracycline, minocycline, doxycycline, erythromycin, clindamycin, and cotrimoxazole) are often used in combination with topical acne products for moderately severe acne. Tetracycline is the most commonly prescribed antibiotic for treating acne, but it may cause sun sensitivity and predispose a woman to vaginal yeast infections. Minocycline and doxycycline are commonly used in people whose acne does not respond to tetracycline. Minocycline may cause skin discoloration. Clindamycin is not as widely used as the other oral antibiotics due to a side effect of diarrhea. Erythromycin is similarly effective to tetracycline and may have fewer side effects. Cotrimoxazole may be as effective as tetracycline but it is generally reserved for acne that doesn't respond to tetracycline or other antibiotics. The reason for this is to minimize the potential for resistance to develop (meaning that the bacteria that cause acne can become resistant to cotrimoxazole's effects). Though these medications are very effective in the treatment of acne, many people find it difficult to take them as prescribed since they require dosing between two and four times daily. The effectiveness of these products is decreased when they are not taken exactly as prescribed. A new product containing extended release minocycline, which is taken once daily, has recently become available and may make it easier for patients to take their medications correctly. Improvement in acne can generally be seen in 6 to 12 weeks when using oral antibiotic medications.

Oral Contraceptives

Excess sebum (oil) production in the skin is typically triggered by an increase in androgen hormones ("masculine hormones"). In recent years, some oral contraceptives like Ortho TriCyclen and Estrostep have gained FDA-approval for the treatment of acne in females. They work to treat acne by decreasing androgen ("masculine") hormone levels and thus decreasing sebum production. Oral contraceptives may be an effective treatment option for women with moderate acne, but it takes three to six months to see their full effect.

Spironolactone

Spironolactone also decreases androgen hormone levels and thus decreases production of sebum. If oral contraceptive therapy is not effective, spironolactone can be added for additional benefit. Some side effects associated with spironolactone include dizziness, breast tenderness, and painful menstruation in women. It is recommended to get blood pressure and potassium levels checked periodically while on this medication.

Isotretinoin

Isotretinoin (Accutane) is used to treat severe, cystic acne that has not improved with other therapies. Some dermatologists use isotretinoin in mild to moderate acne that has not responded well to 6 months of standard therapies. Treatment with this drug usually continues until there is a 70% reduction in the number of cysts, and usually this can be seen in 15 to 20 weeks. A 6-month course of isotretinoin is sufficient for most patients. While extremely effective for treating acne, isotretinoin is associated with some potentially bothersome side effects including extreme drying of the mouth, nose, and eyes (approximately 90% of patients taking isotretinoin experience these side effects); inflammation and peeling of facial skin, joint aches, muscle stiffness, and sun sensitivity. Isotretinoin can also cause birth defects if used during pregnancy, so contraception (some type of effective birth control) is required in females taking isotretinoin. Contraception should begin one month before starting isotretinoin and continued for three months after stopping isotretinoin. Isotretinoin now has a mandatory registry that was put in place by the FDA, which is known as IPLEDGE. IPLEDGE was primarily put in place to prevent unwanted or potentially dangerous adverse effects.

2008-05-02T09:50:00.005+08:00

High Cholesterol and Medical Drug Treatments

Introduction

With cholesterol testing at health fairs and drug stores, and with a breakdown of fat and cholesterol counts on all the packaged food we eat, you are probably well aware of the relationship between high cholesterol and heart disease. Yet, heart disease remains the leading cause of death in the United States; and you may not always eat the healthy, low-cholesterol diet that you should.

Because of the important relationship between high cholesterol and heart disease, all adults over the age of 20 years should have a fasting lipoprotein profile (a complete cholesterol profile--includes measuring total cholesterol, triglycerides, low-density lipoprotein(LDL) and high-density lipoprotein (HDL)) checked at least every 5 years. This should occur more often if a family history of coronary heart disease exists. Most children do not need to have their blood cholesterol level checked.

What is it?

Cholesterol is a soft, waxy, fat-like substance the body needs for cells to grow and regenerate. Cholesterol comes from two sources: your body and the foods you eat. The body makes its own cholesterol in the liver, and it only takes a small amount of cholesterol in the blood to meet your body's needs. However, because cholesterol can be found in foods such as red meats, whole milk dairy foods, and egg yolks, eating too much dietary cholesterol can make your blood cholesterol levels increase. Too much cholesterol circulating in the bloodstream is known as hypercholesterolemia.

Hypercholesterolemia increases the risk of heart disease because it can lead to atherosclerosis, a condition in which fat and cholesterol are deposited on the walls of the arteries. Atherosclerosis can occur in arteries throughout the body, including the coronary arteries (those feeding the heart). In time, narrowing or clogging of the coronary arteries by atherosclerosis can produce the signs and symptoms of heart disease, including angina (chest pain) and heart attacks.

When cholesterol builds up in arteries, it forms plaques which block blood flow and deny oxygen to the heart.

There are a number of types of cholesterol:

Low-density lipoproteins (LDLs) are often referred to as "bad cholesterol" because LDL cholesterol carries cholesterol to the body?s tissues, including the arteries. Elevated levels of LDLs can lead to heart disease.
High-density lipoproteins (HDLs) are referred to as "good cholesterol" because HDL cholesterol carries cholesterol from the tissues to the liver for removal from the body. Elevated levels of HDLs can prevent heart disease.
Triglycerides are a storage form of fat. Elevated levels of triglycerides may also increase the risk of heart disease.

What causes it?

Many factors appear to contribute to the development of high cholesterol:

Heredity--Your genes partly influence how your body makes and handles cholesterol.
Your diet--A high intake of saturated fat, dietary cholesterol, and excess calories can cause your cholesterol levels to increase. Being overweight can increase your LDL levels and decrease your HDL levels.
Age and gender--Cholesterol levels begin to increase in both men and women beginning around 20 years of age. Premenopausal women usually have lower levels of cholesterol when compared with men of the same age. After menopause, a woman's LDL cholesterol level typically goes up, as does her risk for heart disease.
Other medical conditions--Conditions such as diabetes, liver disease, thyroid disease, or kidney disease can cause elevated cholesterol.
Lack of physical activity--Increased physical activity lowers LDL and raises HDL levels. Lack of exercise can cause the opposite.

Who has it?

It is estimated that 100 million American adults have total blood cholesterol values of 200 mg/dL and higher--desirable total cholesterol levels are below 200 mg/dL. This desired level may be lower for those who have already had a heart attack or for those at risk for heart disease because they smoke, have hypertension, or have diabetes. There are about 13.2 million Americans with known coronary heart disease and about 8.7 million adults without formally diagnosed coronary heart disease.

Interestingly, about 10% of adolescents age 12 through 19 have total blood cholesterol levels of greater than 200 mg/dL. This may be due to the increasing rates of obesity among children and adolescents. There is compelling evidence that the development of atherosclerosis begins in childhood and progresses slowly into adulthood.

The good news is that medications and healthier lifestyles are making a difference. Today, the number of Americans with a desirable blood cholesterol level (less than 200 mg/dL) has risen to over 51% and the average total cholesterol in this country has fallen from 220 mg/dL in the early 1960s to 203 mg/dL in 2002. But, we still have a long way to go.

What are the risk factors?

A high fat diet, lack of exercise, and a family history of high cholesterol or heart disease will all increase your risk for high cholesterol and heart disease. If you have high cholesterol, the additional risk factors for developing heart disease include the following:

Increasing age: Being male greater than 45 years old or being female greater than 55 years old (or having premature menopause without estrogen replacement therapy)
Heredity: A family history of heart disease at a young age(that is, having a father or brother who had a heart attack or died of heart disease before the age of 55 years or having a mother or sister who had a heart attack or died of heart disease before the age of 65 years)
Currently smoking cigarettes: Smokers' risk of heart attack is more than twice that of nonsmokers. Cigarette smoking is the biggest risk factor for sudden cardiac death: smokers have two to four times the risk of nonsmokers.
High blood pressure: High blood pressure increases the heart's workload, causing the heart to enlarge and weaken over time.
Low HDL cholesterol (less than 40 mg/dL): High levels of HDL or "good cholesterol (greater than 60 mg/dL) help to lower risk for heart disease.

Additional Factors that May Increase Risk

Diabetes: Two-thirds of people with diabetes die of some form of heart or blood vessel disease. If you have diabetes, it's critically important for you to monitor and control any other risk factors you can.
Obesity/Overweight: People who have excess body fat are more likely to develop heart disease and stroke even if they have no other risk factors. Obesity is unhealthy because excess weight increases the strain on the heart.
High homocysteine levels: Homocysteine is an amino acid in the blood. Initial studies have found an association with high blood levels of homocysteine and an increased risk for heart disease. Homocysteine levels are strongly influenced by dietary intake of folic acid and B vitamins. Insuring adequate intake of these vitamins may help lower homocysteine levels. Ask your doctor if you should have your homocysteine levels tested. Homocysteine testing is done via a simple blood test.

Metabolic Syndrome, a collection of several health risks and problems, can place you at greater risk of developing heart disease, stroke, and diabetes. It is estimated that 1 in 5 Americans has metabolic syndrome, including 43.5% of people 60 to 70 years of age. Although the cause is unknown, researchers believe that it's related to many factors including diet, family history, and the amount of exercise a person gets. Diagnosis of this syndrome includes 3 or more of the following risk factors:

A waistline more than 35 inches for men or 30 inches for women measured across the belly.
Blood pressure of 130/85 mmHg ("130 over 85")or more
A triglyceride level more than 150 mg/dL
A fasting blood sugar level more than 110 mg/dL
A high density lipoprotein level (HDL; also known as the good cholesterol) less than 40 mg/dL for men or less than 50 mg/dL for women

People with established heart disease and metabolic syndrome are considered to be at highest risk for heart problems. This risk is increased even more in people with diabetes. Many of these very high risk patients have a more aggressive LDL (bad cholesterol) goal of less than 70 mg/dL compared to less than 100 mg/dL to 160 mg/dL for healthy individuals.

What are the symptoms?

Before the onset of heart disease, high cholesterol does not usually produce symptoms in and of itself. Without obvious health effects or symptoms, the average person has a hard time making needed diet and exercise improvements. The following are signs or results of high cholesterol:

Coronary heart disease
Heart Attack or stroke
Peripheral arterial disease (narrowing of the blood vessels that deliver oxygen-rich blood to the legs, abdomen, pelvis, arms or neck)
Inflammation of the pancreas

But any heart patient will tell you, the time to make changes is long before chest pain hits. When "bad" cholesterol blocks arteries in a condition called atherosclerosis, the results can be debilitating and even fatal.

How is it treated?

Treatment of high cholesterol is aimed at lowering the low-density lipoproteins (LDL) or "bad cholesterol," lowering triglyceride levels, and increasing the high-density lipoproteins (HDL) or "good cholesterol." Decreasing total cholesterol by 10% can result in a 30% reduction in coronary heart disease incidence. For every 1% decrease in LDL (bad cholesterol levels), heart disease rates drop 2%. On the other hand, for every 1% decrease in HDL, there is a 2 to 3% increase in the risk of heart disease.

A low fat/low cholesterol diet and exercise are essential in helping to lower cholesterol and to maintain low cholesterol levels. While drug therapy is often needed to lower cholesterol, diet and exercise are additionally recommended to help the drug therapy lower and control cholesterol levels. Patients with established cardiac disease and multiple risk factors (metabolic syndrome, diabetes, or smoking) are sometimes given more intense lifestyle changes.

The decision to start a patient with dietary therapy or drug therapy is usually based on a patient's LDL cholesterol levels, presence of heart disease, and risk factors. Your doctor should calculate your "10-year risk" (also known as a Framingham Risk) for developing heart disease and use that risk estimation to decide if and when to start cholesterol-lowering therapy either through dietary modifications or medications.

Drug Therapy For the initial drug treatment of hypercholesterolemia, HMG-CoA reductase inhibitors (also called "statins") are often used because of their effectiveness and low incidence of side effects. Currently, six statin drugs are available. The choice of which to use will depend on how much cholesterol reduction you need, doctor's preference, and prescription insurance benefits. Studies have shown that certain high risk patients, such as those with diabetes, benefit from cholesterol lowering therapy with statins.

Other drug classes that may be used to treat hypercholesterolemia include bile acid resins, nicotinic acid, fibric acid derivatives, and cholesterol absorption inhibitors. Some of these drugs can be used in combination if a further reduction in cholesterol is needed.

If you specifically have elevated triglyceride levels, a fibric acid derivative or niacin may be most effective for you. Both medications work by decreasing the liver's production of triglycerides. Additionally, fibric acid derivatives (or "fibrates") such as gemfibrozil also increase HDL-C (good cholesterol) production.

Bile acid resins are mainly used in young adults with hypercholesterolemia or in combination with another cholesterol-lowering medication. These drugs interact with several medications including carbamazepine, gemfibrozil, and thyroid medication as well as several blood pressure medicines and antibiotics. These medications should be administered at least 1 to 4 hours before or 4 to 6 hours after these cholesterol lowering agents.

Cholesterol absorption inhibitors are a new class of cholesterol lowering agents and work together with statins to lower cholesterol. This class of drugs works to lower blood cholesterol levels by absorbing excess cholesterol (from foods) in the intestines and thus blocking cholesterol's entry into the bloodstream. In a study published by the Mayo Clinic in May 2005, it was found that the addition of Zetia (a cholesterol absorption inhibitor) to statin therapy may cause a further reduction in a patient?s cholesterol levels. It is thought that this reduction may be the result of the two drugs working together but at different areas of the cholesterol production pathway. In fact, one pharmacy manufacturer combined Zetia with a commonly used statin known as Zocor. This combination product is called Vytorin. However, as with any medications it is recommended that you ask your doctor if this drug or combination of drugs is appropriate for you.