Posts Tagged ‘adrenal cortex’

triamcinolone A glucocorticosteroid with the actions, uses and side-effects of hydrocortisone, but differing by promoting sodium excretion, and so is of no value in adrenal cortex deficiency states. It is used in a wide range of inflammatory, allergic and respiratory states, and in inflammatory skin conditions.
Dose: 8-24 mg daily. It is also given as triamcinolone acetonide in doses of 40 ing by deep i.m. injection for a depot action. The acetonide is also given by iniraarticular injection in doses of 2.5-40 mg in local inflammation of the joints, and by intra-lesional injection in doses of 2-3 mg at any one site for the treatment of skin lesions. Triamcinolone actonide is also used as a 1% cream or ointment in severe inflammatory skin conditions. The side-effects are those of the corticosteroids (see hydrocortisone), but triamcinolone may also cause myopathy with high dose treatment. (Kenalog; Ledercort).
triamterene A potassium sparing diuretic, used mainly in association with more powerful drugs. It is indicated in oedematous conditions generally, and, as it causes some retention of potassium, its use avoids the need for supplementary potassium therapy.
Dose: 150-250 mg daily, with lower doses for the elderly and when given in association with other diuretics. Rash .ind gastrointestinal disturbances are ,ide-effects. (Dytac). See page 148 and Kahle 21.
tribavarin An inhibitor of viral replication used in severe viral bronchiolitis in infants.
Dose: by aerosol inhalation of a solution (20 ing/ml) for 12-18 hours daily liar 3-7 days, together with supportive therapy. (Viravid).
triclofos A derivative of chloral, with the sedative properties of the parent drug, but less irritant to the gastric mucosa.
Dose: I 2gdaily.
alternative to penicillamine in other conditions. The main side-effect is nausea.
trifluoperazine A powerful tranquillizing drug of the chlorpromazine type. It is used mainly in schizophrenia and similar psychoses, and in severe anxiety.
Dose: 10-20 nig or more daily according to need. In severe anxiety, 2-6 ing daily. In acute conditions, 1-3 mg daily by deep i.m. injection. As an antiemetic, it is given in doses of 2-4 mg or 1-3 ing by injection. The side-effects are similar to those of chlorpromazine, including extra-pyramidal symptoms, but the anticholinergic and sedative side-effects are less severe. (Stelayine). See page 168 and Table 30.
tri-iodothyronine See liothyronine.
trilostane An inhibitor of enzyme systems concerned with production of mineraloand glucocorticosteroids by the adrenal cortex, and so resembles metyrapone to some extent. It is used to control adrenal cortex hyperfunction and the excessive production of aldosterone.
Dose: 240 ing daily initially, adjusted tip to a maximum of 480 mg daily, according to the plasma corticosteroid levels. Care is necessary in liver and kidney dysfunction. (Modrenal).
trimeprazine A sedative antihistamine used in the treatment of pruritus and allergic itching conditions, and for premedication.
Dose: 30-100nig daily; pre-medication dose: 3 mg/kg. (Vallergan).
trimetaphan A short-acting ganglionic-blocking agent. It is used to produce a controllable reduction in blood pressure (luring neuro- and vascular surgery when a relatively bloodless field is necessary. Dose: by i.v. infusion, 3-4 nighnin initially, with subsequent doses carefully adjusted to the response. Side-effects are tachycardia and respiratory depression. Frequent determination of blood pressure during use is essential.
triclosan A chlorinated phenolic antiseptic, used mainly in surgical scrubs and similar preparations. (Manusept; Ster-Zac).
trientine A copper-chelating agent used in Wilson’s disease, but only for patients unable to tolerate penicillamine.
Dose: 1.2 -2.4 g daily. It is not an
trimethoprim An antibacterial agent similar in action to the sulphonamides. It is used in the prophylaxis and treatment of urinary tract and respiratory infections due to sensitive bacteria.
Dose: in chronic infections, 200-400 nig daily; prophylactic dose, 100mg daily. In severe infections, 130-250 mg twice daily by slow i.v. injection. Side-effects are nausea, vomiting,rash and pruritus, and possible bone marrow depression. (lpral;
Monotrim). See co-trimoxaole.
trimetrexateV An antibacterial agent used like atovaquone in AIDS patients with Pnettinocystis carinii pneumonia.
Dose: 45 ing/nidaily by i.v. infusion for 21 (lays, followed by calcium folinate 80 nighty daily for 28 days, orally or i.v. (Neutrexin).
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oral antidiabetic drugs by increasing the sensitivity to endogenous insulin, and so acts as an insulin enhancer.
Dose: 200 mg daily with breakfast, increased if required by 200 mg at intervals of 2-4 weeks up to 600 mg daily. Side-effects are diarrhoea, fatigue and malaise. (Romozin). See page 131 and Table 13.
tropicamide A short-acting mydriatic agent similar to homatropine. Used as 0.5% and I% solution.
trimipramine A sedative anti-depressant with the action and side-effects of amitriptyline. It is valuable in depression complicated by anxiety.
Dose: 75-300 mg daily. (Surmontil).
triple vaccine Diphtheria, tetanus and pertussis vaccine for the primary ininitinization ofchildren.
Dose: 0.5 ml by i.m. or deep s.c. injection.
triptorelin A synthetic form of gonadorelin, used in the treatment of advanced prostatic cancer. Such cancers are testosterone-dependent, and triptorelin acts by depressing pituitary function, and so indirectly reduces the plasma level of testosterone.
Dose: It has been formulated so that a single i.m. injection of 4.2 ing depresses testosterone production for 28 days. Initially there may be a temporary flare-up of symptoms, which can be prevented by giving an anti-androgen for 3 days before treatment, and continued for 2-3 weeks. Patients should be monitored for uleric obstruction and spinal cord compression during the first months of treatment. DecapepivI Sr). See page 122.
tropisetron A 5–HT.,-receptor antagonist, similar to ondansetron bill with a longer action. It is used to control the nausea and vomiting induced by cancer chemotherapy.
Dose: initially as a 5 mg dose i.v. shortly before such therapy, and followed 1)), oral doses of 5 mg daily, I hour before food, for 5 days. Side-effects are dizziness, headache and gastrointestinal disturbance. (Navoban). See page 122.
tryparsamide Used in late trypansomiasis when the CNS is involved.
Dose: 1-3 g by injection weekly, up to a maximum Lill) of 24 g. May damage optic nerves.
tryptophan\7 An amino acid involved in the biosynthesis of serotonin. It is used in specialist centres for the treatment of severe and prolonged depression resistant to other drugs, and where a deficiency of serotonin may be a factor. (Optimax). See page 128 and Table 11.
tuberculin A product obtained from cultures of Mycobacterium tuberculosis. It is used in the diagnosis of tuberculosis. See BGC vaccine.
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trisodium edetate A chelating or binding agent that is sometimes used in hypercalcaernia. The calcium complex so formed is excreted in the urine.
Dose: slow i.v. infusion tip to 70 rng1kg daily according to need and response, as shown by plasma calcium measurement. It is also used as a 0.4% solution for
ophthalmic use in lime burns of the eyes. Side-effects after injection are nausea, diarrhoea and cramp. Contraindicated in renal impairment. (Limclair).
troglitazone A new drug for non-insulin dependent diabetes. It differs from other
tulobuterol A selective beta,-adrenergic agonist of the salbutamol type, used in the prophylaxis and treatment of bronchospasm in asthma and related conditions. Dose: 4-6 mg daily. (Respacal). See page 118 and’fable 6.
tyrothricin A minor antibiotic used as
lozenges for mouth infections.

undecenoic acid An organic acid with useful antimycotic properties. It is used mainly as powder or ointment (5%), often with zinc undecenoate in the treatment of athlete’s foot and associated conditions.
urea An osmotic diuretic. It has been used orally in doses of 5-15 g. Applied locally as a 10% solution, it promotes granulation and reduces odour front•    foul ulcers.
urofollitrophin A preparation of human lollide-stimulating hormone (FSH) used with nienotrophin for the induction of ovulation. Dose and duration of treatment require careful control to avoid Over-stimulation. (Metrodin; Orgafol).
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allergen vaccines, used for desensitization to various allergens such as grass pollens, arc not true vaccines, but weak solutions of allergen extracts. They may precipitate allergic reactions in susceptible patients, and should be used only when emergency resuscitation measures are immediately available.
valaciclovirV A pro-drug of acyclovir used in herpes zoster. It is well absorbed orally, and quickly converted to the parent drug and promotes an improved response.
Dose: 3 g daily for 7 days, reduce([ in severe renal impairment. Dose in herpes simplex I g daily. Side-effects are headache and nausea. (Valtrcx). See page 144 and Table 19.
valproic acid (Convulex). See sodium valproate.
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urokinase A plasmin activator obtained from human urine. It is used mainly in the thrombolysis of blocked i.v. shunts, and in the lysis of blood clots in the eye. Dose: 5000-37 500 units, instilled into the shunt; similar doses are injected into the anterior chamber of the eye for the resolution ofl)l blood clots. (Ukidan).
ursodeoxycholic acid The acid appears to be a solvent of cholesterol, and is given orally to promote the dissolution of cholesterol-containing gall stones.
Dose: 8-12 mg/kg as a single daily dose, hut prolonged treatment is required, which should be continued after the dissolution of the stones to inhibit recurrence. The dissolution of calcium-containing or radio-opaque stones is unlikely to occur. (Destolit; Ursofalk).
valsartan An angiotensin II receptor antagonist used in hypertension. It has a more selective action than the ACE-inhibitors. Dose: 80 mg daily. Combined treatment with a potassium-sparing diuretic is not advisable. (Diovan). See page 148 and Table 21.
vancomycin An antibiotic used in severe antibiotic-associated staphylococcal colitis ( pseudomembranous colitis).
Dose: 0.5 g daily for i-10 days. It is also given by injection in resistant bacterial endocarditis; I g twice a day by slow i.v. infusion over 1-2 hours, as rapid injection may cause anaphylactic shock. Blood concentrations of the antibiotic should be monitored, as the many side-effects include renal damage, ototoxicity and ncutropenia. Pruritus and upper body flushing may occur, and tinnitus is an indication that the drug should be withdrawn. (Vancocin).
vaccines Bacterial vaccines are suspensions or extracts of dead bacteria, but sonic anti-viral vaccines are also available. They may be given by s.c. or i.m. injection, and are used mainly for prophylaxis against a particular infection. The most commonly used vaccines include those for typhoid, cholera, diphtheria, influenza, tetanus and polio. Protection against mumps, measles, pertussis, rubella, yellow fever and hepatitis can also be obtained. The so-called
vasoconstrictors Drugs such as noradrenaline that constrict the peripheral vessels, and so cause a temporary rise in blood pressure. They are useful in hypotensive conditions when the blood volume is still adequate, and in controlling the fall in blood pressure that occurs in spinal and general anaesthesia.

suramin A drug used in the early treatment of trypanosomiasis, but it is of no value in the later stages of the disease as it does not enter the cerebrospinal fluid.
Dose: I g i.v. weekly for 5 weeks, after a tolerance test dose of 200 mg. Side-effects are gastrointestinal disturbances, dermatitis, hyperac%thesia and kidney damage.
suxamethonium A short-acting, depolarizing muscle relaxant, with an action lasting 3-5 minutes. A preliminary injection of thiopentoric should first be given, as the initial effect of suxamethonium is a
painful muscle contraction before the relaxant action supervenes.
Dose: 20- tOO ing i.v. during surgery, with further doses according to need. Suxamethonium may also be given as a 0.1% solution by i.v. infusion. Exceptionally, the muscle relaxant action of the drug may be prolonged with marked apnoea. Unlike non-depolarizing muscle relaxants, the action of suxamethonium cannot tie reversed. Severe hepatic disease is a contraindication. (Anectine: Scoline).
sympathomimetics Drugs that have an action similar to adrenaline, and act on both alpha- and beta-adrenoceptors. More selective compounds, such as salbutamol, act on the beta,-adrenoceptors in the lungs and have an increased bronchodilator action. They also relax uterine muscle, and are used to prevent premature labour. Others such as dobutamine and dopamine have a more selective action on the beta,- receptors in the heart, and are referred to as isotropic sympathorninictics.
tacalcitol A vitamin D. derivative used in the treatment of psoriasis as an ointment containing 4 pg/g of the drug. It is applied sparingly once daily at night, and continued as required. Not more than 2 treatments over 8 weeks per year. (Curatoderm).
tacrolimusV A macrolide derivative with marked immunosuppressant properties. It is used in liver and kidney transplantation, and appears to act by suppressing T-cell activation. It may also inhibit the formation of cytotoxic lymphocytes that are concerned
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with graft rejection. See Drug Data Sheet for details of dose and extensive side-effects including neurotoxicity and hypertrophic cirdiomyopathy. (Prograf).
talc A form of magnesium silicate, widely used as a skin dusting powder. It has also been used as a lubricant for surgeons’ gloves, but it may cause a talc granuloma if any reaches the tissues during operation, and glove powders prepared from starch are preferred.
tarnoxifen An oestrogen-receptor
antagonist used mainly in breast cancer, particularly when metastases are present. Dose: 20 mg daily. It is usually well tolerated, but side-effects include hot flushes, dizziness, rash, by
. percalcaciiiia and
an increase in tumour pain. Unlike other oestrogen-antagonists, tamoxifen has no androgenic properties. It has also been used in sonic forms of anovulatory sterility. (Nolvadex). See page 122 an(] Table 8.
tamsulosinV A relatively selective alpha adrenoceptor antagonist. It lowers the tone of bladder and prostatic smooth muscle, and is used in benign prostatic hyperplasia. Dose: 400 mg daily after breakfast with a glass of water. The first dose should be taken in bed to avoid postural hypotension. Other side-effects include palpitations and dizziness and hypotension. (Floniax). See page 164 and Table 28.
tazabactam An inhibitor of betalactamases. It is used in association with some antibiotics to extend the activity against resistant beta - lactamase - producing bacteria. Tazacin is a mixed product containing piperacillin and tazabactam.
tazarotene A retinoid used as an aqueous gel (0.05-0.1 %) in psoriasis. Applied once daily to the affected skin area only. (Zorac).
teicoplanin An antibiotic that acts by interfering with bacterial cell wall development. It has a wide range of activity, but is used mainly in the treatment of severe staphylococcal infections that fail to respond to other antibiotics.
Dose: loo mg initially by i.v. injection, lollowed by 200 nig as a single daily dose, which may be given by i.m. injection. Double doses in severe infections. Side-effects include gastrointestinal disturbances, dizziness, fever and rash (Targocid).

temazepam A mild hypnotic of the nitrazepain type, but with a shorter duration of action. It is useful in the insomnia of the elderly, arid is also of value as a preoperative anxiolytic agent.
Dose: 10-20 ing. Daytime drowsiness is less common than with related drugs. See page 152 and Table 22.
ternocillin A penicillin-type of antibiotic active chiefly against infections due to penicillinase-producing Gram-negative bacteria, with the notable exception of pseudomonas. It is used in respiratory and urinary tract infections due to susceptible organisms.
Dose: 2-4 g daily by injection, but in simple urinary tract infections a single daily dose off g may be effective. (Temopen).
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inie’tion. (Bricarly]). See page 118 and Table 6.
terfenadine An antihistamine with reduced sedative and other side-effects on the central nervous system. It is effective in hay fever, allergic skin conditions and other allergic states.
Dose: 120 mg daily. Best given alone, as combined use with imidazole antifungal agents or with many other drugs may cause severe reactions. See Drug Data Sheet for details. (Triludan). See page 110 and Table 2.
terlipressin A synthetic form of vasopressin, used to control bleeding from oesophageal varices.
Dose: 1-2 nig i.v., repeated if required 4-6-hourly, (Gl)j)ressin).
tenoxicam A non-steroidal anti-inflamma- tory drug (NSAID) with the actions, uses and side-effects of that group.
Dose: 20 mg as a single daily dose. (Mobillex). See page 105 arid Table 29.
terazocin An alpha-receptor antagonist used in hypertension. It produces a peripheral vasodilation by a blockade of post-synaptic alpha-receptors.
Dose: I mg tit night initially, slowly increase(] up to 10 mg as a single daily dose. Small initial doses are necessary to avoid episodes of syncope during early treatment. Reduced doses are indicated when terazocin is given with thiazide diuretics or other anti-hypertensive agents. Side-effects are dizziness, drowsiness and peripheral oedema. It is also used in benign prostatic hypertrophy.
(I lvpovase). See page 149 arld’I'able 21.
testosterone The androgenic hormone of the testes, which controls the development of the male sex characteristics. It is used mainly in the treatment of hypogonadism
by the i.m. injection of depot preparations    97 of long-acting testosterone derivatives. Subcutaneous implantation of testosterone pellets (200-600 mg) has been used in the treatment of metastatic breast cancer. Side-effects are weight gain, virilism and hypercalcaemia.
tetanus vaccines Preparations of tetanus toxin that has been modified by treatment with formaldehyde. They stimulate the formation of protective antitoxin. They are used for active immunization against tetanus, but for young children a combined diphtheria, pertussis and tetanus vaccine is usually preferred.
terbinafine An antifungal agent that acts by interfering with the synthesis of ergosterol, an essential constituent of fungal cell membranes. It is used in fungal infections of the skin and nails, but it is not effective in pityriasis (Tines versicolor).
Dose: 250 mg daily for 2-6 weeks; half-doses in severe liver or renal impairment. Side-effects are rash, loss of appetite and gastrointestinal disturbances. (I.arnisil).
terbutaline A selective beta-adrenoceptor stimulant and bronchodilator, with the actions, uses and side-effects of salbutamol.
Dose: 7.5-15 mg orally daily, by aerosol inhalation; 250-500 jig by &L, i.rn. or i.v.
tetrabenazine A drug of the haloperidal type, but used mainly in the treatment of Huntington’s chorea and similar disorders of movement.
Dose: 75-200  ing daily. It may cause drowsiness and extra-pyramidal side-effects.
tetracosactrin A synthetic form of corticotrophin.
Dose: it single injection of 250 pg as a test of adrenal cortex function, as after such an injection the level of cortisol in the plasma should rise within an hour. It is also given as single I mg i.m. depot preparation in
the 5-hour diagnostic test. (Synacthen; Synacthen Depot).

tetracycline A wide-range antibiotic very similar both chemically and pharmacologically to chlortetracycline, oxytetracycline, clomocycline, and related compounds referred to generically as the tetracyclines. They all have the same type of action against both Gram-positive and Gram-negative organisms, but exhibit certain differences in solubility, absorption and excretion. These differences are reflected in the different doses, as tetracycline is given in doses of 250 mg 4 times a day, whereas with doxycycline a single daily dose of 100 ing may be adequate. Long treatment with a tetracycline may lead to gastrointestinal disturbance owing to changes in the normal bacterial population of the intestinal tract. The use of the tetracyclines has declined with the emergence of bacterial resistance. They also have the disadvantage of being taken up and staining growing teeth and bone, and so should riot be given to children or used during pregnancy. The absorption of the tetracyclines is reduced by antacids, calcium, iron and milk. See page 249 art(] Table 35.
theophylline A bronchodilator used in the less severe forms of asthma and respiratory disease. (In severe and acute asthma arninophylline is usually preferred.) Dose: 180 nig- I g daily. Side-effects include gastrointestinal disturbances and tachycardia, but are less frequent when long-acting preparations of theophyllinc are used. Such preparations are also useful in the control of nocturnal asthma. These long-acting forms differ, and a patient stabilized on one preparation should not lie transferred to another without good cause. See page 118 and’I'able 6.
thiabendazole An anthelinintic effective against a wide range of intestinal parasites. Also useful in creeping eruption.
Dose: 2.3 iiig/kg daily, up to a maximum of 3 g daily for 2-3 days. Side-effects knore marked in the elderly) are nausea, diarrhoea, rash, yellow vision and
jaundice. Mintezol).
thiamine (vitamin Bj Essential for carbohydrate metabolism, but is used clinically in cases of deficiency, as in beri-beri, or when the diet is restricted. Also of value in the neuritis of pregnancy and alcoholism. Dose: 2-5 nig daily; therapeutic 25- 100 ing daily, in severe deficiency 200-300 nig
doily. severe allergic reactions have followed the i.v. injection of thiamine in high-dose mixed vitamin products such as Pabrinex. Anaphylactic treatment must be immediately available. (Benerva).
thiazides See diuretics and page 150.
thioguanine A cytotoxic agent similar in action and uses to nicrcaptopurine, and used to induce and maintain remission in acute myeloblastic and other leukaernias. Dose: 2 ing/kg, daily. Side-effects are bone marrow depression, nausea and jaundice. Manvis). See page 122 and Table 8.
thiopentone A widely used, short-acting I.V. anaesthetic.
Dose: 100-150 nig initially, repeated at intervals of 10-15 seconds as required. Solutions should be freshly prepared, and great care must be taken to avoid extrava&ttion, a-, the solution is very alkaline and may cause tissue necrosis. Infra-arterial injection is even more dangerous.
(Iniraval Sodium).
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thiorid zine A tranquillizing drug related  to chlorpromazine, and used in similar doses for the treatment of schizophrenia and other psychiatric conditions. Unlike most related drugs, it has no antiemetic properties.
Dose: 30-600 ing daily. (Melleril). See page 168 and Table 30.
thiotepa A cytotoxic agent used mainly by infra-cavity instillation, particularly for recurrent superficial tumours of the bladder.
Dose: 15-60 mg dissolved in 60 nil of water, instilled weekly for 4 weeks,
followed by a rest period of 2 weeks before lorther doses are given.
thymoxamine A peripheral vasodilator that is useful in vasospastri and other peripheral ischaemic conditions.
Dose: 160-2,10iiig daily. Side-effects such as headache and facial flushing are usually mild and transient. Treatment should be discontinued after 2 weeks if there is tit) response. (Opilon). See 111oxisylyte.
thyroxine The active constituent of thyroid, but now prepared synthetically. Thyroxine is a powerful metabolic stimulant, specific in neonatal hypothyroidism (cretinism) and myxcredenia. In the former, early diagnosis

co-fluampicil -tablets of flucloxacillin and ampicillin
co-flumactone Tablets of spironolactone and hydrochlorothiazide.
colchicine The alkaloid obtained from meadow saffron. It is used in acute gout. Dose: 500mg every 2 hours until relief is obtained. A total dose of 10mg should not be exceeded, but relief of pain or the onset of vomiting or diarrhoea usually renders full doses unnecessary. It is also used prophylactically in doses ol’500pg 2 or 3 times a day during early treatment with allopurinol, probericcid and sulphiripyrazone. Gire is necessary in the elderly, and in renal impairment. See page 140 and’I'able 17.
corticotrophin The adrenocorticotrophic hormone of the anterior pituitary gland. It stimulates the production of corticosteroid hormones by the adrenal cortex. It is now used mainly as a test of adrenocortical function. See tetracosactrin.
Hydrocortisone.
cortisone one of the corticosteroids secreted by the adrenal cortex. Although it is rapidly absorbed orally, it is inactive until converted in the liver to hydrocortisone. It therefore has the actions, uses and side-effects of hydrocortisone, which is often the preferred corticosteroid. It should be noted that cortisone is of no value for topical application. See hydrocortisone, page 250 and Table 36.
colestipol An exchange resin used in hyperlipidaemia that acts by binding with bile salts in the gut and preventing their reabsorption, and so indirectly lowers the plasma level of cholesterol.
Dose: 10-30g daily. May interfere with the absorption of many drugs. (Colostid). See page 146 and Table 20.
colfoseeril A pulmonary surfactant used in the respiratory distress syndrome of the new-born. (Exosurf). See beractant.
colistin An antibiotic used mainly for bowel sterilization.
Dose: 4.5-9 mega-units daily. In systemic gram-negative infections 2 mega-units 8-hourly by injection have been used, but less toxic antibiotics are now preferred. Colonlycin).
collodion When applied to the skin, it dries to form a flexible film, and is used as a vehicle for the extended local application of drugs such as salicylic acid.
co-phenotrope tablets of diphenoxylate
and atropine. (Lomotil; Tropergen).
co-prenozide Tablets of oxprenolol and cyclopenthiazide. (Trasidex).
co-proxamol Tablets  and paracetamol. (Distalgesic).
corticosteroids Hormones secreted by the cortex of the suprarenal gland. The principal hormone is hydrocortisone but more potent synthetic derivatives such as dexamethasone are also in use.
co-tenidone Tablets of atenolol and chlorthaliclone. (Tenoretic).
co-triamterzide Tablets of hydrochlorothiazide and triannerine. (Diazide).
co-trimoxazole A mixture of trimethoprini and sulpliaiiietlioxazole. Trimethoprim, like the sulphonamides, interferes with the folic acid cycle of bacterial metabolism, but at a different point, and the mixture has an increased antibacterial action. It was once widely used, but is now advised only for Prieunjocystis carinii pneumonia. Occasionally given in acute bronchitis and urinary infections when no other drug is acceptable.
Dose: 120 nig/kf; daily lot- 14 days; 960 ing 12-hourly by i.v. infusion. (Bactrin); Septrin).
coumarins Compounds that depress the formation in the liver of prothrombin and other blood coagulation factors. See warfarin and phenindione.
counter-irritants Substances, also referred to as rubifacients, that, when applied to the skin, produce a mild, local irritation and inflammation, and give symptomatic relief in painful conditions of the muscles and joints. Creams and liniments containing methyl salicylate, turpentine, capsicum resin and menthol are examples of rubifacients.
crisantaspase Asparagine is an aminoacid essential for the development of some malignant cells. Crisantaspase is an enzyme, also known as asparaginase, that breaks down asparagine, and so has an indirect cytotoxic action. It is used to induce remission in acute lymphoblastic leukaemia in children.
Dose: (after pre-treatment with other drugs): 1000 units/kg by slow i.v. injection daily for 10 days. Side-effects include anaphylactic reactions, and skin tests to detect hypersensitivity
are essential before initial and re-treatment. (Erwinase).
crotamiton An ascaricide and antipruritiL. Used by local application as cream or lotion (10%) in the treatment of scabies and itching conditions. (Eurax).
crystal violet A dyestuffwith a selective action against Gram-positive organisms and yeasts. Used as a 0.5% solution for infected skin conditions, and for skin
preparation.
cyanocobalamin The anti-anaemic factor present III liver. It is specific in the treatment of pernicious anaemia and its neurological complications, and of value in some other anaernias due to nutritional deficiencies.
Dose: in pernicious anaemia, I Ing by i.m. injection at monthly intervals. It has been largely replaced by hydroxocobalamin, which has a more prolonged action. (Cytanien). See page 112 and’I'able 3.
cyclizine An antihistamine, used mainly in I ravel sickness and nausea generally. Also useful in vertigo.
Dose: 100-150 mg daily. Side-effects include dryness of the mouth, headache and drowsiness. (%Ialoid).
cyclopenthiazide A thiazide diuretic with the actions, uses and side-effects of bend roll tiazide.
Dose: I mg initially, 250-500mg daily or on alternate days, in the morning, according to need. (Navidrex). See page 148 and Table 21.
cyclopentolate An anticholinergic agent use(] to produce cycloplegia and mydriasis. The action is more rapid and less prolonged than atropine, particularly in children. (Mydrilate).
cyclophosphamide A widely used alkylating
cytotoxic agent, active orally and by injec-
tion. Used in I lodgkin’s disease, chronic
lymphocytic leukaemia and lymphomas. Dose: 100-300 Ing daily, orally or i.v., or 300 mg-1 g weekly. A high fluid intake is necessary, as a metabolite may cause hacm- ( )rrhagic cystitis, and it is sometimes used with mesna to reduce the risk of such cystitis. Nausea and vomiting are common side-effects, as is epilation with high doses. (Endoxana). See page 122 and Table 8.
cyclopropane An inhalation anaesthetic of high potency with which induction and recovery are rapid. It causes some respiratory depression and cardiac irregularities, and its administration requires care. It is used with closed-circuit apparatus as it forms an explosive mixture with air and oxygen. Supplied in orange-coloured cylinders.
cycloserine An antibiotic used in
pulmonary tuberculosis when standard drugs are ineffective. Occasionally used in urinary infections.
Dose: 250-750 mg daily. Side-effects include drowsiness, vertigo and rash. See page 170 and Table 31.
cyclosporin An antibiotic with a powerful inuininosuppressant action. It is used under expert control to prevent graft rejection in organ and bone marrow transplantation, and in the prevention of graft-versus-host disease (GVI-ID). Prolonged therapy over some months may be required. Side-effects may include tremor, gastrointestinal disturbance, hypertrichosis and nephrotoxicity (Neural; Sandinimun).
cyproheptadine A compound with antihistamine and antiserotonin properties. Sonic allergic reactions are due not only to histamine, but also to serotonin, and cyproheptadine is useful in conditions not responding completely to an antihistamine. Dose: 4-20 ing daily. It has been used as an appetile stimulant in doses of 12 mg daily and in refractory migraine. (11criactin). See page 110 and Table 2.
cyproterone An anti-androgen used to reduce libido in sexual deviants. Dose: 50-100 nig daily. It is also used in the palliative treatment of prostatic carcinoma, particularly in advanced cases that have become resistant to other therapy. Dose: 300 mg daily.