Posts Tagged ‘analgesic action’

oxitropium An anticholinergic bronchodilator similar to ipratropium, and used by aerosol inhalation in stable chronic asthma and related conditions.
Dose: 200-300pg (4-6 puffs) daily. . See page 118 and Table 6.

Dose: 1-3 mega-units/min by i.v. infu,ion only, with monitoring. Excessive doses may cause severe uterine contractions with the risk of fetal asphyxiation. (Syntocinon).

oxpentity1fine An aminophyline-like drug used mainly as a vasodilator in periphei at vascular disorders.
Dose: 800-1200 mg. It may cause nausea, flushing and dizziness. Care is necessary in hypotensive states. (Trental).
oxprenoW A beta- ad renoceptor blocking agent with the actions, uses and side-effects of propranolol. It also has anxiolytic properties, and may reduce the symptoms of transient stress such as tremor and palpitations.
Dose: 60-480 mg daily. (Slow- Trasicor). See page 148 and Table 21.
oxybuprocaine A local anaesthetic for ophthalmic use, including tonometry, as a 0.4% solution.
oxybutynin An anticholinergic antispasmodic that promotes relaxation of the detrusor muscle of the bladder.
Dose: in urinary incontinence, 10-20 ing daily; 10 mg daily for children with neurogenic bladder instability. Side-effects are those of anticholinergic drugs generally. (Cystrin; Ditropan). See page 174.
toxycodone A powerful narcotic analgesic with a prolonged action. Used as suppositories of 30 mg in terminal care.
oxypertine A tranquillizer with a chlorpromazine-like action, and used in anxiety neuroses, psychoses and schizophrenic states.
Dose: 30-60 mg daily in anxiety states; up to 300 nig daily in schizophrenia.In higher doses it may cause nausea, dizziness and drowsiness. See page 168 and Table 30.
paclitaxelk’ A new cytotoxic agent originally obtained from the bark of the Pacific Yew. It prevents mitosis and inhibits cell growth by stabilizing microtubule production. It is used by specialists for metastatic ovarian cancer not responding to platinum therapy. Premedication is necessary to prevent severe hypersensitivity reactions. (Taxol). See page 122 and,rable 8.
pamidronate disodium A bisphosphonate with the actions and uses of etidronate. It is used mainly in the hypercalcaemia of malignancy, as it inhibits the development of active osteoclasts.
Dose: by i.v. infusion 10-90 mg or more according to the degree of hypercalcaemia. The initial response may occur within 24-48 hours. Dose in Paget’s disease of bone, 30 nig weekly. Care is necessary in marked renal impairment. (Aredia).
pancreatin A preparation containing the pancreatic enzymes, trypsin, lipase and amylase. It is used to aid the digestion of fats, proteins and carbohydrates in cystic fibrosis and pancreatitis. Some high-strength products have caused fibrotic strictures of the large bowel.
pancuronium A non-depolarizing or competitive muscle relaxant that has little histamine-releasing or cardiovascular action.
Dose: 50-100 pg/kg i.v. initially with Supplementary doses of 10-20 pg/kg as required. (Pavulon).
oxytetracycline (Terramycin). See tetracv-
oxytocin The oxytocic fraction of pituitary extract, but now made synthetically. Used for the induction and maintenance of labour, and to control post-partum haemorrhage, either alone or in association with ergometrinc.
pantoprazoleV A proton pump inhibitor similar to omeprazole, used in peptic ulcer and reflex oesophagitis.
Dose: 40 mg daily with breakfast. The tablets must be swallowed whole with water, and not chewed or crushed. (Proteunfl. See page 162 and Table 27.
papaveretum A preparation of the alkaloids of opium, containing approximately 50% of morphine together with papaverine and codeine. Used mainly by injection, often in association with hyoscine (scopolamine) for premedication. Dose: 7.7-15.4 nig repeated as required.
papaverine One of the alkaloids of opium. It has little analgesic action, and has been used mainly as a smooth muscle relaxant in peripheral vascular diseases. More recently it has been used by intracavernosal injection in the treatment of impotence.
paracetamol A widely used mild analgesic with few side-effects except in large doses. It differs from aspirin in the absence of any anti-inflammatory action.
Dose: 2-4 g daily. Paediatric suppositories of 125 mg are available. Overdose may cause severe liver damage (see acetylcysIcinc).
paraffin A generic name for hydrocarbon mixtures. Soft paraffin is the common ointment base; liquid paraffin is a lubricant laxative. Hard paraffin was used in the wax bath treatment of rheumatic conditions.
paraldehyde A colourless liquid with a strong characteristic odour. It was once used as a chloral-like sedative causing little respiratory depression; now given by deep i.m. injection in status asthinaticus. Dose: 5-10 nil. Occasionally given in similar doses by rectUril, diluted with saline or arachis oil. Discoloured paraldehyde must not be used.
paroxetine A selective inhibitor of sero(011111 uptake in the central nervous system, and indicated in the treatment of depression.
Dose: 20 ing daily, initially in the morning, with food, slowly increased as required to 50 mg daily. It should not be given with any other drug likely to increase serotonin uptake. Side-effects are nausea, drowsiness and insomnia. Extrapyramidal reactions may occur more often with paroxetine. (Seroxat). See page 128 and Table i I.
penciclovir An antiviral agent used as a 1% cream for cold sores (Herpes kabialis). Treatment should be started as soon as possible by applying the cream every 2 hours for 4 days. (Vectavir). See page 144 anti Table 19.
penicillarnine A breakdown product of penicillin which has the power of combining with certain metals to form a water-soluble, non-toxic complex that is excreted in the urine. It is used in Wilson’s disease, which is due to the retention of copper in the body, in poisoning by lead and mercury, in chronic active hepatitis (after the condition has been controlled), in cystinuria, and in severe rheumatoid arthritis in which it has an action similar to that of gold.
Dose: in Wilson’s disease, 1.5-2 g daily before food for sonic months. In chronic hepatitis, 500 mg daily initially, slowly increased over some weeks to 1.25g daily. In rheumatoid arthritis, 125-250 trig daily initially before food, slowly increased at monthly intervals with maintenance doses of 500-750 mg daily. Patients should be warned that the response in rheumatoid arthritis is slow. In cystinuria, 1-3 g daily with adequate fluids, ad iusted later to maintain the urinary cysteine level below 200 mg/I. Dose in heavy metal poisoning, 2g daily. Side-effects include nausea, loss of taste, rash and thrombocytopenia. Blood Counts during treatment are essential and patients should be advised to report most side-effects. A late onset rash may require cessation of treatment. (Distarnine; Pendramine). See page 165 and Table 29.
penicillin, benzyl penicillin, penicillin G I lie first of the antibiotics. It acts by pre venting the development of the bacterial cell wall, but some groups of organisms vary widely in the degree of sensitivity to penicillin, and it is inactivated by penicillinase-producing organisms. Penicillin is inactive orally, and so is given by i.m. injection, but as it is rapidly excreted the action is relatively brief. Derivatives such as procaine-penicillin have a longer action (penicillin V is an orally active derivative). The main side-effect is hypersensitivity, and sensitivity to one penicillin extends to any other penicillin, and may also include sensitivity to the related cephalosporins. High doses of penicillin, especially in patients with renal insufficiency, may occasionally cause cerebral irritation and encephalopathy. Cloxacillin and amoxycillin are derivatives of penicillin active against resistant staphylococci; ampicillin has a wide range of activity against Gram-positive and Gram-negative organisms; piperacillin and ticarcillin are active against Pseudomottas acruginosa.

pentaerythitol tetranitrate A vasodilator with properties resembling those of glyceryl trinitrate, but with a more prolonged action. Used mainly in the prophylaxis of angina as side-effects are relatively infrequent.
Dose: 60-240 mg daily. (Mycardol). See page 114 and Table 4.
pentamidine A synthetic drug used in the treatment ofPneutnocystiscarinii pneumonia in AIDS and other immunocompromised patients, as an alternative to co-trimoxazole.
Dose: 4 nig/kg daily by i.v. infusion for 14 clays or more, or by inhalation of a nebulized solution. Other dosage schemes are used in the treatment of’trypaiiosomiasis and leislunaniasis. Severe reactions, particularly hypotension, may occur, and pentamidine should be used only under expert supervision. (Pentacarinao.
pentastarch A starch-derived plasma substitute used as a 10% solution in burns and septicaemia.
Dose: by i.v. infusion 500 nil-21.. (Haes.
See hetastarch.
tpentazocine A powerful analgesic of the morphine type, but less likely to cause addiction, although dependence may occur with long treatment.
Dose: 100 -400 nig daily after food, up to 360 nig daily by injection. Suppositories of 50 mg are available. Hallucinations ions are an occasional side-effect. It should be
avoided after myocardial infarction as it may increase the cardiac load. Other side effects include dizziness, nausea, tachycardia and rash. It should be avoided in opioid-dependent patients. (Fortral).
pentostatin A potent cytotoxic agent used in hairy cell leukaemia. It is an inhibitor of adenosine deaminase, and may affect RNA synthesis and cause DNA breakdown.
Dose: i.v. under specialist supervision, 4 ing/ni’every other week, continued up to 6 months unless a remission has been achieved. Side-effects include myelosuppression, leukopenia, renal and liver toxicity and rash. Blood counts are necessary during treatment. (Nipent). See page 122.
peppermint oil Aromatic carminative. Dose: 0.2 -0.4 ml. (Colpermin; Nlintec).
pergolide A dopamine agonist with a stimulating action on both D, and D, receptors. It is used in the auxiliary treatment of parkinsonism, and combined treatment may permit a reduction in the dose of levodopa and its side-effects. Dose: 100 jig daily initially, slowly increased at 3-day intervals according to response, with care taken to avoid initial hypotension. Other side-effects include nausea, diarrhoea, confusion and hallucinations. (Celance). See page 160 and
pericyazine A tranquillizer of the chlorpromazine type with similar uses and side-effects. It is used mainly in schizophrenia and severe anxiety states.
Dose: 15-75ingdaily, slowly Y increased according to need up to 300 111g. ( Neulactil). See page 168 and Table 30.
perindopril A long-acting ACE inhibitor used in the control of essential hypertension not responding to other drugs. Dose: initially, it single daily dose of 2 mg (before food), subsequently adjusted up to a maximum of 8 nig daily. Diuretic therapy should first be withdrawn for 2-3 days, and renal function should be assessed before and during treatment. It is also used as supplementary therapy in heart failure in doses of 2-4 ing. (Coversyl). See page H8 and Table 21.
permethrin An insecticide used as 1% cream for head lice, and 5% cream for scabies. (Lyclear).
perphenazine A tranquillizer with the actions, uses and side-effects of chlorpromazine, but it is less sedating, and effective in lower doses.
Dose: psychiatric and antiemetic, 12-24 nig daily. It is sometimes useful in the control of, intractable hiccup. (Fentazin). See page 168 and Table 30.
pethidine A synthetic analgesic with spasmolytic properties. Widely employed as an alternative to morphine for pre- and post-operative use. Of value in obstetrics as it has a less depressant action than morphine on the respiration.

itraconazole An orally active antifungal agent used in the treatment of vulvovaginal candidiasis, pityriasis and tinea infections. Dose: 200 mg twice a day for the I -day treatment of vulvovaginal infections; 200 nig daily for 7 days in pityriasis, 100nig daily for 15-30 days in tinea infections. Side-effects are nausea and abdominal pain. Liver disease is a contraindication. Combined treatment with astiniazole or ierfenadine should be avoided. (Sporonox).
ivermeclin A fungal derivative effective against the microfilaria causing ‘river blindness. It does not kill either the adult worms or their larvae, but prevents the growth of the latter, and treatment must be continued until the adult worms die out. Dose: 150. (Mectizan).
kanamycin An aminoglycoside antibiotic now used mainly in gentamicin-resistant infections.
Dose: I g daily by i.m. injection; 15-30 rng/ kg daily by i.v. infusion. (Kannasyn).
kaolin Aluminium silicate. Used as an absorbent in diarrhoea, colitis, food poisoning, etc., often as Kaolin and Morphine Mixture.
Dose: 10-20 nil as required. It is also used externally as Kaolin Poultice to relieve the pain of sprains, etc.
kelocyanor A specific antidote for cyanide poisoning. See dicobalt edetate.
ketamine A short-acting i.v. anaesthetic with analgesic properties.
Dose: 1-2 mg/kg i.v. over I minute, repeated as required; 4-10 nig/kg by deep Lin. injection. It is used mainly in paediatric anaesthesia, and its analgesic action is also of value in neurodiagnostic procedures, and other painful investigations. Hallucinations may occur during the recovery period. (Ketalar).
ketoconazole A broad-spectrum, orally active antifungal agent. It is of value in systemic and deep mycoses, and in severe and resistant mycoses of the gastrointestinal tract and the vagina. It is also effective in severe mycoses of the skin, but it should be used only for superficial fungal infections not responding to other treatment.
Dose: 200 mg daily with ft)od, up to a maximum of 4tH) mg daily. Side-effects include nausea, rash and pruritus. It may cause hepatitis; liver function tests may be necessary if given for more than 14 (lays. (Ki-zoral).
ketoprofen A non-steroidal anti-inflammatory and analgesic agent of the ibuprofen type. It is of value in rheumatoid arthritis, gout, spondylitis and related conditions, and in dysmenorrhoea.
Dose: 100-200 mg daily with food;
100 Ing by suppository at night, 50-100 mg by deep Lin. injection 4-hourly. Care is necessary in peptic ulcer and hepatic disease. May increase the action of anticoagulants and other drugs bound to plasma protein. (AlrheLiniat; OrUdis; Orivail). See page 165 and Table 29.
ketorolacV A potent analgesic used for the short-term reliefofacute postoperative pain.
Dose: tO mg 4-6-hourly up to 40 ing daily for not more than 7 days; dose by deep i.m. or slow i.v. injection. 10 mg initially, then 30 mg 4-6-hourly up to 90 mg daily for not more than 2 days. Side-effects are numerous; see data sheet. (Toradol). Also used as eye drops (0.51)/0 to reduce pain and inflammation after ocular surgery. (Acular).
keftotifen An antihistamine that may also have some of the properties ofsodium cromoglycate. It is used in the prophylactic treatment of asthma.
Dose: 4 mg daily with food, continued lor ,sine weeks. Other anti-asthmatic therapy should be continued for at least 2 weeks to ensure maintenance of control. Side-
effects include sedation and dryness of the mouth. (Zadi(en). See page 110 and Table 2.
Kogenate A recombinant form of the human blood Factor Vill, given i.v, as replacement therapy in the treatment of haemophilia A.

labetalol A beta - adrenocepior blocking agent with some alpha-blocking activity. Like related drugs, labetalol is indicated in all types of hypertension, including that following myocardial infarction.
Dose: 200 mg daily initially, with food, slowly increased up to a maximum of 2.4 g daily; by i.v. injection 50 mg repeated as required; for the rapid control of the hypertension of pregnancy 20-160 ing by i.v. infusion hourly. It should be used with care in asthma and heart block. Side-effects include weakness, nausea, bradycardia and postural hypotension. Liver damage has been reported. (Trandate). See page 148 and `fable 21.
lacidipine A calcium channel blocking agent with the actions and uses of nifedipine. In hypertension it is given as a single morning dose of 2 nig with food, increased up to 6 mg as the response develops over 3-4 weeks. Half doses in hepatic impairment and the elderly. Early chest pain is an indication that the drug should be withdrawn. (Motens). See page 148 and Table 21.
lactilol A semi-synthetic sugar that is not absorbed orally, and acts as an osmotic laxative by retaining water in the intestinal tract. Also inhibits ammonia-producing organisms, and is of value in hepatic encephalopathy.
Dose: as laxative 20 mg daily mixed with food, together with 2 glasses of water. Dose in hepatic encephalopathy, 500700 inglkl; daily.
lactulose An osmotic laxative. See lactilol.
laevulose Fructose. A sugar sometimes given i.v. as an alternative to glucose.
in the brain by inhibiting the influx of sodium ions. It is used both as primary treatment and as additional therapy (often with sodium valproate) for seizures not fully controlled by other drugs.
Dose: 25 ing daily initially for 14 (lays, slowly rising to 100-200 nig daily. See data sheet for details of combined therapy. (Limictal). See page 136 and Table 15.
lanolin See wool fat.
lansoprazole An inhibitor of the enzyme 11, K’-AI’Pase (the proton pump) used in the treatment of peptic ulcer.
Dose: 30 ing daily for 4-8 weeks. (Luton). See orneprazole, page 162 and Table 27.
Lasser’s paste A stiffointment containing zinc oxide, starch and white soft paraffin with 2% salicylic acid. Used as protective in eczema.
latanoprost A prostaglandin alpha-analogue used once daily as eye drops (0.00596) in glaucoma. It increases the outflow of the aqueous humour, whereas other agents reduce its secretion. Continued use may cause changes in eye colour. (Xalantan). See page 138.
lenograstimV A recombinant form of the granulocyte colony stimulating factor (G–GSF) that governs the production of neutrophils. It is used as supplementary treatment in cancer chemotherapy to stimulate neutrophil production in drug induced neutropenia.
Dose: under expert supervision by s.,:. injection, in daily doses of 150 pg/m2 Until neutrophil count is satisfactory. Also used i.v. after hone narrow transplantation. (Granocyte). See filgrastim and rinolgraniostirn. See page 122 and Table 8.
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lamivudine An antiviral agent that acts like zidovudine by inhibiting reverse transcriptase, an enzyme essential for DNA formation and viral replication. It is used in HIV infections.
Dose: 300 ing daily, preferably with food, and combined with a protease inhibitor. (Epivir). See page 144 and Table 19.
lamotrigine\” An anti-epileptic that alleviates the imbalance of neurotransmitters
letrozoleV A non-steroid inhibitor of aromatase, the enzyme that controls the conversion of testosterone to oestrogen. It acts as an anti-oestrogen and is used in advanced breast cancer that has not responded to tamoxifen or similar therapy. Dose: 2.5 mg once daily. Side-effects include musculoskeletal pain, arthralgia and hot flushes. (Fernara). See page 122 and Table 8.
leucovorin See folinic acid.

leuprorelin A synthetic hormone that indiandrogen and oestrogen production by inhibiting gonadotrophin activity. It is used in endonietriosis and
advanced prostatic cancer.
Dose: 3.73 rig by s.c. or i.m. injection every 4 weeks. Side-effects are impotence, flushing and local irritation. There may be an initial and temporary increase in pain. The injection site should be varied. (Prostap SR). See buserelin, goserelin, page 122 and Table 8.
levamisole A single-dose (150 mg) anthelmintic of value in round worm (Ascaris). It is also effective against hookworm (Ancylostoma and Necator). Dose: 2.5-5 mg1kg daily for 2-5 days.
levobunolol A beta-blocker used as eye drops 0.5% in glaucoma. (Betagaii). See carteolol.
levocabastine An antihistamine used as drops (0.05% twice a day in the symptomatic treatment of seasonal allergic conjunctivitis and rhinitis. (Livostin).
levodopa An amino acid that is converted to dopamine in the body. It is used in the treatment of Parkinson’s disease, which is associated with a reduction in brain
dopamine levels due to degeneration in the substantia nigra, thus causing an imbalance in the neurohorinonal system of the brain. Levodopa is essentially replacement therapy, but as an oral dose is metabolized to some extent in the peripheral circulation It is often given with art enzyme inhibitor such as benserazide or carbidopa. Combined therapy permits a larger dose of active drug to reach the cerebral tissues, and at the same time reduces some of the general side-effects of levodopa.
Dose: 125-300 mg initially, increased according to need and response. Side-effects include nausea and cardiovascular disturbances, but psychiatric side- effects may be (lose limiting. Close angle glaucoma is a contraindication. See page 160 and ‘I able 26.
lignocaine (lidocaine) A local anaesthetic widely used for infiltration anaesthesia as a 0.25-0.5% solution, usually with adrenaline, as well as for epidural, caudal and nerve block anaesthesia. It is the local anaesthetic present in many dental cartridges. A 2-4% solution is used for
surface anaesthesia, and a 2% gel is used to relieve the pain and discomfort of catheterization, but rapid absorption may cause side-effects. Lignocaine is also the drug of choice in the control of ventricular tachycardia following myocardial infarction. Dose: 100 mg as an i.v. bolus, followed by a dose of 4 mg/min by i.v. infusion for 3(t minutes, with subsequent doses of 2 inghnin. Side-effects include confusion, convulsions, bradycardia and I p hy oten- sion. (Xylocard). Emla cream contains lignocaine and prilocaine. It is used for local anaesthesia and to relieve the pain associated with injections, especially in children. It is applied under an occlusive dressing 1-2 hours before the injection.
lindane A pesticide used as a 1% solution for the treatment of scabies.
liothyronine (tri-iodothyronine) A thyroid hormone with it rapid action, an(] probably a precursor of thyroxine. It is given orally in severe hypothyroid conditions when a rapid action is necessary, and by injection in hypothyroid coma. Dose: 20-60 fag daily; 5-20 pg i.v.
0 ertroxin).
liquid paraffin A lubricant laxative and faecal softener.
Dose: la-mj, nil. Its extensive use is now
discouraged, as it may cause granulomatous reactions and reduce the absorption of fat-soluble vitamins.
lisinopril An ACE inhibitor similar to enalapril, but with it longer action that permits the use of a single daily dose. Dose: in the treatment of hypertension, (loses of 2.5 rig daily initially, slowly increased according to response up to 10-20 mg daily, occasionally up to 40 mg. In patients receiving diuretics, such Ilierapy should be withdrawn for 2-3 days before lisinopril therapy and resumed later if necessary. (Carace; Zesiril). See
page 148 and Table 21.
lithium carbonate Lithium carbonate and itratearc used for their mood-regulating action in the prophylaxis and treatment of mania and depressive illness, but the mode of action is not known. The therapeutic/ toxic range of lithium is very narrow, and continuous control of the plasma/lithium level is essential to avoid the many side-effects and hazards of therapy.