I dont think its sedative or induce the duration of sleep directlly. It slow down sress induced HT....load on heart....may be. due to reaxed stress and load on chambers pt feels more cofirtable for ease sleep.
Usually it causes insomnia , anxiety , and depression as psychiatric disorders...Significant adverse drug effect include peripheral edema , hypotension , bradycardia.....
Never seen and never complained by any patients
Not documented or experienced till now
Mild sedative in some cases..
I have never seen. Look for other causes
In 1-10% of patients it cause fatigue,dizziness and drowsiness.
Cases that would interest you
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Friends today I am disscussing about a very serious problem now a days women are facing. Reasons can be many Low Sex Drive in Women: Hypoactive sexual desire disorder (HSDD), now known as female sexual interest/arousal disorder, is a sexual dysfunction that causes a lowered sex drive in women. Many women will pass off the symptoms of HSDD as the inevitable effects of aging or changes in their body. If your sex drive is affecting your quality of life, it may be time to talk to your doctor. What are the symptoms of HSDD? While it’s healthy for sexual desire to fluctuate, a woman with HSDD will usually experience a lack of sexual desire for six months or more. If changes in sexual desire are so extreme that it’s affected your relationships or self-esteem, it could be HSDD. Symptoms associated with HSDD include: little to no interest in sexual activity few to no sexual thoughts or fantasies disinterest in initiating sex difficulty getting pleasure from sex lack of pleasurable sensations when the genitals are stimulated How do doctors diagnose HSDD? Unlike other medical conditions, there is no specific test to diagnose HSDD. Yet, there are a few methods used by doctors to diagnose the condition. Start by telling your doctor about your symptoms. Your doctor may ask questions about how your low sex drive is impacting your well-being. Your doctor will try to identify an underlying cause for the condition. These causes could be physical, emotional, or a combination. Physical causes of HSDD can include: arthritis coronary artery disease diabetes decreased estrogen or testosterone levels hormonal changes during or after pregnancy fatigue or exhaustion due to a grueling work, family, or school schedule taking certain medications that affect sex drive Emotional causes of HSDD include: a history of anxiety, depression, or low self-esteem a history of sexual abuse trust issues with a sexual partner Your doctor may also conduct a pelvic exam to identify any changes that might have affected your sexual desire. A blood test to check for affected hormone levels might be performed, as well. However, sometimes there is no specific underlying cause for HSDD. This does not mean that HSDD cannot be treated. How do doctors treat HSDD? There are various methods used to treat HSDD. To find the right treatment, it’s key to understand the underlying cause of your symptoms. Your doctor may ask if you’re currently taking any medications. Certain medicines can negatively affect sex drive. For example, some antidepressants may cause a lowered sex drive. In such cases, a doctor may suggest a prescription with fewer side effects. Do not stop taking antidepressants without a doctor’s approval. If it seems that emotional issues are the root of your symptoms, your doctor may suggest counseling. Not only can a specialist teach you how to communicate better with your partner, but they can also help you identify sexual techniques for a more pleasurable experience. It’s common for premenopausal and postmenopausal women to experience changes in estrogen levels. This is due to a reduction of blood flow to the vagina. If lowered estrogen levels are causing your symptoms of HSDD, estrogen therapy may be suggested. Your doctor will recommend applying a cream, suppository, or ring that releases estrogen in the vagina. This can increase blood flow without the unwanted side effects that come with taking an estrogen pill. Another treatment option is the FDA-approved pill flibanserin (Addyi). This medication has been shown to boost sex drive in women with low sexual desire. However, the drug is not for everyone; side effects include hypotension (low blood pressure), fainting, and dizziness. Lifestyle changes could also relieve stress and help improve a woman’s libido. These include: exercising regularly setting aside time for intimacy sexual experimentation (such as different positions, role-playing, or sex toys) avoiding substances that affect sexual desire, like tobacco and alcohol practicing stress-relieving techniques, such as mindfulness-based interventions Don’t underestimate the effect a decreased sexual desire can have on your well-being. If you feel symptoms of HSDD have impacted your quality of life, talk to your doctor. There are treatment options available. Onsomodium, staphisgaria, sepia, Berberis vulg. Are few homoeopathic medicines which can be used in such cases.Dr. Rajesh Gupta20 Likes27 Answers
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Medicinal Use of Rauwolfia serpentina ( Sarpagandha,snakeroot) Rauwolfia serpentina contains a number of bioactive chemicals, including yohimbine, reserpine, ajmaline, deserpidine, rescinnamine, serpentinine. The extract of the plant has also been used in India — Alexander the Great administered this plant to cure his general Ptolemy of a poisoned arrow. It was reported that Mahatma Gandhi took it as a tranquilizer during his lifetimeA compound which it contains called reserpine, is used to treat high blood pressure and mental disorders including schizophrenia, and was particularly popular for that purpose in the West from 1954 to 1957. It has been used for millennia as an antidote against bites of venomous reptiles Principal Constituents Reserpine is the most important alkaloid present in root, stem and leaves of the plant. It varies from 1.7 to 3.0 %. The root barks has more than 90% of the total alkaloids in roots. The % of the alkaloid depends on the geographical place from where the plant is collected and also the season of collection. Generally samples from Assam have a higher % of alkaloids (2.57 %) than the other parts of India and December is the best month for the collection for getting more % of alkaloids. But, age of the plant has no effect on the % of alkaloid content (up to 4 years). Ajmalicine, ajmaline, isoajmaline, ajmalinine, chandrine, rauwolfinine, renoxidine, rescin-namine, reserpiline, reserpin, reserpinine, sarpagine, serpentine, serpentinine, tetraphyllicine, yohimbine, 3-epi-a-yohimbine are the minor alkaloids identified from samples collected from India. Pharmacology Reserpine has a highly complex pattern of activity. Besides the amine concentration in brain, it is also reported to influence the concentration of glycogen, acetyl choline, g-amino butyric acid, nucleic acids and anti-diuretic hormone. The effects of reserpine include respiratory inhibition, stimulation of peristalsis, myosis, relaxation of nictating membranes, and influence on the temperature regulating centre. It increases the volume and free acidity of gastric secretion. Reserpine reduces glycaemia in some cases but the effect is short-lived. In some patients it has a stimulating effect on prothrombin activity. Reserpine also favors permeation of blood into areas rendered ischemic by burns1. It produces sedation and a lowering of blood pressure. If administered orally, in hypertension, the effects of reserpine are slow, seldom appearing before 3-6 days of administration and continuing for some time after withdrawal of the drug and have a cumulative effect. It is most valuable in young patients with mild labile hypertension associated with tachycardia. In long established hypertension, it is best used in conjunction with more potent hypertensive drugs such as hexamethonium or hydralazine. Combined with polythiazide, it is a useful hypotensive in mild to moderate thiazide, it is a useful hypotensive in mild to moderate conditions. The response to reserpine varies in patients and the dosage must be adjusted to individual requirements. In severe hypertension, it may be given by intravenous or intramuscular injection when the effect begins within a few hours. Parenteral therapy of reserpine is indicated in the treatment of hypertension only when oral administration is impracticable Toxicology In patients with cardiac arrhythmia, myocardial infarction or severe cardiac damage, bronchitis, asthma or gastric ulcer, reserpine has a relatively low toxicity, but even the minimum therapeutic doses may give rise to nasal congestion, lethargy, drowsiness, peculiar dreams, vertigo and gastro-intestinal upsets; sometimes dyspnea and urticarial rash may occur. Higher doses may cause flushing, injection of conjunctivae, insomnia, bradycardia, occasionally parkinsonism, and severe mental depression which may lead to suicide. Cases of asthenia and edema have also been reported. Side effects of reserpine are usually transient and quickly disappear on reducing the dosage or discontinuing treatment. Tolerance to reserpine does not develop and it does not appear to be habit-forming. Prolonged previous use of reserpine may cause disturbances in blood pressure during operation under general anesthesia, while some patients may be highly susceptible to a small parenteral dosage. When give to nursing mothers to increase the secretion of milk, it is excreted with milk but the amount is not therapeutically harmful3. Minimum therapeutic doses may give rise to nasal congestion, lethargy drowsiness, peculiar dreams, vertigo and gastro-intestinal upsets; sometimes dyspnea and urticarial rash may occur. Higher doses may cause flushing, injection of conjunctivae, insomnia, bradycardia, occasionally parkinsonism, and severe mental depression which may lead to suicide. Cases of asthenia and edema have also been reported. Side effects of reserpine are usually transient and quickly disappear on reducing the dosage or discontinuing treatment. Serpentine is more toxic than ajmaline or serpentinine.Dr. Ankit Agarwal4 Likes8 Answers
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Practice Essentials A must read till end, to all surgeons TOXICITY OF LIGNOCAINE While generally safe, local anesthetic agents can be toxic if administered inappropriately, and in some cases may cause unintended reactions even when properly administered. The toxicity of local and infiltration anesthetics can be local or systemic. Systemic toxicity of anesthetics most often involves the central nervous system (CNS) or the cardiovascular system. Signs and symptoms Manifestations of local anesthetic toxicity typically appear 1 to 5 minutes after the injection, but onset may range from 30 seconds to as long as 60 minute Toxicity manifestations can be categorized as follows: CNS Cardiovascular Hematologic Allergic Local tissue CNS manifestations Classically, systemic toxicity begins with excitement, psychosis Circumoral and/or tongue numbness Metallic taste Lightheadedness Dizziness Visual and auditory disturbances (difficulty focusing and tinnitus) Disorientation Drowsiness With higher doses, initial CNS excitation is often followed by a rapid CNS depression, with the following features: Muscle twitching Convulsions Unconsciousness Coma Respiratory depression and arrest Cardiovascular depression and collapse Cardiovascular manifestations Chest pain Shortness of breath Palpitations Lightheadedness Diaphoresis Hypotension Syncope Hematologic manifestations Methemoglobinemia has been frequently reported in association with benzocaine use; however, lidocaine and prilocaine have also been implicated. At low levels (1-3%), methemoglobinemia can be asymptomatic, but higher levels (10-40%) may be accompanied by any of the following complaints: Cyanosis Cutaneous discoloration (gray) Tachypnea Dyspnea Exercise intolerance Fatigue Dizziness and syncope Weakness Allergic manifestations Rash Urticaria Anaphylaxis is rare. Imaging studies are determined by the overall clinical picture. For example, if the patient has a seizure and the etiology of the seizure is not apparent, consider a head computed tomography scan. See Workup for more detail. Management Attention to impending airway compromise, significant hypotension, dysrhythmias, and seizures takes precedence. Once other possible etiologies of the patient's new symptoms have been excluded, management of the specific symptoms can begin. Treatment of local anesthetic toxicity may include the following : Airway management Seizure suppression (benzodiazepines preferred) Management of cardiac dysrhythmias Lipid emulsion therapy Adverse effects are usually caused by high plasma concentrations of the agent, which may result from one of the following: Inadvertent intravascular injection Excessive dose or rate of injection Delayed drug clearance Administration into vascular tissue Patient factors can also affect toxicity. For example, because lidocaine is hepatically metabolized, liver dysfunction increases the risk of toxicity. Because lidocaine is also protein bound, low protein states may also increase risk. Acidosis increases the risk because it favors dissociation of lidocaine from plasma proteins. Interactions with other drugs (eg, cimetidine, beta-blockers) can also affect lidocaine drug levels. See Etiology. The toxicity of local and infiltration anesthetics can be localized or systemic. The localized adverse effects of anesthetic agents include neurovascular manifestations such as prolonged anesthesia and paresthesias, which may become irreversible. Systemic toxicity of anesthetics most often involves the central nervous system (CNS) or the cardiovascular system. Concurrent administration of other drugs, such as benzodiazepines, may mask the development of CNS symptoms but not cardiovascular symptoms. Relatively rarely (<1%), local anesthetic agents can affect the immune system, producing an immunoglobulin E (IgE)–mediated allergic reaction. Most cases are associated with the use of amino esters. Some anesthetics, particularly benzocaine, are associated with hematologic effects, namely methemoglobinemia. CNS toxicity is biphasic. The earlier manifestations are due to CNS excitation, with problems such as seizures. Subsequent manifestations include CNS depression with a cessation of convulsions and the onset of unconsciousness and respiratory depression or arrest. Cardiovascular effects occur at higher serum concentrations of local anesthetics. These effects may include reentrant arrhythmias. Acceleration of the ventricular rate has been reported in patients with atrial arrhythmias. See Presentation. Treatment of local anesthetic toxicity may include the following : Airway management Seizure suppression Management of cardiac arrhythmias Lipid emulsion therapy Most local anesthetic solutions that contain premixed epinephrine contain preservatives; in these solutions, the pH is adjusted lower to maintain the stability of epinephrine and antioxidants The following factors influence duration of action: Addition of epinephrine to local anesthetic solutions prolongs duration of action by causing vasoconstriction and decreasing systemic absorption Degree of protein binding primarily determines duration of action; high protein binding increases duration Increasing pH (using sodium bicarbonate) also prolongs duration of action Anesthetic concentration and dilution CNS toxicity from local anesthetics manifests initially as CNS excitation, followed by CNS depression. This biphasic effect occurs because local anesthetics first block inhibitory CNS pathways (resulting in stimulation) and then eventually block both inhibitory and excitatory pathways (resulting in overall CNS inhibition). Cardiovascular effects occur because these agents block sodium channels through a fast-in, slow-out mechanism that affects impulse conduction through the heart and nerve tissue. In the heart, this depresses Vmax (ie, the rate of depolarization during phase 0 of the cardiac action potential) and may lead to reentrant arrhythmias. Additionally, conduction through the sinus and atrioventricular nodes is suppressed. avoid rapid injection. The occurrence of numerous fatalities associated with the cardiovascular toxicity of bupivacaine prompted a search for less toxic long-acting local anesthetic agents. The minimum doses of anesthetics in which adverse reactions have occurred are listed in Table 3, below. Table 3. Minimum Intravenous Toxic Dose of Local Anesthetic in Humans . Agent Minimum Toxic Dose (mg/kg) Procaine 19.2 Tetracaine 2.5 Chloroprocaine 22.8 Lidocaine 6.4 Mepivacaine 9.8 Bupivacaine 1.6 Etidocaine 3.4 In addition to high doses, high injection rates also increase the risk of adverse reactions to local anesthetics. Patient factors that increase risk include the following: Renal or hepatic compromise Metabolic or respiratory acidosis Preexisting heart block or heart conditions Pregnancy Extremes of age Hypoxia Epidemiology The frequency of local anesthetic toxicity is difficult to determine because these agents are used widely in a variety of settings, and most reactions are not reported. Systemic toxicity from local anesthetics may occur in as many as 1:1000 peripheral nerve blocks; however, most of these probably involve only minor subjective symptoms. Without treatment, local anesthetic toxicity can result in seizures, respiratory depression or arrest, hypotension, cardiovascular collapse or cardiac arrest, and death. Patient Education Advise patients with adverse reactions to a specific anesthetic agent to avoid that specific anesthetic agent in the future and to alert medical personnel of the reaction. If a patient has experienced an adverse reaction to one class of anesthetic (ester or amide), risk for adverse reactions is higher for all agents in that class. However, if the episode involved seizures, the patient should be reassured that this does not indicate an increased risk for the development of a seizure disorder in the future.Dr. Abhishek Chatterjee4 Likes1 Answer
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￼ Symptoms Of Addison's Disease Addison’s disease, where your adrenal glands don’t function properly, can cause low levels of the hormones aldosterone and cortisol. Early symptoms include fatigue, lethargy, muscle weakness, poor mood, dehydration, frequent urination, a hankering for salty foods, and loss of appetite and weight. Later, symptoms like dizziness, vomiting, diarrhea, cramps, hyperpigmentation, low libido, missed periods, delayed puberty, and abdominal, joint, and back pain kick in. Your adrenal glands may be tiny but they produce two important hormones – aldosterone and cortisol. Cortisol helps control metabolism and blood sugar while aldosterone controls potassium and sodium levels in your blood. When you have Addison’s disease, your adrenal glands don’t function properly. As a result, you may have low levels of these hormones, affecting your body’s capacity to respond effectively to physical stress. In most cases – around 70% or more – Addison’s disease is caused by an issue in the immune system. It attacks the outer layer of your adrenal gland and disrupts the normal production of hormones. However, Addison’s disease may also be caused by damage to your adrenal glands through an infection like tuberculosis, cancer, genetic defect in the adrenal glands, or other diseases. Let’s take a look at some symptoms that can alert you to the presence of this disease. Symptoms experienced during Addison’s disease can vary from person to person. It is also easy to miss this disease in the initial stage because the signs can be similar to other more common conditions like flu or even depression. Some **early signs include: 1. Fatigue Fatigue is characterized by an intense need for rest. When you feel fatigued you may be so low in energy that doing anything can seem difficult. Fatigue is a normal response to prolonged stress, physical exertion, and lack of sleep. But if you are not able to trace it to a specific cause, it is a cause for concern and needs to be checked out. 2. Lethargy Lethargy or feeling abnormally drowsy or tired is another symptom of Addison’s disease. Changes in the sodium levels in your blood, because of aldosterone imbalance, can lead to drowsiness. This is also an often neglected sign, especially when it’s the only prominent sign. But if you have been feeling overwhelmed by a sense of lassitude, it’s time to probe deeper. 3. Muscle Weakness Muscle weakness is the loss of strength in your muscles. That is, you find it difficult to move your muscle in spite of trying hard. Even simple, mundane things like getting up from a chair, brushing your hair, or lifting something becomes tough. 4. Dehydration Dehydration can be an early indicator of Addison’s disease. It is caused by low levels of aldosterone which plays a role in regulating the water and salt balance in your body. Some early signs of dehydration include thirst, strong smelling and dark-colored urine, a dry mouth, and tiredness. 5. Low Mood Feeling low, mildly depressed, or irritable can be an early symptom of Addison’s disease. 6. Appetite Loss If you have Addison’s disease, you may experience a loss of appetite as well as lose weight without intending to do so. 7. Frequent Urination A need to frequently urinate is also associated with this condition. 8. Hankering For Salt A reduction in aldosterone can cause low levels of sodium. Your body tries to compensate for this by consuming salt and that’s why a craving for salty foods. While these symptoms tend to crop up early, other later symptoms of Addison’s disease develop slowly over months or even years. But there isn’t really a clear demarcation in how the symptoms appear. For instance, extra stress, as is caused by an accident or another illness, can aggravate the condition and result in symptoms suddenly becoming worse. 9. Dizziness Dizziness is another symptom that people with Addison’s disease experience. When you have low levels of aldosterone, you lose too much sodium. This can cause a drop in blood volume, which in turn lowers your blood pressure. And low blood pressure can cause symptoms like dizziness and even fainting, especially when you stand up. 10. Gastrointestinal Problems Gastrointestinal problems like nausea and vomiting can also be signs of Addison’s disease. High levels of potassium may be leaving you nauseated. Some people also face diarrhea. 11. Pain Abdominal pain, back pain, and joint pain are all symptoms that tend to show up later. 12. Muscle Cramps As Addison’s disease progresses, you may experience muscle cramps. A cramp is a brief, sudden, and involuntary contraction of a muscle that causes you pain. 13. Persistent Exhaustion Addison’s disease can cause you to feel chronically exhausted. This may sometimes lead to depression in certain people. 14. Hyperpigmentation Of Skin In people with Addison’s disease, the pituitary gland releases extra corticotropin to try to trigger the adrenal glands. Since corticotropin also triggers the production of melanin, the pigment which gives skin color, you may experience hyperpigmentation of skin if you have this condition. Your lips, gums, the creases in the palms of your hands, knees, knuckles, or the area around your nipples may develop a dark discoloration. You may also notice black freckles over your face, forehead, and shoulders. 15. Low Libido Another sign of this disease is a reduced sex drive or loss of interest in sex. This symptom tends to show up especially among women. 16. Missed Periods Certain women with Addison’s disease may also get irregular periods or skip their period entirely on some months. 17. Low Blood Sugar Addison’s disease can increase your body’s sensitivity to insulin, which may lead to low levels of blood sugar. This can result in symptoms like confusion, trouble concentrating, anxiety, and loss of consciousness. 18. Delayed Development In Children A child’s body starts to change and develop during puberty. The age at which this happens can vary from 8 to 14, though the average age at which puberty begins is 11 for girls and 12 for boys. However, puberty may be delayed and occur much later than is normal in children who suffer from Addison’s disease. 19. Signs Of Adrenal Crisis If you don’t treat Addison’s disease, levels of hormones in your body slowly decrease, causing your symptoms to become progressively worse. This ultimately leads to what is known as an adrenal crisis – which can potentially be fatal. When you have an adrenal crisis, your symptoms can come on quickly and be extremely severe. These may show up alongside symptoms of Addison’s disease. But there is also the chance of these severe signs kicking in even when you’ve not experienced any other symptoms before. Here’s what you need to look out for: Severe Dehydration Signs of severe dehydration include extreme thirst, feeling abnormally confused or lethargic, and a rapid heartbeat. You may also experience dizziness when you stand up which doesn’t pass after a few seconds. Changes To Your Skin Your skin may feel clammy, pale, and cold. You may also sweat excessively. Changes To Your Breathing Your breathing may become shallow and rapid. Worsening Symptoms You may experience a severe form of the symptoms typically experienced in Addison’s disease. That is, you may suffer from: Severe diarrhea and vomitingSevere muscle weaknessSevere drowsiness, even a loss of consciousnessSevere and sudden pain in the abdomen, lower back, or legs Headache A headache is another sign which may indicate an adrenal crisis when seen in conjunction with the other symptoms described above. An adrenal crisis should be treated as a medical emergency. If immediate medical assistance is not provided it can result in a coma and even death. A delay in treatment can also result in permanent disability as your brain may be deprived of sufficient oxygen. What Can You Do About Addison’s Disease? Addison’s disease is typically treated with medicines that augment low levels of hormones. And you’ll usually need to be on medication throughout your life if you have this condition. But the good news is that the symptoms of this condition can be controlled with treatment and you can lead a normal life without many restrictions. Do take the precaution of carrying a card specifying that you have Addison’s disease – in case of an emergency healthcare workers can treat youDr. Tapan Kumar Sau1 Like5 Answers
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56 yr old lady with no h/o DM, HTN came to OPD complaining of chest pain and ghabrahat off'n' since 1 month. BP was 180/90. Rest normal. What is the line of management.Dr. Shiv Sharma3 Likes27 Answers