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Compazine

Prochlorperazine is a highly potent neuroleptic, which is 10 to 20-times more potent than chlorpromazine. It is a typical antipsychotic drug of the phenothiazine class sold under the names Compazine®, Buccastem® and Stemetil®. more...

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It is now relatively seldom used for the treatment of psychosis and the manic phase of bipolar disorder. It has a prominent antiemetic/antivertignoic activity and is more often used for the (short-time) treatment of nauses/emesis and vertigo as follows:

1.To alleviate the symptoms of vertigo

2. As an antiemetic, particularly for nausea and vomiting caused by cancer treatment and in the pre- and postoperative setting

3. Quite recently, in the UK prochlorperazine maleate has been made available as Buccastem M® in buccal form as an OTC-treatment for migraine. In this indication it blocks the CTZ (Chemical Trigger Zone) in the brain, which is responsible for causing severe nausea and emesis. Its OTC use is strictly restricted to a maximum of 2 days, because of the potentially severe side-effects of Procloperazine, which mandate supervision by a health care provider.

Prochlorperazine is available as an oral liquid, tablets, and suppositories, as well as in an injectable form.

Following i.m.-injection the antiemetic action is evident within 5 to 10 minutes and lasts for 3 to 4 hours. Rapid action is also noted after buccal treatment. With oral dosing the start of action is delayed but the duration somewhat longer (approximately 6 hours).

Due to the short duration of treatment it is usually well tolerated. It shares in general all side-effects of chlorpromazine, but these are seen less frequently so and are less disturbing to the patient, particularly as most patients with the aforementioned conditions are hospitalized. In the treatment of nauses/emesis it might be given together with an antiparkinsonian drug to prevent extrapyramidal side effects of prochlorperazine.

If treating psychotic conditions on a long-term basis, the high incidence of early and late (tardive dyskinesia) extrapyramidal side-effects should be considered carefully. Prochlorperazine has in the long-term treatment approximately the same incidence and severity of extrapyramidal side-effects as haloperidol.

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Useful signs and symptoms to evaluate vaginal complaints
From Journal of Family Practice, 6/1/04

Anderson MR, Klink K, Cohrssen A. Evaluation of vaginal complaints. JAMA 2004; 291:1368-1379.

* CLINICAL QUESTION

How useful are the history, physical examination, and routine office-based laboratory studies in the diagnosis of vaginitis?

* BOTTOM LINE

In the diagnosis of vaginitis, useful symptoms include information about itching. Useful signs include odor and the presence of inflammatory changes. Office microscopy is the most accurate laboratory test. (LOE=3a)

* STUDY DESIGN

Systematic review

* SETTING

Outpatient (any)

* SYNOPSIS

The 3 major causes of vaginitis include vaginal candidiasis, bacterial vaginosis, and trichomoniasis. The authors thoroughly searched Medline and the bibliographies of recent reviews, and contacted primary authors of identified studies, for articles evaluating the usefulness of the history and physical examination in conjunction with routine office-based laboratory testing in the diagnosis of vaginitis.

Articles were included if they involved original research on symptomatic premenopausal women in a primary care setting, compared a diagnostic sign/symptom/test with a recognized reference standard, and allowed the calculation of sensitivity and specificity. A total of 18 studies met the established criteria. All 18 studies were evaluated for quality: of these, 15 received a score of 2 (i= best, 3=worst), and 3 studies received a score of 3.

Symptoms useful in diagnosis included a lack of itching (making candidiasis less likely; negative likelihood ratio [LR-] = 0.18-0.79) and a lack of perceived odor (making bacterial vaginosis unlikely; LR- = 0.07). Useful physical examination signs were limited. Findings predictive of candidiasis included the presence of inflammation (eg, erythema, edema, excoriations; positive likelihood ratio [LR+] range = 2.1-8.4) and a lack of odor (LR+ = 2.9).

The presence of a high "cheese" odor was predictive of bacterial vaginosis (LR+ = 3.2). The whiff test (fishy odor from the slide after the application of potassium hydroxide) is part of the reference standard for bacterial vaginosis and was therefore not evaluated independently.

Of the various office laboratory tests available, microscopy of vaginal discharge was the most useful. The presence of many leukocytes was uncommon in candidiasis and bacterial vaginosis. In the absence of trichomonads, it is important in this instance to consider other causes, such as gonorrhea or chlamydia.

DRUG BRAND NAMES

Ciprofloxacin * Cipro

Ketorolac * Toradol

Prochlorperazine * Compazine

COPYRIGHT 2004 Dowden Health Media, Inc.
COPYRIGHT 2004 Gale Group

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