Anxiety and Medical Drugs Treatment

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

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:

1. To increase comfort
2. To reduce or lessen the course of infection or inflammation
3. 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

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.

Cancer and Medical Drugs Treatment

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.

1. 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.
2. 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.
3. 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.

Headache and Drug Medical Treatment

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. 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

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

• 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)

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:

1. Nucleoside Reverse Transcriptase Inhibitors (NRTIs), which includes Nucleotide Analogs
2. Non-nucleoside Reverse Transcriptase Inhibitors (NNRTIs)
3. Protease Inhibitors
4. Fusion Inhibitors, sometimes also referred to as Entry Inhibitors
5. CCR5 Entry Inhibitors, sometimes also referred to as CCR5 Co-receptor Antagonist
6. 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

1. 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)