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Urinary Retention

Urinary Retention is a condition where a patient cannot empty the bladder completely. A person suffering from urinary retention will have a strong urge to urinate but will not be able to do so totally. Acute urinary retention is characterized by sharp pain and often needs surgery. Men are more likely to suffer urinary retention.


Urinary retention might occur due to urethral obstruction or weakness in the bladder well. Urine analysis can aid in detecting the cause for urinary retention. PSA levels can help in diagnosing enlarged prostate. Renal failure or prostatitis or UTI can also manifest with urinary retention. Bladder stones are another cause for incomplete passage of urine. Patients suffering from urinary retention tend to experience abdominal swelling and difficulty in starting urination. There might be dribbling of urine at other times. A urethral catheter is used to allow free passage of urine. Medications to encourage urination are given to patients suffering from urinary retention.

Tension Headache

Do you feel a dull ache on both sides of the head? Do the muscles in the neck and head feel tight ? You are most likely suffering a tension headache or stress headache as it is otherwise referred. Such headaches are one of the most common forms of headache and can occur in adults and adolescents. The pain due to tension headache is vise-like and is generalized. Tension headaches may result from fluctuations in the levels of brain chemicals such as serotonin, endorphins and others. Tension headaches are noticed more often in women.


Tension headaches occur due to contraction of neck and scalp muscles. This contraction can be a reaction to stress, anxiety or posture. Excessive smoking, alcohol use, sinusitis, eye strain can also bring on tension headache. Unlike migraine, tension headaches do not cause nausea and vomiting or numbness. Episodic tension headaches come a couple of times a month and last a few hours. If there are frequent episodes of tension headache, the condition is chronic. Skipping meals, stress, hormonal changes and hypertension medication can trigger tension headaches. Such headaches often have a genetic predisposition.


Tension Headache and Treatment

Treatment:
There are many issues to consider before arriving at treating headaches - frequency, severity, the effect on lifestyle, the results of previous treatment and any history of drug abuse. Mild cases of tension headaches which occur occasionally can be managed with symptomatic treatment by using Analgesics or nonsteroidal anti-inflammatory drugs (NSAIDs).

Tension headaches are treated with NSAIDs, aspirin or acetaminophen. A non sedating muscle relaxant such as Skelaxin provides relief to persons suffering from tension headaches. Those who suffer from frequent bouts of tension headaches may need medications to reduce anxiety such as amitriptyline, nortriptyline or desipramine. But overuse of these medicines can lead to rebound headaches. You can try some of the following measures to bring tension headaches under control:


  • Enough rest

  • Regular exercise regimen

  • Warm or cold compress on the head and neck

  • Relaxation exercises, yoga, deep breathing, acupuncture

  • Good posture while sleeping, reading, using the computer

  • Massage

  • Swimming


Prophylactic Therapy :
If the frequency of headaches is so regular or if the severity of the headache is so high that the patient can't normally cope, then prophylactic therapy might be indicated. Antidepressants are the drugs of choice for treating tension type headache. Relief of headache may take about 3 to 4 weeks and the patient may have the following side effects:


  • sedation
  • dry mouth
  • blurred vision
  • constipation
  • urinary retention

Amitriptyline - single dose of 25 mg at bed time may be a good option. Trazodone (75 to 300 mg at bedtime) or Fluoxetine (20 to 40 mg at lunchtime) are other options if the patient does not tolerate the sedative and anticholinergic effects of amitriptyline.

There are other alternate options like Cervical Epidural Nerve Block which can be performed on a regular basis depending on clinical symptoms.



Sedatives

Antihistamines

Antihistamines are widely used for allergies and motion sickness. As they exhibit properties that can indirectly induce drowsiness, there is a class of antihistamines, sold as OTC sleeping pills. However, the American Academy of Sleep Medicine warns that such pills should be used only occasionally. Beware that there is a price to pay for buying OTC antihistamines. Some OTC sedatives combine antihistamines with pain relievers and some combine it with alcohol.


They can induce abnormal muscle spasms. Other side effects are blurred vision, constipation, diarrhea, nausea and vomiting, dry mouth and general dehydration. Therefore she needs to consume plenty of water if she is taking any antihistamine. In elders and children, antihistamines can cause nervousness and insomnia. Similarly, asthmatics should steer clear of antihistamines as these can aggravate their condition. They can affect the behavior of the fetus in the womb. Antihistamines also interfere with lactation. Be warned that OTC antihistamines should never be clubbed with alcohol or other sedatives.


Although it is construed that some antihistamines are non prescription sleep aids, and they are more sedating than prescription hypnotics, beware that their effectiveness may decrease over time. More importantly, OTC sedative is only meant for short-term insomnia and by and large the long term effectiveness and safety of the OTC drugs is questionable. However, for transient insomnia or insomnia based on illness or depression, antihistamines can be an effective OTC tool.


Sedative antihistamine list includes (the following list also contains suggested dosage for an adult. Always take the medications e.m.p (ex modo prescripto as directed by the physician):

  • Chlorpheniramine (Chlor-Trimeton) 4 mg every 4 to 6 hrs; maximum dose: 24 mg/day

  • Cyproheptadine (Periactin) , 4 mg at bedtime

  • Clemastine (Tavist), 50-100 mg every 4-6 hours, not to exceed 400 mg/day and it is supplied in table form chewable

  • Diphenhydramine (Benadryl), as a night sleep aid to be taken 30 minutes before bedtime, and the dosage is 50 mg for adults

  • Promethazine (Phenergan) Sedation: 25-50 mg orally or 50 mg rectally

  • Hydroxyzine (Atarax, Vistaril), oral sedation dosage 50-100 mg, IM 25-100 mg. Intravenous (IV), subcutaneous and intra-arterial administrations are not recommended as these can cause thrombosis and digital gangrene.


These come in various brand and trade names and they can be taken as tablets, syrups or nasal sprays. Droplet form for use in the eyes is also available. The effects of these antihistamines including drowsiness, dizziness, headache, loss of appetite, vision changes, irritability, dry mouth, stomach upset should subside, when the body begins to adjust with the medication. If these side effects continue, it is better to contact the medical practitioner. Sedative antihistamines may be taken with food and milk. Sustained release low acting tablets can be swallowed whole as chewing the sustained release long acting tablets may destroy the action and increase the side effects. Chewable tablets can be chewed thoroughly and swallowed. Suspensions should be shaken before food consumption.


Melatonin

This is a hormone produced by human body – by the pineal gland, a pea-sized structure at the center of the brain. This regulates sleep and wakefulness. Taken as a supplement, melatonin helps to reduce delayed sleep syndrome. This also improves sleep quality and lengthens the period of sleep. Day time alertness also seems to improve when this is taken. Melatonin can treat insomnia without altering the sleep pattern of the individual. It also does not impair any performance related skills.


This may help elders with insomnia as the amount of melatonin produced in the body seems to decrease as one gets older, although it is not recommended for chronic insomnia. Melatonin works on the circadian rhythm – the biological clock that regulates our sleep and wake cycles. Many become melatonin deficient due to age, work schedules and stress. Melatonin supplements are a quick way to adjust the lack of melatonin in the body and rebalance the sleep cycle. These are available OTC and when used in conjunction with herbs like chamomile and lemon balm, help lull the body to sleep acting as a true sedative.

Although Melatonin shows good effects for the treatment of insomnia, if used in excess, this sedative can produce side effects including sexual irregularities, mood swings and depression. Although by and large safe when used in moderation, it is unsafe for small children and pregnant women to use melatonin supplements. It is also not recommended for those with lymphoma, extreme allergies, depression, rheumatoid arthritis, auto immune diseases and for cancer patients. Some melatonin sedatives include:

  • clonazepam (Klonopin)

  • lorazepam (Ativan)

  • phenobarbital (Donnatal)

  • zolpidem (Ambien)


As such Melatonin can cause sleepiness and drowsiness, and if taken with sedatives that cause sleepiness, then too much of sleepiness can result. Research indicates that quick release Melatonin can be more effective than sustained-release formulations, especially when used as sedatives. Intramuscular injections of 20 mg of Melatonin are also available.


SAMe

This is also found naturally in the body. This OTC aid can not only help to sleep but also treats depression and chronic fatigue by promoting serotonin production in the body. Unless consumed in large quantities, SAMe has no known side effects.


Antidepressants used as sedatives

Although the FDA has not approved the use of antidepressants as sedatives, there are those who believe that insomnia is related to depression. As with any other medication for depression, there is a significant risk of suicidal thoughts particularly in adolescents and children. Approximate dosage of antidepressants s.o.s (si opus sit only if there is a need) :

Citalopram 20 mg
Escitalopram 5-10 mg
Fluvoxamine 100 mg
Fluoxetine 20 mg
Paroxetine 20 mg
Sertraline 50-75 mg
Venlafaxine 75 mg
Donormyl sleeping pills are available without prescription and they are approved by the FDA for non-prescription. They are used in the treatment of insomnia. 25 mg of Donormyl is the strongest non-prescription sleeping pill. Possible common side effects of antidepressant sedatives include diarrhea, dizziness, headache, insomnia, rash, vomiting, blurred vision, decreased appetite, cold symptoms, nervousness, cramps, hallucinations, hair loss and decreased coordination.


OTC sedatives side effects

Although OTC sedatives can be effective for an occasional sleepless night, the longer you take them, the less they are likely to make you sleepy. OTC sleep aids can leave you feeling groggy and unwell the next day. This is like the 'hangover' effect. Much remains unknown about the safety and effectiveness of OTC sleep aids.

Dizziness and forgetfulness, clumsiness, feeling off balance, dry mouth and throat are some common side effects. Serious risks of OTC sedatives include severe allergic reaction, facial swelling, memory lapses, hallucinations, suicidal tendencies, sleep-related complexities such as sleep-walking, sleep-driving, and sleep-eating. If any unusual sleep-related behavior is exhibited, consult the doctor immediately.


Over-the-counter sedative tips


  • Consult the doctor before taking OTC sedative, although you do not need the doctor concurrence to buy an OTC drug. This is because your doctor can make sure that the sedative does not interfere with other underlying medications.
  • Certain OTC drugs are not recommended for those with glaucoma, asthma, chronic pulmonary disorders, liver diseases and urinary retention.
  • Remember that OTC sedatives are only a temporary solution for insomnia and they are not intended to be used for longer than about two weeks.
  • Persistent insomnia is a symptom of an underlying medical or psychological problem. These cannot be cured with OTC sedatives. It is better to learn about safer and effective way of end sleepless nights.
  • Never mix alcohol with sedatives and this can increase the sedative effects of the medication.
  • Combining medications such as OTC sedatives and pain relievers and allergy medicines is very dangerous.
  • Do not drive or attempt any other activity that may require alertness while taking a sedative.
  • Over a period of time, you may build up intolerance to sedatives and this can in turn lead to more side effects.
  • You may also come to rely on sedatives and will be unable to sleep without them.

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Bibliography / Reference

Collection of Pages - Last revised Date: November 12, 2019