Gale Encyclopedia of Medicine Vol 2 (C F) pdf

  GALE The

  

ENCYCLOPEDIA

M EDICINE of

SECOND EDITION

  The GALE

ENCYCLOPEDIA

of

  M EDICINE

SECOND EDITION

J A C Q U E L I N E L . L O N G E , E D I T O R

  

D E I R D R E S . B L A N C H F I E L D , A S S O C I A T E E D I T O R

  

V O L U M E

C-F

  

2

SECOND EDITION

  and Electronic Prepress

  2001051245

  II. Blanchfield, Deirdre S. III. Gale Research Company. RC41.G35 2001 616’.003—dc21

  1. Internal medicine—Encyclopedias. I. Longe, Jacqueline L.

  ISBN 0-7876-5489-2 (set: hardcover) — ISBN 0-7876-5490-6 (vol. 1) — ISBN 0-7876-5491-4 (vol. 2) — ISBN 0-7876-5492-2 (vol. 3) — ISBN 0-7876-5493-0 (vol. 4) — ISBN 0-7876-5494-9 (vol. 5)

  Library of Congress Cataloging-in-Publication Data Gale encyclopedia of medicine / Jacqueline L. Longe, editor; Deirdre S. Blanchfield, associate editor — 2nd ed. p. cm. Includes bibliographical references and index. Contents: Vol. 1. A-B — v. 2. C-F — v. 3. G-M — v. 4. N-S — v. 5. T-Z.

  ISBN 0-7876-5489-2 (set) 0-7876-5490-6 (Vol. 1) 0-7876-5491-4 (Vol. 2) 0-7876-5492-2 (Vol. 3) 0-7876-5493-0 (Vol. 4) 0-7876-5494-9 (Vol. 5) Printed in the United States of America 10 9 8 7 6 5 4 3 2 1

  Since this page cannot legibly accommodate all copyright notices, the acknowledgments constitute an extension of the copyright notice. While every effort has been made to ensure the reliability of the infor- mation presented in this publication, the Gale Group neither guarantees the accuracy of the data contained herein nor assumes any responsibili- ty for errors, omissions or discrepancies. The Gale Group accepts no payment for listing, and inclusion in the publication of any organiza- tion, agency, institution, publication, service, or individual does not imply endorsement of the editor or publisher. Errors brought to the attention of the publisher and verified to the satisfaction of the publish- er will be corrected in future editions. This book is printed on recycled paper that meets Environmental Pro- tection Agency standards. The paper used in this publication meets the minimum requirements of American National Standard for Information Sciences-Permanence Paper for Printed Library Materials, ANSI Z39.48-1984. This publication is a creative work fully protected by all applicable copyright laws, as well as by misappropriation, trade secret, unfair com- petition, and other applicable laws. The authors and editor of this work have added value to the underlying factual material herein through one or more of the following: unique and original selection, coordination, expression, arrangement, and classification of the information. Gale Group and design is a trademark used herein under license. All rights to this publication will be vigorously defended. Copyright © 2002 Gale Group 27500 Drake Road Farmington Hills, MI 48331-3535 All rights reserved including the right of reproduction in whole or in part in any form.

  The GALE ENCYCLOPEDIA of MEDICINE

  Dorothy Maki, Manufacturing Manager Wendy Blurton, Senior Manufacturing Specialist

  STAFF

  Jacqueline L. Longe, Project Editor Deirdre S. Blanchfield, Associate Editor Christine B. Jeryan, Managing Editor Donna Olendorf, Senior Editor Stacey Blachford, Associate Editor Kate Kretschmann, Melissa C. McDade, Ryan

  Electronic Prepress

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  Robyn V. Young, Project Manager, Imaging and

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  Thomason, Assistant Editors Mark Springer, Technical Specialist Andrea Lopeman, Programmer/Analyst Barbara J. Yarrow, Manager, Imaging and Multimedia

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Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ix

Advisory Board . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xi

Contributors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xiii

Entries

  

Volume 1: A-B . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

  1 Volume 2: C-F . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 625

Volume 3: G-M . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1375

Volume 4: N-S . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2307

Volume 5: T-Z . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3237

  

Organizations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3603

General Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3625

CONTENTS The Gale Encyclopedia of Medicine 2 is a medical ref- erence product designed to inform and educate readers about a wide variety of disorders, conditions, treatments, and diagnostic tests. The Gale Group believes the product to be comprehensive, but not necessarily definitive. It is intended to supplement, not replace, consultation with a physician or other healthcare practitioner. While the Gale Group has made substantial efforts to provide information that is accurate, comprehensive, and up-to-date, the Gale Group makes no representations or warranties of any kind, including without limitation, warranties of mer- chantability or fitness for a particular purpose, nor does it guarantee the accuracy, comprehensiveness, or timeliness of the information contained in this product. Readers should be aware that the universe of medical knowledge is constantly growing and changing, and that differences of medical opinion exist among authorities. Readers are also advised to seek professional diagnosis and treatment for any medical condition, and to discuss information obtained from this book with their health care provider.

  

PLEASE READ—IMPORTANT INFORMATION The Gale Encyclopedia of Medicine 2 (GEM2) is a one-stop source for medical information on nearly 1,700 common medical disorders, conditions, tests, and treat- ments, including high-profile diseases such as AIDS, Alzheimer’s disease, cancer, and heart attack. This ency- clopedia avoids medical jargon and uses language that laypersons can understand, while still providing thor- ough coverage of each topic. The Gale Encyclopedia of Medicine 2 fills a gap between basic consumer health resources, such as single-volume family medical guides, and highly technical professional materials.

INCLUSION CRITERIA

  SCOPE Almost 1,700 full-length articles are included in the

  Gale Encyclopedia of Medicine 2, including disorders/ conditions, tests/procedures, and treatments/therapies.

  Many common drugs are also covered, with generic drug names appearing first and brand names following in parentheses, eg. acetaminophen (Tylenol). Throughout the Gale Encyclopedia of Medicine 2, many prominent individuals are highlighted as sidebar biographies that accompany the main topical essays. Articles follow a standardized format that provides information at a glance. Rubrics include:

ABOUT THE CONTRIBUTORS

  Disorders/Conditions Tests/Treatments Definition Definition Description Purpose Causes and symptoms Precautions Diagnosis Description Treatment Preparation Alternative treatment Aftercare Prognosis Risks Prevention Normal/Abnormal results Resources Resources Key terms Key terms

  A preliminary list of diseases, disorders, tests and treat- ments was compiled from a wide variety of sources, including professional medical guides and textbooks as well as consumer guides and encyclopedias. The general advisory board, made up of public librarians, medical librarians and consumer health experts, evaluated the top- ics and made suggestions for inclusion. The list was sorted by category and sent to GEM2 medical advisors, certified physicians with various medical specialities, for review. Final selection of topics to include was made by the med- ical advisors in conjunction with the Gale Group editor.

  The essays were compiled by experienced medical writers, including physicians, pharmacists, nurses, and other health care professionals. GEM2 medical advisors reviewed the completed essays to insure that they are appropriate, up-to-date, and medically accurate.

HOW TO USE THIS BOOK

  The Gale Encyclopedia of Medicine 2 has been designed with ready reference in mind.

  • Straight

  In recent years there has been a resurgence of interest in holistic medicine that emphasizes the connection between mind and body. Aimed at achieving and main- taining good health rather than just eliminating disease, this approach has come to be known as alternative medi- cine. The Gale Encyclopedia of Medicine 2 includes a number of essays on alternative therapies, ranging from traditional Chinese medicine to homeopathy and from meditation to aromatherapy. In addition to full essays on alternative therapies, the encyclopedia features specific Alternative treatment sections for diseases and condi- tions that may be helped by complementary therapies.

  alphabetical arrangement allows users to locate information quickly.

  

INTRODUCTION

  • Bold-faced terms function as print hyperlinks that point the reader to related entries in the encyclopedia.

  Cross-references placed throughout the encyclopedia Resources section directs users to additional sources •

  • direct readers to where information on subjects with- of medical information on a topic. out entries can be found. Synonyms are also cross-ref-
  • A comprehensive

  general index allows users to easily oduction erenced. target detailed aspects of any topic, including Latin

  Intr names.

  • A list of

  key terms are provided where appropriate to define unfamiliar terms or concepts.

  GRAPHICS

  • Valuable

  contact information for organizations and support groups is included with each entry. The The Gale Encyclopedia of Medicine 2 is enhanced appendix contains an extensive list of organizations with over 675 color images, including photos, charts, arranged in alphabetical order. tables, and customized line drawings.

ADVISORY BOARD

MEDICAL ADVISORS

A. Richard Adrouny, M.D., F.A.C.P.

  Clinical Professor of Medicine

Medical College of Pennsylvania–

Hahnemann University Philadelphia, PA Ronald Pies, M.D.

  

A number of experts in the library and medical communities provided invaluable assistance in the formulation of this ency-

clopedia. Our advisory board performed a myriad of duties, from defining the scope of coverage to reviewing individual

entries for accuracy and accessibility. The editor would like to express her appreciation to them.

  Sharon, MA LIBRARIAN ADVISORS Maureen O. Carleton, MLIS Medical Reference Specialist King County Library System Bellevue, WA Elizabeth Clewis Crim, MLS Collection Specialist Prince William Public Library, VA Valerie J. Lawrence, MLS Assistant Librarian Western States Chiropractic College Portland, OR Barbara J. O’Hara, MLS Adult Services Librarian Free Library of Philadelphia, PA Alan M. Rees, MLS Professor Emeritus Case Western Reserve University Cleveland, OH

  Staff Radiologist The Permanente Medical Group Richmond, CA Amy B. Tuteur, M.D.

  Clinical Professor of Psychiatry Tufts University School of Medicine Boston, MA Lecturer on Psychiatry Harvard Medical School Cambridge, MA Lee A. Shratter, M.D.

  Clinical Assistant Professor of Medicine Division of Oncology Stanford University Director of Medical Oncology Community Hospital of Los Gatos- Saratoga Los Gatos, CA Laurie Barclay, M.D.

  Neurological Consulting Services Tampa, FL Kenneth J. Berniker, M.D.

  

Physician and Clinical Instructor

University of Michigan Ann Arbor, MI Susan Mockus, M.D.

  VA Medical Center Brooklyn, NY Ira Michelson, M.D., M.B.A., F.A.C.O.G.

  Director, Infectious Diseases

  Southfield, MI

Larry I. Lutwick M.D., F.A.C.P.

  Consultant Psychotherapist in Private Practice Lathrup Village, MI L. Anne Hirschel, D.D.S.

  Durham, NC Robin Dipasquale, N.D. Clinical Faculty Bastyr University Seattle, WA Faye Fishman, D.O. Randolph, NJ J. Gary Grant, M.D. Pacific Grove, CA Laith F. Gulli, M.D. M.Sc., M.Sc.(MedSci), MSA, Msc.Psych., MRSNZ FRSH, FRIPHH, FAIC, FZS DAPA, DABFC, DABCI

  Attending Physician Emergency Department Kaiser Permanente Medical Center Vallejo, CA Rosalyn Carson-DeWitt, M.D.

  Scientific Consultant Seattle, WA Ralph M. Myerson, M.D., F.A.C.P.

  Margaret Alic, Ph.D.

  Genetic Counselor Eugene, OR Barbara Boughton Health and Medical Writer El Cerrito, CA Cheryl Branche, M.D.

  Editor Canine Sports Medicine Update Newmarket, NH

  Science Writer Hamden, CT Geoffrey N. Clark, D.V.M.

  Science Writing Intern Cancer Research Institute New York, NY Linda Chrisman Massage Therapist and Educator Oakland, CA Lisa Christenson, Ph.D.

  Medical Writer Durham, NC Lata Cherath, Ph.D.

  Medical Writer Chevy Chase, MD Diane Calbrese Medical Sciences and Technology Writer Silver Spring, Maryland Richard H. Camer Editor International Medical News Group Silver Spring, MD Rosalyn Carson-DeWitt, M.D.

  Science Writer Berkeley, CA Leonard C. Bruno, Ph.D.

  Health Communicator/Journalist Northport, AL Ruthan Brodsky Medical Writer Bloomfield Hills, MI Tom Brody, Ph.D.

  Retired General Practitioner Jackson, MS Michelle Lee Brandt Medical Writer San Francisco, CA Maury M. Breecher, Ph.D.

  Genetic Counselor Children’s Hospital Oakland Oakland, CA

Michelle Q. Bosworth, M.S., C.G.C.

  Science Writer Eastsound, WA Janet Byron Anderson Linguist/Language Consultant Rocky River, OH Lisa Andres, M.S., C.G.C.

  Science Writer Bethanne Black Medical Writer Atlanta, GA Jennifer Bowjanowski, M.S., C.G.C.

  Science Writer Virginia Beach, VA Issac R. Berniker Medical Writer Vallejo, CA Kathleen Berrisford, M.S.V.

  Genetic Counselor and Program Director

The Center for Genetic Counseling

Indianapolis, IN Linda K. Bennington, C.N.S.

  Clincal Nurse Specialist Oklahoma City, OK Carin Lea Beltz, M.S.

  Neurological Consulting Services Tampa, FL Jeanine Barone Nutritionist, Exercise Physiologist New York, NY Julia R. Barrett Science Writer Madison, WI Donald G. Barstow, R.N.

  Genetic Counselor Rockford Memorial Hospital Rockford, IL Sandra Bain Cushman Massage Therapist, Alexander Technique Practitioner Charlottesville, VA Howard Baker Medical Writer North York, Ontario Laurie Barclay, M.D.

  Science Writer Iowa City, IA Sharon A. Aufox, M.S., C.G.C.

  Certified Genetic Counselor and Medical Writer San Jose, CA Greg Annussek Medical Writer/Editor New York, NY Bill Asenjo, M.S., C.R.C.

  

CONTRIBUTORS

  Rhonda Cloos, R.N.

  Medical Writer Wauconda, IL Harry W. Golden Medical Writer Shoreline Medical Writers Old Lyme, CT Debra Gordon Medical Writer Nazareth, PA Megan Gourley Writer Germantown, MD Jill Granger, M.S.

  Medical Writer New Milford, PA

  Nurse, Medical Writer Manitowoc, WI Ron Gasbarro, Pharm.D.

  Research and Administrative Associate East Rock Institute New Haven, CT Cynthia L. Frozena, R.N.

  Medical Writer Atlanta, GA Rebecca J. Frey, Ph.D.

  Physician Randolph, NJ Janis Flores Medical Writer Lexikon Communications Sebastopol, CA Risa Flynn Medical Writer Culver City, CA Paula Ford-Martin Medical Writer Chaplin, MN Janie F. Franz Writer Grand Forks, ND

Sallie Freeman, Ph.D., B.S.N.

  Medical Writer Estes Park, CO

L. Fleming Fallon Jr., M.D.,

Dr.PH

Associate Professor of Public

Health

Bowling Green State University

Bowling Green, OH Faye Fishman, D.O.

  Thomas Scott Eagan Student Researcher University of Arizona Tucson, AZ Altha Roberts Edgren Medical Writer Medical Ink St. Paul, MN Karen Ericson, R.N.

  Medical Writer Winston-Salem, NC Maureen Haggerty Medical Writer Ambler, PA Clare Hanrahan Medical Writer Asheville, NC

  M.Sc., M.Sc.(MedSci), M.S.A., Msc.Psych, MRSNZ FRSH, FRIPHH, FAIC, FZS DAPA, DABFC, DABCI Consultant Psychotherapist in Private Practice Lathrup Village, MI Kapil Gupta, M.D.

  Senior Research Associate University of Michigan Ann Arbor, MI Alison Grant Medical Writer Averill Park, NY Elliot Greene, M.A. former president, American Massage Therapy Association Massage Therapist Silver Spring, MD Peter Gregutt Writer Asheville, NC Laith F. Gulli, M.D.

  Julie A. Gelderloos Biomedical Writer Playa del Rey, CA Gary Gilles, M.A.

  Medical Writer Austin, TX Gloria Cooksey, C.N.E Medical Writer Sacramento, CA Amy Cooper, M.A., M.S.I.

  Science Writer Boulder, CO

  Genetic Counselor Milwaukee, WI Doug Dupler, M.A.

  Technical Writer/Editor Centinela Hospital and Medical Center Inglewood, CA David Doermann Medical Writer Salt Lake City, UT Stefanie B. N. Dugan, M.S.

  Medical Writer Ann Arbor, MI Martin W. Dodge, Ph.D.

  Medical Writer/Editor Mahopac, NY Lori De Milto Medical Writer Sicklerville, NJ Robert S. Dinsmoor Medical Writer South Hamilton, MA Stephanie Dionne, B.S.

  Medical Writer Fremont, California Dominic De Bellis, Ph.D.

  Physician Brooklyn, NY Tish Davidson, A.M.

  Medical Writer Holbrook, MA Arnold Cua, M.D.

  Medical Writer Chicago, IL Esther Csapo Rastega, R.N., B.S.N.

  Medical Writer Vermillion, SD David A. Cramer, M.D.

  Contributors

  Ann M. Haren Science Writer Madison, CT Judy C. Hawkins, M.S.

  Medical Writer Beloit, WI Ruth E. Mawyer, R.N.

  Medical Writer San Diego, CA

  Biological Consultant Huntington Beach, CA Lorraine Lica, Ph.D.

  Physical Therapist Sabin, MN Jill Lasker Medical Writer Midlothian, VA Kristy Layman Music Therapist East Lansing, MI Victor Leipzig, Ph.D.

  Philadelphia, PA Jeffrey P. Larson, R.P.T.

  Physician, writer Pittsburgh, PA Jennifer Lamb Medical Writer Spokane, WA Richard H. Lampert Senior Medical Editor W.B. Saunders Co.

  Genetic Counselor Assistant Professor of Neurology Wayne State University Detroit, MI Jeanne Krob, M.D., F.A.C.S.

  Medical Writer Winton, CA Melissa Knopper Medical Writer Chicago, IL Karen Krajewski, M.S., C.G.C.

  Beth A. Kapes Medical Writer Bay Village, OH Christine Kuehn Kelly Medical Writer Havertown, PA Bob Kirsch Medical Writer Ossining, NY Joseph Knight, P.A.

  Medical Writer and Editor Montreal, Quebec Liz Meszaros Medical Writer Lakewood, OH West Chester, PA

  Medical Writer Greensboro, NC Sally C. McFarlane-Parrott Medical Writer Ann Arbor, MI Mercedes McLaughlin Medical Writer Phoenixville, CA Alison McTavish, M.Sc.

  Fellow, American College of Surgeons Diplomat American Board of Surgery Richland, WA Bonny McClain, Ph.D.

  Medical Writer Charlottesville, VA Richard A. McCartney M.D.

  Consultant, Molecular Pathology Demarest, NJ Adrienne Massel, R.N.

  Genetic Counselor The University of Texas Medical Branch Galveston, TX Caroline Helwick Medical Writer New Orleans, LA David Helwig Medical Writer London, Ontario Lisette Hilton Medical Writer Boca Raton, FL Katherine S. Hunt, M.S.

  Medical Student Wayne State University Detroit, MI Warren Maltzman, Ph.D.

  VA Medical Center Brooklyn, NY Suzanne M. Lutwick Medical Writer Brooklyn, NY Nicole Mallory, M.S.

  Director, Infectious Diseases

  Assistant Director, Biotechnology Center Utah State University Logan, UT Larry Lutwick, M.D., F.A.C.P.

  Medical Writer John T. Lohr, Ph.D.

  Biomedical Writer Sagescript Communications Lakewood, CO David Kaminstein, M.D.

  Medical Writer San Diego, CA Cindy L. A. Jones, Ph.D.

  Patent Attorney and Medical Writer Portland, OR Paul A. Johnson, Ed.M.

  Medical Writer Los Angeles, CA Michelle L. Johnson, M.S., J.D.

  Genetic Counselor Obstetrix Medical Group of Texas Fort Worth, TX Sally J. Jacobs, Ed.D.

  Genetic Counselor The Children’s Mercy Hospital Kansas City, MO Dawn A. Jacob, M.S.

  Medical Writer Morristown, NJ Holly Ann Ishmael, M.S., C.G.C.

  Genetic Counselor University of New Mexico Health Sciences Center Albuquerque, NM Kevin Hwang, M.D.

  Contributors

  Betty Mishkin Medical Writer Skokie, IL Barbara J. Mitchell Medical Writer Hallstead, PA Mark A. Mitchell, M.D.

  Genetic Counselor Center for Cancer Risk Analysis Massachusetts General Hospital Boston, MA Kim A. Sharp, M.Ln.

  Medical Writer Moorehead, KY

  

Registered Nurse, Medical Writer

Holbrook, MA Toni Rizzo Medical Writer Salt Lake City, UT Martha Robbins Medical Writer Evanston, IL Richard Robinson Medical Writer Tucson, AZ Nancy Ross-Flanigan Science Writer Belleville, MI

Anna Rovid Spickler, D.V.M.,

Ph.D.

  Medical Doctor and Writer New York, NY

Esther Csapo Rastegari, Ed.M.,

R.N./B.S.N.

  Medical Student University of Medicine & Dentistry of New Jersey Stratford, NJ Kulbir Rangi, D.O.

  Genetic Counselor Division of Clinical and Metabolic Genetics

The Hospital for Sick Children

Toronto, ON, Canada Ann Quigley Medical Writer New York, NY Robert Ramirez, B.S.

  Medical Writer Phoenix, Arizona

Nada Quercia, M.S., C.C.G.C.

  Medical Writer Buffalo Grove, IL Elizabeth J. Pulcini, M.S.

  Medical Writer Phoenix, AZ Scott Polzin, M.S., C.G.C.

  Medical Writer South Windsor, CT J. Ricker Polsdorfer, M.D.

  Medical Writer Logan, UT Joyce S. Siok, R.N.

  Writer Richmond, TX Judith Sims, M.S.

  Clinical Geneticist Greenwood Genetic Center Greenwood, SC Catherine Seeley Medical Writer Kristen Mahoney Shannon, M.S., C.G.C.

  Medical Writer Seattle, WA Susan J. Montgomery Medical Writer Milwaukee, WI Louann W. Murray, PhD Medical Writer Huntington Beach, CA Bilal Nasser, M.Sc.

  Mental Health Marlborough, MA Laurie Heron Seaver, M.D.

  Holland, OH Joan Schonbeck Medical Writer Nursing Massachusetts Department of

  Chiropractor Holland Chiropractic, Inc.

  Technical Writer Branford, CT Jason S. Schliesser, D.C.

  Medical, Science, & Technology Writer Los Angeles, CA Karen Sandrick Medical Writer Chicago, IL Kausalya Santhanam, Ph.D.

  Whittingham Cancer Center Norwalk, CT Laura Ruth, Ph.D.

  Medical Writer Voorheesville, NY Andrea Ruskin, M.D.

  Medical Writer Chicago, IL Collette Placek Medical Writer Wheaton, IL Belinda Rowland, Ph.D.

  Medical Writer Cherry Hill, NJ Patience Paradox Medical Writer Bainbridge Island, WA Barbara J. Pettersen Genetic Counselor Genetic Counseling of Central Oregon Bend, OR Genevieve Pham-Kanter, M.S.

  Medical Writer Ute Park, NM Lisa Papp, R.N.

  Republic Laura Ninger Medical Writer Weehawken, NJ Nancy J. Nordenson Medical Writer Minneapolis, MN Teresa Norris, R.N.

  Senior Medical Student Universidad Iberoamericana Santo Domingo, Domincan

  Contributors

  Jennifer Sisk Medical Writer Havertown, PA Patricia Skinner Medical Writer Amman, Jordan Genevieve Slomski, Ph.D.

  Medical Writer Boulder, CO

  Medical Writer Wantagh, NY

  Medical Advisor Sharon, MA Samuel Uretsky, Pharm.D.

  Medical Writer Sandy, UT Amy B. Tuteur, M.D.

  Medical Writer Troy, MI Carol Turkington Medical Writer Lancaster, PA Judith Turner, B.S.

  Senior Associate, Faculty Dept. of Pediatrics, Division of Medical Genetics Emory University School of Medicine Atlanta, GA Bethany Thivierge Biotechnical Writer/Editor Technicality Resources Rockland, ME Mai Tran, Pharm.D.

  Medical Writer Mary Jane Tenerelli, M.S. Medical Writer East Northport, NY Catherine L. Tesla, M.S., C.G.C.

  Medical Writer Thompsons Station, TN Keith Tatarelli, J.D.

  Liz Swain Medical Writer San Diego, CA Deanna M. Swartout-Corbeil, R.N.

  Science Writer Newton Center, MA Jon Zonderman Medical Writer Orange, CA Michael V. Zuck, Ph.D.

  Medical Writer New Britain, CT Stephanie Slon Medical Writer Portland, OR Linda Wasmer Smith Medical Writer Albuquerque, NM Java O. Solis, M.S.

  Medical Writer Delmar, DE Jennifer Wurges Medical Writer Rochester Hills, MI Mary Zoll, Ph.D.

  Science Writer Haddonfield, NJ Kathleen D. Wright, R.N.

  Medical Writer Fort Wayne, IN Ken R. Wells Freelance Writer Laguna Hills, CA Jennifer F. Wilson, M.S.

  Science Writer Tucson, AZ Ellen S. Weber, M.S.N.

  San Francisco, CA Michael Sherwin Walston Student Researcher University of Arizona Tucson, AZ Ronald Watson, Ph.D.

  Genetic Counselor GeneSage, Inc.

  Director Greenwood Genetic Center Greenwood, SC Dorothy Stonely Medical Writer Los Gatos, CA Amy Vance, M.S., C.G.C.

  Medical Writer Morganville, NJ Kurt Sternlof Science Writer New Rochelle, NY Roger E. Stevenson, M.D.

  Medical Writer Decatur, GA Elaine Souder, PhD Medical Writer Little Rock, AR Jane E. Spehar Medical Writer Canton, OH Lorraine Steefel, R.N.

  Contributors

  

C

  Timed-release forms should not be taken less than six

  CABG surgery see Coronary artery bypass hours before bedtime. graft surgery

  CAD see Coronary artery disease Children under 12 years Not recommended.

  Other considerations Caffeine

  Avoid taking too much caffeine when it is being taken as an over-the-counter drug. Consider how much

  Definition

  caffeine is being taken in from coffee, tea, chocolate, soft Caffeine is a drug that stimulates the central nervous drinks, and other foods that contain caffeine. Check with system. a pharmacist or physician to find out how much caffeine is safe to use.

  Purpose

  Caffeine makes people more alert, less drowsy, and Precautions improves coordination. Combined with certain

  pain

  Caffeine cannot replace sleep and should not be used relievers or medicines for treating

  migraine headache,

  regularly to stay awake as the drug can lead to more seri- caffeine makes those drugs work more quickly and effec- ous sleep disorders, like insomnia. tively. Caffeine alone can also help relieve headaches.

  People who use large amounts of caffeine over long

  Antihistamines are sometimes combined with caffeine

  periods build up a tolerance to it. When that happens, to counteract the drowsiness that those drugs cause. Caf- they have to use more and more caffeine to get the same feine is also sometimes used to treat other conditions, effects. Heavy caffeine use can also lead to dependence. including breathing problems in newborns and in young

  If the person then stops using caffeine abruptly, with- babies after surgery. drawal symptoms may occur. These can include throb- bing headaches,

  fatigue, drowsiness, yawning, irritabili- Description

  ty, restlessness, vomiting, or runny nose. These symp- Caffeine is found naturally in coffee, tea, and chocolate. toms can go on for as long as a week if caffeine is avoid- Colas and some other soft drinks contain it. Caffeine also ed. Then the symptoms usually disappear. comes in tablet and capsule forms and can be bought without

  If taken too close to bedtime, caffeine can interfere a prescription. Over-the-counter caffeine brands include No with sleep. Even if it does not prevent a person from

  Doz, Overtime, Pep-Back, Quick-Pep, Caffedrine, and falling asleep, it may disturb sleep during the night. Vivarin. Some pain relievers, medicines for migraine

  The notion that caffeine helps people sober up after headaches, and antihistamines also contain caffeine. drinking too much alcohol is a myth. In fact, using caf- feine and alcohol together is not a good idea. The combi-

  Recommended dosage nation can lead to an upset stomach, nausea, and vomiting.

  Adults and children age 12 years and over

  Older people may be more sensitive to caffeine and 100–200 mg no more than every 3–4 hours. In thus more likely to have certain side effects, such as irri- timed-release form, the dose is 200–250 mg once a day. tability, nervousness,

  anxiety, and sleep problems.

  • heart disease or recent heart attack (within a few weeks)
  • high blood pressure
  • liver disease
  • insomnia (trouble sleeping)
  • anxiety or panic attacks
  • agoraphobia (fear of being in open places)
  • premenstrual syndrome (PMS) USE OF CERTAIN MEDICINES.

  Using caffeine with certain other drugs may interfere with the effects of the drugs or cause unwanted—and possibly serious—side effects.

  mental symptoms that may occur when a person suddenly stops using a drug to which he or she has become dependent.

  Parkinson’s disease, depression, and other

  used to treat

  monoamine oxidase inhibitors (MAO) are taken together. These drugs are

  Serious side effects are possible when caffeine is combined with certain drugs. For example, taking caf- feine with the decongestant phenylpropanolamine can raise blood pressure. And very serious heart problems may occur if caffeine and

  Caffeine interferes with drugs that regulate heart rhythm, such as quinidine and propranolol (Inderal). Caf- feine may also interfere with the body’s absorption of iron. Anyone who takes iron supplements should take them at least an hour before or two hours after using caffeine.

  alcoholism.

  contain estrogen, the antiarrhythmia drug mexiletine (Mexitil), the ulcer drug cimetidine (Tagamet), and the drug disulfiram (Antabuse), used to treat

  oral contraceptives that

  Certain drugs interfere with the breakdown of caf- feine in the body. These include

  Interactions

  At recommended doses, caffeine can cause restless- ness, irritability, nervousness, shakiness, headache, light- headedness, sleeplessness, nausea, vomiting, and upset stomach. At higher than recommended doses, caffeine can cause excitement, agitation, anxiety, confusion, a sensa- tion of light flashing before the eyes, unusual sensitivity to touch, unusual sensitivity of other senses, ringing in the ears, frequent urination, muscle twitches or tremors, heart arrhythmias, rapid heartbeat, flushing, and convulsions.

  Side effects

  Withdrawal symptoms—A group of physical or

  Because caffeine stimulates the nervous system, anyone taking other central nervous system (CNS) stim- ulants should be careful about using caffeine.

  Fetus—A developing baby inside the womb. Palpitation—Rapid, forceful, throbbing, or flutter- ing heartbeat.

  Caffeine

  Caffeine may cause problems for people with these medical conditions:

  Caffeine passes into breast milk and can affect the nursing baby. Nursing babies whose mothers use 600 mg or more of caffeine a day may be irritable and have trouble sleeping. Women who are breastfeeding should check with their physicians before using caffeine.

  BREASTFEEDING.

  woman’s body into the developing fetus. Although there is no evidence that caffeine causes birth defects in peo- ple, it does cause such effects in laboratory animals given very large doses (equal to human doses of 12–24 cups of coffee a day). In humans, evidence exists that doses of more than 300 mg of caffeine a day (about the amount of caffeine in 2–3 cups of coffee) may cause miscarriage or problems with the baby’s heart rhythm. Women who take more than 300 mg of caffeine a day during pregnancy are also more likely to have babies with low birth weights. Any woman who is pregnant or planning to become pregnant should check with her physician before using caffeine.

  PREGNANCY. Caffeine can pass from a pregnant

  preservatives, or to the compounds aminophylline, dyphylline, oxtriphylline, theobromine, or theophylline should check with a physician before using caffeine. Anyone who has ever had an unusual reaction to caffeine should also check with a physician before using it again.

  allergies to foods, dyes,

  Anyone with

  ALLERGIES.

  Caffeine may cause problems for people with certain medical conditions or who are taking certain medicines.

  Special conditions

  psychiatric conditions. Consult with a pharmacist or physician about which drugs can interact with caffeine.

OTHER MEDICAL CONDITIONS.

  • peptic ulcer
  • heart

  Nancy Ross-Flanigan

  arrhythmias or palpitations KEY TERMS Arrhythmia—Abnormal heart rhythm. Central nervous system—The brain, spinal cord and nerves throughout the body. CAH see Congenital adrenal hyperplasia Caisson disease see Decompression sickness

  Calcaneal spurs see Heel spurs Calcitonin see Bone disorder drugs Calcium carbonate see Antacids

  they are taking calcium channel blockers. This could lead them to be more active than they should be. Anyone tak- ing calcium channel blockers should therefore consult with the prescribing physician concerning how much exercise and activity may be considered safe.

  The effects of taking calcium channel blockers during

  PREGNANCY.

  allergies to foods, dyes, preservatives, or other substances.

  Anyone who has had a previous unusual reaction to any calcium channel blocker should let his or her physician know before taking the drugs again. The physician should also be notified about any

  People with certain medical conditions or who are taking certain other medicines may develop problems if they also take calcium channel blockers. Before taking these drugs, the prescribing physician should be informed about any of these conditions: ALLERGIES.

  Special conditions

  Older people may be unusually sensitive to the effects of calcium channel blockers. This may increase the chance of side effects.

  This type of medication may cause the gums to swell, bleed, or become tender. If this problem occurs, a medical physician or dentist should be consulted. To help prevent the problem, care should be taken when brushing and flossing the teeth. Regular dental check-ups and cleanings are also recommended.

  Patients taking certain calcium channel blockers may need to check their pulse regularly, as the drugs may slow the pulse too much. If the pulse is too slow, circula- tion problems may result. The prescribing physician can show patients the correct way to check their pulse.

  Some people get headaches that last for a short time after taking a dose of this medication. This problem usu- ally goes away during the course of treatment. If it does not, or if the headaches are severe, the prescribing physi- cian should be informed.

  exercise or exert themselves may not have the pain when

  Calcium channel blockers Definition

  People who normally have chest pain when they

  Some people feel drowsy or less alert than usual when taking calcium channel blockers. Anyone who takes these drugs should not drive, use machines, or do anything else that might be dangerous until they have found out how the drugs affect them.

  Anyone taking calcium channel blockers for high blood pressure should not take any other prescription or over-the-counter medication without first checking with the prescribing physician, as some of these drugs may increase blood pressure.

  diets without consulting their physicians.

  Calcium channel blockers will not cure high blood pressure, but will help to control the condition. To avoid the serious health problems associated with high blood pressure, patients may have to take this type of medica- tion for the rest of their lives. Furthermore, the blockers alone may not be enough. People with high blood pres- sure may also need to avoid certain foods and keep their weight under control. The health care professional who is treating the condition can offer advice as to what mea- sures may be necessary. Patients being treated for high blood pressure should not change their

  Seeing a physician regularly while taking calcium channel blockers is important. The physician will check to make certain the medicine is working as it should and will watch for unwanted side effects. People who have high blood pressure often feel perfectly fine. However, they should continue to see their prescribing physician even when they feel well so that he can keep a close watch on their condition. They should also continue to take their medicine even when they feel fine.

  Precautions

  Calcium channel blockers are used to treat high blood pressure, to correct abnormal heart rhythms, and to relieve the type of chest pain called angina pectoris. Physicians also prescribe calcium channel blockers to treat panic attacks and bipolar disorder (manic depres- sive illness) and to prevent migraine headache.

  Purpose

  Calcium channel blockers are medicines that slow the movement of calcium into the cells of the heart and blood vessels. This, in turn, relaxes blood vessels, increases the supply of oxygen-rich blood to the heart, and reduces the heart’s workload.

  pregnancy have not been studied in Calcium c hannel bloc kers

KEY TERMS

  headache, and nausea, usual-

  Calcium c hannel bloc kers

  drugs with calcium channel blockers may increase the effects of both types of medicine and may cause prob- lems if either drug is stopped suddenly.

  glaucoma. Taking any of these

  (Timoptic), used to treat

  beta blockers, such as timolol

  Calcium channel blockers may interact with a num- ber of other medications. When this happens, the effects of one or both of the drugs may change or the risk of side effects may increase. Anyone who takes calcium channel blockers should not take any other prescription or non- prescription (over-the-counter) medicines without first checking with the prescribing physician. Substances that may interact with calcium channel blockers include:

  Interactions

  Other side effects may occur. Anyone who has unusual symptoms after taking calcium blockers should contact the prescribing physician.

  If any of the following side effects occur, the pre- scribing physician should be notified as soon as possible:

  affects only one side of the head. Nausea, vomit- ing, increased sensitivity to light, and other symp- toms often accompany migraine. ly go away as the body adjusts to the drug and do not require medical treatment unless they persist or they are bothersome.

  Migraine—A throbbing headache that usually

  known as manic depression, in which a person has extreme mood swings, ranging from a highly excited state—sometimes with a false sense of well-being—to depression.

  Bipolar disorder—A severe mental illness, also

  ness, or pain in the chest, caused by a lack of oxy- gen in the muscular wall of the heart.

  Angina pectoris—A feeling of tightness, heavi-

  • breathing problems, coughing or wheezing
  • irregular, fast, or pounding heartbeat
  • slow heartbeat (less than 50 beats per minute)
  • skin rash
  • swollen ankles, feet, or lower legs

  humans. However, in studies of laboratory animals, large doses of these drugs have been reported to cause birth

  defects, stillbirth, poor bone growth, and other problems

  when taken during pregnancy. Women who are pregnant or who may become pregnant should check with their physicians before using these drugs.

  BREASTFEEDING.

  • Diuretics (water pills). This type of medicine may cause low levels of potassium in the body, which may increase the chance of unwanted effects from some cal- cium channel blockers.
  • Beta-blockers, such as atenolol (Tenormin), propra- nolol (Inderal), and metoprolol (Lopressor), used to treat high blood pressure, angina, and other conditions. Also, eye drop forms of