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Common/useful drugs
Published in Jonathan P Rogers, Cheryl CY Leung, Timothy RJ Nicholson, Pocket Prescriber Psychiatry, 2019
Jonathan P Rogers, Cheryl CY Leung, Timothy RJ Nicholson
Caution: asthma or COPD, recent MI, ↓HR/BP, arrhythmias, vagotonia, ↑T4, PU, epilepsy, parkinsonism, R/P/B/E.
Part 5: Hyperactivity, Attention Deficit Disorders and Homeopathy
Published in Aruna Bakhru, Nutrition and Integrative Medicine, 2018
Fears and delusions, night restlessness, moaning and screaming, despaired and furious, prostration with icy coldness, vagotonia, fainting fits, violent vomiting and diarrhea with colic, anxious chest constriction: VERATRUM ALBUM 4CH
Fundamentals of cardiac electrophysiology
Published in Ever D. Grech, Practical Interventional Cardiology, 2017
Sunil Kapur, William G Stevenson, Roy M John
It is important to recognise potentially reversible causes of AV block. Important examples include acute myocarditis (e.g. Lyme disease), drug toxicity, hypoxia and vagotonia. AV block related to these situations usually resolves with specific treatment of the primary condition, and although temporary pacing may be necessary, permanent cardiac pacing can often be avoided.
Direct bronchoprovocation test methods: history 1945–2018
Published in Expert Review of Respiratory Medicine, 2019
Donald W. Cockcroft, Beth E. Davis, Christianne M. Blais
In the first half of the 20th century, there are scattered reports of asthma (wheezing dyspnea) induced by parenteral administration of what we now recognize as direct non-selective bronchoconstricting stimuli. Chemicals included pilocarpine, acetylcholine, methacholine and histamine. Pilocarpine is a naturally occurring plant-based alkaloid and muscarinic agonist identified in 1874 [5]. Acetylcholine is a major muscarinic/nicotinic neurotransmitter synthesized in 1867, first identified to occur naturally in 1913, and eventually identified as one, in fact the most important, neurotransmitter in 1933 [6]. Acetyl-β-methacholine, simply referred to as methacholine in the remainder of this review is a synthetic muscarinic agonist first developed in 1913 [7]. Histamine, an inflammatory/immune mediator produced by mast cells and basophils, was identified in 1910 [8]. Alexander and Paddock [9] (1921) administered pilocarpine, 3 mg subcutaneously, to 20 asthmatic and 11 normal subjects and identified vagotonia (excessive vagal symptoms including salivation, flushing and sweating) in asthmatic but not in normal subjects, and found that 10 of the 20 asthmatics also developed asthmatic breathing. Weiss et al. [10] (1929) used intravenous histamine to study circulation time in cardiac patients and noted that wheezing developed in several patients with coincidental asthma. In what appears to be the first human study using methacholine, Starr et al. [11] (1933) administered methacholine 5–25 mg subcutaneously to 20 normal individuals and provoked systemic vagal-like symptoms in most and an episode of asthma in one, an individual with a prior history of asthma. Villaret et al. [12] (1934) administered methacholine 20–40 mg subcutaneously to 15 asthmatics, and induced significant asthma as well as marked systemic muscarinic vagal effects. The potential for using (parenteral) methacholine as a diagnostic test for asthma was discussed in this paper and discounted because of the marked systemic side effects. Moll [13] (1940), likewise, showed that methacholine 10–20 mg subcutaneously resulted in mild to severe episodes of asthma in all 28 asthmatic subjects but not in the 19 normal controls; all (both asthmatic and normal subjects) had pronounced systemic muscarinic effects in contrast to the observations of Alexander and Paddock [9]. Occasional respiratory symptoms were induced in 18 individuals with other non-asthmatic respiratory diseases [13]. The first description of the effect of inhaled muscarinic agonists appears to be that of Dautrebande et al. in 1941 [14]. Two subjects developed asthma symptoms and changes in gas exchange following inhalation of carbachol (another synthetic muscarinic agonist).