A-Z Principal Drugs (suramin - thyroxine)
suramin A drug used in the early treatment of trypanosomiasis, but it is of no value in the later stages of the disease as it does not enter the cerebrospinal fluid.
Dose: I g i.v. weekly for 5 weeks, after a tolerance test dose of 200 mg. Side-effects are gastrointestinal disturbances, dermatitis, hyperac%thesia and kidney damage.
suxamethonium A short-acting, depolarizing muscle relaxant, with an action lasting 3-5 minutes. A preliminary injection of thiopentoric should first be given, as the initial effect of suxamethonium is a
painful muscle contraction before the relaxant action supervenes.
Dose: 20- tOO ing i.v. during surgery, with further doses according to need. Suxamethonium may also be given as a 0.1% solution by i.v. infusion. Exceptionally, the muscle relaxant action of the drug may be prolonged with marked apnoea. Unlike non-depolarizing muscle relaxants, the action of suxamethonium cannot tie reversed. Severe hepatic disease is a contraindication. (Anectine: Scoline).
sympathomimetics Drugs that have an action similar to adrenaline, and act on both alpha- and beta-adrenoceptors. More selective compounds, such as salbutamol, act on the beta,-adrenoceptors in the lungs and have an increased bronchodilator action. They also relax uterine muscle, and are used to prevent premature labour. Others such as dobutamine and dopamine have a more selective action on the beta,- receptors in the heart, and are referred to as isotropic sympathorninictics.
tacalcitol A vitamin D. derivative used in the treatment of psoriasis as an ointment containing 4 pg/g of the drug. It is applied sparingly once daily at night, and continued as required. Not more than 2 treatments over 8 weeks per year. (Curatoderm).
tacrolimusV A macrolide derivative with marked immunosuppressant properties. It is used in liver and kidney transplantation, and appears to act by suppressing T-cell activation. It may also inhibit the formation of cytotoxic lymphocytes that are concerned
Tel
with graft rejection. See Drug Data Sheet for details of dose and extensive side-effects including neurotoxicity and hypertrophic cirdiomyopathy. (Prograf).
talc A form of magnesium silicate, widely used as a skin dusting powder. It has also been used as a lubricant for surgeons’ gloves, but it may cause a talc granuloma if any reaches the tissues during operation, and glove powders prepared from starch are preferred.
tarnoxifen An oestrogen-receptor
antagonist used mainly in breast cancer, particularly when metastases are present. Dose: 20 mg daily. It is usually well tolerated, but side-effects include hot flushes, dizziness, rash, by
. percalcaciiiia and
an increase in tumour pain. Unlike other oestrogen-antagonists, tamoxifen has no androgenic properties. It has also been used in sonic forms of anovulatory sterility. (Nolvadex). See page 122 an(] Table 8.
tamsulosinV A relatively selective alpha adrenoceptor antagonist. It lowers the tone of bladder and prostatic smooth muscle, and is used in benign prostatic hyperplasia. Dose: 400 mg daily after breakfast with a glass of water. The first dose should be taken in bed to avoid postural hypotension. Other side-effects include palpitations and dizziness and hypotension. (Floniax). See page 164 and Table 28.
tazabactam An inhibitor of betalactamases. It is used in association with some antibiotics to extend the activity against resistant beta - lactamase - producing bacteria. Tazacin is a mixed product containing piperacillin and tazabactam.
tazarotene A retinoid used as an aqueous gel (0.05-0.1 %) in psoriasis. Applied once daily to the affected skin area only. (Zorac).
teicoplanin An antibiotic that acts by interfering with bacterial cell wall development. It has a wide range of activity, but is used mainly in the treatment of severe staphylococcal infections that fail to respond to other antibiotics.
Dose: loo mg initially by i.v. injection, lollowed by 200 nig as a single daily dose, which may be given by i.m. injection. Double doses in severe infections. Side-effects include gastrointestinal disturbances, dizziness, fever and rash (Targocid).
temazepam A mild hypnotic of the nitrazepain type, but with a shorter duration of action. It is useful in the insomnia of the elderly, arid is also of value as a preoperative anxiolytic agent.
Dose: 10-20 ing. Daytime drowsiness is less common than with related drugs. See page 152 and Table 22.
ternocillin A penicillin-type of antibiotic active chiefly against infections due to penicillinase-producing Gram-negative bacteria, with the notable exception of pseudomonas. It is used in respiratory and urinary tract infections due to susceptible organisms.
Dose: 2-4 g daily by injection, but in simple urinary tract infections a single daily dose off g may be effective. (Temopen).
I Tet
inie’tion. (Bricarly]). See page 118 and Table 6.
terfenadine An antihistamine with reduced sedative and other side-effects on the central nervous system. It is effective in hay fever, allergic skin conditions and other allergic states.
Dose: 120 mg daily. Best given alone, as combined use with imidazole antifungal agents or with many other drugs may cause severe reactions. See Drug Data Sheet for details. (Triludan). See page 110 and Table 2.
terlipressin A synthetic form of vasopressin, used to control bleeding from oesophageal varices.
Dose: 1-2 nig i.v., repeated if required 4-6-hourly, (Gl)j)ressin).
tenoxicam A non-steroidal anti-inflamma- tory drug (NSAID) with the actions, uses and side-effects of that group.
Dose: 20 mg as a single daily dose. (Mobillex). See page 105 arid Table 29.
terazocin An alpha-receptor antagonist used in hypertension. It produces a peripheral vasodilation by a blockade of post-synaptic alpha-receptors.
Dose: I mg tit night initially, slowly increase(] up to 10 mg as a single daily dose. Small initial doses are necessary to avoid episodes of syncope during early treatment. Reduced doses are indicated when terazocin is given with thiazide diuretics or other anti-hypertensive agents. Side-effects are dizziness, drowsiness and peripheral oedema. It is also used in benign prostatic hypertrophy.
(I lvpovase). See page 149 arld’I'able 21.
testosterone The androgenic hormone of the testes, which controls the development of the male sex characteristics. It is used mainly in the treatment of hypogonadism
by the i.m. injection of depot preparations 97 of long-acting testosterone derivatives. Subcutaneous implantation of testosterone pellets (200-600 mg) has been used in the treatment of metastatic breast cancer. Side-effects are weight gain, virilism and hypercalcaemia.
tetanus vaccines Preparations of tetanus toxin that has been modified by treatment with formaldehyde. They stimulate the formation of protective antitoxin. They are used for active immunization against tetanus, but for young children a combined diphtheria, pertussis and tetanus vaccine is usually preferred.
terbinafine An antifungal agent that acts by interfering with the synthesis of ergosterol, an essential constituent of fungal cell membranes. It is used in fungal infections of the skin and nails, but it is not effective in pityriasis (Tines versicolor).
Dose: 250 mg daily for 2-6 weeks; half-doses in severe liver or renal impairment. Side-effects are rash, loss of appetite and gastrointestinal disturbances. (I.arnisil).
terbutaline A selective beta-adrenoceptor stimulant and bronchodilator, with the actions, uses and side-effects of salbutamol.
Dose: 7.5-15 mg orally daily, by aerosol inhalation; 250-500 jig by &L, i.rn. or i.v.
tetrabenazine A drug of the haloperidal type, but used mainly in the treatment of Huntington’s chorea and similar disorders of movement.
Dose: 75-200 ing daily. It may cause drowsiness and extra-pyramidal side-effects.
tetracosactrin A synthetic form of corticotrophin.
Dose: it single injection of 250 pg as a test of adrenal cortex function, as after such an injection the level of cortisol in the plasma should rise within an hour. It is also given as single I mg i.m. depot preparation in
the 5-hour diagnostic test. (Synacthen; Synacthen Depot).
tetracycline A wide-range antibiotic very similar both chemically and pharmacologically to chlortetracycline, oxytetracycline, clomocycline, and related compounds referred to generically as the tetracyclines. They all have the same type of action against both Gram-positive and Gram-negative organisms, but exhibit certain differences in solubility, absorption and excretion. These differences are reflected in the different doses, as tetracycline is given in doses of 250 mg 4 times a day, whereas with doxycycline a single daily dose of 100 ing may be adequate. Long treatment with a tetracycline may lead to gastrointestinal disturbance owing to changes in the normal bacterial population of the intestinal tract. The use of the tetracyclines has declined with the emergence of bacterial resistance. They also have the disadvantage of being taken up and staining growing teeth and bone, and so should riot be given to children or used during pregnancy. The absorption of the tetracyclines is reduced by antacids, calcium, iron and milk. See page 249 art(] Table 35.
theophylline A bronchodilator used in the less severe forms of asthma and respiratory disease. (In severe and acute asthma arninophylline is usually preferred.) Dose: 180 nig- I g daily. Side-effects include gastrointestinal disturbances and tachycardia, but are less frequent when long-acting preparations of theophyllinc are used. Such preparations are also useful in the control of nocturnal asthma. These long-acting forms differ, and a patient stabilized on one preparation should not lie transferred to another without good cause. See page 118 and’I'able 6.
thiabendazole An anthelinintic effective against a wide range of intestinal parasites. Also useful in creeping eruption.
Dose: 2.3 iiig/kg daily, up to a maximum of 3 g daily for 2-3 days. Side-effects knore marked in the elderly) are nausea, diarrhoea, rash, yellow vision and
jaundice. Mintezol).
thiamine (vitamin Bj Essential for carbohydrate metabolism, but is used clinically in cases of deficiency, as in beri-beri, or when the diet is restricted. Also of value in the neuritis of pregnancy and alcoholism. Dose: 2-5 nig daily; therapeutic 25- 100 ing daily, in severe deficiency 200-300 nig
doily. severe allergic reactions have followed the i.v. injection of thiamine in high-dose mixed vitamin products such as Pabrinex. Anaphylactic treatment must be immediately available. (Benerva).
thiazides See diuretics and page 150.
thioguanine A cytotoxic agent similar in action and uses to nicrcaptopurine, and used to induce and maintain remission in acute myeloblastic and other leukaernias. Dose: 2 ing/kg, daily. Side-effects are bone marrow depression, nausea and jaundice. Manvis). See page 122 and Table 8.
thiopentone A widely used, short-acting I.V. anaesthetic.
Dose: 100-150 nig initially, repeated at intervals of 10-15 seconds as required. Solutions should be freshly prepared, and great care must be taken to avoid extrava&ttion, a-, the solution is very alkaline and may cause tissue necrosis. Infra-arterial injection is even more dangerous.
(Iniraval Sodium).
a’
thiorid zine A tranquillizing drug related to chlorpromazine, and used in similar doses for the treatment of schizophrenia and other psychiatric conditions. Unlike most related drugs, it has no antiemetic properties.
Dose: 30-600 ing daily. (Melleril). See page 168 and Table 30.
thiotepa A cytotoxic agent used mainly by infra-cavity instillation, particularly for recurrent superficial tumours of the bladder.
Dose: 15-60 mg dissolved in 60 nil of water, instilled weekly for 4 weeks,
followed by a rest period of 2 weeks before lorther doses are given.
thymoxamine A peripheral vasodilator that is useful in vasospastri and other peripheral ischaemic conditions.
Dose: 160-2,10iiig daily. Side-effects such as headache and facial flushing are usually mild and transient. Treatment should be discontinued after 2 weeks if there is tit) response. (Opilon). See 111oxisylyte.
thyroxine The active constituent of thyroid, but now prepared synthetically. Thyroxine is a powerful metabolic stimulant, specific in neonatal hypothyroidism (cretinism) and myxcredenia. In the former, early diagnosis