Posts Tagged ‘glaucoma’

Generic Name
Deferasirox (deh-fur-ASS-sih-rox)
Brand Name Exjade
Type of Drug
Iron chelating agent. Prescribed For
Chronic iron overload. General Information
Deferasirox binds with iron in stored in the liver. It can also bind small amounts of zinc and copper but the importance of these effects are not known. Almost 3/4 of every dose is absorbed into the bloodstream. Most of the drug is broken down in the liver and passes out of the body in the feces. Women clear this drug from their bodies 17.5% slower than men, but this has not affected how it is used or the doses given.
Cautions and Warnings
Do not take deferasirox if you are allergic or sensitive to any of its ingredients. Most reactions occur within the first month of treatment.
People with liver disease should have monthly blood tests while taking deferasirox.
Kidney failure has developed in people taking deferasirox with fatal results in some cases. People with or those who are at risk of kidney failure should have routine kidney monitoring while taking this medication. People who are at risk for kidney failure in-ciudes seniors, those with kidney disease, and people taking medicines that affect kidney function. Dose adjustment may be needed.
Deferasirox has been associated with potentially severe reduced white-blood-cell and platelet counts, usually in people with preexisting blood disorders.
Rarely, deferasirox has caused hearing loss and eye problems. You should have a full hearing and eye exam before starting on this drug and once a year thereafter.
Skin rash can occur with this medicine. If it is severe, the drug may have to be temporarily stopped. It may be restarted at a lower dosage.
Possible Side Effects
♦    Most common: fever, headache, abdominal pain, cough, sore throat, nasal irritation, diarrhea, flu symptoms, nausea, and vomiting.
✓    Common: respiratory infections, bronchitis, runny nose, rash, upper abdominal pain, joint pain, back pain, tonsillitis, and ear infection.
✓    Less common: itching.
✓    Rare: stomach pain, swelling in the arms or legs, sleep disorder, skin color changes, dizziness, anxiety, gallstones, fatigue, early cataract and hearing loss, some visual haziness, and other eye disorders. Contact your doctor if you experience anything unusual.
Drug Interactions
•    Do not mix antacids containing aluminum with deferasirox. They can prevent it from being absorbed.
Food Interactions
This drug should be taken at the same time every day on an empAq stomach, 30 minutes before eating.
Ustlak 13bSe
Adult and Child (age 2 and over): 9-13.6 mg per lb. of body weight once a day. Dose adjustments will be made according to your response. See “Special Information” for a specific instructions on how to take these tablets.
Overdosage
Large doses of 2-3 times the prescribed amount taken for several weeks with no adverse effects have occurred. Overdose symptoms include hepatitis (mild fever, muscle or joint aches, nausea, vomiting, appetite loss, slight abdominal pain, diarrhea, and fatigue) and some drug side effects. Take the victim to a hospital emergency room for treatment because the heart may be affected. ALWAYS bring the prescription bottle or container.
Special Information
Call your doctor at once if you develop a severe skin rash.
You must have regular vision and hearing tests while taking deferasirox.
Deferasirox tablets should not be chewed or swallowed whole. They must first be mixed completely in 1/2-1 glass of water, orange juice, or apple juice. The tablet will not dissolve but tablet particles will become suspended in the liquid. Drink the resulting sus-Pension immediately. If there is anything left in the glass after drinking the suspension, add a small amount of liquid, mix it with the remaining tablet particles and drink it.
This drug can cause dizziness. Be cautious while driving, operating machinery, or doing anything that requires intense concentration.
If you forget a dose, take it as soon as you remember. If it is almost time for the next dose, skip the one you forgot and continue with your regular schedule. Do not take a double dose.
Special Populations
Pregnancy/Breast-feeding: There are no studies of ranolazine in pregnant women or of its effect on the developing fetus. Pregnant women should take this drug only if its potential benefits outweigh the risks.
This drug may pass into breast milk. Nursing mothers should consider using infant formula.
Seniors: Seniors may experience more drug side effects than younger adults due to greater chances of reduced kidney, liver, and heart function; other diseases; or drug side effects.

Generic Name
Desmopressin (dez-moe-PRES-in)
Brand Names
DDAVP Minirin
Type of Drug
Pituitary hormone replacement.
Stimate
Prescribed For
Nighttime bed-wetting and diabetes insipidus (central or cranial diabetes); also used to control bleeding in certain forms of hemophilia A and von Willebrand’s disease.
General Information
Desmopressin acetate is a synthetic version of antidiuretic hormone (ADH). When ADH is lacking, the body has difficulty retaining fluid. People lacking ADH experience excessive thirst, increased urination, and dehydration; desmopressin controls these symptoms. When used for nighttime bed-wetting, desmopressin should be used in conjunction with behavioral or other non-drug therapies.
Cautions and Warnings
Do not take desmopressin if you are allergic or sensitive to any of its ingredients.
People, especially children and seniors and people with cystic fibrosis and electrolyte imbalances, should only drink enough fluid to satisfy their thirst while taking desmopressin because of the risk of water intoxication, which can result in seizures that could lead to coma. People with coronary artery disease, heart disease, or high blood pressure should use this drug with caution.
Heart attacks and St&D’KeS after treatment with desmopressin MV~bEbn reported in people at risk for them, but there is no definite link to desmopressin use.
People using desmopressin should have their urine checked regularly by their doctor. Your doctor should also check for nasal swelling, congestion, and scarring.
Drug Interactions
experience in blood pressure, loss of sodium, symptoms include coma, confusion, ng headache, decreased urination, rapid
zures), edema, stomach or abdominal dness or flushing of the skin, passing ain, and stuffy or runny nose. Contact perience any side effect not listed above.
Possible Side Effects
V Rare: slight increase
intoxication (
drowsiness, continuin
gain, and seizures)
nausea, rednes
vulvar pain
doctor if you
•    Desmopressin may increase the effects of other drugs that raise blood pressure. This only happens with large dosages.
•    Chlorpropamide and carbamazepine may increase the effects of desmopressin.
Food Interactions None known.
Usual Dose
Nasal Solution—Nighttime Bed-Wetting
Adult and Child (age 6 and over): 20 mcg (0.2 mL) at bedtime. Child (under age 6): not recommended.
Nasal Solution—Diabetes Insipidus
Adult: 0.1-0.4 mL a day in 1-3 doses.
Child (age 3 months-12 years): 0.05-0.3 mL a day in 1-2 doses.
Tablets—Nighttime Bed-wetting
Adult and Child (age 6 and over): Begin with 0.2 mg at bedtime, adjusting to individual need up to 0.6 mg.
Child (under age 6): not recommended.
Tablets—Diabetes Insipidus
Adult: Begin with 0.05 mg twice a day. Daily dosage should be increased according to individual need, up to 1.2 mg a day divided into 2-3 doses.
Child (age 4 aid over): Begin with 0.05 mg and adjust according to individual need.
Child (under age 4): not recommended.
Overdosage
Symptoms include headache, difficulty breathing, abdominal cramps, nausea, and facial flushing. Call your doctor or a hospi-tal emergency room if you suspect an overdose. Because there is no known antidote to desmopressin, your dosage may be temporarily reduced until overdose symptoms subside. If you seek treatment, ALWAYS bring the prescription bottle or container.
Special Information
Call your doctor if you develop headache, breathing difficulties, heartburn, nausea, abdominal or stomach cramps, or vulvar pain.
The Stimate Nasal Solution spray pump and Minirin spray must be primed before its first use. To prime the pump, press down 4 times. Stimate delivers 25 doses per bottle. Throw away the bottle after 25 doses have been used, because anything remaining after the 25th dose is likely to deliver less drug than is needed.
If you forget a dose of desmopressin, take it as soon as you remember. If you don’t remember until your next dose, skip the forgotten dose and continue with your regular schedule. Do not take a double dose.
Special Populations
Pregnancy/Breast-feeding: The safety of using desmopressin during pregnancy is not known, though it has been used to treat diabetes insipidus in pregnant women without apparent harm to the fetus. When this drug is considered crucial by your doctor, its potential benefits must be carefully weighed against its risks.
Desmopressin may pass into breast milk. Nursing mothers who must use this drug should use infant formula.
Seniors: Seniors should avoid drinking too much fluid while taking desmopressin.

Generic Name
Diazepam (dye-AZ-uh-pam) rVg_l
Brand Names
Diastat    Valium
Diazepam Intensol    Valrelease
The information in this profile also applies to the following drugs:
Lorazepam &
Ativan    Lorazepam Intensol
Oxazepam M
Type of Drug  Benzodiazepine sedative.
Prescribed For
Anxiety, tension, fatigue, agitation (particularly due to alcohol withdrawal), muscle spasm, and seizures; also prescribed for irritable bowel syndrome and panic attacks.
General Information
Diazepam and other benzodiazepines directly affect the brain. They can relax you and make you more tranquil or sleepy, or they can slow nervous system transmissions in such a way as to act as an anticonvulsant.
Cautions and Warnings
Do not take diazepam if you know you are allergic or sensitive to any of its ingredients or to another benzodiazepine drug, including clonazepam.
Diazepam can aggravate narrow-angle glaucoma, but you may take it if you have open-angle glaucoma and are receiving therapy for it.
Other conditions in which diazepam should be avoided are severe depression, severe lung disease, steep apnea (intermittent cessation of breathing during sleep), liver disease, drunkenness, and kidney disease. In all of these conditions, the depressive effects of diazepam may be enhanced or could be detrimental to your overall condition.
Diazepam should not be taken by psychotic patients. It is not effective for them and can trigger unusual excitement, stimulation, and rage.
Diazepam is not intended for more \han 3-4 months of continuous use. Your comikkni) should be reassessed before continuing YOU( MS-16cation beyond that time.
Diazepam may be addictive. It should be used with caution in people with a history of drug dependence.
Drug withdrawal may develop if you stop taking it after only 4 weeks of regular use but is more likely after longer use. It may start with anxiety and progress to tingling in the hands or feet, sensi-tivity to bright light, sleep disturbances, cramps, tremors, muscle tension or twitching, poor concentration, flu-like symptoms, fatigue, appetite loss, sweating, and changes in mental state. Your dosage should always be reduced gradually to prevent drug withdrawal symptoms.
Possible Side Effects
Y Most common: mild drowsiness during the first few days of therapy. Weakness and confusion may occur, especially in seniors and in those who are sickly. If these effects persist, contact your doctor.
♦ Less common: depression, lethargy, disorientation, headache, inactivity, slurred speech, stupor, dizziness, tremors, constipation, dry mouth, nausea, inability to control urination, sexual difficulties, irregular menstrual cycle, changes in heart rhythm, low blood pressure, fluid retention, blurred or double vision, itching, rash, hiccups, nervousness, hysteria, psychosis, inability to fall asleep, and occasional liver dysfunction. If you have any of these symptoms, stop taking the drug and contact your doctor at once.
•    Rare: Rare side effects can affect your heart, stomach and intestines, urinary tract, blood, muscles, and joints. Contact your doctor if you experience any side effect not listed above.
Drug Interactions
•    Diazepam is a central-nervous-system depressant. Avoid alcohol, other sedatives, narcotics, barbiturates, monoamine oxidase inhibitor antidepressants, antihistamines, and antidepressants. Taking diazepam with these drugs may lead to excessive depression, drowsiness, or difficulty breathing.
•    Smoking may reduce diazepam’s effectiveness by increasing the rate at which it is broken down by the body.
•    Effects of diazepam may be prolonged when taken with cimeti(1(m,, Contraceptive drugs, disulfiram, fluoxetine, isoniazid, ketoconazole, rifampin, metoprolol, probenecid, propoxyphene, propranolol, and valproic acid.
•    Theophylline may reduce the sedative effects of diazepam.
•    If you take antacids, separate them from your diazepam dose by at least 1 hour to prevent them from interfering with the passage of diazepam into the bloodstream.
•    Diazepam may increase blood levels of digoxin and the chances for digoxin toxicity.
•    Levodopa + carbidopa’s effects may be decreased if it is taken with diazepam.
Combining diazepam and phenytoin may increase phenytoin blood concentrations and the risk of phenytoin toxicity.
Food Interactions
Diazepam is best taken on an empty stomach, but it may be taken with food if it upsets your stomach.
Usual Dose
Solution or Tablets
Adult’. 2-40 mg a day. Dosage must be adjusted to individual response for maximum effect. In seniors, less of the drug is usually required to control tension and anxiety.
Child (6 months and over): 1-2.5 mg 3 or 4 times a day; more may be needed to control anxiety and tension.
Child (under 6 months): not recommended.
Rectal Gel
Adult and Child (age 12 and over): 0.09 mg per lb. of body weight. Approximate dosage: 5 mg if 31-60 lbs., 10 mg if 61 -110 lbs., 15 mg if 111-165 lbs., or 20 mg if 166-244 lbs.
Child (age 6-11): 0.14 mg per lb. of body weight. Approximate dosage: 5 mg if 22-40 lbs., 10 mg if 41-82 lbs., 15 mg if 83-121 lbs., or 20 mg if 122-163 lbs.
Child (age 2-5): 0.23 mg per lb. of body weight. Approximate dosage: 5 mg if 13-24 lbs., 10 mg if 25-49 lbs., 15 mg if 50-73 lbs., or 20 mg if 74-97 lbs.
An extra 2.5 mg of the rectal gel may be given if a more precise dosage is needed or as a partial replacement for people who do not retain the full dosage after it is first inserted rectally.
Overdosage
SYMPUns of overdose include confusion, sleepiness, poor coordination, lack of response to pain, loss of reflexes, shallow breathing, low blood pressure, and coma. The victim should be taken to a hospital emergency room. ALWAYS bring the prescription bottle or container.

Type of Drug
Carbonic-Anhydrase Inhibitors,
Eyedrops (kar-BON-ik an-HYE-drase)
Brand Names
Generic Ingredient: Dorzolamide Trusopt
Generic Ingredient: Brinzolamide Azopt
Combination Product
Generic Ingredients: Dorzolamide + Timolol Cosopt
Prescribed For  Glaucoma.
General Information
These drugs are similar to acetazolamide, a carbonic-anhydrase inhibitor taken by mouth. Carbonic anhydrase is an enzyme found in many parts of the body, including the eyes. By blocking the effects of this enzyme, dorzolamide and brinzolamide slow the production of fluid inside the eye, reducing pit:ssure. This cffc,, i3 usetul in ir83t
ino, open-angle glaucoma because the disease is characterized by elevated eye pressure. Dorzolamide and brinzolamide are sulfonamides, or sulfa drugs, and although they are administered topically, they affect the body systemically.
Cautions and Warnings
Do not use these drugs if you are allergic or sensitive to any of their ingredients or to other sulfa drugs. Small amounts of these drugs enter the bloodstream. Rarely, people using them experience side effects or allergies associated with sulfa drugs.
These drugs have not been studied in people with very poor kidney or liver function. Since these drugs are eliminated via the kidneys, people with impaired kidney function should use an alternate glaucoma medication.
These drugs have not been studied in people with acute angle-closure glaucoma.
See Timolol, page 1129, for more information on the combination product Cosopt.
Possible Side Effects
Dorzolamide
✓    Most common: eye burning, stinging, or discomfort and a bitter taste in the mouth immediately after administering the eyedrops.
✓    Less common: allergic reactions, conjunctivitis (pinkeye), blurred vision, tearing, dry eye, and increased sensitivity to bright light.
♦    Rare: headache, nausea, weakness, tiredness, rash, and kidney stones. Dorzolamide can cause the same types of side effects as other sulfa drugs, but this is very unlikely. Contact your doctor if you experience any side effects not listed above.
Brinzolamide
♦    Common: blurred vision and a bitter, sour, or unusual taste in the mouth.
♦    Less common: eyelid inflammation; conjunctivitis (pink-
eyeY, nsh; dry eye; sensation of something in the eye;
headache; eye redness, itching, discharge, or pain; and
runny nose.
✓    Rare: allergic reactions, hair loss, chest pain, diarrhea, nausea, sore throat, tearing, itchy rash, double vision, dizziness, Possible Side Effects (continued)
dry mouth, breathing difficulties, upset stomach, tired eyes, kidney pain, cornea problems, and formation of a crust or sticky sensation around the eyelid. Brinzolamide can cause the same types of side effects as other sulfa drugs, but this is very unlikely. Contact your doctor if you experience any side effect not listed above.
Drug Interactions
• If you are using more than 1 eyedrop product, separate doses of these drugs by at least 10 minutes.
Usual Dose
Adult: 1 drop in the affected eye 3 times a day. Overdosage
Accidental ingestion of a bottle of dorzolamide or brinzolamide may affect blood levels of potassium and other electrolytes. The victim should be taken to a hospital emergency room. ALWAYS bring the prescription bottle or container.
Special Information
Call your doctor and stop using your eyedrops if you develop any unusual eye reaction or condition, including swollen eyelids and conjunctivitis (pinkeye).
Vision may be temporarily blurred when using the eyedrops. Use caution when driving or operating machinery.
If you wear soft contact lenses, take them out before using the eyedrops and put them back in 15 minutes after a dose.
To prevent infection, do not allow the eyedropper tip to touch your fingers, eyelids, or any surface. Wait at least 10 minutes before using any other eyedrops.
If you forget to administer a dose, do so as soon as you remember. If it is almost time for your next dose, skip the one you forgot and continue with your regular schedule. Do not take a double dose.
Special Populations
Pregnancy/Breast-feeding: Very high dosages of dorzolamide or brinzolamide caused birth defects in animal studies. While the risks of using these drugs during pregnancy are small in people, pregnant women should use dorzolamide or brinzolamide only after discussing its potential benefits and risks with their doctors.
it is not known if these drugs pass into breast milk. Nursing mothers who must use either drug should use infant formula.
Seniors: Seniors may be more sensitive to side effects.

halothane A potent non-inflammable inhalation anaesthetic. It suppresses mucous and bronchial secretions, and reduces capillary bleeding. It has sonic muscle-relaxant properties, but in major surgery, supplementary treatment with a muscle relaxant is necessary. Halothane may cause some cardiac irregularities, but an occasional serious side-effect is severe hepatotoxicity, particularly after further exposure to the drug within periods of 441 weeks. Such susceptibility cannot yet be detected, so great care is necessary in any cases of liver dysfunction.
(Fluothane).
hamamelis An extract of witch hazel leaves referred to as harnarnelis or witch hazel water is used as a soothing application for bruises and sprains.
Hartmann’s solution An electrolyte-replacement solution containing sodium lactate, sodium chloride, potassium chloride and calcium chloride.
heparin The natural anticoagulant obtained front lung and liver tissue. It is widely used in deep-vein thrombosis and pulmonary embolism.
Dose: by i.v. injection 5000 units initially, followed by 1000-2000 units hourly by i.v. infusion, or 15000 units by s.c. injection 12-hourly under laboratory control. Prophylactic dose before surgery 5000 units, then 5000 units every 8-12 hours for 7 days. Overdosage call be controlled by the i.v. injection of prolamine sulphate. Treatment with heparin may be combined with that of oral anticoagulants such as phenindione or warfarin to provide immediate action before the slow-acting oral drugs begin to take effect. Occasional side-effects include hypersensitivity reactions and alopecia. Heparin is a complex polysaccharide, but certain fragments of that large molecule retain sonic anticoagulant activity, and are referred to as low molecular weight heparins. They are used mainly in the prophylaxis of venous thrombo-embolism, as they have a longer
action than standard heparin. They are given by once-daily s.c. injection, and laboratory control of the bleeding time is not necessary. The dose varies to some extent with the product used.
hepatitis A & 8 vaccines Inactivated hepatitis virus antigens for the protection of individuals highly exposed to the infections. Dose: see data sheets. (I iaverix A;
kncigix B; II–B–Vax).
theroin See diamorphine.
hetastarch A soluble modified starch that is used as a 6% solution with 0.9% sodium chloride as a plasma volume expander. Dose: 500-1500 nil daily by i.v. infusion, up to a maximum of 20 mltkg daily. It is excreted by the kidneys, and care must be taken to avoid circulatory overload. Not for use in congestive heart failure or renal insufficiency. Side-effects are vomiting, chills, fever and urticaria. (clol-IAES; Hespan).
hexachlorophene A slow-acting antiseptic used for skin sterilization, and present in sonic medicated soaps.
hexamine (methenamine) A formaldehyde derivative of low toxicity, occasionally used as a urinary antiseptic. Dose: 2 g daily. It is usually given as hexamine hippurate to ensure the necessary acidification ol’the urine. (Iliprex).
histamine A compound present in a bound form in all mammalian tissues; its release is probably the ultimate cause of many allergic conditions.
histamine H,-receptor antagonists See antihistamines. See page 110 and Table 2.
histamine Hz -receptor antagonists Drugs that (litter from conventional antihistamines in having a selective blocking action on receptors ill the gastric cells that secrete acid. They are widely used in the treatment of peptic ulcer and other conditions requiring a reduction in gastric acid secretion. See page 162 and Table 27.
homatropine An atropine derivative with a similar but more rapid mydriatic action (15-30 minutes), but a shorter duration of effect of about 24 hours. Eye drops
(1-2%) sometimes with cocaine.

hyaluronidase A ’spreading’ factor used to increase the absorption of large-volume s.c. injections. The injection of 1500 units of hyaluronidase, either into the injection site or mixed with the injection fluid, will promote the absorption of 500-1000 mL of electrolyte solution by s.c. drip infusion. (Hyalase).
hydralazine A vasodilator that is useful in the supplementary treatment of hypertension.
Dose: 50- 100 nig daily, usually with a IlliaUide diuretic or a beta-blocking agent. Also given in hypertensive crisis by slots, i.v. injection in doses of 5-10 mg; over-rapid injection may cause a marked fall in blood pressure. Side-effects are nausea, tachycardia and fluid retention (less likely with low doses), but a lupus erythematOSLIS- like syndromemay occur with extended high-dose therapy. (Apresoline). See page 148 and “Fable 21.
hydrochlorothiazide A thiazide diuretic that brings about it marked increase in the excretion of salts and water, and is of value in congestive heart failure and other oedematous conditions. It is also of value iii    as it reduces peripheral resistance, and potentiates the action of some other antihypertensive drugs.
Dose: 50-111(1 Ing daily initially in
oedenia; maintenance dose 25-50 mg daily or oil alternate days. III hypertension, 25-30 Ing daily according to need.
I lydrochlorolhiazidc, like other thiazid”, Increases the excretion of potassium as well as sodium, and in extended treatment supplementary treatment with potassium chloride or effervescent potassium tablets may be required. Side-effects include nausea, rash, dizziness and photosensitivity. (I lydroSaluric). See page 148
and ‘I able 21.
acute lyniphoblastic leukaemia and some lymphomas. In common with some other corticosteroids, hydrocortisone inhibits organ-transplant rejection and in high doses it is given to control incipient rejection.
Dose: varies considerably according to need: for replacement therapy, 20-30 mg daily: in shock, 100-300 mg or more by slow i.v. injection, repeated as required. Side-effects are numerous and include hypertension, oedema, mental disturbances, re-activation of peptic ulcer, muscle weakness and diabetes. Cushing’s syndrome may occur with high doses.
I I ydrocortisone, unlike cortisone, is active topically, in(] is used as eye drops 0.3% (usually with an antibiotic), ointment and cream (0.50/o and 11M, often with an antibiotic to control any secondary infection.
hydroflumethiazide A thiazide diuretic N,ith the actions, uses and side-effects of bendrofluazide.
Dose: 25- 100 nig daily in (lie morning; 25-50 Ing daily in hypertension.
ff lydrenox). See page 148.
hydrogen peroxide solution It contains 5-7% of H 02
, equivalent to about 20 volumes oJ oxygen. It has antiseptic and deodorizing properties, and is used mainly for cleaning wounds. It is also used as a mouthwash (diluted 1:7), and as ear drops (1:4 in water or 501% alcohol).
thydromorphone A potent opioid analgesic of the morphine type. Dose: in severe pain 1.3-2.6 Ing 4 t,-hourly. Walladone).
hydrotalcite Aluminium magnesium hydroxide carbonate. An antacid used in dyspepsia and related conditions.
Dose: I g as required.
55
hydrocortisone The principal corticosteroid, also known as cortisol, that is secreted by the adrenal cortex. It plays a major role in the metabolism of glucose, protein and calcium, in maintaining the electrolyte balance, and in reducing inflammatory and allergic responses. It is used in all cases of adrenocortical insufficiency, including Addison’s disease and after adrenalectomy. It is also used in anaphylactic shock, asthma, rheumatoid disease and allergic states. It is valuable in
hydroxocobalamin A derivative of eydnu,obdlaniin, and now the preferred form of vitamin B,, as it has a more prolonged action.
Dose: in pernicious anaemia and other vitamin 13, deficiency states, I Ing initially ian. repeated 5 times at intervals of 2-3 days; maintenance dose 1 mg by I’ll’
by )CC- Lion every 3 months. It is also given
prophylactically after total gastrectonly. (Cobalin-H; NCO-Cytalliell). See
page 112.

hydroxyapatite A natural substance with a mineral composition somewhat similar to that of bone. It is used as a source of calcium and phosphorus in osteoporosis and other deficiency states. Tablets of 830 mg are available. (Ossopan).
hypermotility of the gastrointestinal tract, and may be useful in spasmodic dysmenorrhoea.
Dose: 40-80 mg daily; in acute spasm, .10 mg by injection. (Buscopan).
hydroxychloroquine An antimalarial with the actions, uses and side-effects of chloroquine. It is also useful in rheumatoid arthritis in doses of 200-400mg daily, and in lupus erythematosus, but side-effects are numerous, and treatment requires expert supervision. (Plaquenil). See page 165.
hypromellose A cellulose-derivative that dissolves in water to form a viscid, colloidal solution. Such a solution is used as a base for eye drops to extend the action of a dissolved ophthalmic drug; to lubricate contact lenses; and to act as a lubricant in chronic, sore eye conditions.
5-hydroxytryptamine See serotonin.
hydroxurea (hydrocarbamide) A cytotoxic agent sometimes used in chronic myeloid leukaemia.
Dose: 20- 30 mg/kg as a single dose daily or 80 nig/kg every third day. Side-effects are nausea, skin reactions and myelo- suppression. (Hydrea). See page 122 and Table 8.
hydroxyzine A mild tranquillizer with some sedative and antihistaminic properties. It is given in the short-term treatment of anxiety, and in pruritus and dermatoses complicated by emotional tension. Dose: 50-400 mg daily. It has the side-effects of the antihistamines, and is not recommended where some sedation is undesirable. (Atarax; Ucerax). See page 117 and Table 3.
hyoscine (scopolamine) An alkaloid obtained from plants of the belladonna group. It is a powerful hypnotic and is widely used together with papaveretum for premedication before anaesthesia in doses of 300-600 pg by s.c. or i.m. injection. It has some antiemetic properties, and is useful in travel sickness and vertigo. Dose: 300 mg 30 minutes before starting the iourney, followed by up to 3 doses 6-hourly. Scopoderm is a patch of 500 pg. Thc side-effects of mouth dryness and dizziness are those of the anticholinergic drugs generally. It is contraindicated in glaucoma. It is used occasionally in terminal care for bowel colic and excessive respiratory secretions. Dose: 600 pg-2.4 mg daily by s.c. infusion.
hyoscine butylbromide A derivative of hyoscine that differs in lacking any central action. It is given in spasm and
I
ibuprofen A non-steroidal anti-inflammatory agent (NSAID) widely used in rheumatoid and arthritic conditions. It is also given as an analgesic for mild to moderate pain, but not for acute gout. Dose: 1.8 g daily initially; lly; maintenance duos, 600 lllg-L2 daily after food. A 5% cream is available for local use. The sideeflicts are those of the NSAID& generally. (BrUlen; Feribid). See page 165.
ichthammol A thick, dark brown liquid with a characteristic odour, derived from certain bituminous oils. It is a mild antiseptic and is used mainly in chronic eczema as a 100A, ointment or zinc paste. A solution (10% in glycerin) has been used oil ulcers and inflamed areas.
idarubicin A potent cytotoxic agent similar in actions and uses to doxorubicin. It is given orally and i.v. in acute nonlymphocytic leukaemia, breast cancer, and as second-line therapy in acute lymphatic leukaemia. Dose is based on skin area. (Zavedos). See page 122 and Table 8.
idoxuridine An antiviral agent now virtually superseded by acyclovir and related drugs. Used occasionally in herpes zoster skin infection by local application of a 5% solution. See page 144 and Table 19.

fosfamide A derivative of cyclophosphamide with similar actions and uses. It is effective in lung, ovary, breast and soft-tissue tumours, as well as some malignant lymphomas.

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).
51
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