Posts Tagged ‘diabetes mellitus’

imipenem An antibiotic with a range of activity that includes Gram-positive and Gram-negative bacteria, as well as aerobes and anaerobes, and is indicated in infections due to such organisms. It is given by i.v. infusion in doses of 1-2 g daily. Also used in surgical prophylaxis. As it is inactivated to some extent by kidney enzymes, it is always given together with the specific enzyme inhibitor cilastatin. The side-effects are numerous and include those common to other antibiotics. Care is necessary in hypersensitivity to the penicillins, cephalosporins and related antibiotics, and in epilepsy. (Prinlaxin).
imipramine A tricyclic antidepressant with the general action, uses and side-effects of amitriptyline, but with a reduced sedative action. It has been widely used in acute
endogenous depression, although the initial response may be slow, and long treatment may be required.
Dose: 7; ing daily, increased up to 200 mg. A single (lose of 150 mg may be given at night. It is sometimes used in the treatment of enuresis in closes of 25-50 mg. liniprarnine should not be given in association with or soon after monoamine oxidase inhibitors, as the effects of both drugs may be increased. Innipramine may also reduce the response to some anti-hypertensive drugs. (Tofranil). See
page 128 and Table 11.
immune defence system of the body, their use requires care. The systemically acting corticosteroids such as prednisolone also have valuable immunosuppressant
properties. Cyclosporin has a powerful immunosuppressant action with little myelotoxicity, and is also used in the prophylaxis of graft-versus-host disease (GVEID). Tacrolinus is a new product with the actions and uses of cyclosporin.
indapamide A slow-acting thiazide- related
drug used in hypertension.    57 Dose: 2.5 nig daily, continued for some months, until a maximum response has been obtained. Combined treatment with beta-blocking agents and other drugs may increase the response, but saluretic diuretics are not recommended as they may cause hypokalaemia. (Natrilix). See page 1,18and’I able 21.
indigo carmine A blue dye that has been used as a 0.4% solution by injection as a renal function test. Normally the urine is coloured blue in 10 minutes or so.
indinavirV An antiviral agent that functions as all inhibitor of HIV-protease. It prevents the development of immature virus particles into infective virus. It is best given in combination with another antiviral agent such as acyclovir which acts by a different mechanism.
Dose: 2A g daily, with ample fluid between meals. Care is necessary in hepatic impairment. (Crixivan). See page’ 144 and Table 19.
immunoglobulin The normal product obtained from plasma is given for protection against hepatitis, measles, rubella and hepatitis A in susceptible patients. More specific products are hepatitis B immunoglobulin, tetanus human immunoglobulin (H’1′1(;) and varicella-zoster immunoglobulin (VZIG). Anti-D(Rh) immunoglobulin is used to prevent a rhesus-negative mother from forming antibodies to fetal rhesus-positive cells that may reach the maternal circulation, and so protect any further child from the risks of haemolytic disease.
immunosuppressants Drugs such as azathioprine that suppress the normal immune response are used in transplant surgery to prevent tissue rejection, but as their action includes depression of the
indomethacin A non-steroidal anti-inflammatory and analgesic agent (NSAID) of value in arthritic and rheumatoid conditions, and in acute gout. Dose: 50-200 mg daily with loud. Suppositories 100 mg are useful at night to reduce morning stiffness. Dose in dysmenorrhoea, up to 75gdaily. Side-effects are numerous and include gastrointestinal disturbances, which may be severe and cause bleeding,
dizziness and confusion. Hypersensitivity I PC
reactions with blood disorders have been reported, and blurred vision with corneal deposits may occur with prolonged treatment. Indornethacin is also used by i.v.
injection for the closure of the patent ductus arteriosus in premature babies, but the dose requires careful assessment under specialist supervision. (Iriclocid; Inibrilon). See page 161 and Table 29.

indoramin An alpha-adrenoceptor blocking agent used in hypertension. It has a selective action on the alpha- receptors, and by preventing the release of noradrenaline it reduces peripheral resistance and lowers the blood pressure. The response may be increased by combined treatment with a thiazide diuretic or a beta-blocking agent. Dose: 30 nig initially daily, increased, if required, up to 200 nig daily. Side-effects include drowsiness, dizziness and some anticholinergic reactions such as dryness of the mouth. (Baratol). It is also used for the symptomatic reliefofbenign prostatic hypertrophy in doses of 40-100 mg daily, although in elderly patients small doses of 20 nig at night may be effective.
(Doralese). See page 148 and Table 21.
inosine pranobex A complex containing the pinkie metabolite inosine. The complex has antiviral properties, and may act more by stimulating the immune system than by a direct action on viral replication. Indicated in herpes simplex virus infections of the skin and mucous membranes.
Dose: 4 g daily for 1-2 weeks. (,are is necessary in renal impairment, gout or hyperuricaernia. flinintmovir).
inositol nicotinate A vasodilator agent used mainly in peripheral vascular disorders such as Raynaud’s disease, and acrocyanosis.
Dose: 1-4 g daily. (Hexopal).
insulin The antidiabetic principle of the pancreas, regulating the metabolism of carbohydrates and fats. It is widely used in the treatment of diabetes mellitus by s.c. injection in doses adjusted to individual need. Many modified insulin products are available, designed to extend the duration of action and reduce the frequency of injections, and so simulate the effects of the natural hormone more closely. Human insulins, obtained by the modification of pork insulin (erne) or by biosynthesis (crb) are also available, and are used routinely to an increasing extent. A transfer front animal to human insulin requires monitoring, and patients should be warned that the usual early symptoms of hypoglycaemia may be less marked. In diabetic emergency, soluble insulin remains the preparation of choice. See page 131 ;in(] Table 12.
interferons Protective proteins formed in
mammalian cells in response to viral
invasion. Interferon alfa, obtained by DNA technology, has cytotoxic properties, and is used in hairy cell leukaemia and renal cell carcinoma. Interferon gamma is used with antibiotics in chronic granulomatous disease.
Dose: sec data sheets.
interleukin See aldesleukin.
iodine Powerful antiseptic used as povidoneiodine for skin preparation. Hypersensitivity to iodine skin applications is not unknown. Given orally in preoperative Treatment of thyrotoxicosis.
Dose: as Aqueous Iodine Solution
I IA1g0l’S solution) 0.3-1 nil diluted with milk or water.
iodized oil Poppy-seed oil containing 40% iodine in combination. Used as a contrast agent in lymphangiography, hysterosalpingography, and other radiological
examinations.
iodoform Yellow powder with strong odour. Ni ill antiseptic used occasionally as BIPP.
iopanoic acid A radio-opaque substance used as a contrast agent in cholecystography. It is largely excreted in the bile when given orally.
Dose: 2-6g.
iophendylate An oily liquid containing 300,’o of combined iodine. It is mainly used as a contrast agent in myelography. Dose: 6-9 nil by injection into the subarachnoid space. Before intrauterine blood transfusion, 9 nil have been injected into the amniotic sac to outline the fetus. Shock and violent coughing may occur if any iophendylate reaches the circulation.
ipecacuanha The dried root front which enietine is obtained. It has emetic properties, and is used mainly as Ipecacuanha Emetic Mixture in some forms of
Poisoning.
Dose: 30 ml in adults; 10-13 nil in
children.
ipratropium An anticholinergic agent with hronchodilator properties. Of value in bronchoconstrictive states not responding to selective beta,-receptor stimulants represented by salbutamol. It is relatively free front the side-eficcts associated with anticholinergic drugs.

Dose: by aerosol inhalation, 20-40pg (1-2 puffs) 4 times a day. Similar doses are given by nasal spray in watery rhinorrhoca. (Atrovent). See page I IS and Table 3.
irbisartan An angimensin 11-receptor antagonist used in hypertension. It acts at a later stage than the ACE-inhibitors, and is less likely to cause drug-induced cough. Dose: 150-300 mg once a day. (Aprovel See page 148 and Table 21.
irinotecanV An inhibitor of topoisomerase 1, an enzyme involved in DNA replication. Used in colorectal cancer. Dose: 150-350 nighn’by i.v. infusion. Side-effects are neutropenia and diarrhoea. (C.-arripto). See page 122.
iron-sorbitol An injectable iron product for me when oral iron therapy is not possible or not effective. It is given by deep i.m. injection, taking care to prevent leakage back along the injection track to avoid staining the skin, in doses based on the degree of iron deficiency. (Jectofer). See page 112 and Table 3.
iron salts See ferrous sulphate.
isocarboxazid A monoamine oxidase inhibitor with the antidepressant action, uses and side-effects of phenelzine. Dose: 30 mg initially daily, subsequently increased if necessary up to 60 mg daily, reduced later to 10-20 mg daily according to need. (Marplan). See page 128 and Table 11.
isoconazole An antifungal agent similar to miconazole. Used tot the single-dose local treatment of candidal and trichomonal vaginal infections.
Dose: 600 mg as 2 vaginal pessaries. I r.i\ogvn,.
isofluorane An inhalation anaesthetic with the action and uses of halothane and enllurane. It is given as a 0.5-3% oxygen-nitrous oxide mixture from a calibrated vaporizer.
isonlazid A pyridine derivative with a specific action against Mycobacterium tuberculosis. Widely used in the treatment of tuberculosis, but as bacterial resistance soon develops combined treatment with other drugs such as rifampicin is essential. Dose: 300 mg daily, or 1 g twice it week,
I tar
and Mien continued for some months. Side-effects include nausea and peripheral neuritis, rash and psychotic episodes. See page 170 and Table 31.
isoprenaline An old adrenaline-like beta-receptor agonist. It is used occasionally for the short-term treatment of severe heart block and bradycardia.
Dose: 5-10 lighnin by i.v. injection. Also used in airways obstructive conditions by aerosol inhalation in doses of 80-240 pg ( 1-3 puffs) as required. (Saventrine).
isosorbide dinitrate A vasodilator with
the actions, uses and side-effects of
glyceryl trinitrate, but with a more prolonged action.
Dose: in acute angina, 5-10 mg, sublingually; for extended treatment 30-120 mg orally daily; in left ventricular failure tip to 240 nig daily; by i.v. infusion, 2-10 mg/hr. See page 114 and Table 4.
isosorbide mononitrate The active metabolite of the dinitrate. It escapes first-pass loss in the liver, and has a more rapid action. May cause peripheral vasodilatation and headache.
Dose: 40-120 mg daily. See page 114 and
isotretinoin A potent, orally active derivative of vitamin A. It is used for severe acne not responding to other treatment, and brings about a prolonged remission of symptoms.
Dose: iOo pg/kg daily for 4 weeks to assess response, followed by treatment for 8-10 weeks. An exacerbation of symptoms is common after 2-8 weeks which usually subsides later. Side-effects include dryness of mucous membranes, conjunctivitis, nausea and muscle pain. Isotretinoin is teratogenic so pregnancy must be avoided. Its use requires care under expert supervision. (Roaccutime).
ispaghula The husk of ispaghula seed. It swells in water and is used as a bulk laxative It is also useful in irritable bowel syndrome and diverticulitis.
Dose: 3–,g daily.
isradipine A calcium channel blocking agent used in hypertension.
Dose: 5 mg daily initially

A-Z Principal Drugs (antidepressants - astemizole)
antidepressants The drugs used in the treatment of depression fall into two main groups, the so-called tricyclic antidepressants and the monoamine oxidase inhibitors (MA01s). (Unrelated drugs include lithium carbonate, used only for the prophylaxis and treatment of manic depressive illness.) The tricyclic group, which also includes sonic other compounds with a similar action, appear to act by blocking the neuronal uptake of central transmitters such as noradrenaline and serotonin. They are more widely used than the MAOIs because they are more generally effective, and interact less extensively with other drugs and certain foods. The tricyclic drugs are widely used in endogenous depression, particularly when sleep disturbances are present, but the onset of action is slow, and improvement may not commence until after 2-4 weeks of treatment. Extended therapy is usually required to avoid the risk of a relapse, and patients should be advised accordingly. Sonic tricyclic antidepressants, such as amitriptyline, have a sedative action of value when anxiety is a complicating factor, whereas a less sedating drug such as imipramine may be useful in patients exhibiting apathy and withdrawal. Some of the side-effects, such as dryness of the mouth, are linked with their anti-
cholinergic activity, but tolerance may develop with continued treatment. They also influence the cardio-vascular system and may cause arrhythmias, tachycardia and hypotension, and may interfere with the action of some antihypertensive drugs, although the response to beta-blocking agents is unaffected. Care is necessary in cardiac disease, and with the elderly initial doses should be low. The use of tricyclic antidepressants in epileptic patients may result in a lowering of the convulsive threshold. See page 128 and Table 11.
antidiabetic agents Diabetes mellitus is a deficiency disease due to a lack of insulin, and is characterized by an excessive level of glucose in the blood and urine. Treatment is either replacement therapy with daily injection of insulin, or orally by hypoglycaemic agents such as chlorpropamide. Such agents act by stimulating insulin secretion and release by the beta-cells of the pancreas, and are ineffective in the absence of such cells. See page 132 and Tables 12 & 13.
anti-D(Rh.) immunoglobulin An ininiurioglobulin that is given to a rhesus-negative mother to prevent her forming anti-bodies against fetal rhesus-positive cells which may pass into the maternal circulation during childbirth or abortion and which, in a later pregnancy, could cause haemolytic disease.
Dose: 504) units Lin. within 60-72 hours of delivery or abortion. Doses of 1250 units are given prophylactically. It is of no value it’given after anti-D antibodies have been formed. The inimunoglobulin has also been given after the transfusion of rhesus-incompatible blood. (Partobulin).
antiemetics Nausea and vomiting may be due to several causes, including stimulation of the chemoreceptor trigger zone in the reticular formation of the brain. Man), antiemetics have some degree of central activity, and in some cases their action may be mediated by blocking the effects of dopamine on the trigger zone. Effective drugs include some antihistamines and sonic phenothiazine-based tranquillizers such as prochlorperazine. The alkaloid hyoscine is widely used in travel sickness. More powerful drugs such as domperidone, metoclopramide, nabilone and ondansetron, are of value in the control of the severe nausea and vomiting induced by cytotoxic drugs. The use of antiemetics in early pregnancy requires great care, and is seldom essential.
antiepileptics See anticonvulsants, page 136 and’] able 15.
antihistamines Drugs such as promethazine are of value in conditions associated with the release of histamine from mast cells, such as hayfever, rhinitis, urticaria, pruritus, insect bites and stings. They are also useful in drug allergies. Some antihistamines also have antienietic properties, and are useful in travel sickness. Although all antihistamines have the same basic action, the degree and duration of response and the severity of side-effects may vary. Some antihistamines pass easily into the central nervous system arid are more likely to cause drowsiness. Others may have reduced anticholinergic properties, and cause less dryness of the mouth and blurring of vision. Care is necessary in epilepsy, glaucoma, hepatic disease or prostatic enlargement. See page 110 and Table 2.

antihypertensive agents See page 148 and Table 2 1.
anti-inflammatory agents See non-steroidal anti-inflammatory drugs (NSAIDS) and page 165 and Table 29.
antimetabolites Cytotoxic drugs that appear to act by combining irreversibly with cell enzymes, and so prevent cell division. Methotrexate and mercaptopurine are examples. See page 122 and Table 8.
dermatology and pruritus as oily calamine lotion. Arachis oil enema is used to soften impacted faeces.
argipressin A synthetic form of vasopressin.
artificial tears Some chronic sore eye con clitions may occur in rheumatoid arthritis, and may be due to tear deficiency. Solutions of itypromellose or polyvinylalcohol, sometimes referred to as’artificial tears’, are useful as a bland lubricant to replace the tear deficiency. (Isopto; Hypotears).
antimuscarinic agents See anticholinergic agent” page 160 and Table 26.
antineoplastic agents Anti-cancer drugs. See page 122 and ‘rabic 8.
antipsychotic agents See pages 117 & 1(,8, and Tables 5 & 30.
antitetanus immunoglobulin aulloglobulin obtained from plasma is used in injured patients who have not previously been immunized, and when tetanus is a definite risk. Dose: 250 units jan. A course of tetanus vaccine should also be commenced,
antitubercular agents See rifampicin, page 170 and I able 31.
antiviral agents See page 144 and Table 19.
anxiolytics See page H 7 and Table 5.
apomorphine A morphine derivative formerly used as a powerful emetic, but now considered to be too toxic. Occasionally used in the hospital treatment of parkinsonism. (Britaject).
apraclorildine A clonidine derivative used as eye drops I 9A, to control intraocular
pressure during ophthalmic surgery. Some absorption may occur, so care is necessary in severe cardiovascular disease. (lopidine).
aprotinin An inhibitor of the proteolytic enzyme plasmin, obtained from bovine lung tissue. It is used in the severe haemorrhage due to hyperplasminaemia.
Dose: 500 000-1 000 000 units by i.v. infu.ioll. (Trasylol).
arachis oil Groundnut or peanut oil. It has
emollient properties, and is used in
ascorbic acid (vitamin C) Present in many citrus fruits. Deficiency is not uncommon in the elderly receiving inadequate diets. Severe deficiency causes scurvy, once the bane of seafarers.
Dose: for prophylaxis 25-75 mg daily; therapeutic dose 200-500 mg daily. Doses of 4 g daily are given for acidification of the urine. Claims that vitamin C prevents colds are unproven.
asparaginase Crisantaspase. See page 122 and Table 8.
aspirin (acetylsalicylic acid) Widely used as a mild analgesic and anti-inflammatory agent, often in association with other drugs such as paracetamol and codeine. Dose: 1.2-4 g daily, but in acute rheumatoid conditions doses of 4-8 g daily have been given. Long-term treatment with (loses of 75 mg daily are given liar the prophylaxis of cardiovascular disease. Side-effects include gastric irritation with some blood loss, hyperventilation, and bonitos, with the risk of deafness, may occur with high doses. Aspirin may cause rash and bronchospasm in asthmatic and other sensitive patients. As aspirin is now thought to be associated with Reye’s syndrome, the drug should not be given to children under 12 years of age unless specifically indicated. Aspirin may increase the effects of certain hypoglycaemic and anticoagulant drugs.
astemizole An antihistamine with an extended action and reduced sedative effects.
Dose: Wring once daily before food, and must not be exceeded. Higher doses may cause cardiotoxic side-effects such as ventricular tachycardia. Arrhythmias may follow combined treatment with many other drugs. (Hismanol; Pollen-ese). See page 110 and Table 2.