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6 results

  • Histamine in psychiatry: promethazine as a sedative anticholinergic

  • John Cookson
  • Journal:
    BJPsych Advances / Volume 25 / Issue 4 / July 2019
    Published online by Cambridge University Press:
    17 April 2019, pp. 265-268
    Print publication:
    July 2019
    • Article
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  • The author reflects on discoveries over the course of a century concerning histamine as a potent chemical signal and neurotransmitter, the development of antihistamines, including promethazine, and chlorpromazine from a common precursor, and the recognition of a major brain pathway involving histamine. Although chlorpromazine has been succeeded by numerous other antipsychotics, promethazine remains the antihistamine recommended for sedation in acutely disturbed patients, largely because it is potently anticholinergic at atropinic muscarinic receptors and therefore anti-Parkinsonian: this means it is also useful in combination with older antipsychotics such as haloperidol.

    DECLARATION OF INTEREST

    None.

  • Corneal abrasion

  • from Chief complaints and diagnoses
  • Edited by Stephen H. Thomas
  • Book:
    Emergency Department Analgesia
    Published online:
    18 December 2009
    Print publication:
    25 September 2008, pp 184-187

  • Summary

    Treating the pain of land-based envenomations is an acute care priority, since the discomfort may be both severe and long lasting. In some cases, administration of antivenom (or antivenin) can dramatically relieve pain and other symptoms of envenomation, even after failure of other approaches such as opioids and muscle relaxants. While neurotoxic envenomation should prompt close respiratory monitoring, opioids should be administered if clinically indicated for pain relief. The histamine pathway's contributions to terrestrial envenomation symptoms create a role for antihistamines (e.g. diphenhydramine) in treating land-based bites and stings. NSAIDs have been reported useful in small case series of bites from spiders such as brown recluses and tarantulas. Preliminary evidence from animal models and case reports suggests a role for NSAIDs for scorpion envenomation. Case studies suggest that corticosteroids are occasionally useful for some centipede bites, especially in cases in which Wells' syndrome (eosinophilic cellulitis) develops.

  • Rhinitis symptoms and quality of life in patients with chronic perennial rhinitis treated with desloratadine

  • H C K Lam, M C F Tong, C A Van Hasselt
  • Journal:
    The Journal of Laryngology & Otology / Volume 121 / Issue 12 / December 2007
    Published online by Cambridge University Press:
    19 July 2007, pp. 1151-1155
    Print publication:
    December 2007
  • Objective:

    To evaluate the outcome and the change in quality of life of patients with chronic rhinitis after treatment with desloratadine.

    Study design:

    A prospective, open-label, non-blinded, non-randomised study of patients in a secondary and tertiary ENT referral centre.

    Methods:

    Chinese patients with chronic rhinitis were recruited. The patients were assessed by a questionnaire that included rhinitis symptoms score and SF-36 health survey components. Endoscopic assessment was performed with a rigid nasoendoscope and scored according to the modified endoscopic appearance score of Lund and Kennedy. A 12-week course of desloratadine 5 mg daily was prescribed. Patients were re-evaluated after treatment. A total of 47 subjects completed the study.

    Results:

    There were significant reductions in median rhinitis symptoms score, from six to five (p < 0.001), and in median endoscopic appearance score, from five to three (p < 0.001). Patients' general health perception was also improved after treatment (p == 0.022).

    Conclusion:

    Desloratadine may be an effective treatment which provides symptomatic relief and improves the quality of life in patients with chronic rhinitis.

  • 21 - Common gastrointestinal and urinary problems

  • from Part IV - Cancer prevention
  • Edited by Jo Ann Rosenfeld, The Johns Hopkins University
  • Book:
    Women's Health in Mid-Life
    Published online:
    21 August 2009
    Print publication:
    25 March 2004, pp 335-356

  • Summary

    The most common gastrointestinal (GI) complaints are constipation, diarrhea, and irritable bowel syndrome (IBS). The incidence of urinary incontinence (UI) is high. In several studies of women aged 42-50 years, more than 60% reported urine loss at some time, and more than 30% reported UI regularly. Pregnancy complications have been related positively to later UI, including loss of pelvic support, perhaps caused by multiple and large pregnancies and instrumented deliveries. Any medication with an anticholinergic effect including antispasmodics, antihistamines, antipsychotics, antidepressants, and anti-Parkinsonian drugs, can induce urinary retention and overflow incontinence. Although dysuria, polyuria, and nocturia are primarily symptoms of lower tract disease, they can also occur with upper tract infection or pyelonephritis. Indications for hospitalization and intravenous antibiotic medication include dehydration, vomiting, inability to take oral medication, and severe pain. Women with diabetes or abnormal urinary tract are more likely to need intravenous antibiotics and hospitalization.

  • 6 - Interstitial Cystitis

  • Edited by Peter Manu, Albert Einstein College of Medicine, New York
  • Book:
    Functional Somatic Syndromes
    Published online:
    08 January 2010
    Print publication:
    10 December 1998, pp 98-126

  • Summary

    Interstitial cystitis (IC) is characterized by pain in the region of the bladder and pelvic musculature, and variable motor and sensory dysfunctions of the bladder. The most prevalent symptoms of IC are urinary frequency, urgency and suprapubic, perineal pain. IC can be classified into the two categories of Hunner's ulcer and nonulcer, based on cystoscopic findings. This chapter highlights research contradictions regarding IC, along with research findings relating to the therapeutic effectiveness of various treatment modalities in IC. The lack of specific pathognomonic markers for the diagnosis of IC has resulted in a host of plausible hypotheses for its etiology. To be diagnosed with IC, patients must undergo cystoscopic examination under general anesthesia with hydrodistention of the bladder and bladder biopsy. Antihistamines are critical to managing IC in people with hay fever, sinusitis or food allergies. One major breakthrough in therapy is the use of heparin-like drugs.