SandboxAlonso: Difference between revisions

Jump to navigation Jump to search
VisualWikitext
No edit summary
No edit summary
 
(13 intermediate revisions by the same user not shown)
Line 1: Line 1:
{{DrugProjectFormSinglePage
__NOTOC__
|authorTag={{Alonso}}
{{CMG}}; {{AE}} {{Alonso}}
|genericName=generic name
|aOrAn=a
|drugClass=Adrenergic receptor agonist
|indication=[[ventricular arrhythmias]] such as those occurring in relation to acute [[myocardial infarction]], or during cardiac manipulation, such as [[cardiac surgery]]
|adverseReactions=[[bradyarrhythmia]], [[hypotension]], [[backache]] [[dizziness]], [[headache]], [[lightheadedness]], [[numbness]], [[paresthesia]], [[shivering]], [[somnolence]], blurred vision, burning sensation in eye, [[conjunctival hyperemia]], corneal epithelial defect, [[diplopia]], [[apprehension]], [[confusion]], [[euphoria]], feeling nervous.
|blackBoxWarningTitle=Warning Title
|blackBoxWarningBody=<i><span style="color:#FF0000;">Condition Name:</span></i> (Content)
|fdaLIADAdult======Single Direct Intravenous Injection (bolus)=====
* Only the 50 and 100 mg dosage sizes should be used for direct intravenous injection. The usual dose is 50 to 100 mg of lidocaine hydrochloride (0.70 to 1.4 mg/kg; 0.32 to 0.63 mg/lb) administered intravenously under [[ECG monitoring]]. This dose may be administered at the rate of approximately 25 to 50 mg/min (0.35 to 0.70 mg/kg/min; 0.16 to 0.32 mg/lb/min).
* Sufficient time should be allowed to enable a slow circulation to carry the drug to the site of action. If the initial injection of 50 to 100 mg does not produce a desired response, a second dose may be injected after 5 minutes. No more than 200 to 300 mg of lidocaine hydocloride should be administered during a one hour period.


=====Continuous Intravenous Infusion=====
Infobox goes here
* Following bolus administration, intravenous infusions of lidocaine hydrochloride may be initiated at the rate of 1 to 4 mg/min of lidocaine hydrochloride (0.014 to 0.057 mg/kg/min; 0.006 to 0.026 mg/lb/min). The rate of intravenous infusions should be reassessed as soon as the patient’s basic [[cardiac rhythm]] appears to be stable or at the earliest signs of toxicity. It should rarely be necessary to continue intravenous infusions of lidocaine for prolonged periods.
* Solutions for intravenous infusion may be prepared by the addition of one gram (or two grams) of lidocaine hydrochloride to one liter of 5% dextrose in water using aseptic technique. Approximately a 0.1% (or 0.2%) solution will result from this procedure; that is, each milliliter will contain approximately 1 (or 2) mg of lidocaine hydrochloride. In those cases in which fluid restriction is medically appropriate, a more concentrated solution may be prepared.
* Lidocaine hydrochloride injection has been found to be chemically stable for 24 hours after dilution in 5% dextrose in water. However, as with all intravenous admixtures, dilution of the solution should be made just prior to its administration.
* It is very important that after adding lidocaine hydrochloride, or any other medication, to an I.V. container, the contents be thoroughly mixed before beginning the infusion.
* When administering by continuous I.V. infusion, it is advisable to use a precision volume control I.V. set.
|offLabelAdultNoGuideSupport======Aortocoronary Bypass Grafting=====


* Dosing Information
<nowiki>{{SI}}</nowiki>


:* 1 mg/min IV infusion<ref name="pmid6981016">{{cite journal| author=Sunamori M, Okamura T, Amano J, Suma H, Suzuki A| title=Myocardial protection by lidocaine hydrochloride in aorto-coronary bypass surgery. | journal=Jpn J Surg | year= 1982 | volume= 12 | issue= 2 | pages= 93-7 | pmid=6981016 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6981016  }} </ref>
'''''Synonyms and keywords:'''''
:* 100 mg bolus 2 minutes before releasing the aortic clamp administered through a bypass pump.<ref name="pmid11052433">{{cite journal| author=Baraka A, Kawkabani N, Dabbous A, Nawfal M| title=Lidocaine for prevention of reperfusion ventricular fibrillation after release of aortic cross-clamping. | journal=J Cardiothorac Vasc Anesth | year= 2000 | volume= 14 | issue= 5 | pages= 531-3 | pmid=11052433 | doi=10.1053/jcan.2000.9484 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11052433  }} </ref>


=====Regional Pain Syndrome=====
== Overview ==
'''Body dysmorphic disorder (BDD)''' is a mental disorder that involves a disturbed [[body image]]. It is generally diagnosed in those who are extremely critical of their physique or self-image, despite the fact there may be no noticeable disfigurement or defect.


* Dosing Information
Most people wish they could change or improve some aspect of their physical appearance, but people suffering from BDD, generally considered of normal appearance, believe that they are so unspeakably hideous that they are unable to interact with others or function normally for fear of ridicule and humiliation at their appearance. They tend to be very secretive and reluctant to seek help because they are afraid others will think them vanity|vain or they may feel too embarrassed to do so.


:* Lidocaine continuous infusion administered as a initial dose of 200 mg through the first hour, followed by  100 to 190 mg/h according to tolerance. Infusion should be continue until maximum pain control is reached.<ref name="pmid10206569">{{cite journal| author=Linchitz RM, Raheb JC| title=Subcutaneous infusion of lidocaine provides effective pain relief for CRPS patients. | journal=Clin J Pain | year= 1999 | volume= 15 | issue= 1 | pages= 67-72 | pmid=10206569 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10206569  }} </ref>
Ironically, BDD is often misunderstood as a vanity driven obsession, whereas it is quite the opposite; people with BDD believe themselves to be irrevocably ugly or defective.  


=====Infusion Pain=====
BDD combines obsessive and compulsive aspects, which links it to the [[Obsessive-Compulsive Disorder|OCD]] spectrum disorders among psychologists. People with BDD may engage in compulsive mirror checking behaviors or mirror avoidance, typically think about their appearance for more than one hour a day, and in severe cases may drop all social contact and responsibilities as they become homebound. The disorder is linked to an unusually high [[suicide]] rate among all mental disorders.


* Dosing Information
A German study has shown that 1-2% of the population meet all the diagnostic criteria of BDD, with a larger percentage showing milder symptoms of the disorder (''Psychological Medicine'', vol 36, p 877). Chronically low self-esteem is characteristic of those with BDD due to the value of oneself being so closely linked with their perceived appearance. The prevalence of BDD is equal in men and women, and causes chronic social [[anxiety]] for those suffering from the disorder[http://www.lipo.com/Health_Articles/Lifestyle_Articles/When_the_mirror_lies_-_Body_dysmorphic_disorder_(dysmorphophobia)_on_the_rise_and_taking_lives./].


:* Addition to methohexital and propofol, concentrations: lidocaine 0.1% to 1%.<ref name="pmid10470630">{{cite journal| author=Ho CM, Tsou MY, Sun MS, Chu CC, Lee TY| title=The optimal effective concentration of lidocaine to reduce pain on injection of propofol. | journal=J Clin Anesth | year= 1999 | volume= 11 | issue= 4 | pages= 296-300 | pmid=10470630 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10470630  }} </ref><ref name="pmid9175962">{{cite journal| author=Eriksson M, Englesson S, Niklasson F, Hartvig P| title=Effect of lignocaine and pH on propofol-induced pain. | journal=Br J Anaesth | year= 1997 | volume= 78 | issue= 5 | pages= 502-6 | pmid=9175962 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9175962  }} </ref>  
Phillips & Menard (2006) found the completed suicide rate in patients with BDD to be 45 times higher than in the general US population. This rate is more than double that of those with [[Clinical depression]] and three times as high as those with [[bipolar disorder]]<ref>http://ajp.psychiatryonline.org/cgi/content/full/163/7/1280</ref>. There has also been a suggested link between undiagnosed BDD and a higher than average suicide rate among people who have undergone cosmetic surgery<ref>http://www.newscientist.com/channel/health/mg19225745.200-cosmetic-surgery-special-when-looks-can-kill.html</ref>.


=====Cough=====
==Historical Perspective==
BDD was first documented in 1886 by the researcher Morselli, who called the condition simply "'''Dysmorphophobia'''". BDD was first recorded/formally recognized in 1997 as a disorder in the [[Diagnostic and Statistical Manual of Mental Disorders|DSM]]; however, in 1987 it was first truly recognized by the [[American Psychiatric Association]].


* Dosing Information
In his practice, [[Sigmund Freud|Freud]] eventually had a patient who would today be diagnosed with the disorder; Russian [[aristocrat]] [[Sergei Pankejeff]], nicknamed "The Wolf Man" by Freud himself in order to protect Pankejeff's identity, had a preoccupation with his nose to an extent that greatly limited his functioning.


:* 1 to 2 mg/kg.<ref name="pmid6837243">{{cite journal| author=Gefke K, Andersen LW, Friesel E| title=Lidocaine given intravenously as a suppressant of cough and laryngospasm in connection with extubation after tonsillectomy. | journal=Acta Anaesthesiol Scand | year= 1983 | volume= 27 | issue= 2 | pages= 111-2 | pmid=6837243 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6837243  }} </ref><ref name="pmid3347458">{{cite journal| author=Stewart RH, Kimbrough RL, Engstrom PF, Cameron B| title=Lidocaine: an anti-tussive for ophthalmic surgery. | journal=Ophthalmic Surg | year= 1988 | volume= 19 | issue= 2 | pages= 130-1 | pmid=3347458 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3347458  }} </ref>
==Classification==


=====Elective Abortion=====
==Pathophysiology==
BDD usually develops in adolescence, a time when people are generally most sensitive about their appearance. However, many patients suffer for years before seeking help. When they do seek help through mental health professionals, patients often complain of other symptoms such as depression, social anxiety or obsessive compulsive disorder, but do not reveal their real concern over body image. Most patients cannot be convinced that they have a distorted view of their body image, due to the very limited knowledge of the disorder as compared to OCD or others.


* Dosing Information
An absolute cause of body dysmorphic disorder is unknown. However research shows that a number of factors may be involved and that they can occur in combination, including:


:* 7 to 30 mL of 1% lidocaine administered through the umbilical vein, associated to 5 mcg of sufentanil, both administered 48 hours following mifepristone treatment (600 mg).<ref name="pmid12628271">{{cite journal| author=Senat MV, Fischer C, Bernard JP, Ville Y| title=The use of lidocaine for fetocide in late termination of pregnancy. | journal=BJOG | year= 2003 | volume= 110 | issue= 3 | pages= 296-300 | pmid=12628271 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12628271  }} </ref>
'''A chemical imbalance in the brain.''' An insufficient level of [[serotonin]], one of the brain's [[neurotransmitter]]s involved in mood and pain, may contribute to body dysmorphic disorder. Although such an imbalance in the brain is unexplained, it may be hereditary.
'''Obsessive-compulsive disorder.''' BDD often occurs with OCD, where the patient uncontrollably practices ritual behaviors that may literally take over their life. A history of, or [[gene]]tic predisposition to, OCD may make people more susceptible to BDD.


=====Fibromyalgia=====
'''Generalized anxiety disorder.''' Body dysmorphic disorder may co-exist with generalized anxiety disorder. This condition involves excessive worrying that disrupts the patient's daily life, often causing exaggerated or unrealistic anxiety about life circumstances, such as a perceived flaw or defect in appearance, as in BDD.


* Dosing Information
==Causes==


:* Administer an initial dose of 5 mg/kg minus 100 mg, followed by 50 mg/day increases up to 5 mg/kg plus 150 mg. Do not excede 550 mg infused. Infusion should be administered over 6 hours, diluted in 500 mL of Hartman's solution.<ref name="pmid12217079">{{cite journal| author=Raphael JH, Southall JL, Treharne GJ, Kitas GD| title=Efficacy and adverse effects of intravenous lignocaine therapy in fibromyalgia syndrome. | journal=BMC Musculoskelet Disord | year= 2002 | volume= 3 | issue=  | pages= 21 | pmid=12217079 | doi= | pmc=PMC126218 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12217079  }} </ref>
==Differentiating type page name here from other Diseases==


=====Indigestion=====
== Epidemiology and Demographics ==
''According to Dr Katharine Phillips (2004) :''


* Dosing Information
Although large [[epidemiology|epidemiologic]] surveys of BDD's prevalence have not been done, studies to date indicate that BDD is relatively common in both nonclinical and clinical settings (Phillips & Castle, 2002). Studies in community samples have reported current rates of 0.7% and 1.1%, and studies in nonclinical student samples have reported rates of 2.2%, 4%, and 13% (Phillips & Castle, 2002). A study in a general inpatient setting found that 13% of patients had BDD (Grant, Won Kim, Crow, 2001). Studies in outpatient settings have reported rates of 8%-37% in patients with OCD, 11%-13% in social phobia, 26% in trichotillomania, 8% in major depression, and 14%-42% in atypical major depression (Phillips & Castle, 2002). In one study of atypical depression, BDD was more than twice as common as OCD (Phillips, Nierenberg, Brendel et al 1996), and in another (Perugi, Akiskal, Lattanzi et al, 1998) it was more common than many other disorders, including OCD, social phobia, simple phobia, generalized anxiety disorder, [[bulimia nervosa]], and substance abuse or dependence. In a [[dermatology]] setting, 12% of patients screened positive for BDD, and in [[cosmetic surgery]] settings, rates of 6%-15% have been reported (Phillips & Castle, 2002).


:* 30 mL of antacid associated with 15 mL of 2% viscous lidocaine, both administered simultaneously PO.<ref name="pmid2202240">{{cite journal| author=Welling LR, Watson WA| title=The emergency department treatment of dyspepsia with antacids and oral lidocaine. | journal=Ann Emerg Med | year= 1990 | volume= 19 | issue= 7 | pages= 785-8 | pmid=2202240 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2202240  }} </ref>
BDD is underdiagnosed, however. Two studies of inpatients (Phillips, McElroy, Keck et al, 1993, and Grant, Won Kim, Crow, 2001), as well as studies in general outpatients (Zimmerman & Mattia, 1998) and depressed outpatients (Phillips, Nierenberg, Brendel et al 1996), systematically assessed a series of patients for the presence of BDD and then determined whether clinicians had made the diagnosis in the clinical record. All four studies found that BDD was missed by the clinician in every case in which it was present. Thus, underdiagnosis of BDD appears common.


=====Peritubular Block=====
== Risk Factors ==


* Dosing Information
== Screening ==


:*  5 mL of lidocaine (2%) plus 5 mL bupivacaine 0.75% with 150 IU of hyaluronidase.<ref name="pmid9038442">{{cite journal| author=Gao F, Budd AJ| title=Venous levels of lignocaine and bupivacaine after peribulbar block. | journal=Anaesthesia | year= 1996 | volume= 51 | issue= 12 | pages= 1109-12 | pmid=9038442 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9038442  }} </ref>
== Natural History, Complications, and Prognosis==


=====Tumescent Anesthesia-Liposuction Procedure=====
== Diagnosis ==  


* Dosing Information
=== Symptoms ===
*Compulsive mirror checking, glancing in reflective doors, windows and other reflective surfaces.
*Alternatively, an inability to look at one's own reflection or photographs of oneself; often the removal of mirrors from the home.
*Compulsive skin-touching, especially to measure or feel the perceived defect.
*Reassurance-seeking from loved ones.
*Social withdrawal and co-morbid depression.
*Obsessive viewing of favorite celebrities or models the person suffering from BDD may wish to resemble.
*Excessive grooming behaviors: combing hair, plucking eyebrows, shaving, etc.
*Obsession with [[plastic surgery]] or multiple plastic surgeries with little satisfactory results for the patient.
*In obscure cases patients have performed plastic surgery on themselves, including [[liposuction]] and various implants with disastrous results.


:* Administer a solution of: lidocaine 500 to 1000 mg + epinephrine 0.5 mg + sodium bicarbonate 10 mEq + triamcinolone 10 mg + 1 liter saline solution 0.09%. Solution should be administered directly into the subcutaneous tissue undergoing the procedure at a rate of 150 mL/hour. Administer over an average time of 90 to 120 minutes.<ref name="pmid9063507">{{cite journal| author=Ostad A, Kageyama N, Moy RL| title=Tumescent anesthesia with a lidocaine dose of 55 mg/kg is safe for liposuction. | journal=Dermatol Surg | year= 1996 | volume= 22 | issue= 11 | pages= 921-7 | pmid=9063507 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9063507  }} </ref>
===Location of imagined defects===
In research carried out by Dr. Katharine Philips, involving over 500 patients, the percentage of patients concerned with the most common locations were as follows:
{{col-begin}}
{{col-break}}
*skin (73%)
*hair (56%)
*nose (37%)
*weight (22%)
*stomach (22%)
*breasts/chest/nipples (21%)
*eyes (20%)
*thighs (20%)
*teeth (20%)
*legs (overall) (18%)
*body build / bone structure (16%)
*ugly face (general) (14%)
*lips (12%)
*buttocks (12%)
*chin (11%)
*fingers
*eyebrows (11%)


=====Postoperative Pain=====
''source: '''The Broken Mirror''', Katharine A Philips, Oxford University Press, 2005 ed, p56 ''


* Dosing Information
People with BDD often have more than one area of concern.


:* Administer 1.5 mg/kg 30 minutes before surgery, followed by a 1.5 mg/kg/hour continuous infusion through the first hour following surgery.<ref name="pmid15041597">{{cite journal| author=Koppert W, Weigand M, Neumann F, Sittl R, Schuettler J, Schmelz M et al.| title=Perioperative intravenous lidocaine has preventive effects on postoperative pain and morphine consumption after major abdominal surgery. | journal=Anesth Analg | year= 2004 | volume= 98 | issue= 4 | pages= 1050-5, table of contents | pmid=15041597 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15041597  }} </ref>
==The Disabling Effects of BDD==
BDD can be anywhere from slightly to severely debilitating. It can make normal employment or family life impossible. Those who are in regular employment or who have family responsibilities would almost certainly find life more productive and satisfying if they did not have the symptoms. The partners of sufferers of BDD may also become involved and suffer greatly, sometimes losing their loved one to [[suicide]].


=====Seizure=====
==Prognosis==
Many individuals with BDD have repeatedly sought treatment from dermatologists or cosmetic surgeons with little satisfaction before finally accepting psychiatric or psychological help. Treatment can improve the outcome of the illness for most people. Other patients may function reasonably well for a time and then relapse, while others may remain chronically ill. Research on outcome without therapy is not known but it is thought the symptoms persist unless treated.


* Dosing Information
== Treatment ==
Typically the [[psychodynamic]] approach to therapy does not seem to be effective in battling BDD while in some patients it may even be countereffective.


:* Administer 1.5 to 2 mg/kg IV infucion over 2 minutes. If seizure recurrence is observed dosage can be repeated.<ref name="pmid3409844">{{cite journal| author=Pascual J, Sedano MJ, Polo JM, Berciano J| title=Intravenous lidocaine for status epilepticus. | journal=Epilepsia | year= 1988 | volume= 29 | issue= 5 | pages= 584-9 | pmid=3409844 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3409844  }} </ref>
CBT ([[Cognitive Behavioral Therapy]]) coupled with [[exposure therapy]] has been shown effective in the treatment of BDD. Low levels or insufficient use of serotonin in the brain has been implicated with the disorder and so [[SSRI]] drugs are commonly used, and with some success, in the treatment of Body Dysmorphic Disorder. Drug treatment will sometimes also include the use of an [[anxiolytic]].


=====Tinnitus=====
BDD tends to be chronic; current information suggests that symptoms do not subside, but rather worsen through time. Indeed in most patients, the symptoms and concerns diversify and social contacts may further deteriorate. As so, treatment should be initiated as early as possible following the diagnoses.


* Dosing Information
==References==
{{reflist|2}}


:* 1.5 mg/kg IV.<ref name="pmid7049137">{{cite journal| author=Israel JM, Connelly JS, McTigue ST, Brummett RE, Brown J| title=Lidocaine in the treatment of tinnitus aurium. A double-blind study. | journal=Arch Otolaryngol | year= 1982 | volume= 108 | issue= 8 | pages= 471-3 | pmid=7049137 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7049137  }} </ref>
{{WikiDoc Help Menu}}
|fdaLIADPed=Controlled clinical studies in the pediatric population to establish dosing schedules have not been conducted. The American Heart Association’s Standards and Guidelines recommends a bolus dose of 1 mg/kg, and an infusion rate of between 20 to 50 mcg/kg/min for prolonged therapy. When drug clearance is reduced, as in patients with shock, [[congestive heart failure]] or [[cardiac arrest]], the infusion rate should not exceed 20 mcg/kg/min.
{{WikiDoc Sources}}


'''Note Regarding Prolonged Infusion:''' There are data that indicate the half-life may be 3 hours or longer following infusions of greater than 24 hours in duration.
[[Category:Disease]]
'''Note:''' Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration whenever the solution and container permit.
[[Category:FLK]]
|offLabelPedGuideSupport=There is limited information regarding <i>Off-Label Guideline-Supported Use</i> of Lidocaine in pediatric patients.
|offLabelPedNoGuideSupport======Seizure=====
 
* Dosing Information
 
:* Initial dose of 4 to 6 mg/kg/hr, followed by infusions of 4 to 8 mg/kg/hr administered over 11 to 60 hours until successful response was achieved.<ref name="pmid23738612">{{cite journal| author=Lundqvist M, Ågren J, Hellström-Westas L, Flink R, Wickström R| title=Efficacy and safety of lidocaine for treatment of neonatal seizures. | journal=Acta Paediatr | year= 2013 | volume= 102 | issue= 9 | pages= 863-7 | pmid=23738612 | doi=10.1111/apa.12311 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23738612  }} </ref>
|contraindications=* [[Hypersensitivity]] to local anesthetics of the amide type.
* [[Stokes-Adams syndrome]].
* [[Wolff-Parkinson-White syndrome]].
* Patients with severe degrees of sinoatrial, atrioventricular, or intraventricular block in the absence of an artificial pacemaker.
|warnings=* Systemic toxicity may result in manifestations of [[central nervous system depression]] ([[sedation]]) or [[irritability]] (twitching), which may progress to frank [[convulsions]] accompanied by [[respiratory depression]] and/or [[Respiratory depression|arrest]]. Early recognition of premonitory signs, assurance of adequate oxygenation and, where necessary, establishment of artificial airway with [[ventilatory support]] are essential to management of this problem. Should [[convulsions]] persist despite [[ventilatory therapy]] with oxygen, small increments of [[anticonvulsant drugs]] may be used intravenously. Examples of such agents include [[benzodiazepines]] (e.g., [[diazepam]]), ultra short-acting [[barbiturates]] (e.g., [[thiopental]] or [[thiamylal]]), or a short-acting [[barbiturate]] (e.g., [[pentobarbital]] or [[secobarbital]]). If the patient is under anesthesia, a short-acting muscle relaxant (e.g., [[succinylcholine]]) may be used. Longer acting drugs should be used only when recurrent convulsions are evidenced.
* Should circulatory depression occur, [[vasopressors]] may be used.
* Constant [[electrocardiographic]] monitoring is essential to the proper administration of lidocaine hydrochloride. Signs of excessive depression of cardiac electrical activity such as sinus node dysfunction, prolongation of the P-R interval and QRS complex or the appearance or aggravation of [[arrhythmias]], should be followed by flow adjustment and, if necessary, prompt cessation of the intravenous infusion of this agent. Occasionally, acceleration of ventricular rate may occur when lidocaine hydrochloride is administered to patients with [[atrial flutter]] or [[atrial fibrillation]].
 
====Precautions====
=====General=====
* Caution should be employed in the use of lidocaine hydrochloride in patients with severe [[liver disease]] or [[kidney disease]] because accumulation of the drug or metabolites may occur.
* Lidocaine hydrochloride should be used with caution in the treatment of patients with [[hypovolemia]], severe [[congestive heart failure]], shock, and all forms of [[heart block]]. In patients with sinus [[bradycardia]] or incomplete [[heart block]], the administration of lidocaine hydrochloride intravenously for the elimination of ventricular ectopic beats, without prior acceleration in [[heart rate]] (e.g., by [[atropine]], [[isoproterenol]] or electric pacing), may promote more frequent and serious [[ventricular arrhythmias]] or complete [[heart block]].
* Dosage should be reduced for children and for debilitated and/or elderly patients, commensurate with their age and physical status.
* The safety of amide local anesthetic agents in patients with genetic predisposition to malignant [[hyperthermia]] has not been fully assessed; therefore, lidocaine should be used with caution in such patients.
* In hospital environments where drugs known to be triggering agents for malignant [[hyperthermia]] (fulminant hypermetabolism) are administered, it is suggested that a standard protocol for management should be available.
* It is not known whether lidocaine may trigger this reaction; however, large doses resulting in significant plasma concentrations, as may be achieved by intravenous infusion, pose potential risk to these individuals. Recognition of early unexplained signs of [[tachycardia]], [[tachypnea]], labile [[blood pressure]] and [[metabolic acidosis]] may precede temperature elevation. Successful outcome is dependent on early diagnosis, prompt discontinuance of the triggering agent and institution of treatment including oxygen therapy, supportive measures and dantrolene.
|clinicalTrials=Adverse experiences following the administration of lidocaine are similar in nature to those observed with other amide local anesthetic agents. Adverse experiences may result from high plasma levels caused by excessive dosage or may result from a [[hypersensitivity]], idiosyncrasy or diminished tolerance on the part of the patient. Serious adverse experiences are generally systemic in nature. The following types are those most commonly reported. The adverse experiences under [[Central Nervous System]] and [[Cardiovascular System]] are listed, in general, in a progression from mild to severe.
 
=====Central Nervous System=====
CNS reactions are excitatory and/or depressant, and may be characterized by [[lightheadedness]], [[nervousness]], apprehension, [[euphoria]], [[confusion]], [[dizziness]], [[drowsiness]], [[tinnitus]], blurred or double vision, [[vomiting]], sensations of heat, cold or numbness, twitching, [[tremors]], [[convulsions]], [[unconsciousness]], [[respiratory depression]] and [[respiratory arrest]]. The excitatory reactions may be very brief or may not occur at all, in which case, the first manifestation of toxicity may be [[drowsiness]], merging into [[unconsciousness]] and [[respiratory arrest]].
 
=====Cardiovascular System=====
Cardiovascular reactions are usually depressant in nature and are characterized by [[bradycardia]], [[hypotension]], and cardiovascular collapse, which may lead to [[cardiac arrest]].
 
=====Allergic Reactions=====
[[Allergic reactions]] as a result of sensitivity to lidocaine are extremely rare and, if they occur, should be managed by conventional means.
 
=====Drug Abuse or Dependance=====
Although specific studies have not been conducted, lidocaine hydrochloride has been used clinically without evidence of abuse of this drug or of physiological or physical dependence as a result of its use.
|drugInteractions=* Lidocaine hydrochloride should be used with caution in patients with [[digitalis]] toxicity accompanied by [[atrioventricular block]].
* Concomitant use of [[beta blockers]] may reduce hepatic blood flow and thereby reduce lidocaine clearance.
* Lidocaine and [[tocainide]] are pharmacologically similar.
* The concomitant use of these two agents may cause an increased incidence of adverse reactions, including [[central nervous system]] adverse reactions such as [[seizure]].
|FDAPregCat=B
|useInPregnancyFDA=Reproduction studies have been performed in rats at doses up to 6.6 times the maximum human doses and have revealed no significant findings. There are, however, no adequate and well-controlled studies in pregnant women. Because animal reproduction studies are not always predicted of human response, this drug should be used during pregnancy only if clearly needed.
|useInLaborDelivery=The effects of lidocaine hydrochloride on the mother and the fetus, when used in the management of cardiac arrhythmias during labor and delivery, are not known. Lidocaine readily crosses the placental barrier.
|useInNursing=It is not known whether this drug is excreted in human milk. Because many drugs are excreted in human milk, caution should be exercised when lidocaine is administered to a nursing woman.
|useInPed=Safety and effectiveness in children have not been established by controlled clinical studies.
|administration=* Intravenous
|monitoring=Lidocaine hydrochloride is administered intravenously under [[ECG monitoring]].
|IVCompat=There is no information regarding IV compatibility provided by the label.
|overdose=* Overdosage of lidocaine hydrochloride usually results in signs of [[central nervous system]] or [[cardiovascular system]] toxicity.
* Should convulsions or signs of [[respiratory depression]] and [[respiratory arrest]] develop, the patency of the airway and adequacy of ventilation must be assured immediately. Should [[convulsions]] persist despite ventilatory therapy with oxygen, small increments of [[anticonvulsive agents]] may be given intravenously. Examples of such agents include a [[benzodiazepine]] (e.g., [[diazepam]]), an ultrashort-acting [[barbiturate]] (e.g., [[thiopental]] or [[thiamylal]]), or a short-acting barbiturate (e.g., [[pentobarbital]] or [[secobarbital]]). If the patient is under general anesthesia, a short-acting muscle relaxant (e.g., [[succinylcholine]]) may be administered.
* Should circulatory depression occur, [[vasopressors]] may be used. Should cardiac arrest occur, standard [[CPR]] procedures should be instituted.
* [[Dialysis]] is of negligible value in the treatment of acute overdosage from lidocaine hydrochloride.
|drugBox=| verifiedrevid = 464370713
| IUPAC_name = 2-(diethylamino)-<br>''N''-(2,6-dimethylphenyl)acetamide
| image = LidocaineStructure.png
| width = 200px
 
<!--Clinical data-->
| tradename = Xylocaine
| Drugs.com = {{drugs.com|CONS|lidocaine}}
| pregnancy_AU = A
| pregnancy_US = B
| legal_AU = S4
| legal_US = Rx Only (U.S.) (excluding 1%)
| routes_of_administration = [[Intravenous therapy|intravenous]], [[subcutaneous]], [[topical]], [[oral]]
 
<!--Pharmacokinetic data-->
| bioavailability = 35% (oral) <br> 3% (topical)
| metabolism = [[Liver|Hepatic]], 90% [[CYP1A2]]-mediated
| elimination_half-life = 1.5–2 hours
| excretion = [[renal]]
 
<!--Identifiers-->
| CASNo_Ref = {{cascite|correct|CAS}}
| CAS_number_Ref = {{cascite|correct|??}}
| CAS_number = 137-58-6
| CAS_supplemental = <br>{{CAS|73-78-9}} (hydrochloride)
| ATC_prefix = C01
| ATC_suffix = BB01
| ATC_supplemental = {{ATC|C05|AD01}} {{ATC|D04|AB01}} {{ATC|N01|BB02}} {{ATC|R02|AD02}} {{ATC|S01|HA07}} {{ATC|S02|DA01}}
| PubChem = 367
| IUPHAR_ligand = 2623
| DrugBank_Ref = {{drugbankcite|correct|drugbank}}
| DrugBank = DB00281
| ChemSpiderID_Ref = {{chemspidercite|correct|chemspider}}
| ChemSpiderID = 3548
| UNII_Ref = {{fdacite|correct|FDA}}
| UNII = 98PI200987
| KEGG_Ref = {{keggcite|correct|kegg}}
| KEGG = D00358
| ChEBI_Ref = {{ebicite|correct|EBI}}
| ChEBI = 6456
| ChEMBL_Ref = {{ebicite|correct|EBI}}
| ChEMBL = 79
 
<!--Chemical data-->
| C=14 | H=22 | N=2 | O=1
| molecular_weight = 234.34 g/mol
| smiles = O=C(Nc1c(cccc1C)C)CN(CC)CC
| InChI = 1/C14H22N2O/c1-5-16(6-2)10-13(17)15-14-11(3)8-7-9-12(14)4/h7-9H,5-6,10H2,1-4H3,(H,15,17)
| StdInChI_Ref = {{stdinchicite|correct|chemspider}}
| StdInChI = 1S/C14H22N2O/c1-5-16(6-2)10-13(17)15-14-11(3)8-7-9-12(14)4/h7-9H,5-6,10H2,1-4H3,(H,15,17)
| StdInChIKey_Ref = {{stdinchicite|correct|chemspider}}
| StdInChIKey = NNJVILVZKWQKPM-UHFFFAOYSA-N
| synonyms = ''N''-(2,6-dimethylphenyl)-''N''<sup>2</sup>,''N''<sup>2</sup>-diethylglycinamide
| melting_point = 68
}}
|mechAction=Studies of the effects of therapeutic concentrations of lidocaine on the electrophysiological properties of mammalian [[Purkinje fibers]] have shown that lidocaine attenuates phase 4 diastolic depolarization, decreases automaticity and causes a decrease or no change in excitability and membrane responsiveness.
|structure=Lidocaine Hydrochloride Injection USP, is a sterile, aqueous solution of lidocaine, an antiarrhythmic agent, prepared with the aid of hydrochloric acid. It is intended for intravenous administration by either direct injection or continuous infusion. 
 
Lidocaine hydrochloride is designated 2-(Diethylamino)-2’, 6’-acetoxylidide monohydrochloride and isrepresented by the following structural formula:
 
 
[[File:LidocaineStructure.png|600px|thumbnail|left|This image is provided by the National Library of Medicine.]]
{{clr}}
 
*pH of the above solution adjusted with sodium hydroxide and/or hydrochloric acid to finished product pH limits between 5 and 7.
The medication and fluid pathway of these disposable syringes are sterile and nonpyrogenic in the original, unopened package with component caps in place. These dosage forms do not contain preservatives; once the unit is assembled and used, any remaining portion of the solution must be discarded with the entire unit.
|PD=Action potential duration and effective refractory period of [[Purkinje fibers]] are decreased, while the ratio of effective refractory period to action potential duration is increased. Action potential duration and effective refractory period of ventricular muscle are also decreased. Effective refractory period of the [[AV node]] may increase, decrease or remain unchanged, and atrial effective refractory period is unchanged. Lidocaine raises the [[ventricular fibrillation]] threshold. No significant interactions between lidocaine and the autonomic nervous system have been described and consequently lidocaine has little or no effect on autonomic tone.
 
Clinical electrophysiological studies with lidocaine have demonstrated no change in [[sinus node]] recovery time or sinoatrial conduction time. [[AV nodal conduction]] time is unchanged or shortened, and [[His-Purkinje conduction]] time is unchanged.
 
=====Hemodynamics=====
At therapeutic doses, lidocaine has minimal hemodynamic effects in normal subjects and in patients with heart disease. Lidocaine has been shown to cause no, or minimal, decrease in ventricular contractility, cardiac output, arterial pressure or heart rate.
|PK=Lidocaine is rapidly metabolized by the liver, and less than 10% of a dose is excreted unchanged in the urine. Oxidative N dealkylation, a major pathway of metabolism, results in the metabolites monoethylglycinexylidide and glycinexylidide. The pharmacological/toxicological activities of these metabolites are similar to, but less potent than, lidocaine. The primary metabolite in urine is a conjugate of 4-hydroxy-2,6,-dimethylaniline.
 
The elimination half-life of lidocaine following an intravenous bolus injection is typically 1.5 to 2 hours. There are data that indicate that the half-life may be 3 hours or longer following infusions of greater than 24 hours.
 
Because of the rapid rate at which lidocaine is metabolized, any condition that alters liver function, including changes in liver blood flow, which could result from severe congestive heart failure in shock, may alter lidocaine kinetics. The half-life may be two-fold or more, greater in patients with liver dysfunction. [[Renal dysfunction]] does not affect lidocaine kinetics, but may increase the accumulation of metabolites. Therapeutic effects of lidocaine are generally associated with plasma levels at 6 to 25 μmole/L (1.5 to 6 mcg free base per mL). The blood to plasma distribution ratio is approximately 0.84. Objective adverse manifestations become increasingly apparent with increasing plasma levels above 6 mcg free base per mL.
   
The plasma protein binding of lidocaine is dependent on drug concentration, and the fraction bound decreases with increasing concentration. At concentrations of 1 to 4 mcg free base per mL, 60 to 80 percent of lidocaine is protein bound. In addition to lidocaine concentration, the binding is dependent on the plasma concentration of the α-1-acid glycoprotein.
   
Lidocaine readily crosses the placental and blood-brain barriers. [[Dialysis]] has negligible effects on the kinetics of lidocaine.
|nonClinToxic=Long term studies in animals to evaluate the carcinogenic and mutagenic potential or the effect on fertility of lidocaine hydrochloride have not been conducted.
|clinicalStudies======Condition 1=====
 
(Description)
 
=====Condition 2=====
 
(Description)
 
=====Condition 3=====
 
(Description)
|howSupplied=In unit-use packages containing a Luer-JetTM Luer-Lock Prefilled Syringe, ten cartons per package:
* Concentration: 2%               
* Stock No.: 3390               
* NDC No.: 76329-3390-1               
* Size: 5 mL (100 mg)
|storage=* Store at 20 to 25°C (68 to 77°F).
|fdaPatientInfo=The patients should be advised of the possible occurrence of the experiences listed under adverse reactions.
|alcohol=Alcohol-Lidocaine interaction has not been established. Talk to your doctor about the effects of taking alcohol with this medication.
|lookAlike=* (Paired Confused Name 1a) — (Paired Confused Name 1b)
* (Paired Confused Name 2a) — (Paired Confused Name 2b)
* (Paired Confused Name 3a) — (Paired Confused Name 3b)
|nlmPatientInfo=(Link to patient information page)
|drugShortage=Drug Shortage
}}
{{LabelImage
|fileName=LidocaineHydrochloridePackage1.png
}}
[[Category:Antiarrhythmic agents]]
[[Category:Cardiovascular Drugs]]
[[Category:Drug]]

Latest revision as of 01:53, 14 October 2014

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Alonso Alvarado, M.D. [2]

Infobox goes here

{{SI}}

Synonyms and keywords:

Overview

Body dysmorphic disorder (BDD) is a mental disorder that involves a disturbed body image. It is generally diagnosed in those who are extremely critical of their physique or self-image, despite the fact there may be no noticeable disfigurement or defect.

Most people wish they could change or improve some aspect of their physical appearance, but people suffering from BDD, generally considered of normal appearance, believe that they are so unspeakably hideous that they are unable to interact with others or function normally for fear of ridicule and humiliation at their appearance. They tend to be very secretive and reluctant to seek help because they are afraid others will think them vanity|vain or they may feel too embarrassed to do so.

Ironically, BDD is often misunderstood as a vanity driven obsession, whereas it is quite the opposite; people with BDD believe themselves to be irrevocably ugly or defective.

BDD combines obsessive and compulsive aspects, which links it to the OCD spectrum disorders among psychologists. People with BDD may engage in compulsive mirror checking behaviors or mirror avoidance, typically think about their appearance for more than one hour a day, and in severe cases may drop all social contact and responsibilities as they become homebound. The disorder is linked to an unusually high suicide rate among all mental disorders.

A German study has shown that 1-2% of the population meet all the diagnostic criteria of BDD, with a larger percentage showing milder symptoms of the disorder (Psychological Medicine, vol 36, p 877). Chronically low self-esteem is characteristic of those with BDD due to the value of oneself being so closely linked with their perceived appearance. The prevalence of BDD is equal in men and women, and causes chronic social anxiety for those suffering from the disorder[3].

Phillips & Menard (2006) found the completed suicide rate in patients with BDD to be 45 times higher than in the general US population. This rate is more than double that of those with Clinical depression and three times as high as those with bipolar disorder[1]. There has also been a suggested link between undiagnosed BDD and a higher than average suicide rate among people who have undergone cosmetic surgery[2].

Historical Perspective

BDD was first documented in 1886 by the researcher Morselli, who called the condition simply "Dysmorphophobia". BDD was first recorded/formally recognized in 1997 as a disorder in the DSM; however, in 1987 it was first truly recognized by the American Psychiatric Association.

In his practice, Freud eventually had a patient who would today be diagnosed with the disorder; Russian aristocrat Sergei Pankejeff, nicknamed "The Wolf Man" by Freud himself in order to protect Pankejeff's identity, had a preoccupation with his nose to an extent that greatly limited his functioning.

Classification

Pathophysiology

BDD usually develops in adolescence, a time when people are generally most sensitive about their appearance. However, many patients suffer for years before seeking help. When they do seek help through mental health professionals, patients often complain of other symptoms such as depression, social anxiety or obsessive compulsive disorder, but do not reveal their real concern over body image. Most patients cannot be convinced that they have a distorted view of their body image, due to the very limited knowledge of the disorder as compared to OCD or others.

An absolute cause of body dysmorphic disorder is unknown. However research shows that a number of factors may be involved and that they can occur in combination, including:

A chemical imbalance in the brain. An insufficient level of serotonin, one of the brain's neurotransmitters involved in mood and pain, may contribute to body dysmorphic disorder. Although such an imbalance in the brain is unexplained, it may be hereditary.

Obsessive-compulsive disorder. BDD often occurs with OCD, where the patient uncontrollably practices ritual behaviors that may literally take over their life. A history of, or genetic predisposition to, OCD may make people more susceptible to BDD.

Generalized anxiety disorder. Body dysmorphic disorder may co-exist with generalized anxiety disorder. This condition involves excessive worrying that disrupts the patient's daily life, often causing exaggerated or unrealistic anxiety about life circumstances, such as a perceived flaw or defect in appearance, as in BDD.

Causes

Differentiating type page name here from other Diseases

Epidemiology and Demographics

According to Dr Katharine Phillips (2004) :

Although large epidemiologic surveys of BDD's prevalence have not been done, studies to date indicate that BDD is relatively common in both nonclinical and clinical settings (Phillips & Castle, 2002). Studies in community samples have reported current rates of 0.7% and 1.1%, and studies in nonclinical student samples have reported rates of 2.2%, 4%, and 13% (Phillips & Castle, 2002). A study in a general inpatient setting found that 13% of patients had BDD (Grant, Won Kim, Crow, 2001). Studies in outpatient settings have reported rates of 8%-37% in patients with OCD, 11%-13% in social phobia, 26% in trichotillomania, 8% in major depression, and 14%-42% in atypical major depression (Phillips & Castle, 2002). In one study of atypical depression, BDD was more than twice as common as OCD (Phillips, Nierenberg, Brendel et al 1996), and in another (Perugi, Akiskal, Lattanzi et al, 1998) it was more common than many other disorders, including OCD, social phobia, simple phobia, generalized anxiety disorder, bulimia nervosa, and substance abuse or dependence. In a dermatology setting, 12% of patients screened positive for BDD, and in cosmetic surgery settings, rates of 6%-15% have been reported (Phillips & Castle, 2002).

BDD is underdiagnosed, however. Two studies of inpatients (Phillips, McElroy, Keck et al, 1993, and Grant, Won Kim, Crow, 2001), as well as studies in general outpatients (Zimmerman & Mattia, 1998) and depressed outpatients (Phillips, Nierenberg, Brendel et al 1996), systematically assessed a series of patients for the presence of BDD and then determined whether clinicians had made the diagnosis in the clinical record. All four studies found that BDD was missed by the clinician in every case in which it was present. Thus, underdiagnosis of BDD appears common.

Risk Factors

Screening

Natural History, Complications, and Prognosis

Diagnosis

Symptoms

  • Compulsive mirror checking, glancing in reflective doors, windows and other reflective surfaces.
  • Alternatively, an inability to look at one's own reflection or photographs of oneself; often the removal of mirrors from the home.
  • Compulsive skin-touching, especially to measure or feel the perceived defect.
  • Reassurance-seeking from loved ones.
  • Social withdrawal and co-morbid depression.
  • Obsessive viewing of favorite celebrities or models the person suffering from BDD may wish to resemble.
  • Excessive grooming behaviors: combing hair, plucking eyebrows, shaving, etc.
  • Obsession with plastic surgery or multiple plastic surgeries with little satisfactory results for the patient.
  • In obscure cases patients have performed plastic surgery on themselves, including liposuction and various implants with disastrous results.

Location of imagined defects

In research carried out by Dr. Katharine Philips, involving over 500 patients, the percentage of patients concerned with the most common locations were as follows:

Retrieved from "https://www.wikidoc.org/index.php?title=SandboxAlonso&oldid=1031829"