Jitteriness

Use of diethylpropion for a period longer than 3 months is associated with an increased risk for development of pulmonary hypertension. When used as directed, reported common central nervous system adverse effects included overstimulation, restlessness, dizziness, insomnia, euphoria, dysphoria, tremor, headache, jitteriness, anxiety, nervousness, depression, drowsiness, malaise, mydriasis, and blurred vision. In addition, diethylpropion can decrease seizure threshold, subsequently increasing a patient s risk for an epileptic event. Other organ systems also can adversely be affected, resulting in tachycardia, elevated blood pressure, palpitations, dry mouth, abdominal discomfort, constipation,... 

Another test that I have found always brings out the inherent weaknesses of the part is the hard dV/dt test. Basically, I simply slam the red banana plug into the already-powered-up DC bench power supply and look for overshoots (voltage or current) in the switcher. There is a fair amount of natural input bounce created by this rather unofficial test, but that can really help aggravate/expose any startup logic issues with the IC. Of course we may later decide to specify a smooth (non-jittery) input AVI At for the IC and just move on. My colleague used to use a mercury switch for the same purpose. That gives almost the same hard input AV At, but without all the bounce. 

As he finished the essays on the eve of French capitulation, there was no need for diabolical caution. Yet with another Farben victory in the offing, he was as jittery as a tomcat on the backyard fence. 

Sprecher still believed the political atmosphere would seriously influence the outcome. The Soviets had just cut off rail, highway, and barge shipments to Berlin. Everyone was jittery. Judge Hebert had sent his wife and children home. So had I. Still, I made a bet with Sprecher that at least Carl Krauch would be convicted of preparing an aggressive war. 

Selegiline also increases the peak effects of L-dopa and can worsen preexisting dyskinesias or psychiatric symptoms such as delusions and hallucinations. Other adverse effects include insomnia, jitteriness. 

Stimulatory side effects (e.g., anxiety, insomnia, jitteriness, irritability) can occur in TCA- and SSRI-treated patients. This may affect compliance and hinder dose increases. Low initial doses and gradual dose titration may eliminate these effects (see Table 68-12). 

Adverse effects include nausea, vomiting, tachycardia, jitteriness, and difficulty sleeping more severe toxicities include cardiac tachyarrhythmias and seizures. 

Giddiness, tension, anxiety, jitteriness, restlessness, emotional lability, excessive dreaming, insomnia, nightmares, headaches, tremor, withdrawal and depression, bursts of slow waves of elevated voltage in EEC, especially on over-ventilation, drowsiness, difficult concentration, slowness on recall, confusion, slurred speech, ataxia, generalized weakness, coma, with absence of reflexes, Cheyne-Stokes respirations, convulsions, depression of respiratory and circulatory centers, with dyspnea, cyanosis, and fall in blood pressure. 

Adverse reactions occurring in at least 3% of patients include the following diarrhea, dizziness, dyspepsia, feeling jittery, headache, hypoglycemia, nausea, vomiting. 

CNS- Dizziness vertigo headache overactivity hyperreflexia tremors muscle twitching mania hypomania jitteriness confusion memory impairment sleep disturbances including hypersomnia and insomnia weakness myoclonic movements fatigue drowsiness restlessness overstimulation including increased anxiety, agitation and manic symptoms. 

Alprostadil JProstaglandin E ] (Prostin VR) [Vasodilator/ Prostaglandin] WARNING Apnea in up to 12% of neonates esp <2 kg at birth Uses Conditions ductus arteriosus blood flow must be maintained sustain puhn/systemic circulation until OR (eg, pulm atresia/stenosis and transposition) Action Vasodilator (ductus arteriosus very sensitive), pit inhibitor Dose 0.05 mcg/kg/min IV to lowest that maintains response Caution [X, -] Contra Neonatal resp distress synd Disp Inj meg SE Cutaneous vasodilation, Sz like activity, jitteriness, T temp, thrombocytopenia, BP may cause apnea Interactions T Effects OF anticoagulants antihypertensives, effects OF cyclosporine EMS Given to newborns in hospital OD May cause apnea, bradycardia, hypotension, and flushing symptomatic and supportive... 

Notify clinician if nausea, vomiting, insomnia, jitteriness, headache, rash, palpitations occur... 

Nausea, vomiting, diarrhea, jittery feeling, dizziness, headache, dyspepsia Occasional... 

With an estimated 3 million children and adolescents in the United States taking stimulants daily, the management of side effects is a significant clinical issue. Psychostimulant use is associated with several minor negative side effects in 10% to 15% of children treated that respond to adjustments in dose or in time of administration. Delay of sleep onset, reduced appetite, headache, and jitteriness are the most frequently cited stimulant-related side effects that have been identified in placebo-controlled trials Barkley et ah, 1990. No additional delay in sleep onset was seen after adding a third, mid-afternoon dose of MPH to standard bid dosing regimens (Kent et ah, 1995). Some children experience motor tics while on stimulants, but the mecha-... 

Behavioral activation. Adverse effects while on the SSRIs may include anxiety, restlessness, agitation, ak-athisia, jitteriness, disinhibition, and/or activation. The development of anxiety, restlessness, and agitation while on an antidepressant has been described as part of the complex and poorly self-described syndrome of akathisia (Kalda, 1993). Behavioral activation is variously reported as akathisia, jitteriness, disinhibition, activation, or agitation, and may represent overlapping or different phenomena. It is important for clinicians to discuss these potential symptoms with children and their parents, as the symptoms certainly can occur in the pediatric age group, and it is not known if there is an additional age-related risk. 

Pohl, R., Yeragani, V.K., Balon, R., and Lycaki, H. (1988) The jitteriness syndrome in panic disorder patients treated with antidepressants. J Clin Psychiatry 49 100-104. 

Some patients may experience jitteriness, restlessness, muscle tension, and disturbed sleep. These side effects typically occur early in treatment, before the antidepressant effect. All patients should be informed of the possibility of these side effects and be reassured that if they develop, they tend to be transient. In patients with preexisting anxiety, therapy should be started at low doses, with subsequent titration as tolerated. If overstimulation occurs with this approach, it will be less likely to be severe enough to result in nonadherence with therapy. The short-term use of a benzodiazepine also may help the patient cope with overstimulation in the early stages of treatment until tolerance to this side effect occurs. Despite these common transient stimulating effects, SSRIs are clearly effective in patients with anxiety or agitated depression. Similarly, insomnia that commonly occurs early in treatment may be tolerable if the patient is reassured that the side effect will be transient. Symptomatic, short-term treatment with a hypnotic at bedtime is reasonable. 

Tolerance to inhalants can develop with frequent use, and withdrawal symptoms include sleep disturbance, irritability, jitteriness, sweating, nausea and vomiting, fast heart rate, and hallucinations or delusions. Withdrawal can last one month or longer, and the relapse rate is high. 

All psychostimulants can cause jitteriness, palpitations, and psychic dependence. Depression may arise after their discontinuance, and high doses can produce a florid psychosis. On occasion, even small doses of amphetamine can precipitate psychotic episodes in those with an underlying predisposition (e.g., schizophrenic disorder). 

Jitteriness, tachycardia, and tremor can occur early in the course of treatment, particularly in patients with co-morbid panic attacks. TCAs may cause a persistent, fine, rapid tremor, particularly in the upper extremities. Desipramine and protriptyline may be the most common offenders. Propranolol (60 mg per day) may help and is unlikely to worsen depression. Alternatively, switching to a drug with less NE activity may also help. 

Alprazolam has been shown to be effective in alleviating the jitteriness syndrome ( 94). A patient s inability to tolerate these adverse effects may be the most important treatment-limiting factor with these drugs. Alternatively, short-term combination with another BZD may be helpful until the full impact of the antidepressant is realized. 

SSRIs sometimes cause an initial jitteriness similar to that noted with initial imipramine therapy for PD. This may be more common with SSRIs than with other currently available non-TCA antidepressant therapies for PD. Just as low initial imipramine doses avert this reaction, initiating SSRI therapies with one fourth to one half the usual starting antidepressant dose followed by gradual increments with low doses can avert this reaction. This syndrome can also be blocked by add-on, low-dose, as-needed BZD therapy (e.g., alprazolam or lorazepam). 

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