Posts Tagged ‘deficiency states’

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).
I Tyr
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.
103
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).
I Vas
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.
104
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.

pyrazinamide An antituberculous drug that is active against the intracellular and dividing forms of M. tuberculosis, and is most effective in the early stages of die disease. It penetrates the meninges, and is Of value in tuberculous meningitis. Dose: in combination with other drugs, 2 g 3 times a week. Side-effects include fever, jaundice and hepatotoxicity. Liver function tests should be carried out before and during treatment. (Zinamide). See page 170 and Table 31.
pyridostigmine An anticholinesterase similar to neostigmine. It has a slower and more prolonged action that is useful in some cases of myasthenia graves. Dose: 300–720 mg daily. The side-effect, are similar to those of neostigmine, but may be less severe. (Mestinon).
pyridoxine (vitamin B,) This vitamin plays an essential part in protein metabolism. Apart from its use in deficiency states, which are uncommon, pyridoxine has been used in isoniazid-induced neuropathy. Dose: 2,5-150 rig daily; in some sideroblastic anaemias, up to 400 rig daily.
pyrimethamine Ail antimalarial drug used with dapsone as Maloprint or with sulphadoxine as Fansidar in the prophylaxis of malaria. The use of these mixed products is not without risk, as they may have severe and sometimes fatal side-effects.
quetiapine A new ‘atypical’ antischizophrenic drug of the clozapine type with a high affinity for serotonin (5-HT) and dopamine DI and D2 receptors.
Dose: in schizophrenia, initilal doses of 25 rig twice a day, slowly increased up to 150-750 mg daily. Initial doses may cause hypotension. Care is necessary in cardiovascular disease. Side-effects include drowsiness and dizziness. The routine blood monitoring necessary with dozapine is not required. (Sew,jud). See page 108 and Table 30.
quinagolide A dopamine agonise used in
the treatment of hyperprolactinaemia.
I Rai
Dose: 25 jig at bedtime initially, increased at 3-day intervals to 75-100µg daily. Side-effects include hypotension, and the blood pressure should be monitored after a
change of dose. (Norprolac). See brornocriptine and cabergoline.
tquinalbarbitone sodium A short-acting barbiturate. Used in mild insoninia and anxiety states.
Dose: 50-100mg. (Seconal).
quinapril Ail ACE inhibitor with the actions, use and side-effects of that group of drugs. Dose: in hypertension, 5-10 mg daily initially, slowly increased to 20-40 mg as a single daily dose. (Accupro). See ACE inhibitors, page 148, and Table 21.
quinidine Ail alkaloid of cinchona, similar to quinine, that has been used in the preventive treatment of ventricular arrhydimias, but beta-blocking agents are now preferred.
Dose: (after a test dose of 200 rig) 200-400 mg 3-4 times a day. Side-effects are tinnitus, vertigo and confusion. Treatment should be stopped if response does not occur within 10 days.
quinine The principal alkaloid of cinchona bark. It was once used extensively in the treatment of malignant tertian malaria, and recently it has regained some of its value with the emergence of chloroquineresistant malaria.
Dose: 1.8 g daily for 7 days; in serious infections it is given by i.v. infusion in doses of 10 rig/kg for up to 3 doses, followed by oral therapy. Side-effects include tinnitus, nausea, rash and visual disturbances. See specialist literature.
rattitroxedV A selective enzyme inhibitor used in the palliative treatment of advanced colorectal cancer. It has advantages over fluorouracil, as treatment is less complicated and the incidence of leucopenia, mucositosis and other side-effects is less severe. Dose: 3 mg/ni! by slow i.v. injection, repeated at intervals of 3 weeks if tolerated. Blood counts and liver function tests are necessary. (Tomudex). See page 122 and Table 8.

ramipril An ACE inhibitor with the general properties of such drugs.
Dose: in mild hypertension, L25 ing daily, increased at intervals of 1-2 weeks tip to a maximum of 10 mg, given with food and adequate fluid. Prophylactic dose after myocardial infarction 5-10 ing daily. (Tritace). See page 148 and Table 21.
ranitidine A powerful and selective histamine H, antagonist of the cimetidine type, but with a longer action. It reduces the volume, acidity and pepsin content of gastric secretion, and is of value in peptic ulcer, reflux oesophagitis and similar conditions.
Dose: 300 nig daily for at least 4 weeks, maintenance (loses, 150 mg daily. In severe conditions, 50nig by i.ma or slow i.v. injection repeated at intervals of 6-8 hours. In suspected gastric ulcer, malignancy should be excluded before treatment is commenced. (Zantac). See cimetidine, page [62 and Table 27.
ranitidine bismuth citrateV It has the general action of ranitidine, but it also has a protective effect on the ulcerated area, and inhibits digestive action of pepsin on the gastric mucosa. It is given with amoxycillin and clarithromycin to promotethe elimination of Helicobacter pylori.
Dose: 800 mg daily. (Pylorid). See page 162.
razoxane A cytotoxic agent occasionally used in the treatment of leukaemias. Dose: 150-500 nighril daily for 3-5 clays, under laboratory control. Side electsare nausea and myleosuppression. (Razoxin).
Rif
Dose: by aerosol inhalation; 0.5-1 mg
( 1 -2 puffs), repeated up to 3 times a day. Side-effects include tremor an(] mild tachycardia. (Bronchodil). See page 118 and Table 6.
resorcinol A keratolytic agent used mainly as an ointment in acne, and as a hair lotion for removing dandruff. Myxoedema has been reported following the prolonged use of resorcin preparations.
reteplase A thrombolytic agent used in acute myocardial infarction.
Dose: 10 units by slow i.v. injection within 2 hours of the infarction. A second dose may be given 36 hours later, together with heparin, to reduce the risk of rethrombosis. Side-effects are arrhythmias an(] gastrointestinal bleeding. (Rapilysin). See page 156 and Table 24.
retinol See vitamin A.
riboflavine (vitamin B2) Part of the vitamin B complex, it is concerned with the oxidation of carbohydrates and amino acids. A deficiency causes several characteristic effects, including angular stomatitis and’burning feet’.
Dose: 1-10 mg in deficiency states associated with restricted diets or poor absorption.
rifabutinV A derivative of rifampicin used in the multi-drug treatment of pulmonary tuberculosis.
Dose: 150-450 mg daily. It is also used I,i,)I,Iiyl.iclically.ig,.iiii.%t opportunistic infection with Mycobacterium avium. (Mycobutin). See page 170 and Table 31.
reboxetineV An inhibitor of noradrenaline reuptake used in depression.
Dose: 4 ing twice a day, half-doses for the elderly. Side-effects are those of other antidepressants. Care in renal/hepatic impairment. (Fdronax). See page 128 and Table 11.
remifentanilV An analgesic of the fentanyl type used as an adjunct in doses of
0.5-1 fig/kg/min for the induction of anaesthesia. Its use reduces the amount of general anaesthetic required. (Ultiva).
reproterol A bronchodilator with the actions, uses and side-effects of salbutamol.
rifampicin An antibiotic now considered to be the first-choice drug in the treatment of tuberculosis, and given together with isoniazid and pyrazinamide.
Dose: 600 mg before breakfast. It is also used with dapsone and clofazimine in the initial treatment of severe leprosy. Combined therapy is also used in brucellosis, legionnaire’s disease and severe staphylococcal infections. Side-effects include gastrointestinal disturbances, rash, an influenza-likesyndrorne and hepatic reactions. Jaundice is a contraindication. Patients should be warned that rifampicin gives a red colour to the urine, sputum and tears, and to soft contact lenses. It may decrease the response to oral anticoagulants such as warfarin, and the failure of oral contraceptives has also been reported in patients receiving rifampicin. (Rifadin; Itiniaciane), See page 170 and Table 31.
riluzoleV A new drug used only for motor neurone disease (a myotrophic lateral sclerosis-ALS). ALS is a degenerative disease and may be due to the local accumulation of the neurotransmitter glutamate, with consequent neurone damage. Riluzole slows down the progressive nature of the disease, and improves the response to mechanical ventilation. Dose: 100 mg daily. See specialist liteiawre. Milutek).
rimiterol A bronchodilator similar in actions and uses to salbutamol, but with a shorter duration of effect. It is largely free from any cardiac stimulant activity. Rimiterol is used mainly for the relief of bronchospasm in bronchitis, bronchial asthma and similar conditions.
Dose: by aerosol inhalation, 200-600 pg ( 1-3 puffs) up to a maximum of 8 puffs daily. (Pulmadil). See page 118 and Table 6.
I sac
Lip to 350 pg/min. or 10 mg by i.m. injection and continued until the contractions have ceased; then orally up to 120 mg daily to prevent relapse. Side-effects include tremor, nausea and hyj)otension. (Yutopar).
rocuronlurn A muscle relaxant similar in actions and uses to vercuronium. Dose: 600 pg/kg initially, followed by 300-600 pglkglhrly as required.
(lisincron).
ropiniroleV A potent and selective
dopamine D,-receptor agonist used in the treatment of Parkinson’s disease, a condition basically due to a deficiency of dopamine in the brain. It is well absorbed orally, and reaches the central nervous system where it functions as dopamine replacement therapy.
Dose: first week 750µg daily with food; second week 13 ing daily, third week 2.25 mg daily, then 3 ing daily. Ropinirole may be given as monotherapy or together with levodopa. Side-effects are somnolence, hypotension, leg oedema and gastrointestinal disturbances. Caution in severe cardiac, renal and hepatic conditions. (Requip). See page 160 and Table 26.
89
Ringer’s solution An electrolyte replacement solution containing sodium
chloride, potassium chloride and calcium chloride.
risperidone An antischizophrenic agent of the clozapine type, with a selective affinity for serotonin and dopamine receptors. It may relieve the aggressive symptoms of
schizophrenia as well as the negative aspects such as apathy.
Dose: 6-10 mg. daily. Side-effects are headache, dizziness and agitation. Agranulocytosis is uncommon, and the close blood monitoring required with clozapine is not necessary. (Risperdal). See page 168 and Table 30.
ritonavirV An HIV-protease inhibitor used in HIV infections in association with a nucleoside analogue.
Dose: 1.2 g daily with food. (Norvir). See page 144 and Table 19.
ritodrine A beta,-adrenoceptor stimulant with a relaxant action on uterine muscle, used to inhibit premature labour.
Dose: 5opg/niin initially by i.v. infusion (avoiding fluid overload), slowly increased
ropivacaine A local anaesthetic with the actions and uses of lignocaine. (Naropin).
Rose bengal A (lye used as eye drops (M) to stain and detect damaged conjunctival cells, and in the diagnosis of dry eye.
rubella vaccine A suspension of a live, attenuated strain of rubella virus. It is used for active immunization in girls of 10-14 years, and in seronegative women of childbearing age.
Dose: 0.5 nil by s.c. injection. It is contraindicated in pregnancy, and pregnancy within 3 months of vaccination should be avoided. A combined rneasles/mUnipsit-111101,a (MMR) vaccine is now recommended for all children.
saccharin A synthetic sweetening agent widely used as a non-calorific substitute for sugar. Has been used by rapid i.v. injection (2.5 g in 4 ml) for arm-tongue circulation time.

mupirocin An antibacterial agent that is effective against most of the pathogens responsible for skin infections. It is used as a 2% ointment in impetigo, folliculitis and similar conditions. It should not be used for longer than 10 days to avoid the development of resistance. (Bactroban).
mustine A cytotoxic drug used mainly in the treatment of Hodgkin’s disease and related conditions.
Dose: 0.1 mg/kg daily for 3 days as a fast-running i.v. infusion, or as a single dose of oA ing/kg. The solution is highly irritant, and extra venous injection causes very severe local necrosis. Side-effects include severe vomiting, bone marrow depression and alopecia. Close haematologicalcontrol during treatment is essential. Now in less frequent use. See page 122 and Tabl’. 8.
nabumetone A non-acidic anti-inflammatory agent of the naproxen type. It is effective in rheumatoid and osteoarthritis and has reduced gastric irritant properties. Dose: I g at night. Reduced closes are necessary in renal impairment, and the dose of any oral anticoagulant or hypoglycaemic agent may require adjustment. (Relifex). See page 165 and Table 29.
nadolol A beta-blocking agent with the
actions and uses of propranolol.
Dose: in angina, 40 mg daily, or more; in hypertension, 80 mg daily, increased slowly as required; in the prophylaxis and treatment of migraine, 80-160 mg daily. Maximum daily dose 240 mg. (Corgard). See pages 114 & 148, and Tables 4 & 21.
nafarelin A synthetic suppressant of steroid production by the gonads, and used in the treatment of endometriosis.
Dose: given as it once-only course of treatment by nasal spray in doses of 200 pg twice a day, starting between 2 and 4 days of the menstrual cycle, and continued for up to 6 months. Side-effects are numerous and of the menopausal type. (Synarel). See buserelin, goserelin and leuprorelin.
mycophenolate mofetil An immunosuppressant used together with cyclosporin and corticosteroids to prevent acute renal transplant rejection. It acts on a specific enzyme concerned with”]’- and B-lymphocyte proliferation, as well as inhibiting antibody formation.
Dose: 2 g daily, starting within 24 hours (d transplantation. Blood counts are necessary during treatment, and, as with other immunosuppressants, there is an increased risk of opportunistic infection. (CellCept).
nabilone A cannabinoid antiemetic used in the treatment of nausea and vomiting associated with cancer chemotherapy. Dose: 2-4 ing daily, beginning the day before cytotoxic treatment is commenced, and continued for a day after the end of the course. Side-effects are drowsiness, confusion and tremor. Care is necessary in liver dysfunction or any history of psychotic illness. See page 158.
naftidrofuryl A peripheral and cerebral vasodilator. Claimed to be of value in cerebrovascular disorders.
Dose: 300-600 ing daily. (Praxilene).
nalbuphine An opioid analgesic, comparable with morphine in potency, but with reduced side-effects and a reduced dependence potential.
Dose: by injection, 10-20 ingas required. It may cause nausea and dizziness, and care is necessary in respiratory, renal or hepatic dysfunction. (Nubain).
nalidixic acid A quinolone antibacterial agent used in cystitis and infections of the lower urinary tract, especially those due to Gram-negative bacteria (except Pseudornoricts). It is not suitable for systemic infections as the blood levels reached with nalidixic acid are too low to be effective.
Dose: 4 g daily for 7 days, with subsequent doses of 2 g daily. Side-effects arc nausea, visual disturbance, rash, jaundice and phototoxicity. Exposure to sunlight should be avoided; epilepsy is a contraindication. (Mictral; Negrain). See ciprotloxacin and norfloxacin.

naloxone A powerful and rapidly acting opioid narcotics antagonist. It is used immediately after operation to reduce any narcotic-induced respiratory depression. Dose: 100-200µg i.v. initially, followed by 100 µg at 2- minute intervals, as required. For neonates, 10 pglkg by iniection are given. In narcotic analgesic overdose, 800 lig-2 nig may be given, 111, to a total dose of 1 0 ing. (Narcan).
naltrexone A long-acting narcotic antagonist used only to prevent relapse and maintain recovery after treatment for opioid addiction. It prevents re-addiction only whilst the drug is being taken. Dose: 25 ing initially, later up to 50 mg daily. It must not be given to patients who are still opioid-dependent as an acute withdrawal syndrome may be precipitated. (Nalorex).
nandrolone An anabolic steroid related to testosterone, with markedly reduced virilizing properties. It has anabolic or tissue-building properties and has been used in postoperative convalescence, osteoporosis and wasting diseases but the response is poor. It is sometimes effective in aplastic anaemia.
Dose: 50 ing by deep Lin. injection every 3 weeks. (Deca-Durabolin).
the prophylactic treatment of asthma, but it is not effective in an established attack. Dose: by aerosol inhalation, 8 mg (4 pulls) daily. Side-effects are transient nausea and headache. (Tiladc). See page 118. It is also used as eye drops in allergic conjunctivitis. (Rapitil). See page 118 and Table 2.
nefazodoneV A new antidepressant of the selective serotonin-re-uptake inhibitor (SSRI) type.
Dose: 200-600 mg daily. (Dutonin).
nefopam An analgesic for moderate, acute and chronic pain before using more potent drugs. Dose: 90-270 ing daily; 20 mg by i.m. injection. Side-effects include drowsiness, headache and tachycardia. Care is necessary in hepatic or renal disease. (Acupan).
neomycin An antibiotic with a wide range of activity against Gram-positive and Gram-negative bacteria, but it is too toxic for systemic use. It is used mainly as an
ointment or cream (0.5%), often with an anti-inflammatory steroid, in infected skin conditions. It is also used locally for ear and eye infections as drops (0.5%), and it is occasionally given orally in doses of 6 g daily before bowel surgery. Extended local use may cause allergic reactions, and occasionally ototoxicity. (Mycifradin; Nivemycin).
73
naproxen A widely used non-steroidal anti-inflammatory agent (NSAID) for the relief of rheumatic and musculoskeletal
disorders and acute gout.
Dose: 10-1 g daily, increased up to 2g daily in severe conditions. Suppositories of 500 ing are useful at night to reduce morning stiffness. Side-effects include headache, dizziness, and dyspepsia with occasional bleeding. Blurred vision may also occur, as well as I p hy ersensitivity reactions such as rash and bronchospasm. Care is necessary in renal and hepatic impairment; peptic ulcer is a contraindication. (Naprosyn; Syntlex). See page 165 and Table 29.
naratriptanVA serotonin (5-H’I',) receptor agonist for the treatment of acute migraine. Dose: 2.5 mg. A second dose may be given after at least 4 hours if the symptoms recur. (Nararnig). See page 154 and Table 23.
nedocromil An inhibitor of the release of inflammatory mediators in the respiratory tract. It is used like sodium cromoglycate in
neostigmine An inhibitor of cholinesterase which thus indirectly prolongs the action of acetylcholine released at nerve endings. It is used mainly in the treatment of myasthenia gravis.
Dose: 75-300 mg daily; 1-23 mg by injection. Side-effects are nausea, salivation, diarrhoea and abdominal cramp, and supplementary treatment with an anticholinergic drug may be required. It is also used postoperatively to antagonize the residual effects of muscle relaxants. Dose: 1-5 mg i.v., after a preliminary iniection of 0.3-1 nig of atropine. It is contraindicated in urinary or intestinal obstruction. (Prostiginio).
netilmidn An aminoglycoside antibiotic, less toxic than related drugs. Used mainly in severe infections of the urinary and respiratory tracts that are resistant to gentamicin. Dose: 4-6 mg1kg daily by i.v. injection; in urinary tract infections a single oral daily dose of 150 mg is given for 5 days. Side-’ effects are dizziness, vertigo, malaise and rash; ototoxicity may also occur. (Netillin).

neuromuscular blocking agents Drugs used to induce adequate muscle relaxation under a light plane of anaesthesia to facilitate surgery. The non-depolarizing agents such as vercuronium compete with acetylcholine at the neuromuscular receptor site, and have a relatively long action that can be reversed by neostigmine. The depolarizing relaxants, such as suxamethonium, have an acetylcholine-like action oil the receptor site, but as they are broken down less rapidly than acetylcholine, they delay the return of the ability of the muscle to contract again. The action of suxamethonium cannot be reversed by neostigmine.
niacin See nicotinic acid.
nicardipine A calcium channel blocking agent with it coronary vasodilator action similar to that ofverapaiiiii, but with reduced anti-arrhythmic activity. It is used mainly in angina and hypertension, and unlike verapamil it may be given to patients already receiving beta-blockers. Dose: 60-120 ing daily. Side-effects arc dizziness, flushing, nausea and palpita-
tions. If chest pain occurs early, the drugshould be withdrawn. Marked aortic
stenosis is a contraindication. (Cardene). See page I H and ‘]’able 4.
niclosamide A synthetic anthelmintic of value in the elimination of tapeworm. Dose: after lasting 2 g followed 2 hours later by a purge. The tablets should be chewed or crushed, and taken with a glass of water. Side-effects are nausea and abdominal pain, and occasionally pruritus. (Yoniesan).
nicorandil A cardiac drug that has an action mediated by the activation of potassium channels. It reduces the excitability of cardiac muscle and promotes coronary circulation, and is used in the prophylaxis and treatment of angina.
Dose: 5 10ing twice daily initially, rising to a maxintuin of6onig daily. Side-effects are initial headache, palpitations, dizziness. (lkorel). See page 114 and Table 4.
nicotinarnide A compound derived from nicotinic acid, possessing similar properties, but differing in that it has little vasodilator action. It is useful in
deficiency states as well as in pellagra when the vasodilator action of nicotinic
acid limits the dose. It is also used locally as a 4% gel (Papulex) for the treatment of inflammatory acne vulgaris.
nicotinic acid An essential food factor, occurring in yeast, liver, etc., but now prepared synthetically. It is a specific in the treatment of pellagra. It causes vasodilation, and has been used in Wni&e’s disease and chilblains, but with variable results. In large doses it reduces the plasma levels of some lipoproteins. Dose: 10-30 mg daily for prophylaxis; therapeutic dose in pellagra, 250-500 mg daily. In hyperlipidacinia up to 6 g daily have been given. Side-effects include flushing, dizziness and pruritus, which may sometimes lie reduced by taking aspirin 75 mg half an hour before a dose. See page 146,
nicotinyl alcohol A derivative with the vasodilator properties of nicotinic acid, but they are less intense. Useful in peripheral circulatory disturbances such as Raynaud’s disease and acrocyanosis. Dose: 100-200 mg daily. (Ronicol).
nicournalone A synthetic anti-coagulant similar to warfarin, and used mainly in the treatment of deep-vein thrombosis. Dose: 8-12 ing initially; subsequent doses are based on the response, as shown by determination of the blood prothrombin time, expressed as the International Normalized Ratio (INR). Haemorrhage is a potential side-effect. (Sinthrome).
nifedipine A calcium channel blocking agent similar to verapamil, but with a more powerful peripheral and coronary vasodilator action. It is used in the treatment of angina, hypertension and Raynatid’s disease, and may be given if required in association with a beta-blocking agent.
Dose: in angina, 15-60 mg daily; in hypertension 40-80 mg daily. Side-effects are flushing and headache, which are usually transient, and some ankle oedema may occur. It should be withdrawn if anginal pain develops. Severe aortic stenosis is a contraindication. (Adalat• Coracten; Nifensar). See pages 114 & 148, and “fables 4 & 21.
nimodipine A calcium channel blocking agent that acts preferentially on the cerebral vessels. It is used in subarachnoid haemorrhage to prevent ischaemic sequelae.

butobarbitone A barbiturate of medium clisityand rapidity of onset.
Dose: 60-200 mg. (Soneryl).
cabergoline A dopamine similar to bromocriptine, but with a longer .1, 1 ioli.
Dose: for suppression of lactation I mg, followed by doses of 0.25 ing for 2 days. Nausea, dizziness and breast pain are side effects. (Cabaser; Dostinex).
cadexomer iodine A modified starch powder containing 0.9% of iodine in a slow release form. It is used as an antiseptic application for venous ulcers and pressure sores. It should not be used during prenancy or lactation, during thyroid investigations or in patients sensitive to iodine. (lodosorb).
caffeine The central nervous system stimulant present in tea and coffee. It is used with paracetamol and other mild analgesics.
calamine Zinc carbonate. It has a mild astringent and soothing action and is widely used as Calamine Lotion for skin irritation and as Oily Calamine Lotion in eczema.
calciferol (vitamin D 2) form of vitamin 1) used in the prophylaxis and treatment of deficiency states such as rickets in children and osteomalacia in adults, and in other bone disorders. Dose: prophylactic 800 units daily; therapeutic 5000-50 000 units daily. In resistant rickets and parathyroid deficiency, higher doses may be required, but such therapy requires care, as hypercalcaemia percalcaernia and irreversible renal damage may occur. See ako alfacalcidol and calcitriol.
calcipotriol An analogue of vitamin D with a selective inhibitory action on the proliferation of keratinocytes. Used in the treatment of psoriasis as a 0.005% cream or ointment twice a day. Not more than 100 g/week. (Dovonex).
calcitonin Pork-derived calcitonin is a hormone that has an action similar to that
of the parathyroid gland in regulating blood calcium levels. It is used in the hypercalcaemia associated with malignancy, and in osteoporosis. It is also of value in Paget’s disease of bone, in which it relieves bone pain and reduces the neurological symptoms.
Dose: 10-160 units daily by s.c. or i.m. injection according to need and response. In Paget’s disease, prolonged treatment for some months may he required. Side-effects are nausea, flushing and paraesthesia, and local reactions may also occur. (Calcynar; Calcitare; Miacalcic). See salcatonin.
calcitrol The metabolite formed in the kidney from calciferol. It is the most powerful and rapidly acting metabolite with vitamin L) activity. It is of value in chronic renal deficiency states when the normal metabolism of calcium and phosphorus is impaired, as in renal osteodystrophy. Dose: 1-2 pg daily under biochemical control. Side-effects, such as hypercal-
caemia and hypercalciuria, are usually , P
reversible on withdrawing the drug. (Rocaltrol).
calcium channel blocking agents The movement of calcium ions through the calcium channels of the myocardium plays an essential role in cardiac activity. The inhibition of such movement by channel blocking agents reduces myocardial contractility and lowers the tone of the cardiovascular system. Such a reduction is of value in angina, hypertension and cardiac arrhythmias, and can be obtained by the use of calcium channel blocking agents such as diltiazem, felodipine, isradipine, nicardipine, nifedipine, nimidopine and verapamil. These compounds exhibit certain differences in action and in therapeutic applications, and their use requires care. Nifedipine and veraparail have been used in the prophylactic treatment of migraine. Their side-effects include nausea, oedema, rash and bradycardia. See pages 114 & 148, and Tables 4 & 21.
calcium carbonate A time honoured antacid now used less frequently. It also acts as a phosphate binder, and is used in hyperphosphatacinia.
calcium chloride The calcium salt present In various intravenous electrolyte solutions.

calcium folinate See folinic acid.
calcium gluconate A soluble and well-tolerated calcium salt used in many condi- tions associated with calcium deficiency such &i rickets, coeliac disease and parathyroid deficiency; also during pregnancy and lactation often in association with vitamin D. Calcium gluconate is also given in chilblains, urticaria and allergic reactions. Dose: usually given in (loses of 0.5-2g, but ill hypocalcaemic tetany it is given by slow i.v. injection in doses of 10 ml of a 100% solution, with laboratory control of the blood calcium levels. Calcium gluconate is also given i.v. in the early
treatment of toxic hyperkalaemia.
calcium lactate The calcium salt most commonly given orally in mild deficiency states.
Dose: 1-5 g.
Calcium Resonium An ion-exchange resin that take, up potassium in exchange for calcium. Used in hyperkailatentia associated with anuria and haernodialysis. Should be used only when potassium and calcium serum levels are under biochemical control. Dose: 15- 30g 3 or 4 times a day. In children, 0.5-1 g/kg daily. It is sometimes given as a retention enema.
are given in heart failure. Side-effects include proteinuria, neutropenia, agranulocytosis, rash and loss of taste. (Acepril; Capotin). See ACE inhibitors, page 148 and Table 21.
carbachol A parasympathomimetic agent used orally and by injection in the treatment of postoperative atony and retention of urine, and occasionally as eye drops (3%) in i the treatment ofglaucoma. Dose: 2-4 ing orally, 250 pg by s.c. injection. Side-effects include nausea, bradycardia and colic.
carbamazepine An anticonvulsant effective in all types of epilepsy except petit mat (absence seizures). It is also of value in trigeminal neuralgia and is given prophylactically in manic-depressive states. Dose: 200-400 ing daily initially, slowly increased up to 1.8 g daily if required. Suppositories of 125-250 mg are available. Carbamazepine has some antidiuretic properties, and has been used in diabetes insipidus in doses of 100-2M mg daily. Side-effects include dizziness, gastrointestinal disturbances and all erythematous rash. (Tegretol). See page 136 andTable 15.
carbaryl An insecticide used as it lotion and shampoo in pediculosis.
canrenoate A steroid-derived aldosterone antagonist with the actions and uses of spironolactone.
Dose: given in oedema by slow i.v, inject ion or infusion in doses of 200-400 mg daily. Nausea and vomiting are high-dose side-effects. (Spiroctan-M).
capreomycin An antibiotic of value in resistant i uberculosis or when other drugs are not tolerated.
Dose: I g daily by i.m. injection. It may cause tinnitus, deafness, renal damage and allergic reactions. (Capastat).
captopril An inhibitor of the angiownsin converting enzyme. It is used in the treatment of hypertension, including that resistant to other therapy, but care is necessary as the initial dose may cause marked hypotension, and so is best taken ill bed. It is often given with a thiazide diuretic to improve the response, and with a beta-blacker to maintain the effect. Dose: 25 mg initially, slowly increased, as required, up to 450 mg daily. Similar doses
carbenoxcilone A cytoprotectant derived front liquorice, used for mouth ulcers. (Bioplex; Bioral). See Table 27.
carbidopa An enzyme inhibitor used with ievodopa in parkinsonism. It prevents the breakdown of levodopa, thus permitting a larger amount to reach the brain. See
page 160.
carbimazole An antithyroid drug. It inhibits the formation of thyroxine and is valuable in the treatment of thyrotoxicosis and in preparation for thyroidectomy. Dose: 30-60 mg, daily initially; maintenance dose, 5-20 ing daily. It is sometimes given together with thyroxine it) the’blockage replacement’ treatment of hyperthyroidism. Side-effects are nausea, rash and pruritus; alopecia and agranulcytosis have been reported. (Neo-Mercazole).
carbocisteine A mucolytic agent used to reduce the production and viscosity of sputum in respiratory disorders.
Dose: 1.5 g daily. (Mucodyne).