A common complaint: dizziness

Vertigo-ness may suggest BPPV/peripheral.

Anyway, adequate physical exam and work-up is needed.

Peripheral causes:
Common
1. Vestibular neuronitis
2. BPPV
3. Meniere’s disease

Other
1. Infection
2. Trauma
3. Structural/residual defecta
4. Herpes zoster oticus

Should resolve in 6 weeks, i think

Panic attack

Diagnostic criteria for panic attack มีอาการ 4/11 เกิดขึ้นรวดเร็ว ถึงจุดสูงสุดใน 10 นาที
ใจสั่น หายใจไม่อิ่ม มึนหัว เป็นลม De-realization มือสั่น อึดอัด แน่น คลื่นไส้ ท้องปั่นป่วน คุมตัวเองไม่ได้ เหงื่อแตก เจ็บ แน่นหน้าอก กลัวว่าก าลังจะตาย

Types:
1. Avoidance behavior (agoraphobia)
2. Triggers

Management
- Anxiety non-pharmacologic management
- Cognitive behavioral therapy
- Drugs
》》First line: SSRI 1/2 tab morning in first week
》》Second line: benzodiazepine
》》Severe case: SSRI+clonazepam?

Psychosupport Close F/U

Omeprazole caution!

Many interactions — the most well-known is warfarin.

Also, clopidogrel (Plavix), digoxin,.

Pneumonia

Complications of prolonged use are many including community-acquired pneumonia (aspiration pneumonitis too?)

1. Clostridium difficile
2. Hypomagnesemia
3. Hip fracture, wrist fracture, spine fracture (decreased bone mineral density (BMD))
4. Vitamin B12 deficiency
5. Iron deficiency anemia
6. Gastric carcinoma
7. Community-acquired pneumonia — risk increases with PPI dosage, H2 blocker also conferred risk, but less than PPI

Drug interactions

1. Decreased absorption — iron salts, vitamin B12, itraconazole, cefpodoxime, griseofulvin, ketoconazole
2. Increased absorption — digoxin, nifedipine
3. Increased specific to omeprazole (CYP450) — diazepam, phenytoin, warfarin, carbamazepine, methotrexate
4. Lowered efficacy specific to omeprazole — clopidogrel
5. Decreased specific to lansoprazole (Prevacid) — Theophylline (Theo-Dur)

Most potent agents appear to be — esomeprazole (Nexium), rabeprazole.

Source/credit: family physician notebook