Posts Tagged ‘cystic fibrosis’

vasodilators Traditional vasodilators used in the prophylaxis and treatment of angina include glyceryl trinitrate and other nitrates. They have a general effect on the venous system but newer and more selectively acting antihypertensive drugs are the betaadrenoceptor blocking agents represented by propranolol, and the calcium channel blocking agents such as nifedipine. Other vasodilator drugs are the alpha-adrenoceptor blocking agents (indorarnin, prazosin) and the ACE inhibitors (captopril). Cerebral vasodilators are represented by isoxsuprine. Peripheral vasodilators include cinnarizine and thymoxamine. See pages 114 & 148.
vasopressin A preparation of the blood pressure- raising and antidiuretic factors of the pituitary gland. It has been used in doses of 5-20 units twice daily by s.c. or i.m. injection in diabetes insipidus, but has been largely superseded by demopressin. (Pilressin).
vecuronitim A non-depolarizing muscle relaxant of the rocuronium type. It has a medium duration of action, with the advantage of not causing histamine release. Dose: 80-100fLgjkg1min initially, with supplementary doses as required. (Norcuron).
venlafaxine An antidepressant that inhibits the re-uptake of both serotonin and nor-adrenaline.
Dose: in depressive illness, 75 mg daily, rising if necessary after some weeks to 150 ing daily, or exceptionally to 375 mg daily. Prolonged treatment is necessary for an adequate response and reduce potential relapse. Reduced doses are given in hepatic disease and lite elderly. Care is necessary in epilepsy, and before and after morloaniine oxidase inhibator (MAGI) therapy. Many side-effects have been noted, but any skin reaction should be reported to the prescriber. (Ffcxor). See page 128 and Table 11.
Dose: 120-480 mg daily according to the condition and degree of response. In severe arrhythinias, 5-10 mg i.v. under ECG control. Contraindicated in bradycardia, heart failure and heart block. Side-effects include nausea, hypotension and heart block. It should be used with caution in a patient already receiving a betaadrenoceptor blocking agent. (Cordilox; Securon). See page 148 and Table 21.
vigabatrin A new anti-epileptic drug. GABA (a gamma aminobutyric acid) is an inhibitor of neurotransmission, and epileptic seizures may be linked with a GABA deficiency. Vigabatrin has an inhibitory action on the GABAmetabolizing enzyme, and so indirectly permits a rise in the brain level of GABA. It is used in the treatment of epilepsy not responding to other anticonvulsants. Dose: 2 g daily initially, with adjustments up to 4 g daily together with current antiepileptic therapy. Side effects are numerous, and include drowsiness, fatigue, dizziness and weight gain. Sudden withdrawal is inadvisable. (Sabril). See page 136 and Table 15.
viloxazine An antidepressant with the general action, uses and side-effects of amitriptyline, but with a reduced sedative activity. It is given in depression associated with apathy, and in the depression of epilepsy.
Dose: 150-400 mg daily. It may increase the action of phenytoin and antihypertensive agents. (Vivalan). See page 128 an(] Table 11.
vinblastine An alkaloid of periwinkle that has cytotoxic properties. It is used in the control of acute leukaemias, lymphomas and other malignant conditions, and in mycosis fungoides.
Dose: 100 ltrjkg weekly i.v., increased by 50 pg/ki; weekly, up to 500 µg/kg weekly according to response. Side-effects include myclosuppress.ion, neurotoxicity and abdominal disturbances. The drug should be handled with care as it is a tissue irritant. (Velbe). See page 122 and Table 8.
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verapamil A calcium channel blocking agent that reduces the movement ofcalciurn ions in cardiac tissues. It reduces the oxygen demand as well as the contractility of the myocardium, and it is used in angina, arrhythmias and hypertension.
vincristine A vinca alkaloid with the action and uses of vinblastine, but much less likely to cause myclodepression. It is used mainly in the treatment of acute
leukaemias in children, Hodgkin’s disease and other malignant lymphomas.

Neuromuscular side-effects may limit the dose. Other side-effects are abdominal disturbance and alopecia. The injection of the drug requires care as it is a tissue irritant. (Oncovin). See page 122 and Table 8.
vindesine A vinca alkaloid with an action similar to that of vincristine. It is used mainly in acute lyniphoblastic leukaemia in children, and in other malignant conditions not responding to treatment.
Dose: 3 nig/m` weekly by i.m. injection, subsequently increased up to 5 mg/in’ according to response. The side-effects are similar to those of other vinca alkaloids, but granulocytopenia may be a close-limiting factor. Extravasation should he avoided, as it may cause considerable local irritation. (Eldesine). See page 122 and fable R.
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vitamin D. Calciferol.
vitamin E The vitamin in the germ of wheat, rice and other grains. Deficiency States are uncommon, but may occur in cystic fibrosis and other conditions where fat absorption is impaired. It has been used empirically in many other
conditions, but its therapeutic value is questionable.
Dose: 5-15 ing daily. Now largely replaced by the synthetic form tocopherol.
vitamin K The vitamin concerned with the formation of prothrombin, and so with blood coagulation. Given as menadiol in haemorrhagic disorders, vitamin K, or phytomenadione has a similar but more rapid and sustained action. Of no value when the prothrombin level of the blood is adequate.
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vinorelbine A cytostatic drug of the vinca alkaloid type. It is used in non-small cell lung cancer and in advanced breast cancer resistant to other drugs.
Dose: 25-36 ing/inweekly by i.v.
infusion. Main side-effect is neutropenia. (Navelbine). See page 122.
vitamin A One of the vitamins obtained from fish-liver oils. A deficiency in the diet causes night-blindness, skin changes and a decreased resistance to infection. Dose: 2500-25 000 units daily.
vitamin B A group of water soluble vitamins obtained from yeast or rice polishings. The constituents include thiamine, riboflavine, nicotinic acid, pyridoxine, and small amounts of other factors.
vitamin B. Pyridoxine.
vitamin B,, Cynacobalamin. vitamin C Ascorbic acid.
warfarin A synthetic anticoagulant similar to phenindione, but with reduced side-effects and it is now the preferred drug. It is used mainly in deep-vein thrombosis and transient brain ischaernia, in doses based on the prothrombin time as
reported by the laboratory in terms of the International Normalized Ratio (INR). Dose: Pending INR report, 10 ing daily initially for up to 3 days. Haemorrhage is the main side-effect, and may require the use of phytornenadione to control the excessive response.
Whitfield’s ointment Benzoic acid 6%, salicylic acid 3%. Has keratolytic and fungicidal properties, and is used mainly for ringworm.
wool alcohols A water-in-oil emulsifying agent obtained from wool fat. It is used in many water-containing ointments, such as ointment of wool alcohols and hydrous ointment.
vitamin D The vitamin essential for the absorption of calcium and phosphorus and subsequent bone formation. Several forms of the vitamin are known, but it is used chiefly as calciferol. Vitamin D is activated in the liver and kidneys to more powerful derivatives such as calcitriol and alfacalcidol.
wool fat A pale yellow, waxy substance, also known as lanolin, obtained from sheep’s wool. It consists mainly of cholesterol-derivatives, and is a constituent of various water-in-oil emulsifying and emollient ointment bases. It may cause skin sensitization in some susceptible patients.

xamoterol A partial 0, adrenoceptor agonist with a cardiac stimulant action. It is given only in mild chronic heart failure to control exercise-induced symptoms. Dose: 400 ing daily. Side-effects are dizziness, headache and gastrointestinal disturbances. Contraindicated in severe heart failure, and care is necessary in asthmatic conditions. (Corwin). See page 141 and Table 18.
xipamide A long-acting diuretic and anti-hypertensive similar to chlorthalidone. Dose: in hypertension, 20 ing is given as a morning close: in oedematous states, 40-90 mg as a single dose, reduced later as necessary. (Diurexan). See page 148 and Table 21.
xylometazoline A sympathomimetic agent used as a nasal decongestant, and to relieve allergic conjuncfivitis as drops of 0.05-0.1%. Rebound congestion may be a side-effect.
Z
zalcitabineV An antiviral agent used in the suppressive treatment of AIDS patients who have become resistant to or have failed to respond to zidovudine therapy. Dose: 2.25 nig daily under expert supervision, as the drug has many side-effects including
., peripheral neuropathy. 0 livid).
zidovudine An antiviral agent effective against the human immunodeficiency virus (HIV) associated with the acquired immune deficiency syndrome (AIDS). It inhibits the enzyme reverse transcriptase and, by preventing the formation of viral DNIA, it inhibits viral development. Dose: 33 ing/kg4-hourly for some months. Side-effects include anaemia, neutropenia, nausea, fever and malaise. Liver-function tests are necessary during treatment. The chronic use of analgesics such as paracetamol may increase the risk of neutropenia. (Retrovir). See page 144 and “table 19.
zinc oxide A soft white powder widely used in dusting powders, ointments, pastes, etc., for its mild astringent and antiseptic properties. It is a constituent of Lassar’s paste, Unna’s paste, Calamine Lotion and similar preparations.
zinc sulphate Used as an astringent and stimulating lotion (1%) for indolent ulcers; and in conjunctivitis as eye drops (0.25%).
zinc undecenoate A white insoluble powder. Constituent of dusting powders and ointments for mycolic conditions.
zolmitriptan A serotonin receptor agonist used only in the treatment of acute migraine.
Dose: 2.5 ing as soon as possible after onset. .A second dose may be given not less than 2 hours later if symptoms persist. Vornig). See page 154 and Table 23.
zolpidem A mild hypnotic that acts by binding with a sub-group of benzodiazepine receptors. It has a rapid action, and is used in the short-term treatment of insomnia.
Dose: 10 mg. Side-effects are dizziness and gastrointestinal disturbance. (SI ilnoct). See page 152 and Table 22.
zopiclone A mild hypnotic that binds with a sub-group of benzodiazepine receptors, and may modulate the neurotransmitter GABA.
Dose: in insomnia and early awakening, 7.. —]S mg with initial doses of 3.75 mg for the elderly. A side-effect is a bitter or metallic after-taste. (Zimovane). See page 152.
zuclopenthixol A powerful tranquillizing drug with actions, uses and side-effects similar to those of chlorpromazine. It is of value in schizophrenia with agitation and aggression.
Dose: 20-30 mg or more up to 150 mg daily. For depot maintenance treatment, 100-200 mg or more by deep i.m. injection at intervals of 2-3 weeks, according to need and response. (Clopixol). See page 168.

dornase alfa A recombinant form of human deoxyribonuclease (rhDNase) used in cystic fibrosis. The viscous purulent airways secretion of that disease is due to the presence of large amounts of extra-cellular DNA from degenerating leucocytes. Dornase alfa breaks down the DNA and reduces the sputum viscosity. Dose: 2500 units daily by inhalation from it jet nebulizer. Daily treatment is necessary to maintain the response. (Ptilillozvme).
dorzolamide An inhibitor of carbonic anhydrase that reduces the amount of sodium bicarbonate in the aqueous humour of the eye. It is used as eye drops (2%) 2 or 3 times a day as adjunctive therapy in ocular hypertension when beta-blockers are unsuitable or ineffective. (Trusopt). See page 138 and Table 16.
dothiepin (dosulepin) A tricyclic antidepressant with the uses and side-effects of antitriptyline. It is used in the treatment of depression when a sedative action is also indicated.
Dose: 75-150 mg daily. It may also be given as a single nightly dose to reduce daytime drowsiness. (Prothiaden). See page 128 and Table 11.
doxapram A respiratory stimulant useful in postoperative respiratory failure under expert control.
Dose: by i.v. injection 1-1.5 nig1kg according to need. It is also given by i.v. infusion in doses controlled by arterial food gas studies. Side-effects include hypertension, Ypertension, bronchospasin and tachycardia. (Dopram).
doxepin An antidepressant with the actions, uses and side-effects of dothiepin.
Dose: 30–300 nig daily; a single dose of I Ito mg is sometimes given at night. (Sinequan). See page 128 and Table 11.
doxorubicin A cytotoxic antibiotic widely used in leukaemia, lymphosarcoma, breast and lung cancer.
Dose: by fast i.v. infusion 60-75 nigIm’ at intervals of 3 weeks, or 20-25 mg/m’ daily for 3 days. It is also used by bladder installation (50 mg in 50 nil of saline solution) for superficial bladder tumours. Side-effects include bone marrow depression, cardiac damage, alopecia, buccal ulceration and nausea. Doxorubicin is it skin irritant, and should he handled with care. See page 122 and Table 8.
doxycycline A long-acting tetracycline. Dose: 200 mg initially, followed by 100 ing its a single daily (lose. In acne, a dose of 50 mg daily is given for some weeks. It should be taken with adequate fluid, with the patient in a sitting or standing position. (Nordox; Vibramycin).
droperidol A tranquillizer with unusual properties. It is given in severe psychotic conditions such as mania, in drug-induced nausea and vomiting and for preoperative sedation. It is also given with fentanyl to produce a state of detachment (neuroleptanalgesia).
Dose: 20-120 ing daily; 5-10 ing by injection; in cancer therapy induced vomiting (loses of 1-3 nig/hr have been given by continuous i.v. infusion. Side-effects are those of chlorpromazine and haloperidol. (Droleptan).
doxazocin An alpha-adrenoceptor blocking agent of the prazosin type, but with a longer action that permits a single daily dose.
Dose: in hypertension I mg initially, slowly increased after 7-14 days to 2 mg daily, up to a daily maximum of 16 ing, usually in association with other amihypertensive drugs. It is also used in Iliesymptcunitic treatment ofbenign prostatic . P
hy erplasia. Side-effects are
dydrogesterone An orally active progestogen that is virtually free from
any oestrogenic or androgenic side-effects. It is used in amenorrhoea, endometriosis, functional uterine bleeding, and threatened abortion.
Dose: 10-30 mg daily. (Ouphastort).

econazole An antifungal agent similar in actions and uses to clotrimazole. (Ecostatin; Pcvaryl).
ecothiopate A potent and long-acting iniotic that has been used in glaucoma as eye drops of 0.03-0.25%. It may cause cataract; its availability is strictly limited.
edrophonium A very short-acting drug of the neostigniine type. It is used in the diagnosis of myasthenia gravis.
Dose: 2-10 nig by i.v. injection, which causes a marked but transient increase in muscle power if myasthenia gravis is present.
eformoterol A selective P2 stimulant (agonist) with a rapid initial action, used as supplementary treatment in patients receiving other bronchodilator therapy for reversible airway obstruction.
Dose: by inhalation: 12µg twice daily, doubled if necessary. (.are is necessary in ischaernic heart disease and diabetes. Not to be used for acute attacks. (Foradil). Sec page 118 and Table 6.
enalapril An ACE inhibitor used in the treatment of all types of hypertension, and in congestic heart failure, often together with a diuretic.
Dose: i ing daily initially, increase(] as required up to 40 mg daily, and often given as a single dose. Dizziness, hypotension and loss of taste are some side-effects. ! I imov.i, :. See page 148 and Table 21.
enflurane An inhalation anaesthetic with the actions and uses of halothane, but less potent.
epoetin alfa and beta Recombinant fornis of human erythropoietin. (Eprex; Recormon). See erythropoietin.
epoprostenol A prostaglandin present in the walls of blood vessels that inhibits platelet aggregation. It is used to prevent platelet aggregation during cardiopulmonary bypass and charcoal haemoperfusion, and as an alternative to heparin in renal dialysis.
Dose: 10-20 ng1kShnin by continuous i.v. infusion. Smaller doses in renal dialysis. It is also a vasodilator, and side-effects are flushing and hypotension. (Flolan).
enoxaparin A low-molecular weight and longer acting form of heparin. It has the general properties of heparin, but with less effect on blood platelet activity. It is used in the prevention of venous thrombosis. Dose: 20 mg by sx. injection once daily ( I hour before surgery) for 7-10 days. (Clexane). See certoparin, dalteparin and tinzaparin.
enoximone An inhibitor of the enzyme phosphodiesterase. It has a digoxin-like action on the myocardium and is used in
eptacog alfa See Factor VIIa.
ergocalciferol See calciferol.
ergometrine The principal alkaloid of ergot. It promotes uterine contraction and is used for the rapid control of postpartum haemorrhage. Dangerous in the early stages of labour.
Dose: 05-1 nig orally; or 200-500 jig by injection. It is often used together with oxycytocin as Syntometrine. Side-effects are nausea and transient hypertension.

ergot A fungus that develops in rye and replaces the normal grain. The active principles include ergometrine and ergotamine. Chronic toxic effects characterized by gangrene of the extremities have followed the use of ergot-contaminated rye bread.
ergotamine Air alkaloid of ergot that constricts the cranial arteries, and is used solely for the relief of migraine not responding to analgesic therapy. Early treatment evokes the best response.
Dose: 2 mg initially up to 6 ing during an attack, not to be repeated until after an interval of some days.”I oral dose in I week: 10– 12 mg. It is also given by oral inhalation in doses of 360pg ( I puff), repeated after 5 minutes, up to a maximum of 6 puffs daily. Side-effects include headache and nausea, and the drug should be withdrawn if tingling of the extremities occurs.
trot suitable for prophylaxis because of the risks of toxicity. (Lingriine). Sec page 154
erythromycin Air antibiotic, resembling penicillin in its general range of activity, with the advantage of being active orally. It is useful in streptococcal and respiratory infections and in penicillin-resistant staphylococcal infections. Erythromycin is also of value in penicillin-sensitive patients. It is also given as a prophylactic before dental surgery. Dose: up to 4 g daily; in severe infections it may lie given by slow i.v. infusion in closes of 50 mg/kg daily. Side-effects include nausea and vomiting, and diarrhoea may occur after high doses. Gore is necessary in hepatic impairment. Preparations of erythromycin estolate are contraindicated in liver disease. Erythromycin may potentiate the action of warfarin. It should not be given with aslenii/.ole or terfenadine.
erythropoietin (epoetin) A renal hormone that regulates blood cell production in the bone marrow. Patients with renal failure maintained by haemodialysis do not
produce epoetin, and so become anaemic. A recombinant form of erythropoietin is available for replacement therapy.
Dose: 20-50 units/kg 3 times a week by s.c. or i.v. injection under haematological control. Side-effects include headache and hypertension, but a sudden migraine-like pain may indicate air impending hypertensive crisis. (Eprex; Itecormon).
eserine See physotiginine.
esmolol A very short-acting betaadrenoceptor blocker used in the emergency treatment of supra-ventricular arrhythmias, tachycardia and perioperative hypertension.
Dose: by i.v. infusion 50-200pg/kg/rniri under close control. (Brevibloc).
estramustine A compound of oestradiol and inustine, designed to release mustinc at oestrogen-receptor sites. It has a more localized action and so causes less myelodepression. It is used mainly in prostatic carcinoma, especially when resistant to other therapy.
Dose: 0.56-1.4 g daily. It should not be taken with food or milk products. Side-effects include gastrointestinal disturbances, nausea and gynaccomastia. (Fstracyt). See page 122 and Table 8.
ethacrynic acid A loop diuretic with a rapid and intense action used mainly in oliguria due to renal failure.
Dose: 50 ing daily initially, increased as required up to a maximum of400rng daily or on alternate days. Ethacrynic acid is also given by slow i.v. iniection in doses of 50-100 mg in acute or refractory conditions. Side-effects include nausea, diarrhoea and deafness. Some hypotension may occur initially. (Edecrin).
ethambutol An antitubercular drug.
Dose: 15 mg/kg daily, together with i i lo i i ipic in or isoniazid. Lower doses should be given in renal damage. It may cause visual disturbances with loss of acuity, but recovery is usually complete on withdrawal of the drug. (Myarnbutol). See page 170 and Table 31.
ethamsylate A haemostatic used in the prophylaxis and treatment of periventricular haemorrhage in low birth-weight infants.
Dose: 12.5 mg/kg by injection 6-hourly within 2 hours of birth and continued for 4 days. It is also used orally in menorrhagia. Dose: 2g daily. (Dicynene).
ethanolamine oleate A sclerosing agent used for varicose veins and bleeding oesophageal varices.
Dose: by local i.v. injection, 2-5 nil.
ether A colourless inflammable liquid, once widely used as a general anaesthetic but now replaced by halothane.