Posts Tagged ‘expert supervision’

abciximab A monoclonal antibody that inhibits platelet aggregation and thrombus formation. Used as an adjunct to heparin in percutaneous transluminal coronary angioplasty under expert supervision. (ReoPro).
glaucoma, as it decreases intraocular pres    9 sure by reducing formation of aqueous humour. It has also been used in epilepsy. Dose: 250 nig-1 g daily. In severe conditions it may be given in similar doses by i.v. injection. Side-effects are drowsiness, gastrointestinal disturbances and paraesthesia. (Dianiox). See page 138 and Table 16.
acamprosate An analogue of GAGA used in alcoholism. It assists in the maintenance of abstinence in alcohol-dependence, but prolonged treatment for a year may be required. Dose: 666 mg 3 times a day. (Campral).
acarbose An inhibitor of alpha-glucosidase, the enzyme that converts dietary carbohydrates to soluble sugars. Used in noninsulin-dependent-diabetes to reduce hyperglycaemic peaks after food. Dose: 50 mg daily initially, rising to 150 mg daily if required. Side-effects are flatulence and diarrhoea; a hypoglycaemic reaction can be treated with oral glucose. (Glucobay). See page 131 and Table 13.
ACE inhibitors See angiotensin-converting enzyme inhibitors.
acebutolol A beta-adrenergic blocking agent with the actions, uses and side-effects of propranolol, but with a more cardioselective effect and less likely to cause bronchospasm.
Dose: in hypertension, 400-800 mg daily; in severe angina, up to 1.2 g daily. It is contraindicated in cardiogenic shock, atrioventricular-block and heart failure. Care is necessary in obstructive airway disease and renal failure (Sectral). See page 148 and Table 21.
aceclofenec A non-steroidal anti-inflammatorydrug (NSAID) used for the relief of pain in arthritic and rheumatoid conditions. Dose: 200 mg daily. (Preservex). See page 131 and Table 29.
acemetacin A derivative of indomethacin with similar actions and uses, but said to be better tolerated.
Dose: 120-180 ing daily. (Finflex). See page 165 and ‘[’able 29.
acetazolamide An inhibitor of the enzyme carbonic anhydrase that has been given as a mild diuretic, as it increases the excretion of bicarbonate. Now used mainly in mild
acetomenaphthone A synthetic form of vitamin K, formerly used in prothrombin deficiency. Menadiol and phytonienadione are now preferred. Acetoinenaphtlione is present in some chilblain preparations.
acetylcholine The neurotransmitter of the parasympathetic nervous system. A 1% solution is sometimes used as a miotic to obtain rapid contraction of the pupil after cataract surgery. (Miochol).
acetylcysteine A mucolytic agent used as eye drops 5% in tear deficiency. Of value in the early treatment (10-15 hours) ofparacetarnol poisoning.
Dose: initially 150 nig/kg by slow i.v. injection, followed by smaller doses up to a total dose of 300 mg/kg over 20 hours. It is inef1ictive, and possibly harmful, if given at a later stage. (Parvolex). See methionine.
acetylsalicylic acid See aspirin. aciclovir See acyclovir.
acipimox A derivative of nicotinic acid used in hypercholesterolaemia.
Dose: 500–750 mg daily. Side-effects are hushing, erythema, nausea and malaise. (Olbetani). See page 146 and Table 20.
acitretin A vitamin A derivative (retinol) used in severe psoriasis resistant to other treatment.
Dose: 20-30 mg daily. Teratogenic - see specialist literature. (Neotigason).
aclarubicin An anthracene cytotoxic agent of the doxorubicin type used in resistant acute non-lymphatic leukaemia. (Aclacin). See specialist literature.
acrivastine one of the newer antihistamines. It is less likely to cause drowsiness, as it does not cross the blood-brain barrier to any great extent, but is correspondingly less effective in non-allergic pruritus. Dose: 24 mg daily. (Semprex). See
page 110 and Table 2.

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

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

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

itraconazole An orally active antifungal agent used in the treatment of vulvovaginal candidiasis, pityriasis and tinea infections. Dose: 200 mg twice a day for the I -day treatment of vulvovaginal infections; 200 nig daily for 7 days in pityriasis, 100nig daily for 15-30 days in tinea infections. Side-effects are nausea and abdominal pain. Liver disease is a contraindication. Combined treatment with astiniazole or ierfenadine should be avoided. (Sporonox).
ivermeclin A fungal derivative effective against the microfilaria causing ‘river blindness. It does not kill either the adult worms or their larvae, but prevents the growth of the latter, and treatment must be continued until the adult worms die out. Dose: 150. (Mectizan).
kanamycin An aminoglycoside antibiotic now used mainly in gentamicin-resistant infections.
Dose: I g daily by i.m. injection; 15-30 rng/ kg daily by i.v. infusion. (Kannasyn).
kaolin Aluminium silicate. Used as an absorbent in diarrhoea, colitis, food poisoning, etc., often as Kaolin and Morphine Mixture.
Dose: 10-20 nil as required. It is also used externally as Kaolin Poultice to relieve the pain of sprains, etc.
kelocyanor A specific antidote for cyanide poisoning. See dicobalt edetate.
ketamine A short-acting i.v. anaesthetic with analgesic properties.
Dose: 1-2 mg/kg i.v. over I minute, repeated as required; 4-10 nig/kg by deep Lin. injection. It is used mainly in paediatric anaesthesia, and its analgesic action is also of value in neurodiagnostic procedures, and other painful investigations. Hallucinations may occur during the recovery period. (Ketalar).
ketoconazole A broad-spectrum, orally active antifungal agent. It is of value in systemic and deep mycoses, and in severe and resistant mycoses of the gastrointestinal tract and the vagina. It is also effective in severe mycoses of the skin, but it should be used only for superficial fungal infections not responding to other treatment.
Dose: 200 mg daily with ft)od, up to a maximum of 4tH) mg daily. Side-effects include nausea, rash and pruritus. It may cause hepatitis; liver function tests may be necessary if given for more than 14 (lays. (Ki-zoral).
ketoprofen A non-steroidal anti-inflammatory and analgesic agent of the ibuprofen type. It is of value in rheumatoid arthritis, gout, spondylitis and related conditions, and in dysmenorrhoea.
Dose: 100-200 mg daily with food;
100 Ing by suppository at night, 50-100 mg by deep Lin. injection 4-hourly. Care is necessary in peptic ulcer and hepatic disease. May increase the action of anticoagulants and other drugs bound to plasma protein. (AlrheLiniat; OrUdis; Orivail). See page 165 and Table 29.
ketorolacV A potent analgesic used for the short-term reliefofacute postoperative pain.
Dose: tO mg 4-6-hourly up to 40 ing daily for not more than 7 days; dose by deep i.m. or slow i.v. injection. 10 mg initially, then 30 mg 4-6-hourly up to 90 mg daily for not more than 2 days. Side-effects are numerous; see data sheet. (Toradol). Also used as eye drops (0.51)/0 to reduce pain and inflammation after ocular surgery. (Acular).
keftotifen An antihistamine that may also have some of the properties ofsodium cromoglycate. It is used in the prophylactic treatment of asthma.
Dose: 4 mg daily with food, continued lor ,sine weeks. Other anti-asthmatic therapy should be continued for at least 2 weeks to ensure maintenance of control. Side-
effects include sedation and dryness of the mouth. (Zadi(en). See page 110 and Table 2.
Kogenate A recombinant form of the human blood Factor Vill, given i.v, as replacement therapy in the treatment of haemophilia A.

labetalol A beta - adrenocepior blocking agent with some alpha-blocking activity. Like related drugs, labetalol is indicated in all types of hypertension, including that following myocardial infarction.
Dose: 200 mg daily initially, with food, slowly increased up to a maximum of 2.4 g daily; by i.v. injection 50 mg repeated as required; for the rapid control of the hypertension of pregnancy 20-160 ing by i.v. infusion hourly. It should be used with care in asthma and heart block. Side-effects include weakness, nausea, bradycardia and postural hypotension. Liver damage has been reported. (Trandate). See page 148 and `fable 21.
lacidipine A calcium channel blocking agent with the actions and uses of nifedipine. In hypertension it is given as a single morning dose of 2 nig with food, increased up to 6 mg as the response develops over 3-4 weeks. Half doses in hepatic impairment and the elderly. Early chest pain is an indication that the drug should be withdrawn. (Motens). See page 148 and Table 21.
lactilol A semi-synthetic sugar that is not absorbed orally, and acts as an osmotic laxative by retaining water in the intestinal tract. Also inhibits ammonia-producing organisms, and is of value in hepatic encephalopathy.
Dose: as laxative 20 mg daily mixed with food, together with 2 glasses of water. Dose in hepatic encephalopathy, 500700 inglkl; daily.
lactulose An osmotic laxative. See lactilol.
laevulose Fructose. A sugar sometimes given i.v. as an alternative to glucose.
in the brain by inhibiting the influx of sodium ions. It is used both as primary treatment and as additional therapy (often with sodium valproate) for seizures not fully controlled by other drugs.
Dose: 25 ing daily initially for 14 (lays, slowly rising to 100-200 nig daily. See data sheet for details of combined therapy. (Limictal). See page 136 and Table 15.
lanolin See wool fat.
lansoprazole An inhibitor of the enzyme 11, K’-AI’Pase (the proton pump) used in the treatment of peptic ulcer.
Dose: 30 ing daily for 4-8 weeks. (Luton). See orneprazole, page 162 and Table 27.
Lasser’s paste A stiffointment containing zinc oxide, starch and white soft paraffin with 2% salicylic acid. Used as protective in eczema.
latanoprost A prostaglandin alpha-analogue used once daily as eye drops (0.00596) in glaucoma. It increases the outflow of the aqueous humour, whereas other agents reduce its secretion. Continued use may cause changes in eye colour. (Xalantan). See page 138.
lenograstimV A recombinant form of the granulocyte colony stimulating factor (G–GSF) that governs the production of neutrophils. It is used as supplementary treatment in cancer chemotherapy to stimulate neutrophil production in drug induced neutropenia.
Dose: under expert supervision by s.,:. injection, in daily doses of 150 pg/m2 Until neutrophil count is satisfactory. Also used i.v. after hone narrow transplantation. (Granocyte). See filgrastim and rinolgraniostirn. See page 122 and Table 8.
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lamivudine An antiviral agent that acts like zidovudine by inhibiting reverse transcriptase, an enzyme essential for DNA formation and viral replication. It is used in HIV infections.
Dose: 300 ing daily, preferably with food, and combined with a protease inhibitor. (Epivir). See page 144 and Table 19.
lamotrigine\” An anti-epileptic that alleviates the imbalance of neurotransmitters
letrozoleV A non-steroid inhibitor of aromatase, the enzyme that controls the conversion of testosterone to oestrogen. It acts as an anti-oestrogen and is used in advanced breast cancer that has not responded to tamoxifen or similar therapy. Dose: 2.5 mg once daily. Side-effects include musculoskeletal pain, arthralgia and hot flushes. (Fernara). See page 122 and Table 8.
leucovorin See folinic acid.

leuprorelin A synthetic hormone that indiandrogen and oestrogen production by inhibiting gonadotrophin activity. It is used in endonietriosis and
advanced prostatic cancer.
Dose: 3.73 rig by s.c. or i.m. injection every 4 weeks. Side-effects are impotence, flushing and local irritation. There may be an initial and temporary increase in pain. The injection site should be varied. (Prostap SR). See buserelin, goserelin, page 122 and Table 8.
levamisole A single-dose (150 mg) anthelmintic of value in round worm (Ascaris). It is also effective against hookworm (Ancylostoma and Necator). Dose: 2.5-5 mg1kg daily for 2-5 days.
levobunolol A beta-blocker used as eye drops 0.5% in glaucoma. (Betagaii). See carteolol.
levocabastine An antihistamine used as drops (0.05% twice a day in the symptomatic treatment of seasonal allergic conjunctivitis and rhinitis. (Livostin).
levodopa An amino acid that is converted to dopamine in the body. It is used in the treatment of Parkinson’s disease, which is associated with a reduction in brain
dopamine levels due to degeneration in the substantia nigra, thus causing an imbalance in the neurohorinonal system of the brain. Levodopa is essentially replacement therapy, but as an oral dose is metabolized to some extent in the peripheral circulation It is often given with art enzyme inhibitor such as benserazide or carbidopa. Combined therapy permits a larger dose of active drug to reach the cerebral tissues, and at the same time reduces some of the general side-effects of levodopa.
Dose: 125-300 mg initially, increased according to need and response. Side-effects include nausea and cardiovascular disturbances, but psychiatric side- effects may be (lose limiting. Close angle glaucoma is a contraindication. See page 160 and ‘I able 26.
lignocaine (lidocaine) A local anaesthetic widely used for infiltration anaesthesia as a 0.25-0.5% solution, usually with adrenaline, as well as for epidural, caudal and nerve block anaesthesia. It is the local anaesthetic present in many dental cartridges. A 2-4% solution is used for
surface anaesthesia, and a 2% gel is used to relieve the pain and discomfort of catheterization, but rapid absorption may cause side-effects. Lignocaine is also the drug of choice in the control of ventricular tachycardia following myocardial infarction. Dose: 100 mg as an i.v. bolus, followed by a dose of 4 mg/min by i.v. infusion for 3(t minutes, with subsequent doses of 2 inghnin. Side-effects include confusion, convulsions, bradycardia and I p hy oten- sion. (Xylocard). Emla cream contains lignocaine and prilocaine. It is used for local anaesthesia and to relieve the pain associated with injections, especially in children. It is applied under an occlusive dressing 1-2 hours before the injection.
lindane A pesticide used as a 1% solution for the treatment of scabies.
liothyronine (tri-iodothyronine) A thyroid hormone with it rapid action, an(] probably a precursor of thyroxine. It is given orally in severe hypothyroid conditions when a rapid action is necessary, and by injection in hypothyroid coma. Dose: 20-60 fag daily; 5-20 pg i.v.
0 ertroxin).
liquid paraffin A lubricant laxative and faecal softener.
Dose: la-mj, nil. Its extensive use is now
discouraged, as it may cause granulomatous reactions and reduce the absorption of fat-soluble vitamins.
lisinopril An ACE inhibitor similar to enalapril, but with it longer action that permits the use of a single daily dose. Dose: in the treatment of hypertension, (loses of 2.5 rig daily initially, slowly increased according to response up to 10-20 mg daily, occasionally up to 40 mg. In patients receiving diuretics, such Ilierapy should be withdrawn for 2-3 days before lisinopril therapy and resumed later if necessary. (Carace; Zesiril). See
page 148 and Table 21.
lithium carbonate Lithium carbonate and itratearc used for their mood-regulating action in the prophylaxis and treatment of mania and depressive illness, but the mode of action is not known. The therapeutic/ toxic range of lithium is very narrow, and continuous control of the plasma/lithium level is essential to avoid the many side-effects and hazards of therapy.

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