Tricyclic Antidepressants Literature is sparse on controlled studies of tricyclic antidepressants for bipolar depression. Tricyclic antidepressants are more effective in the treatment of unipolar depression than in bipolar depression. The risk of switching patients from bipolar depression to mania and of shortening cycle lengths makes tricyclic antidepressants unattractive choices for the treatment of bipolar depression.… Read More »
Psychotherapy An overemphasis on psychopharmacology in the care of medically ill patients may result in overlooking the value of psychotherapy. The first step in the treatment of anxiety is to spend time listening to and talking with the patient. Just as in psychotherapy with any patient, empathic listening is a powerful tool to relieve distress.… Read More »
Managing antipsychotic side effects. Antipsychotic drugs produce problematic side effects in many individuals (see Table Side Effects of Typical Antipsychotic Drugs). A major category of side effects results from neurotransmitter dysregulation of the extra-pyramidal motor system. It is thought that these side effects are the result of an imbalance of dopaminergic and acetylcholinergic activity in… Read More »
The main goal of bipolar disorder drug treatment is to establish euthymia (stable mood with a persistent sense of well-being) without inducing mania or rapid cycling (i.e., four or more mood episodes in a 12-month period). For this reason, drug treatment usually consists of an agent or, more frequently, combinations of agents that exert both… Read More »
Migraine is a common episodic headache disorder characterized by attacks that consist of various combinations of headache and neurologie, gastrointestinal, and autonomie symptoms. It has a one-year prevalence of approximately 18% in women, 6% in men, and 4% in children. The second edition of the International Classification of Headache Disorders (ICHD-2) subclassifies migraine into migraine… Read More »
Anticonvulsant medication is increasingly recommended for migraine prevention, because it was proved to be effective by placebo-controlled, double-blind trials. With the exceptions of valproic acid, topiramate, and zonisamide, anticonvulsants may interfere substantially with the efficacy of oral contraceptives. Nine controlled trials of five different anticonvulsants were included in the AHCPR Technical Report. Carbamazepine The only… Read More »
At a new-patient appointment, a 29-year-old woman reported TTHs occurring about once to twice a week. She had multiple repetitive questions about her headaches and, despite normal brain imaging in the past year, was difficult to reassure that her headaches were not due to a dread disease. At your suggestion, she considered a preventative medication;… Read More »
Which of the following is used to preserve vision in patients with idiopathic intracranial hypertension (IIH)? A. Optic nerve sheath decompression (ONSD) B. Intracranial venous sinus stent placement C. Ventriculoperitoneal shunt placement D. Lumboperitoneal shunt placement E. All of the above The answer is E. Optic nerve sheath decompression (ONSD), which is also called optic… Read More »
Selection of anti-epileptic drugs can be very confusing. Each anti-epileptic drug has unique characteristics, including spectrum of activity, cost, pharmacokinetic and pharmacodynamic properties, likelihood for dose-related side-effects and risk of serious health risks. Therefore, to the frustration of many prescribers, there is not a ‘first choice’ selection in specific treatment situations such as initiation in… Read More »
Understanding the basics of pharmacology is an essential nursing responsibility. Pharmacology is the science that deals with the physical and chemical properties, and biochemical and physiologic effects, of drugs. It includes the areas of pharmacokinetics, pharmacodynamics, pharmacotherapeutics, pharmacognosy, and toxicodynamics. The Drug Online Guide deals primarily with pharmacokinetics, pharmacodynamics, and pharmacotherapeutics — the information you… Read More »