Posts Tagged ‘dryness of the mouth’

nisoldipine A calcium channel blocking agent of the nifedipine type. Used in mild to moderate hypertension pertension and in the prophylaxis of chronic angina.
Dose: 10 ing once daily before breakfast with adequate fluid, slowly increased as required up to 40 mg daily. Tablets to be swallowed whole, not chewed or crushed. It may react with sonic other drugs in common use, and grapefruit juice should be avoided. (Syscor). See pages 114 & 148, and ‘Fables 4 & 21.
nitrazepam A benzodiazepine used as a mild hypnotic when some degree of daytime sedation is acceptable.
Dose: 5-10 mg at night, with reduced doses for elderly patients, and in renal and’ hepatic dysfunction. Care is necessary in respiratory depression. Some dependence on nitrazepam may occur, so extended treatment should be avoided. The combined use of alcohol increases the hypnotic action. (Mogadon; Remnos). Set: page 152 and Table 22.
Nitrocine A solution of glyceryl trinitrate, for i.v. infusion in myocardial ischaemia and refractory angina.
nitrofurantoin An antibacterial agent with a wide range of activity against the majority of urinary pathogens. It is of value in cystitis and pyelitis, and in renal infections that have become resistant to other drugs. It is also used prophylactically but extended use requires care.
Dose: 400 mg daily; 50-100 mg at night for prophylaxis. It is ineffective in an alkaline urine. Nausea, rash and peripheral neuropathy are side-effects, and acute and chronic pulmonary reactions have been reported. (Furadantin; Macrobid).
nitroglycerine See glyceryl trinitrate. nitroprusside See sodium nitroprusside.
nitrous oxide The oldest inhalation anaesthetic. Supplied in blue cylinders, it is widely used for induction and as part of a mixed anaesthetic system. It is also used as
a 50% oxygen mixture as an inhalation analgesic in obstetrics.
nizatidine A potent and selective H,-receptor antagonist chemically distinct from cimetidine or ranitidine.
Dose: in the treatment of benign duodenal and gastric ulcer, single doses of 300 mg daily, taken in the evening, or 150 mg twice a day, and continued for 4 weeks, or for s weeks in gastric ulcer including non-steroidal anti-inflammatory agent (NSAID) -induced ulceration. Occasionally given by i.v. infusion in doses of300mg daily. For prophylactic maintenance, doses of 150 mg daily may be given for up to a year. Reduced doses should be given in renal impairment. Side-effects include headache, niyalgia, cough, pruritus and abnormal dreams. (Axi& Zinga). See page 162 and “Fable 27.
non-steroidal anti-inflammatory drugs (NSAIDs) A group of drugs with analgesic anti-inflammatory properties widely used in arthritic, rheumatoid and related conditions. The response to a NSAID and the incidence and severity of side-effects such as gastric irritation and renal toxicity vary considerably, and the best NSAID for an individual patient is the one that gives optimum relief with minimal side-effects. The NSAIDs, of which aspirin is the oldest example, act by interrupting the biosynthesis of prostaglandins from arachidonic acid, in which process the enzyme cycleoxygenase (COX) plays a key role. It is now known that COX exists in two forms identified as COX-1 and COX-2. The anti-inflammatory action of the NSAIDs appears to be linked with the inhibition of COX-2, whereas the unwanted side-effects are associated with COX- I inhibition. Different NSAIDs have varying degrees of activity against the different forms of COX, which may explain the differences in the therapeutic response and the incidence of side-effects. Recently, a NSAID (meloxicain) has been introduced that has a more selective inhibitory action on COX-2, with which the incidence of side-effects appears to be lower than with the older drugs, and so may have therapeutic advantages. In general, the response to a NSAID may take 1-3 weeks to develop fully, but monitoring for gastrointestinal bleeding may be advisable if treatment is extended. A NSAID should not be given to a patient with a history of asthma or hypersensitivity, nor when peptic ulcer is suspected or present. In all cases, treatment should be commenced with the lowest recommended dose, and caution is necessary in the elderly, and when renal or hepatic function is impaired. See page 165 and Table 29.
Dose: 20 100 mg daily. It is given in nocturnal enuresis in doses of 10-20 mg nightly, but the duration of treatment should not exceed 3 months. (Allcgron). See page 128 and Table 11.
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noradrenaline (norepinephrine) The pressor hormone released at sympathetic nerve endings when such nerves are stimulated. It is also present with adrenaline in the medulla of the adrenal gland. It raises blood pressure mainly by a general vasoconstriction, whereas adrenaline acts by constricting the peripheral vessels and increasing the cardiac output. Noradrenaline is given by slow i.v. infusion in the treatment of shock, peripheral failure, and low blood pressure states, but the response may fluctuate with small variations in dose. The value of vasoconstrictors in shock is now questioned, as in shock the peripheral resistance may well be high, and the blood supply to essential organs such as the kidneys may be reduced.
Dose: 2-20 pg/niin, based on need and response. Great care must be taken to avoid extra-venous injection. (Levophed).
norethisterone An orally active progestogen. Used in amenorrhoea, functional uterine bleeding and dysmenorrhoea. Dose: 5-20 mg daily. In breast cancer, large doses up to 60 mg daily have been used. To postpone menstruation, 15 mg daily for 3 days have been used. In small doses, and in association with an oestrogen, norethisterone and related drugs are widely used as oral contraceptives. See page 264.
norfloxacin A quinolone antibacterial with the actions, uses and side-effects of cinoxacin and other quinolones.
Dose: in acute urinary tract infections, 801) mg daily for 3-10 days: in chronic infections continued for up to 12 weeks. ( I Itinor).
norgestrel (levonorgestrel) An orally active progesterone-like drug and inhibitor of ovulation. Used as a constituent of mixed oral contraceptive products, and as a ‘progestogen -only’ oral contraceptive. See page 264.
nortriptyline A tricyclic antidepressant with actions, uses and side-effects similar to those of amitriptyline, but with a reduced sedative activity.
NSAIDs See non-steroidal anti-inflamma-
tory drugs, page 168 and Table 29.
nystatin A fungicidal antibiotic, used in the treatment of intestinal, vaginal and superficial candidiasis. Oral tablets contain 500 000 units, pessaries contain 100 000 units; cream and ointment 1%. Dose: (oral) 2 million units daily. It is also used as pastilles of 100000 units for mouth infections.
octreotide A synthetic compound that inhibits the release of the growth hormone. It is used in acromegaly, which is caused by an overproduction of the growth hormone by a pituitary tumour and it is given in doses of 100-200pg 8-hourly by s.c. injection. It is also used in the symptomatic treatment of the carcinoid syndrome, in which the release of vasoactive substances by a gastro- pancreatic tumour causes flushing and severe diarrhoea.
Dose: 30 pg by s.c. injection, increased as needed up to 600 pg daily. It has no action on the cause of the syndrome. It is used occasionally in terminal care to reduce intestinal secretions and vomiting. Dose: 300-600 pg by s.c. infusion. (Sandostatin).
oestradloIlThe oestrogenic hormone controlling ovulation and menstruation. It has been used to control menopausal symptoms in doses of 10-20pg daily, but skin patches are now preferred for hormone replacement therapy (HRT). It is used occasionally as s.c. implants for long-term treatment. Oestradiol is also present in some cream preparations for menopausal atrophic vaginitis.
oestriol A natural oestrogen used in intravaginal cream to relieve the atrophic vaginitis and kraurosis vulvae associated with the menopause. Also given in doses of 1-32 mg daily for the genito-urinary symptoms linked with infections in oestrogen deficiency states. (Ovestin).

ofloxacin A fluorinated quinolone with the actions, uses and side-effects of other quinolones such as ciprofloxacin and norfloxacin. It is used mainly in urinary and lower respiratory tract infections. Dose: wii nig daily as a single morning dose. Dose in severe infections 200-400 mg daily by i.v. injection. An occasional side-effect is tendon damage with pain and inflammation, which requires immediate withdrawal of the drug. Exposure to strong sunlight should be avoided. (Tarivid). Also used as eye drops (0.3%) for superficial eye infections. (Exocin).
olanzapineV An antipsychotic agent for the treatment of schizophrenia. It has a more selective action on certain 5-H’I'- receptors, and is less likely to cause extra-pyramidal side-effects.
Dose: 10 mg as a single daily dose, slowly increased as required. Maintenance dose 5-20 mg daily. Side-effects include
sedation and weight gain. (Zyprexa). See page 168 and Table 30.
olsalazine A compound formed from mesalazine, and used in the treatment of ulcerative colitis. It is more slowly
absorbed, and reaches the colon largely unchanged, where it is broken down by intestinal bacteria to release the active metabolite mesalazine.
Dose: 1-3 g daily in acute mild ulcerative colitis; I g daily for maintenance, often for long periods. The common side-effect is a watery diarrhoea. Salicylate sensitivity is a contraindication. Patients are now advised to report any bruising, bleeding or
malaise. I( a blood dyscrasia is suspected, a blood count should be made -,in(] the drug withdrawn. (Dipentuni). See page 172 and Table 32.
ondansetron A potent antiemetic, of value in the nausea and vomiting associated with cancer chemotherapy. Such vomiting appears to be induced by the release of serotonin, which acts on receptors in the gut as well as stimulating the chernoreceptor trigger zone in the brain. Ondansetron is a specific (5—HT,) serotonin blocking agent, and is given before the commencement of cytotoxic treatment or radiotherapy.
Dose: 24 mg daily; in severe vomiting an initial dose of 8 ing is given by slow i.v. injection, followed by I ing/hrly for 24 hours by continuous i.v. infusion, followed by oral therapy. Side-effects are an initial sense of warmth, headache an(] constipation. (Zofran). See page 158.
topium The dried juice from the capsules of the opium poppy. See morphine.
orciprenaline A synipathomimetic agent with the bronchodilator properties of isoprenaline. It is used for the relief of obstructive airway conditions, although more selective drugs of the salbutarnol type are often preferred.
Dose: up to 80 ang daily; by aerosol inhalation up to 12 puffs (9mg) daily. Side-effects include tremor and tachycardia. (Ahiperil). See page 118 and Table 6.
orphenadrine A spasmolytic drug, used in the treatment of parkinsonism, and for the relief of voluntary muscle spasm. Dose: 150-400 nig daily. It may also be given by i.m. injection in doses of 60 mg. In parkinsonism it tends to control the rigidity more than the tremor. Side-effects are anticholinergic and include dryness of the mouth, dizziness and visual disturbances. Weight gain has occurred with high doses. (Disipal; Norflex). See
page 160 and Table 26.
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omeprazole An inhibitor of the enzyme I I*K’A'I’Pase.’rhat enzyme controls the final stage of gastric acid production, and its inhibition by omeprazole is of value in peptic ulcer resistant to H, receptor antagonists, and in reflux oesophagitis, where such agents are not always effective. Dose: in benign gastric and duodenal ulcer, 20-40 ing as it single daily dose for 4-8 weeks. Larger doses may be required in the Zollinger—Ellison syndrome. Side-effects such as nausea, gasiro-intestinal disturbances and headaches are usually mild. (Losec). See page 162 and Table 27.
oxazepam A benzodiazepine with the actions, uses and side-effects of diazepam. It is useful in acute anxiety and panic states.
Dose: 45-120 mg daily. See page 117 and Table 5.
oxerutins A mixture of rutosides (flavonoid derivatives) which is claimed to reduce capillary fragility and permeability. It has been used in venous disorders of the lower limbs.
Dose: 750-1000 nig daily. (Paroven).

gelatin A protein obtained by the hydrolysis of animal tissues. Used orally as nutrient jellies, and specially refined solutions have been used as blood volume expanders (see dextran). (Gelofusine; Haemaccel).
I Gil
nephrotoxic side-effects, and dosage requires care when renal function is inadequate, and also in elderly patients. Gentarnicin is also used locally as cream or ointment (0.3%) and as eye drops (0.3%). (Cidomicin; Genticin).
gemcitabineV A cytotoxic agent related
to cytarabine, but with increased
potency and a longer action. It blocks cancer cell replication by inhibiting DNA synthesis, and may enhance the action of other agents. It is used mainly in the palliative treatment of non-small cell lung cancer.
Dose: 1000 mg/m-’ by slow i.v. infusion over 30 minutes, once a week for 3 weeks, repeated after a rest period. It is generally well tolerated, but a common side-effect is a transient influenza-like reaction. Myelosuppression is less severe than that of related cytotoxic agents. (Gemzar). See page 122 all(] Table 8.
gentian violet See crystal violet.
gestrinone An antiprogestogen used in ctidonictriosis that acts indirectly by suppressing gonadotrophin production. Dose: 2.5 ing twice weekly oil the same day,, each week for o months. Side-effects arc fluid retention, acne and voice changes. ( Dimetriose).
gestronel A synthetic progestogen used in the treatment of breast and endonietrial carcinoma and benign prostatic hypertrophy.
Dose: 200-400 ing i.m. once a week. (Depostat).
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gemeprost A synthetic prostaglandin used to dilate the cervix uteri in first trimester abortion.
Dose: I mg, as a pessary 3 hours before surgery. Side-effects are mild uterine pain and vaginal bleeding initially, nausea and di.11 I hoc.).
gernfibrozil A plasma lipid regulating agent, with the actions and uses of hez.afibrate and clofibrate.
Dose: 901) ing-1.3 mg daily, with regular checks oil plasma lipid levels. Treatment should be withdrawn after 3 months if the response is unsatisfactory. Gernfibrozil may potentiate the action of oral anticoagulants, the dose of which should be adjusted. Side-effects include nausea, diarrhoea, abdominal pain, rash and dizziness. (Lopid). See page 146 and Table 20.
gentamicin An aminoglycoside antibiotic, active against a wide range of Gram-negative organisms, including Pseudomonas aeruginiosa, as well as against many Gram-positive bacteria, although it is not very active against anaerobic organisms. It is of great value in septicaemia and meningitis, as well as in bacterial endocarditis.
Dose: 2-3 nig/kg daily by i.m. injection or i.v. infusion. In serious or undiagnosed infections, supplementary treatment with a penicillin or metronidazole may be require(]. In common with other arninoglycosides, goitarnicin has ototoxic and
glibenclarnide An orally active hypoglycaenfic agent similar to chlorpropamide. Dose: 5-15 nig daily, according to need and response. (Daonil; Euglucon). See
page 131 and’I'able 13.
gliciazide A sulphonylurea with the actions and uses of chlorpropamide and related drugs.
Dose: 40-320 mg orally. (Diarnicron). See page 131 and Table 13.
glimepiride A sulphonylurea used in non-ill Sidi 11 -dependent (Type 11) diabetes mellitus.
Dose: 2 mg after breakfast, increased ill, to .1 mg daily. Side-effects include
transient visual disturbances, rash and urticaria. (Amaryl). See page 131 and Table 13.
glipizide A sulphonylurea, used like chlorpropamide in diabetes, but effective in much lower doses.
Dose: 5 mg initially, maintenance dose 2.5-40 nig daily. (Glibenese; Minodiab). See page 131 and Table 13.
gliquidone An oral hypoglycaemic agent similar to chlorpropamide. Effective in maturity-onset diabetes.
Dose: I5 ing initially; maintenance dose 40-60 nig daily, but up to 180 mg daily have been given. (Glurenorni). See page 131 and Table 13.

glucagon A hormone of the alpha cells of the pancreas which raises the blood sugar level by mobilizing liver glycogen. Used in acute hypoglycaemia.
Dose: 0.5-1 mg by s.c., i.m. or i.v. iniection. (GlucaGen). Give i.v. glucose if there is no response within 10 minutes.
glucocorticoids Those corticostcroids with an anti-inflammatory action similar to hydrocortisone, as distinct from the mmerailocorticoids, such as fludrocortisone, used in Addison’s disease. Thel, differ in anti-inflammatory potency, and 0.75 mg of dexamethasone is considered equivalent to 20 mg of hydrocortisone. See Table 36.
glucose Also known as dextrose. A readily absorbed carbohydrate present in many
man
sweet fruits, but obtained commercially by the hydrolysis of starch. It is given orally as a dietary supplement; in acidosis; and to raise the glycogen reserves of the liver in hepatic damage. Given by i.v. infusion as a 5% solution, or as a glucose-saline infusion in dehydration and shock, and after surgery until fluids call be taken by mouth.
glutaraldehyde A disinfectant of the formaldehyde type, but with a more rapid and powerful action. Effective against a wide range of organisms, including
viruses. Used mainly for instrument sterilization as a 2% solution. Usually activated before use by the addition of a corrosion inhibitor. Such activated solutions are stable for about 2 weeks. It is also used as a 10% solution for the removal of plantar warts.
glycerin (glycerol) A clear syrupy liquid used as a sweetening agent in mixtures and linctuses. It promotes drainage when applied to inflamed areas, and is used as a paste with magnesium sulphate for boils. It is also used as suppositories for constipation.
Dose: sometimes given orally in doses of ]- 1.5 g/kg in glaucoma and before surgery to lower the intraocular pressure.
glyceryl trinitrate A powerful but short-acting vasodilator used in the control of angina pectoris. See page 114.
Dose: 300, 500 or 600 pg tablets which should be dissolved under the tongue for a rapid response. An aerosol spray (400g per
dose), as well as long-acting tablets are also available. Tolerance may occur with prolonged therapy. Side-effects are a throbbing headache, flushing and tachycardia. It is also used locally for all extended action, particularly at night, as ointment and medicated patches. Also given by i.v. infusion to control hypertension and ischaemia during cardiovascular surgery and in left ventricular failure. Dose: 10-200 pg/min in dextrose-saline. A new use of the drug is as an ointment (0.2%) to promote healing of anal Fissure. See page 1] 4 and Table 4.
glycopyrronium A synthetic atropine-like antispasmodic used for preoperative medication.
Dose: 200-400 pg by Lill. or i.v. injection. I i has the side-effects of anticholinergic drugs such as dryness of the mouth and blurred vision. Contraindicated in glaucoma. (Robinul).
GM-CSF Granulocyte-macrophage colony stimulating factor. See molgramostim. gold therapy See sodium aurothionialate.
gonadotrophins The follicle-stimulating hormone (FSH) and the luteinizing hormone (1-11) of the anterior pituitary gland. They stimulate ovarian development and the production of oestrogens; ill the male LH controls the formation of androgens. See gonadorclin.
gonadorefin A synthetic form of the gonadot roph in -releasing hormone of the pituitary gland (M-111-1). It is used to assess pituitary function.
Dose: 100 pg by i.v. injection normally
rise to a rapid rise in the plasma level of the luteinizingand follicle-stimulating hormones. In amenorrhoea and infertility due to gonadorelin insufficiency, it is given by pulsed s.c. infusion in doses of 1-20pg every 90 minutes, day and night. Treatment for up to 6 months may be required. Side-effects are uncommon. (Fertiloli Relefact). Sonic analogues of gonadorelin are used in remain cancers. See page 122.
goserelin A synthetic analogue of the hypothalamic hormone (LH-RH). It
suppresses the production of testosterone, d
anis used in the treatment of hormone-
dependent carcinoma of the prostate. It is also used in endometriosis and postmenopausal breast cancer.

Dose: 3.6 ing by s.c. injection every 28 days or as an implant. Side-effects include impotence, hot flushes, rash, breast swelling and tenderness. (Zoladex). See page 122 and ‘I able 8.
gramicidin A mixture of antibiotics effective against many Gram-positive organisms, but it is too toxic for syitenii, use. Used topically in infected skin conditions, usually in association with neomycin and hydrocortisone.
granisetron A scrotonin (5—HT) antagonist with a highly selective and powerful antiernetic action mediated by its effects on the 5-4-11′, receptors. It is used in the prevention and treatment of the severe nausea and vomiting induced by potent cytotoxic drugs such as cisplatin.
Dose: I mg I hour before treatment, then I ing twice daily, or by i.v. infusion in doses of 3 mg, repeated up to 3 times over 24 hours. For prophylaxis, a dose of 3 mg should be given before chemotherapy is commenced. Headache, rash and consti pation are common side-effects. (Kytril). See page 158.
griseofulvin An orally effective but slow
acting antifungal antibiotic that is
deposited selectively in the skin, hair and nails. It is used in the systemic treatment of ringworm and other dermatophyte infections of the keratin-containing tissues, but only when local treatment has failed.
Dose: 0.5-1 g daily, but prolonged therapy is required. Side-effects are headache, nausea, dizziness, rash and photosensitivity. 11 may also reduce the effects of oral contraceptives. (Fulcin; Grisovin).
growth hormone See soma(ropin.
guanethidine An anti-hypertensive drug that [)rings about a reduction in blood pressure by blocking transmission in adrenergic nerves, and preventing the release of noradrenaline. It has been used in the treatment of hypertension, often with a thiazide diuretic, but its use has declined as it may cause postural hypotension. Still used as part of combined therapy in resistant hypertension.
Dose: 20 mg daily, increased by 10 ing at weekly intervals according to response, up to 50 mg daily, although sometimes larger doses are required. Dose by i.m. injection,
10-20 nig as required. Diarrhoea, weakness, nasal congestion and bradycardia are common side-effects. (Ismelin). See page 148 and Table 21. Guanethidine is occasionally used as eye drops (1-3%) in glaucoma. (Ganda). See page 138 and Table 16.
guar gum A vegetable gum that, when taken with food, appears to retard the absorption of carbohydrates. It is used in the supplementary treatment of diabetes mellitus.
Dose: up to 15 g daily, usually sprinkled mi food. It is essential that a dose should he taken with an adequate fluid intake, and that the final dose is not taken at bedtime. Side-effects are flatulence and abdominal distension. (Guarem). See page 131 and Table 13.
halcinonide A powerful corticosteroid used iii severe inflammatory skin conditions not responding to other corticosteroids. It is applied sparingly as a 0.1% cream. (Halciderin).
halibut-liver oil A rich source of vitamins A ‘Ind 1).
Dose: 0.2-0.5 mi.
halofantrine An antimalarial, acting at the erythrocytic stage of the life cycle of plasmodium, and useful in chloroquine 01 MUlti-drug resistant malaria.
Dose: 500 nig 6-hourly for 3 doses between meals. Side-effects are nausea, vomiting and diarrhoea. It must not be given with or after mefloquine (risks of fatal arrhythmias). Contraindicated in pregnancy. 0 lalfan).
haloperidol A powerful tranquillizer used in schizophrenia, mania and psychoses. Dose: 5-20 ing daily, up to a maximum of 200 mg, reduced later according to
response. Dose by i.m. injection for rapid control of hyperactive psychotic patients, 5-30 mg initially, followed by 5 ing or more as required. For depot treatment, it is given as haloperidol decanoate, 50-300 mg by deep i.m. injection every 4 weeks. It is also given orally in doses of 500 g twice daily in severe anxiety. Doses of 1.5 nig

chymotrypsin A proteolytic enzyme of the pancreas used in ophthalmology to facilitate intracapsular lens extraction. (Zonulysin).
cidofovir An antiviral agent used in cytomegalovirus retinitis resistant to ganciclivir.
Dose: 5 nig/kg by i.v. infusion every 2 weeks. (Vistide). See page 144 and ‘['able 19.
cilastatin See imipenem.
chlorthalidone A diuretic similar in action and uses to bendrofluazide, but with a longer duration of activity that permits a single morning dose. It is also useful in diabetes insipidus.
Dose: as diuretic 50-100 mg daily or on .illci nale days; in hypertension 25-50 mg; up to 350 mg daily in diabetes insipidus. (I lygrolon ). See page 148 and Table 21.
cholecalciferol See vitamin D.
cholestyramine An exchange resin that binds with bile acids in the intestines and prevents their absorption. Such acids are essential for cholesterol synthesis, and resin-binding leads indirectly to a lowering of plasma cholesterol levels.
Dose: in hyperlipidaemia: 12-24 g daily, wilh water; similar doses in the diarrhoea of Crohn's disease. It is also used in doses of 4-8 g daily to relieve the pruritus
associated with biliary obstruction. Side-effects are rash and gastrointestinal disturbances. Cholestyramine and related agents may interfere with the absorption of anticoagulants and other drugs. iQuestrari). See page 146 and Table 20.
choline theophyllinate A bronchodilator ,ilh the actions, uses and side-effects of anlinophyllille.
Dose: 400-1600 mg daily, after food. (C'I ioledyl). See page 118 and Table 6.
chorionic gonadotrophin A gonad-stimulating hormone prepared from the Urine of pregnancy. It has bten used in anovulalory sterility, metropathia haernorrhagica, habitual abortion and undescended testis.
cilazapril A long-acting ACE inhibitor with the actions, uses and side-effects of that group of drugs.
Dose: in essential hypertension 1 mg daily initially, increased up to 5 mg daily according to need. In renovascular hypertension 0.25-0.5 mg daily. (Vascace). See page 148 and'I'able 21.
cimitidine A selective histamine H, receptor antagonist. Unlike ordinary antihistamines, it inhibits gastric secretion, and is used in the treatment of peptic ulcer and other conditions of gastric hyperacidity. Dose: 8(m) nig daily for at least 4 weeks, doubled in severe conditions. Dose by i.m. or slow i.v. injection 200 mg 4-4-hourly. The dose should be reduce(] in renal impairment. The drug may increase the effects of oral anticoagulants and phenytoi ii. Side-effects include diarrhoea, rash and dizziness. It has some anti-androgen activity, and gynaecomastia is all occasional side-effect with high closes. (Dysparneu Tagarnet; Zila). See page 162 and Table 27.
cinchor-aine A local anaesthetic used as
ointment 1% in haemorrhoids and
pruritus. (Nupercainal).
cinnarizine An antihistamine, chiefly of value in Wniere’s disease, although it is also used in travel sickness and in peripheral vascular disorders.
Dose: 45-90 ing daily. Drowsiness and gastrointestinal disturbances are side-effects. (Stugeron).
cinoxacin A quinolone derivative with actions, uses and side-effects similar to i hose of nalidixic acid.

Dose: in urinary tract infections,  daily; prophylaxis 500mg daily. Contraindicated in severe renal impairment. (Cinobac).
ciprofbrate A blood-lipid lowering agent used in diet-resistant hyperlipidaemia as a single daily dose of 100-200 mg. (Modalim). See page 146 and Table 20.
ciprofloxacin A quinolone with a wide range of activity against both Gram-positive and Gram-negative bacteria, including Pseudomonas and Fronts. It is effective in many systemic infections, as well as in bone, joint and urinary infections, and in gonorrhoea, but is indicated mainly in infections resistant to other antibacterial agents. Dose: 500 mg -1.5 g daily for 5-7 days; in gonorrhoea, a single dose of 250 mg is given. In severe infections 200-400 mg daily by i.v, infusion for 5-7 days. Side-effects include nausea, dizziness, headache, rash and pruritus. plasma levels of theophylline may be increased and should be closely controlled. Care is necessary in convulsive disorders. (Ciproxin).
cisapride A gastrointestinal stimulant given to relieve gastro-oesophageal reflex and delayed gastric emptying.
Dose: .10-40 mg daily before meals, and at night, for some weeks. Side-effects are abdominal pain and diarrhoea. Drugs that delay the excretion of cisapride and may cause arrhythmias are erythromycin and clarithromycin-antigungal agents of the ketoconazole type should also be avoided. Unlike metoclopramide, it has no central antiemetic properties. (Alimix; Prepulsin).
cisatracurium A non-depolarizing neuromuscular blocking agent with an intermediate duration of activity. It is used as a muscle- relaxing adjunct in general anaesthesia, and to facilitate tracheal ininhation. (Nimbly).
cisplatin A cytotoxic agent containing platinum bound in an organic complex. The action is linked with drug-induced changes in DNA structure that inhibit cell development. It is used in ovarian, testicular and other solid tumours, and in resistant malignant conditions, sometimes in association with other antineoplastic agents.
Dose: by i.v.  for 5 days a month, or 15-120 mgIm’ monthly. Blood tests are essential
throughout treatment. Side-effects, which may be severe, include nausea, vomiting, and oto-, nephro- anti
citalopram A selective serotoninreuptake inhibitor (SSRI).
Dose: used in depression in single daily doses of 20 ing, increased up to 40 mg daily. Treatment for at least 6 months necessary to avoid relapse. (Cipraruil). See page 128 and Table 11.
cladribine A new agent used by specialists in hairy cell leukaemia. (Leustat).
clarithronlycin A macrolide antibiotic similar to erythromycin, but with better absorption and reduced gastrointestinal side-effects.
Dose: 250 rug twice a day for 7 days, doubled in severe infections. Care in hepatic an([ renal impairment. It may potentiate the effects of warfarin and digoxin. Should not be given with astemizole or terfenadine (risk of arrhythinias). (Khricid).
clavulanic acid An inhibitor of betalactanlase. Many penicillin-resistant organisms contain that enzyme in the cell wall, which inactivates the penicillin before it call enter the cell and exert its bacterial action. clavulanic acid inhibits such enzyme activity, and so facilitates the penetration of the antibiotic into the bacterial cell. It is used in association with amoxycillin as coamoxiclav (Augmentin) and with ticarcillin as Tinientin, in the treatment of infections due to amoxycillin-resistant bacteria.
clemastine An antihistamine used in allergic rhinitis, urticaria and allergic derniatoses.
Dose: I mg twice a day. In common with other antihistamines, it may cause drowsiness, and anticholinergic side-effects such as dryness of the mouth. H avegil). See
page 110 and Table 2.
clindamycin An antibiotic used mainly in staphylococcal bone and joint infections not responding to other drugs. It is also useful in anaerobic abdominal infections.  A serious side-effect is a potentially fatal pseudomernbranous colitis, and the drug should be withdrawn immediately if diarrhoea occurs. See vancomycin and nietronidazole.

atenolol A long-acting beta-adrenoceptor blocking agent of the propranolol type, but with a more cardioselective action. Used mainly in hypertension pertension and angina.
Dose: 50-100 mgdaily. Also given by slow 6. injection in arrhythmias in doses ill, to 10 mg. The side-effects are similar to propranolol, although atenolol may cause fewer sleep disturbances. (”Fenormin). See pages 114 & 148, and Tables 4 & 21.
atorvastatin A lipid-lowering agent with an enzyme-inhibitory action on cholesterol synthesis used in hyperlipidaemia. Dose: 10 mg daily initially, up to a maximum of 80 ing daily. Liver function tests are necessary before and during treatment. (Lipitor). See page 146 and Table 20.
atovaquone An antibacterial agent used in Prietintocyslis carinii pneumonia resistant to co-trimoxazole.
Dose: 750 ing daily with food for 21 days. Side-effects are rash, nausea and diarrhoea. (Welivolle).
atracurium A non-depolarizing muscle relaxant of the gallamine type, but causing less histamine release.
Dose: 30f1-600 pglkg i.v. initially followed by doses of 100-200 µg/kg at intervals as required. Its action can be reversed, if nec- essary, with neostiginine. Arninoglycoside antibiotics may increase the response and require all adjustment of dose. (Tracrium).
atropine An alkaloid with anticholinergic properties obtained from belladonna, hyoscymus and other plants. It is often given in doses of 300-600 pg by injection with morphine for preoperative sedation and to reduce bronchial secretion. Is also of value in gastrointestinal smooth muscle spasm.
Dose: 0.23-2 mg daily. It is used as eye drops (Vyl)) to dilate the pupil, but such use in the elderly requires care, as the long action may precipitate glaucoma. It is also used with neostigmine in doses of 600 pg-1.2 ing to reverse the action of the vecuronium-type muscle-relaxants. Side-effects include dryness of the mouth, disturbed vision, an(] bradycardia followed by tachycardia. Care is necessary in prostatic enlargement and urinary disturbances, and glaucoma is a contraindication.
augmentin See co-amoxiclay.
auranofin An orally active gold compound used in the treatment of active rheumatoid arthritis not relieved by non-steroidal anti-inflammatory drugs (NSAIDs).
Dose: 6 nig daily, increased if necessary .titer 6 months to 9 ing daily. It should be withdrawn if the response is inadequate after 9 months. Side-effects are nausea and diarrhoea. See sodium aurothiomalate for the systemic side-effects of gold therapy. (Ridaura). See page 165 and Table 29.
avomine Derivative of promethazine used in travel sickness, nausea and vomiting. Dose: 25-150 mg daily.
azapropazone A non-steroidal anti-inflammatory agent (NSAID) with actions and uses similar to those of naproxen and used when other NSAIDs are unsuitable. Dose: 1.2 g daily, but in acute gout an initial, divided, dose of 1.8 g is given. Side-effects include rash and occasional photosensitivity, and care is necessary in peptic ulcer. Azapropazone may potentiate the action of warfarin and phenytoin, and require all adjustment of dose
(Rheuniox). See page 165 and *]’able 29.
azatadine An antihistamine with the actions and uses of promethazine.
Dose: 1-2 ing twice daily. (Optimise). See page 110 and Table 2.
azathioprine An immunosuppressive agent mainly used to inhibit rejection after organ transplant surgery. It has also been used in some auto-immune conditions and in
resistant ulcerative colitis.
Dose: 1-5 niglkg daily, but (lose and duration vary according to need and response. Side-effects include depression of bone marrow function, gastrointestinal disturbances, hepatotoxicity and rash. Severe secondary infections may occur as a result of the inunlU1lOSllppreS!aOu, and the use of the drug requires close control. (Az,aniinc).
azoolic acid An organic acid with some antibacterial properties. Used as 20% cream for acne vulgaris. (Skinoren).
azelastine An antihistamine used as a nasal spray 0.1% in allergic rhinitis. (Rhinolast).
azidothymidine See zidovudine.

azithromycin A macrolide antibiotic with a longer action than erythromycin or clarithromycin, used chiefly in respiratory tract infections.
Dose: 500 mg daily for 3 days, I hour before or 2 hours after food or antacids. Side-effects include nausea, abdominal discomfort and diarrhoea. Not to be given with astemizole or terfenadine ( risk of arrhythmias). Vithrornax).
azlocillln A broad-spectrum antibiotic with exceptional activity against Pseudomonas. Of value in respiratory and urinary infections, and in septicaemia.
Dose: in life-threatening infections, 5 g by i.x. infusion 8-hourly. Doses of 2 g 8-hourly may be given in less severe infer lions. III patients with impaired renal function, doses should be given 12-hourly. Allergy to penicillins or cephalosporins is a contraindication. (Securopen).
AZT See zidovudine.
aztreonam An antibiotic that is exceptional in being resistant to breakdown by beta-lactamases. It has a selective action against Gram-negative aerobes, and it is given in urinary, respiratory, bone and other infections caused by susceptible bacteria. When given in association with an aminoglycoside, the activity of aztreonam against Pseudomonas aeruginosa may be increased.
Dose: 4 g daily by i.m. injection and up to 8 e daily i.v. in severe infections. Reduced doses are indicated in renal impairment. Side-effects are skin reactions, nausea, jaundice, blood disorders, and malaise. (Azactam).
is given by intrathecal injection in small doses via an implantable pump, but treatment requires specialist supervision. (Lioresal).
BAL See dimercaprol.
balsalazide A melsalazine complex used in ulcerative colitis. It reaches the colon unchanged, where it is broken down to release active melsalazine.
Dose: 9g daily until remission or for 12 weeks. Side-effects are those of melsalazine. See page 172 and Table 32.
bambuterol A prodrug of terbutaline, with .I similar but more prolonged bronchodilator action.
Dose: 10-20 mg at night. (Bambec). See page 118 and Table 6.
barbiturates A group of hypnotic drugs exemplified by butobarbitone. Once widely used, but their value has declined sharply and safer drugs such as nitrazepam are now preferred.
barium sulphate A very insoluble powder, given orally or rectally as an aqueous suspension as contrast agent for X-ray examination of the alimentary system.
BCG vaccine A preparation of the Calniette-Guerin strain of Mycobacterium tuberculosis. It is used for active immunization against tuberculosis. particularly for individuals likely to be exposed to
infection.
Dose: 0.1 111[. by int radermal injection. A product obtained from an isoniazidresistant strain of the organism is also used for the immunization of individuals receiving prophylactic treatment with isoniazid.
baclofen A muscle relaxant that acts on the spinal end of some motor neurones. Useful in multiple sclerosis and muscle spasms caused by spinal lesions.
Dose: 15 nig daily initially gradL1.111), increased, as required, up to a maximum of 100 mg daily. Side-effects include nausea, fatigue and hypotension. Care is necessary in epilepsy and psychiatric disorders. Withdrawal of treatment is slow over 1-2 weeks to avoid serioius side-effects. In severe spasticity and spinal injury, baclofen
beclomethasone A potent corticosteroid used in the control of asthma and bronchospasin not responding to other drugs. Dose: by oral aerosol inhalation, too pg (two puffs) repeated up to 4 times a day according to need and response. Dose: by powder inhalation 800 pg daily. Hoarseness may develop as a side-effect, and oral candidiasis may occur with high doses. Beclornethasone is also used as a cream or ointment (0.025%) in severe inflammatory skin conditions not responding to less Potent corticosteroids. (Becotide; Propaderm).

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.