Posts Tagged ‘myocardial infarction’

tiaprofenic acid A non-steroidal analgesic and anti-inflammatory agent with the actions, uses and side-effects of related NSAIDs such as naproxen.
Dose: 600-800 nig daily. Mild oedema may occur with extended treatment. Peptic ulcer and asthma are contraindications. Severe cystitis is an occasional side-effect. It should not be given to patients with urinary tract disorders, and should he withdrawn at once if any
urinary symptoms develop. (Surgarn). See Page 165 and Table 29.
t1bolone A compound described as an gonadomimetic steroid as it has oestrogenic and progestogenic properties. It is used to control the vasomotor symptoms of the menopause, including those surgically induced as well as those occurring naturally.
Dose: 2.5 ing daily for some months. Similar doses in the prophylaxis of osteoporosis. Side-effects are headache, dizziness and vaginal bleeding. Treatment should be withdrawn if any thromboembolic symptoms or jaundice appear. (1,ivial).
Dose: 400 nig as a single daily dose for 12 weeks, to be taken with water at least 2 hours before or 2 hours after meals. Antacids and milk should be avoided. The improvement in serum alkaline phosphatase activity may persist, and a second course needed only after an interval of at least 6 months. Gastrointestinal side-effects are common, but renal function should be monitored regularly. (Skelid).
timolol A beta-andrenergic blocking agent of the propranolol type, used in the control of angina and hypertension. Dose: 10-60nigdaily. In the prophylactic t i catment of migraine, 10-20 ing daily. (,’are is necessary in bradycardia, cardiac insufficiency and bronchial disease. It is also of value as eye drops (0.25%-0.5%) in simple chronic glaucoma, as it reduces infra-ocular pressure by reducing the formation of the aqueous humour. (Betim; Blocadren; Timoptol). See pages 148 & 154, and Table 21.
tinidazole A drug similar to metronidazole, and used mainly in the prophylaxis and treatment of anaerobic infections and anioebiasis.
Dose: 2 g initially, followed by I g daily for 5 days. A single oral (lose of 2 g is given 12 hours before abdominal surgery, and a similar single dose is given in amoebiasis and giardiasis. Side-effects are nausea, vomiting and diarrhoea. A disulfiram-like -like reaction may occur if alcohol is taken. ( Fasigyn).
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ticarcillin An antibiotic with an increased activity against Pseudomonas aeruginosa. In pseudomonal septicaemia, combined treatment with an aminoglycoside anti biotic such as gentamicin may evoke an increased response.
Dose: 15-20 g daily by slow i.v. injection or infusion in systemic infections; 3-4 g daily by i.m. injection in urinary infections. (Ticar). It is sometimes given together with clavulanic acid as Timentin, but it delayed post-treatment reaction with Tinientin is cholestatic jaundice, thought to be due to clavulanic acid.
tiludronic acid A bisphosphonate that inhibit., (fie [)one resorbing activity of osteoclasts, and so reduces the excessive demineralization of bone that occurs in Paget’s disease.
tinzaparin A low-molecular weight heparin ti,cd in the prevention ofthromboembolism.
Dose: by s.c. injection 2500-3000 units daily for 7-10 days. It is also used to prevent clotting in haemodialysis apparatus. (Innohep; Logiparin). See dalteparin and enoxaparin. With these products laboratory control is not necessary.
tioconazole An antifungal agent used in
tines infections of the nails by the
extended application of a 289/6 solution. Treatment for 6 months or more may be necessary. (Trosyl).
titanium dioxide A metallic oxide, similar to zinc oxide, with mild astringent properties. It is present in some sunburn protection preparations.

tizanidine A central alpha, receptor agonist use([ in the spasticity associated with multiple sclerosis and spinal injury. Dose: 2 ing weekly, increased according to response up to 24 ing daily. Monitor liver function monthly for 4 months. (Zaiiallex).
tobramycin An aminoglycoside antibiotic with the actions, uses and side-effects of gentamicin, but considered to be more active against Pseudomonas aerugi . nosa. Dose: 3-5 nig1kg daily by i.m. injection or i.v. infusion. It may be given together with a penicillin or nictroniclazole in serious mixed infections. Care is necessary to avoid the ototoxic and nephrotoxic effects of aminoglycosides. (Nebcin).
tocainide An anti-arrhythmic agent similar in action to lignocaine. It is a powerful drug, and may cause severe blood dis(urhances, and its use is largely restricted to the control of life-threatening arrhythmias not responding to other drugs.
Dose: 1.2-2.4 g daily. Blood counts during treatment are essential. Side-effects include bradycardia, hypotension, rash, tremor and aplastic anaemia. (Tonocard).
tocopherol A synthetic form of vitamin E.
tolazamide An oral hypoglycaemic agent related to tolbutamide, with similar actions, uses and side-effects.
Dose: 100-250 mg daily, increased if necessary up to a maximum dose of I g daily. (Tolanase). See page 131 and Table 13.
tolbutamide A sulphonylurea used like Jilorproparnicle in the treatment of maturity-onset diabetes, but it has a shorter action, and twice-daily doses are usually necessary. It is effective only when some insulin-secreting cells of the pancreas are still functioning, and a return to insulin therapy may be necessary during illness and infection. Tolbutarnide is not suitable for the treatment of juvenile or severe diabetes.
Dose: 0.5-2 g daily. Side-effects include hypoglycaemia, poglycaernia. rash, Jaundice and blood dyscrasias, but are uncommon with low doses. (Rastinoo). See page 131 and
Table 13.
tolcapone An inhibitor of the enzyme concerned with the biosynthesis of dopamine. It is used with other drugs in the
treatment of parkinsonism in initial doses of 100 mg 3 times a day. Side-effects are dyskinesia, nausea and sleep disturbances. (Tasmar). See page 160 and Table 26.
tolfenamic acid A non-steroidal anti-inflammatory drug (NSAID) but exceptional in being used in the treatment of migraine, on the basis that prostaglandins are involved in the pathology of migraine. Dose: 200 mg at the onset of an attack, repeated once after 2-3 hours if necessary. Close monitoring is required if anticoagulants also given; caution in peptic ulcer. (Clotani). See page 154 and Table 23.
tolmetin An anti-inflammatory analgesic agent used in rheumatoid and mUSCUIOskeletal conditions. As with related non-steroidal anti-inflammatory drugs
(NSAIDs) it may cause gastrointestinal disturbances in some patients, and should be taken after food. Hypersensitivity reactions may occur occasionally.
Dose: 0.6-1.8 g daily. (Tolectin). See page 163 and -Fable 29.
topiramateV A new anti-epileptic that differs chemically from related drugs. It is used as adjunctive therapy in partial seizure patients not adequately controlled by standard treatment.
Dose: initial (lose 100 nig daily, slowly increased at weekly intervals as required up to 800 mg daily. Patients receiving digoxin should be monitored. Not recommended for children. (Topaniax). See page 136 and Table 15.
topotecanV A new advance in cancer chemotherapy is the use of topoisomerase inhibitors. Topoisomerase I is necessary for DNA replication, and topotican acts by binding with super-coiled DNA and so preventing further DNA development. Dose: 1.5 mg/n’ by i.v. infusion daily for 5 days under expert supervision. Side-effects are myelosuppression and severe neutropenia. (Hycamptin). See page 122 and Table 8.
torasemide A loop diuretic of the
IrLISCII)i(IC type.
Dose: in oedema, 5-20 ing once daily; in pulmonary oedema 10-20 mg daily by slow i.v, injection but much larger doses are sometimes necessary. In hypertension. 5-20 mg daily. (Torero). See page 148 and Table 21.

toremitene’v” An anti-oestrogen used in h0i 11 im ie- dependent metastatic breast cancer.
Dose: 60 mg as a single daily dose. Side- effects are linked with the mode of action
aninclude hot flushes, dizziness and
sweating. Care is necessary in severe hepatic deficiency, angina and cardiac weakness. (Fareston). See page 122 and Table 8.
trannadoW An analgesic used in the short-tan) treatment of moderate to severe pain. It has reduced affinity for opioid receptors, and the action may be mediated by inhibiting the neuronal re-uptake of noradrenaline and related amines. Dose: 300-400nig; in severe pain it may he given by i.m. injection or i.v. injection/infusion in closes of 50- 100 ing 4-6-hourly. (Tramake; Zamadol; Zydol).
trandolapril An ACE inhibitor used in mild io moderate hypertension.
Dose: 500 jig daily initially, increased at intervals of 2-3 weeks up to 1-21ng once daily. If hypotension occurs, reduce supportive therapy before lowering the trandolopril dose. Prophylactic dose after myocardial infarction 500 Vg-4 mg daily. Diuretic therapy should be stopped before starting with trandolapril, to reduce the risks of initial hypotensive side-effects. (’are with monitoring in patients with renal and hepatic impairment. (Gopten; Odrik). See page 148 and Table 21.
tranexamic acid An antifibrinolytic agent used to check haemorrhage after prostactectomy, in surgery generally and in the control of menorrhagia.
Dose: 2-8 g daily; 3 g daily by slow i.v. infection. Side-effects are nausea, diarrhoea and dizziness. (Cyklokapron).
tranquillizers These drugs were once Separated into the major tranquillizers, represented by chlorpromazine, and the minor tranquillizers exemplified by diazepam, but are now often referred to as antipsychotic drugs and anxiolytics respectively. The antipsychotics are used mainly in the control of disturbed patients, and in schizophrenia, although they have some anti-anxiety properties, and long-term treatment is often necessary. The anxiolytic drugs are intended mainly for the short-term treatment of acute anxiety states, as extended use may
cause dependence. See pages H 7 & 168, and Tables 5 & 30.
Transiderm-Nitro A medicated patch containing glyceryl trinitrate designed to have an action over 24 hours in the prophylaxis of angina.
tranylcypromine A monoamine oxidase inhibitor (MACI), of use in severe depression not responding to other drugs. Dose: 20 nig daily initially, increased to .50 ing daily or more according to need. The use of tranylcypromine requires care, as the drug has a stimulant action that may complicate therapy, and phenelzine may be preferred. Side-effects are dizziness, dry mouth and insomnia. Liver damage may also occur, and a hypertensive crisis with throbbing headache requires withdrawal of the drug. Hyperthyroidism is a contraindication. (Parnate). See page 128 and Table 11.
trazodone An antidepressant chemically distinct from other drugs with a similar action, and with reduced anticholinergic and cardiovascular side-effects. It is
indicated mainly in depression associated with anxiety when a sedative action is also required.
Dose: 150-300mgd;iily.’['Iieside-effects are those of the tricyclic antidepressants such as amitriptyline. (Molipaxin). See page 128 and’I'able 11.
treosuffan A cytotoxic agent related to busulphan, but used mainly in ovarian cancer.
Dose: I g daily for 28 days, repeated after a 4-week rest period; 5-15g by i.v. injection at intervals of 1-3 weeks. In all cases the (lose is adjusted according to the
degree of bone marrow depression that occurs. Other side-effects are those of cytotoxic drugs generally. Extravasation causes pain and local tissue damage. See page 122 and Table 8.
tretinoin A derivative of vitamin A. It is used locally for acne (Retin-A) and also for the treatment of photodamage to the skin (Retinova). A new use is the induction of remission in acute promyelocytic leukaemia.
Dose: 22.5 trig/m2 twice daily with food. Combined therapy may reduce the risk of relapse (Vesanoid).

sodium picosulphate A synthetic laxative similar to bisacodyl, but with a slower action.
Dose: 5-15 rug at night.
sodium stibogluconate An organic antimony drug use([ in the treatment of visceral leishmaniasis or kala-azar.
Dose: 20 ruglkg daily by i.m. or i.v. injection for 30 days. Side-effects include anorexia, vomiting, cough and sub-sternal pain. (Pentostain).
I sta
given by i.v. injection as a 50% solution to promote diuresis and to reduce cerebral oedema.
sotalol A beta-adrenergic blocking agent used ill the treatment of hypertension, angina, cardiac arrhythmias and thyrotoxicosis. Dose: 120 nig initially, increased as required; maintenance, 160-600 ing daily. For prophylaxis after infarction, 320 mg daily. In acute cardiac arrhythmias, 20-60 mg by slow i.v. injection under ECG control. Care is necessary in heart block, asthma, hepatic and renal impairment. (BetaCardone; Sotacor). See pages 114 & 148, and Tables 4 & 2 1.
sodium tetradecyl sulphate A venous-occluding agent used in the injection sclerotherapy of varicose veins.
Dose: 0.5-1 nil at any one site, followed by compression bandaging for sonic weeks. The local irritant action of the drug brings about an occlusive venous fibrosis at the injection site. Extra-vascular injection may cause necrosis. Care is necessary in allergic subjects.
sodium thisulphate A 50% solution is given by i.v. injection in cyanide poisoning. See sodium nitrite and kelocyanor.
sodium valproate An anticonvulsant
effective in most forms of epilepsy.
Dose: 600 mg daily in adults initially, increased if required up to a maximum of 2.5 g daily. It may also be given by slow i.v. injection in doses of,100-800ing, followed by similar doses given by i.v. infusion. Liver function tests before and during treatment are essential. Severe side-effects such as vomiting, drowsiness or jaundice require withdrawal of the drug, as does spontaneous bleeding or bruising.
(Epilim). See page 136 and Table 15.
somatropin A form of human growth hormone obtained by biosynthesis. It is used to stimulate growth in hormone-deficient young patients whilst the epiphyses are still open.
Dose: 0.07 units/kg daily by i.m. or s.c. injection. Subcutaneous injection sites should be varied. (Genotropin; Hurrialrope; Norditropin; Salzen).
spectinomycin An antibiotic used in the treatment of penicillin-resistant gonorrhoea.
Dose: 2-4g by deep Lin. injection. Side-effects include nausea, dizziness and tirlicaria. (Trobicin).
spironolactone An aldosterone antagonist which potentiates the action of thiazide and loop diuretics in sonic resistant conditions. It is of value in the oedema of liver cirrhosis, as well as in the nephrotic syndrome and congestive heart failure. Dose: 100 ing daily up to a maximum dose of 400 mg daily. Side-effects include drowsiness, gastrointestinal disturbances, gynacconiastia and an increased sensitivity to warfarin. The combined use of potassium-sparing diuretics or potassium supplements is contraindicated.
(Aldacione; Spiroctan).
SSRls See selective serotonin re-uptake inhibitors.
stanozolol An anabolic steroid with actions and uses similar to those of nandrolone. Dose: 5 ing daily. It also has fibrinolytic properties, and is used in lipoderinatosclerosis (a complication of deep-vein sclerosis), and in some forms of vasculitis. It may also be of sonic value in hereditary angioneurotic oedema and in the relief of itching due to biliary obstruction. Also used in some aplastic anaemias, 2.5-10 ing daily. Sonic androgenic side-effects may Occur, bill are usually mild and reversible Oil stopping treatment. (Stroniba).
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sorbitol A saccharide that after absorption is converted in the liver almost entirely to laevulose. It has been used as a sugar-substitute in diabetes, and it is sometimes
starch Carbohydrate granules obtained from maize, rice, wheat or potato. Widely used as absorbent dusting powder.

stavudineV An antiviral agent that inhibits the enzyme reverse transcriptase, and so indirectly blocks the synthesis of viral DNA. It is used in HIV infections resistant to or not responding to zidovudine. Dose: 00 ing daily, I hour before food. Side-effects include malaise, peripheral neuropathy and pancreatitis. (Zerit). See page 144 and *['able 19.
sterculia A natural gum that swells in water to a gelatinous mass. It is used as a bulk laxative as when taken with plenty of water it increases faecal volume and promotes peristalsis. It is also used in diverticulitis and irritable bowel syndrome, and as an appetite suppressant. Dose: 5-10g daily but not at night. (Normacol).
Sul
Dose-. I g daily by deep i.m. injection. Its use requires care. as it k both ntotnxir and nephro(oxic, especially in full doses and in renal impairment. Measurement of the plasma concentration QfbErCplU1llV0ll P. advisable during treatment. Cutaneous sensitization has followed contact of the drug trill the skin.
sucralfate An aluminium sucrose sulphate use,] in the treatment ofpeptic ulcer. It is not an antacid, but forms a barrier over the ulcer that is resistant to peptic attack and so promotes healing.
Dose: 4g daily for at least 4 weeks. Antacids should not be taken immediately before or after sucralfate. (Antepsin). See page 162.
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stilboestrol A synthetic oestrogen with the actions and uses of oestradiol.
Dose: 0.1-0.5 mg daily for menopausal symptoms, but it is now prescribed less frequently. Dose in breast cancer, 10-20 mg daily; in prostatic carcinoma, 3 mg daily or more, although fosfestrol is often preferred. Side-effects include nausea, fluid retention, thrombosis, impotence and gynacconlastia.
streptokinase Ali enzyme preparation obtained from cultures of haemolytic streptococci. It has fibrinolytic properties, and is of value in deep vein thrombosis, pulmonary embolism, myocardial infarction and other conditions requiring fibrinolytic therapy.
Dose: by i.v. infusion, 250000 units or more initially, followed by maintenance doses of 100000 units hourly for up to 72 hours. For myocardial infarction
1 5(10000 units over l hour. Side-effects are fever, rash, haemorrhage and allergic reactions. (Kabikinaw; Streptase).
sulconazole A synthetic antifungal agent similar in actions and uses to miconazole. Applied as a 1% cream twice daily. (Exelderin).
sulfadoxine A long-acting sulphonamide, with the general antibacterial action of the group. It has been used in the treatment of leprosy.
Dose: I-1.3f; weekly. In association with pyrimethainine, it is used in the treatment of malaria, but the use of such mixed products requires great care, as severe, sometimes fatal side-effects have occurred. It is no longer used for malaria prophylaxis. (Fansidar).
sulfametopyrazine A very long-acting sulphonamide used mainly in chronic bronchitis and urinary tract infections. Dose: 2 g once it week. Side-effects and toxic reactions, although mainly those of the sulphonamides generally, may be linked with the slow excretion of the drug. (Kelfizine).
streptokinase- streptodornase A mixture of enzymes obtained from cultures of haemolytic streptococci. It brings about the dissolution of blood clots and the liquefaction of purulent exudates, anti is used as a solution to clean foul wounds, pressure sores and ulcers. (Varidase).
streptomycin The first of the amino-glycoside antibiotics, but now used mainly as part of the multi-drug treatment of tuberculosis.
sulindaC A non-steroidal anti-inflammatory analgesic agent (NSAID) with actions, uses and side-effects similar to naproxen. It is of value in the pain and inflammation of rheumatoid disease and acute gout. Dose: 200-400 ing daily with food. It may cause gastrointestinal disturbance and occasional bleeding. (Clinoril). See
page 165 and Table 29.
sulphadiazine one of the more active and less toxic sulphonamides. It is used mainly in the treatment of severe conditions such as meningococcal meningitis.

Dose: (, 9 g daily by deep i.m. injection or i.v. infusion for 2 days, followed by 2 g or more orally daily. Dose in the prevention of rheumatic fever I g daily. Side-
effects are nausea, rash and blood dyscrasias.
sulphadimidine One of the least toxic of the sulphonamides, now used mainly in urinary infections.
Dose: 2 g initially, with maintenance of 1. - 4 g daily orally. Side-effects include nausea, drug fever, rash and leucopenia.
sulphamethoxazole A sulphonamide present with trimethaprim in co-trinioxazole.
sulphasalazine A sulphonamide derivative that is taken up selectively by the connective tissues of the intestines. It is used in the treatment and maintenance of remission in ulcerative colitis and Crohn’s disease.
Dose: 4-8g daily initially; maintenance, 1.5-2 g daily. 11 is also given as a 3 g enema and as 500 mg suppositories. Occasionally given in rheumatoid arthritis in doses of 03-3 g daily. Side-effects include nausea, rash, drug fever and blood dyscrasia. If blood dyscrasia is suspected, a blood count should be done and the drug withdrawn. (Salazopyrin). See niesalazine, olsalazine, page 172 and’I'able 32.
sulphathiazole One of the early sulphonamides, and survives in a few mixed products.
sulphinpyrazone. A uricosuric agent with the selective action of increasing the excretion of uric acid, hence used in the treatment of chronic gout and hyperuricaemia. Dose: 100-200 mginitially with food, increased according to the plasma uric acid levels up to 60(1-800 nag daily, with tower maintenance doses according to need and response. Side-effects are nausea, abdominal pain and rash. Care is necessary in peptic ulcer and renal impairment, and blood counts are necessary during, treatment. Salicylates antagonize the action of the drug. (Anturan). See
page 1.10 and Table 17.
sulphonamides A group of drugs that have an antibacterial action by preventing the uptake and use of folic acid. They are thus bacteriostatic and not bactericidal in action. The use of the sulphonamides ides has
declined, and they are now used mainly in urinary tract infections due to sulphonamide-sensitive bacteria. The side-effects of the sulphonamides include nausea, dyspepsia, diarrhoea and allergic reactions. Bone marrow depression may occur if treatment is prolonged. The uncommon Stevens-Johnson syndrome is a very serious reaction. See sulphadiazine ind co-trinioxazole.
sulphonylureas A group of orally active drugs represented by chlorpropamide that promote the release of insulin from the beta-cells of the pancreas. They are used in mild diabetes not controlled by diet, and in the late-onset diabetes of middle age, but they are not suitable for the treatment of juvenile diabetes. The presence of some still-functioning beta-cells is essential for sulphonylurea activity. Side-effects include weight gain, rash, fever and jaundice. During illness and pregnancy, insulin treatment should replace sulphonylurea therapy. See page 131 and Table 13.
sulphide An antipsychotic drug with a central action on dopaminereceptors. It is used in the treatment of acute and chronic schizophrenia, as in low doses it increases awareness in apathetic and withdrawn patients, and in larger doses controls the active forms of the illness.
Dose: 400-800 mg daily: in severe conditions up to 2.4 g daily. The side-effects are similar to those of chlorpromazine. (Dolmatil; Sulparex; Sulpitil). See
page 168 and Table 30.
sumatriptan A serotonin agonist used in
i lie treatment of acute migraine. (It is not suitable for prophylaxis.)
Dose: 50-100 mg orally as soon as possible after onset of an attack, but a second dose should not be given for the same attack, but may be repeated once if migraine symptoms recur. In severe migraine an(] cluster headache 6 mg by S.C. injection, but not more than 12 nig in 24 hours. (Pre-filled syringes and an auto-injector are available.) If should not be given until 24 hours after other antimigraine treatment, or any other drug that influences the re-uptake of serotonin. Side-effects include tingling and tightness in any part of the body, and an angina-like chest pain that may be severe. (I migran). See page 154 and Table 23.

pyrazinamide An antituberculous drug that is active against the intracellular and dividing forms of M. tuberculosis, and is most effective in the early stages of die disease. It penetrates the meninges, and is Of value in tuberculous meningitis. Dose: in combination with other drugs, 2 g 3 times a week. Side-effects include fever, jaundice and hepatotoxicity. Liver function tests should be carried out before and during treatment. (Zinamide). See page 170 and Table 31.
pyridostigmine An anticholinesterase similar to neostigmine. It has a slower and more prolonged action that is useful in some cases of myasthenia graves. Dose: 300–720 mg daily. The side-effect, are similar to those of neostigmine, but may be less severe. (Mestinon).
pyridoxine (vitamin B,) This vitamin plays an essential part in protein metabolism. Apart from its use in deficiency states, which are uncommon, pyridoxine has been used in isoniazid-induced neuropathy. Dose: 2,5-150 rig daily; in some sideroblastic anaemias, up to 400 rig daily.
pyrimethamine Ail antimalarial drug used with dapsone as Maloprint or with sulphadoxine as Fansidar in the prophylaxis of malaria. The use of these mixed products is not without risk, as they may have severe and sometimes fatal side-effects.
quetiapine A new ‘atypical’ antischizophrenic drug of the clozapine type with a high affinity for serotonin (5-HT) and dopamine DI and D2 receptors.
Dose: in schizophrenia, initilal doses of 25 rig twice a day, slowly increased up to 150-750 mg daily. Initial doses may cause hypotension. Care is necessary in cardiovascular disease. Side-effects include drowsiness and dizziness. The routine blood monitoring necessary with dozapine is not required. (Sew,jud). See page 108 and Table 30.
quinagolide A dopamine agonise used in
the treatment of hyperprolactinaemia.
I Rai
Dose: 25 jig at bedtime initially, increased at 3-day intervals to 75-100µg daily. Side-effects include hypotension, and the blood pressure should be monitored after a
change of dose. (Norprolac). See brornocriptine and cabergoline.
tquinalbarbitone sodium A short-acting barbiturate. Used in mild insoninia and anxiety states.
Dose: 50-100mg. (Seconal).
quinapril Ail ACE inhibitor with the actions, use and side-effects of that group of drugs. Dose: in hypertension, 5-10 mg daily initially, slowly increased to 20-40 mg as a single daily dose. (Accupro). See ACE inhibitors, page 148, and Table 21.
quinidine Ail alkaloid of cinchona, similar to quinine, that has been used in the preventive treatment of ventricular arrhydimias, but beta-blocking agents are now preferred.
Dose: (after a test dose of 200 rig) 200-400 mg 3-4 times a day. Side-effects are tinnitus, vertigo and confusion. Treatment should be stopped if response does not occur within 10 days.
quinine The principal alkaloid of cinchona bark. It was once used extensively in the treatment of malignant tertian malaria, and recently it has regained some of its value with the emergence of chloroquineresistant malaria.
Dose: 1.8 g daily for 7 days; in serious infections it is given by i.v. infusion in doses of 10 rig/kg for up to 3 doses, followed by oral therapy. Side-effects include tinnitus, nausea, rash and visual disturbances. See specialist literature.
rattitroxedV A selective enzyme inhibitor used in the palliative treatment of advanced colorectal cancer. It has advantages over fluorouracil, as treatment is less complicated and the incidence of leucopenia, mucositosis and other side-effects is less severe. Dose: 3 mg/ni! by slow i.v. injection, repeated at intervals of 3 weeks if tolerated. Blood counts and liver function tests are necessary. (Tomudex). See page 122 and Table 8.

ramipril An ACE inhibitor with the general properties of such drugs.
Dose: in mild hypertension, L25 ing daily, increased at intervals of 1-2 weeks tip to a maximum of 10 mg, given with food and adequate fluid. Prophylactic dose after myocardial infarction 5-10 ing daily. (Tritace). See page 148 and Table 21.
ranitidine A powerful and selective histamine H, antagonist of the cimetidine type, but with a longer action. It reduces the volume, acidity and pepsin content of gastric secretion, and is of value in peptic ulcer, reflux oesophagitis and similar conditions.
Dose: 300 nig daily for at least 4 weeks, maintenance (loses, 150 mg daily. In severe conditions, 50nig by i.ma or slow i.v. injection repeated at intervals of 6-8 hours. In suspected gastric ulcer, malignancy should be excluded before treatment is commenced. (Zantac). See cimetidine, page [62 and Table 27.
ranitidine bismuth citrateV It has the general action of ranitidine, but it also has a protective effect on the ulcerated area, and inhibits digestive action of pepsin on the gastric mucosa. It is given with amoxycillin and clarithromycin to promotethe elimination of Helicobacter pylori.
Dose: 800 mg daily. (Pylorid). See page 162.
razoxane A cytotoxic agent occasionally used in the treatment of leukaemias. Dose: 150-500 nighril daily for 3-5 clays, under laboratory control. Side electsare nausea and myleosuppression. (Razoxin).
Rif
Dose: by aerosol inhalation; 0.5-1 mg
( 1 -2 puffs), repeated up to 3 times a day. Side-effects include tremor an(] mild tachycardia. (Bronchodil). See page 118 and Table 6.
resorcinol A keratolytic agent used mainly as an ointment in acne, and as a hair lotion for removing dandruff. Myxoedema has been reported following the prolonged use of resorcin preparations.
reteplase A thrombolytic agent used in acute myocardial infarction.
Dose: 10 units by slow i.v. injection within 2 hours of the infarction. A second dose may be given 36 hours later, together with heparin, to reduce the risk of rethrombosis. Side-effects are arrhythmias an(] gastrointestinal bleeding. (Rapilysin). See page 156 and Table 24.
retinol See vitamin A.
riboflavine (vitamin B2) Part of the vitamin B complex, it is concerned with the oxidation of carbohydrates and amino acids. A deficiency causes several characteristic effects, including angular stomatitis and’burning feet’.
Dose: 1-10 mg in deficiency states associated with restricted diets or poor absorption.
rifabutinV A derivative of rifampicin used in the multi-drug treatment of pulmonary tuberculosis.
Dose: 150-450 mg daily. It is also used I,i,)I,Iiyl.iclically.ig,.iiii.%t opportunistic infection with Mycobacterium avium. (Mycobutin). See page 170 and Table 31.
reboxetineV An inhibitor of noradrenaline reuptake used in depression.
Dose: 4 ing twice a day, half-doses for the elderly. Side-effects are those of other antidepressants. Care in renal/hepatic impairment. (Fdronax). See page 128 and Table 11.
remifentanilV An analgesic of the fentanyl type used as an adjunct in doses of
0.5-1 fig/kg/min for the induction of anaesthesia. Its use reduces the amount of general anaesthetic required. (Ultiva).
reproterol A bronchodilator with the actions, uses and side-effects of salbutamol.
rifampicin An antibiotic now considered to be the first-choice drug in the treatment of tuberculosis, and given together with isoniazid and pyrazinamide.
Dose: 600 mg before breakfast. It is also used with dapsone and clofazimine in the initial treatment of severe leprosy. Combined therapy is also used in brucellosis, legionnaire’s disease and severe staphylococcal infections. Side-effects include gastrointestinal disturbances, rash, an influenza-likesyndrorne and hepatic reactions. Jaundice is a contraindication. Patients should be warned that rifampicin gives a red colour to the urine, sputum and tears, and to soft contact lenses. It may decrease the response to oral anticoagulants such as warfarin, and the failure of oral contraceptives has also been reported in patients receiving rifampicin. (Rifadin; Itiniaciane), See page 170 and Table 31.
riluzoleV A new drug used only for motor neurone disease (a myotrophic lateral sclerosis-ALS). ALS is a degenerative disease and may be due to the local accumulation of the neurotransmitter glutamate, with consequent neurone damage. Riluzole slows down the progressive nature of the disease, and improves the response to mechanical ventilation. Dose: 100 mg daily. See specialist liteiawre. Milutek).
rimiterol A bronchodilator similar in actions and uses to salbutamol, but with a shorter duration of effect. It is largely free from any cardiac stimulant activity. Rimiterol is used mainly for the relief of bronchospasm in bronchitis, bronchial asthma and similar conditions.
Dose: by aerosol inhalation, 200-600 pg ( 1-3 puffs) up to a maximum of 8 puffs daily. (Pulmadil). See page 118 and Table 6.
I sac
Lip to 350 pg/min. or 10 mg by i.m. injection and continued until the contractions have ceased; then orally up to 120 mg daily to prevent relapse. Side-effects include tremor, nausea and hyj)otension. (Yutopar).
rocuronlurn A muscle relaxant similar in actions and uses to vercuronium. Dose: 600 pg/kg initially, followed by 300-600 pglkglhrly as required.
(lisincron).
ropiniroleV A potent and selective
dopamine D,-receptor agonist used in the treatment of Parkinson’s disease, a condition basically due to a deficiency of dopamine in the brain. It is well absorbed orally, and reaches the central nervous system where it functions as dopamine replacement therapy.
Dose: first week 750µg daily with food; second week 13 ing daily, third week 2.25 mg daily, then 3 ing daily. Ropinirole may be given as monotherapy or together with levodopa. Side-effects are somnolence, hypotension, leg oedema and gastrointestinal disturbances. Caution in severe cardiac, renal and hepatic conditions. (Requip). See page 160 and Table 26.
89
Ringer’s solution An electrolyte replacement solution containing sodium
chloride, potassium chloride and calcium chloride.
risperidone An antischizophrenic agent of the clozapine type, with a selective affinity for serotonin and dopamine receptors. It may relieve the aggressive symptoms of
schizophrenia as well as the negative aspects such as apathy.
Dose: 6-10 mg. daily. Side-effects are headache, dizziness and agitation. Agranulocytosis is uncommon, and the close blood monitoring required with clozapine is not necessary. (Risperdal). See page 168 and Table 30.
ritonavirV An HIV-protease inhibitor used in HIV infections in association with a nucleoside analogue.
Dose: 1.2 g daily with food. (Norvir). See page 144 and Table 19.
ritodrine A beta,-adrenoceptor stimulant with a relaxant action on uterine muscle, used to inhibit premature labour.
Dose: 5opg/niin initially by i.v. infusion (avoiding fluid overload), slowly increased
ropivacaine A local anaesthetic with the actions and uses of lignocaine. (Naropin).
Rose bengal A (lye used as eye drops (M) to stain and detect damaged conjunctival cells, and in the diagnosis of dry eye.
rubella vaccine A suspension of a live, attenuated strain of rubella virus. It is used for active immunization in girls of 10-14 years, and in seronegative women of childbearing age.
Dose: 0.5 nil by s.c. injection. It is contraindicated in pregnancy, and pregnancy within 3 months of vaccination should be avoided. A combined rneasles/mUnipsit-111101,a (MMR) vaccine is now recommended for all children.
saccharin A synthetic sweetening agent widely used as a non-calorific substitute for sugar. Has been used by rapid i.v. injection (2.5 g in 4 ml) for arm-tongue circulation time.

metronidazole An orally effective drug used in trichomoniasis, amoebiasis and in infections due to anaerobic bacteria. Dose: in bacterial and trichomonal vaginitis, 600 ing daily for 7 days, or as a single dose of 2g. In acute intestinal arnoebiasis, 2.4 g daily for 3 days. In surgical prophylaxis, and in the prophylaxis and treatment of infections caused by colonic anaerobic pathogens such as Racteriodes ftagilis, as well as infections by some Gram-negative organisms. metronidazole is given in doses of 1.2 g daily orally, or as I g suppositories. In severe infections, doses of 1.5 g are given daily by i.v. infusion, replaced by oral therapy as soon as possible. In Giardia laniblia infections, 2g daily for 3 days; 600 mg daily for 3 days in ulcerative gingivitis. Metronidazole is also valuable in pseudomembranous colitis (see clindamycin). Side-effects are mainly gastrointestinal disturbances and can be reduced by giving the close with food, but epileptiforni seizures may occur with high doses, and the drug may cause a disulfiraintype reaction if alcohol is taken. (Flagyl). Metronidazole is also used as a 0.750% gel (Metrogel; Rosex) in rosacea and as Anabact ail(] Metrotop to deodorize malodorous tumours.
metyrapone Ail inhibitor of glucocorticoid synthesis.
Dose: 750 mg 4-hourly for 6 doses as a Icst of anterior pituitary function, as following such doses the plasma concentration ofcorticosteroids falls. The fall stimulates the production of steroid pre cursors by the adrenal glands, and a rise in the urinary excretion of such precursors is indicative of an active anterior pituitary gland. Metyrapone is also used in resistant oedema due to ail increased production of aldosterone, and in the symptomatic con-I rol 01′ Cushing ’s syndrome. Nausea and vomiting are side-effects. (Metopirone).
mexiletine Ail anti-arrhythmic drug that is useful in the control of ventricular arrhythmias, particularly those following myocardial infarction, or when lignocaine is ineffective.
Dose: as a loading dose, 100-250 mg i.v. under I-I’C6 control, followed by i.v. infusion of a 0.1% solution until a further 250 mg have been given. Oral therapy: a
loading dose of 400 mg, followed by 600mgI g daily. Side-effects are nausea, drowsiness, confusion and blurred vision. Contraindicated in bradycardia, hypotension, and hepatic or renal failure. (Mexitil).
mianserin An antidepressant of the amitriptyline type, with reduced anticholinergic and cardiovascular side-effects, and well tolerated by the elderly. It is of value in all types of depression, including those associated with anxiety. Dose: 30-90 mg daily, which may be taken as a single close at night, although higher doses have been given. Care is necessary in recent myocardial infarction and heart block. Severe hepatic disease is a contraindication. Side-effects include aplastic anaemia,and blood counts during treatment are essential. The drug should be withdrawn if any signs of infection occur. See page 128 and Table 11.
miconazole An antiftingal agent of value in systemic and alimentary fungal infections. Dose: I g daily orally, or up to 1.8 g daily by i.v. infusion, and the duration of treatment largely depends on the response.
Pessaries of 100 mg and a cream (2%) are used for vaginal candidiasis. A gel is available for oral fungal infections. Side-effects after systemic use include nausea, pruritus and rash. Miconazole may potentiate the action of anticoagulant, anticonvulsant
and hypoglycaemic drugs, requiring an adjustment of close. Combined use with asternizole, terfenadine and cisapride should be avoided. (Daktarin).
midazolam A sedative of the benzodiazepine group, used mainly for sedation before and during gastroscopy, endoscopy and other investigations. The action is rapid, and an anterograde amnesia often follows.
Dose: by slow i.v. injection 70pglkg tip it) a total d2.5-7 mg. premedication, 2.5-5 mg i.m. For the induction of anaesthesia in poor-risk patients, 104-300pg1kg by slow i.v. injection. Side-effects after i.v. injection include respiratory depression and, occasionally, severe hypotension. (Hypnovel).
mifepristone An antiprogestational agent used as ail alternative to surgery for the termination of pregnancy, up to 63 days’ gestation.
Dose: a single oral dose of 600 mg. For hospital use only. (Nfifegyne).

milrinone An inhibitor of phosphodiesterase, an enzyme concerned in cardiac function. It has a digoxin-like effect on the myocardium, and may be effective in congestive heart failure not responding to other drugs.
Dose: by i.v. infusion as an initial dose of 50 pg1kg, with maintenance doses of 0.5 pg/min up to a total of 1.13 nig/kg over 24 hours. Side-effects are anginal pain, hypotension and headache. (Primacor). See enoximone, page 141 and Table 18.
minocycline A tetracycline with the general properties of that group of antibiotics, with the advantage of being useful in meningococcal prophylaxis. The absorption of minocycline is little influenced by food. It is also suitable for use when the renal function is impaired, as accumulation of the drug is unlikely.
Dose: 200 mg daily. In acne treatment half-dose should be given for 0 weeks. The side-effects are those of the tetracyclines generally, although monocychne may also cause dizziness, vertigo and rash. (Minocin).
minoxidil A vasodilator used in severe hypotension resistant to other drugs. Dose: 5-50 mg daily. Side-effects are Wright gain, breast tenderness and tachycardia. Almost all patients experience hyper1richosis, and should be warned accordingly. (Loniten). A 2% solution is used as a lotion in the local treatment of male-pattern baldness. (Regaine).
mirtazapine An alpha,-receptor antagonist. It is used in depression as it increases central noradrenergic and serotenergic neurotransmission. rot ransmission.
Dose: 15-45 nag at night for 4-6 months. Side-effects are weight gain and drowsiness. (Zispin).
misoprostol A synthetic prostaglandin with an inhibitory action on gastric secretion. It is used in the control of peptic ulcer, and in the prophylaxis of ulcers induced by non-steroidal anti-inflaniniatory drugs (NSAIDs).
Dose: 800pg daily with food, with a last dose at night, and continued for some weeks. Dose in prophylaxis, 400-800µg daily. Side-effects are usually transient, and
.    include diarrhoea, nausea and abdominal pain. (Cytotec). See page 162. Contraindicated in pregnancy.
mitobronitol A cytotoxic agent used mainly in chronic myeloid leukaemia.
Dose: 250 nag daily until the white cell count falls, then 125 mg daily according to need. May cause gastrointestinal disturbance, alopecia and bone marrow depression. Haematological control is necessary. (Myclobromal). See page 122 and Table 8.
mitomycin A cytotoxic antibiotic used in bi cast, gastrointestinal and other cancers. Dose: 4-10 mg by i.v. infusion at intervals of I-6 weeks. Great care must tic taken to avoid extravasation. Also used in bladder cancer by the weekly instillation of a solution of 10-40 nag in 20-40 nil of water. Side-effects include bone marrow and renal damage, and lung fibrosis.
mitozanitrone A cytotoxic drug related to doxorubicin, and indicated in advanced breast cancer.
Dose: 14 nighn= once i.v., repeated after 21 days, provided the white cell and platelets counts have returned to normal. It is highly irritant, and contact of the drug wid the skin must be avoided. Side-effects are nausea, vomiting, alopecia, myelosuppression and cardiac weakness. (Novantrone). See page 122 and Table 8.
mivacurium A non-depolarizing muscle relaxant with the short action and uses of atracurium.
Dose: initial dose 70-250pg/kg i.v., followed by doses of 100µg/kg/min at intervals of 15 minutes as required. Smaller doses are given by i.v. infusion. (Mivacron).
moclobemideVA short-acting, reversible inhibitor of monoamine oxidase (MAO) for the treatment of severe depression. The older MAO-inhibitors act on both the A- and B-forms of the enzyme, and have a long and irreversible action. Moclobemide has a rapid and selective action on MAO-B, but the duration is short and fades after about 24 hours, as the drug is soots    The risks of reactions with other drugs (comnlon with old MAO-inhibitors) are correspondingly reduced.
Dose: 300 mg daily initially (after withdrawal of other therapy), slowly increased up to 600 ing daily. Side-effects are dizziness and sleep disturbances. (N-lanerix). See page 128 and Table 11.

moexepril An ACE-inhibitor.
Dose: (when given alone) 7.5 mg daily initially, increasing if required up to 30 mg daily. When given as a second-line therapy with a diuretic (which should be avoided), initial dose is 3.75 mg under supervision until the blood pressure has stabilized. Side-effects are hypotension and cough. I lyperkalaernia may occur if potassium supplements or potassium sparing diuretics are also given. (Perdix). See page 148 and Table 21.
molgramostimVA recombinant form of human granulocyte macrophage colony stimulating factor (GM–CSF). It is used in the neutropenia following cytotoxic and bone marrow transplant therapy.
Dose: 60 000-100000 units by s.c. injc, tion or i.v. infusion, under haematological control. (Leucomax). See filgrastini and lenograstini.
mometasoneVA potent corticosteroid used as 0.1% creamilotion once a day in severe eczema, psoriasis and other skin conditions not responding to other therapy. (Elocon). Also used as a nasal spray in allergic rhinitis. (Nasonex).
monoamine oxidase inhibitors Monoaniine oxidase is an enzyme concerned with the breakdown of dopamine, serotonin, noradrenaline and adrenaline. Those substances are stored in many organs of the body, including the brain, where they function as transmitters of nerve impulses. The period for which they act is very short, as they are rapidly metabolized by monoamine oxidase. An inhibition of the enzyme could permit an increase in the brain levels of such amines, and on that basis sonic monoamine oxidase inhibitors (MAOIs) have been used in the
treatment of depression. Therapy is complicated by the fact that these drugs can increase the response to pressor drugs, anaesthetics and many other agents, including the mild sympathominictics present in some cough
mixtures and decongestive nasal sprays. Even certain foods, particularly cheese, may cause a dangerous rise in blood pressure during MAO] therapy and patients should always carry the MAN warning card. Great care is necessary during combined therapy, and ideally 10-14 days should elapse after ceasing
MAGI treatment before using other potent drugs. Examples of MAOIs are isocarboxazid, phenelzine and tranylcypromine. Their use has declined as more effective antidepressants of the amitriptyline type, with fewer side-effects, have become available. See moclobemide, page 128 and Table 11.
moraeAzine A potent cardiac membrane-stabilizing agent used like lignocaine to control ventricular arrhythmias.
Dose: 600-900 mg daily initially, adjusted later according to need and response. Side-effects include dizziness, palpitations and chest pain. (Ethniozinc),
tmorphine The principal alkaloid of    71 Opium. It is widely used as a narcotic analgesic for the relief of severe pain and the associated anxiety and stress, and in shock.
Dose: in acute pain, 10 mg by injection as required; in chronic pain it may be given orally or by injection according to need in doses varying from 5-10 mg. Sonic long-acting oral forms of
morphine are available (MST Continus; Oramorph SR) designed to reduce the frequency of dosing in conditions of severe pain. Side-effects include nausea and vomiting, which can often be controlled by small doses of chlorpromazine, or a similar antiemetic.
Morphine may cause respiratory depression, and severe respiratory depression is a contraindication. The possibility of tolerance to and dependence on morphine should be kept in mind if treatment is prolonged, but in terminal Conditions is of little importance.
moxisylyte (thymoxamine) An alpha,- adrenergic blocking agent, given by intracavernous injection for the induction of erection.
Dose: 10 mg not more than 3 times a week. Side-effects are drowsiness. dizziness and flushing. (Erecnos).
moxonidine A centrally acting antihypertcjisive agent of the clonidine type. It has a greater affinity for certain receptors in the brain stem that reduce the peripheral resistance and so indirectly lowers the blood pressure.

mepacrine A synthetic antimalarial. Now replaced by chloroquine and other powerful drugs. It is used occasionally in the treatment for Giardia laynblia infections. Dose: 300 mg daily for 5-8 days.
tmeprobamate A mild tranquillizer used Ili anxiety and tension states, but its extended use may lead to dependence. Dose: 1.2-2.4 g daily. Side-effects are drowsiness, headache, gastrointestinal and visual disturbances. It has been largely replaced by benzodiazepine anxiolytics. (Equallil).
meptazinol An analgesic for the relief of moderate to severe pain. It has a more rapid and extended action than morphine, and is less likely to cause respiratory depression or induce dependence.
Dose: 800-1600 nig orally daily. In severe pain, 50-100nig by injection, repeated as required; in obstetric analgesia, 2 nig/kg. The action can be partly antagonized by naloxone. Side-effects include dizziness and nausea. (IMeptid).
rinequitisizine An antihistamine used for the symptomatic relief of allergic states such as haytever and urticaria. It is less likely to Cause sedation than sonic other antihistamines.
Dose: 10 mg daily. Side-effects may include dry mouth and blurred vision. (Prinialan). See page 110 and Table 2.
mercaptopurine A cytotoxic agent used in the treatment of acute leukaemia.
Dose: 2.5 niWkg daily. Close haernatologi,al control is essential, as the drug has .1 marked niyelosuppressive action. \.lercaptopurine is also hepatotoxic, and should be withdrawn if jaundice occurs. (Puri-Nethol). See page 122 and Table 8.
meropenem An antibiotic similar to imipenem. but more resistant to breakdown by renal enzymes, so combined use with an enzyme inhibitor is unnecessary. Dose: given by i.v. infusion in doses of 500 mg-2 g 8-hourly according to the severity of the infection. Care is necessary in hepatic disease. (Meronem).
mesalazine The active metabolite of sulphasalazine. It is not suitable for oral
use as such, but can be given as a resin-drug complex, so that the drug reaches and is released in the colon unchanged. It is used both for the acute attack and for the maintenance of remission of ulcerative colitis, particularly in patients unable to tolerate sulphasalazine.
Dose: 1.2-2.4 g daily. Side-effects include gastrointestinal disturbances, and care is necessary in patients hypersensitive to salicylates. Patients should be advised to report an), bruising, bleeding or malaise. If .a blood dyscrasia is suspected, a [)food count should be done and the drug withdrawn. Lactulose should not be used as a laxative, as it may hinder the release of the active drug. Also used as enema and suppositories. (Asacol; Pentasa; Salofalk). See page 172 and Table 32.
mesna A compound used to prevent the liaemorrhagic cystitis caused by the cytotoxic drugs cyclophosphamide and ifosfamide. The reaction is caused by the metabolite acrolein, and mesna reduces the toxicity by combining with acrolein in the urinary tract.
Dose: 20%, of that of the cytotoxic drug, and should be given at the same time by i.v. injection. Subsequent supportive doses may be given orally or by injection il - 8 hours after therapy. (Uromitexan).
mesterolone An orally active androgen with the actions and uses of testosterone. It is used in androgen deficiency and male infertility but, unlike other androgens, it does not inhibit endogenous androgen production, and is less hepatotoxic. Dose: 75-100 mg daily for sonic months. (I'm Viron).
mestranol An orally active oestrogen present in some oral contraceptive products. See page 264.
metaraminol A sympathornimetic agent that increases the blood pressure by a general constriction of the peripheral blood vessels. It is used mainly in the acute hypotension that may occur with spinal anaesthesia. It has also been used in shock, but the use of vasoconstrictors has declined, as in shock the peripheral resistance may be already high, and the use of blood volume expanders and dopamine and dubotamine is now preferred.
Dose: 15-100 mg 1)), i.v. infusion. Side-effects are tachycardia and reduced renal blood How. It is contraindicated in myocardial infarction. (Aramine).
metformin An orally active biguanide hypoglycaemic agent. Its action differs from that of the sulphonylureas, as it acts by increasing the peripheral uptake of glucose. It is used mainly in non-insulindependent diabetes not controlled by diet and sulphonylurea therapy.
Dose: 1.5-3 g daily according to need and response. Side-effects include nausea and transient diarrhoea. 11 may cause lactic acidosis and it should not be used in patients with renal impairment. (Glucophage). See page 131 and Table 13.
tmethadone A morphine-like analgesic with reduced sedative effects. Ofvalue in severe pain, and in the relief of useless cough in terminal disease.
Dose: 5-10 mg orally or by i.m. or s.c. injection, in intervals according to need. Prolonged treatment carries the risk of cumulative effects and overdose.
(Physeptone).
methenamine See hexarnine.
methionine A sulphur-containing amino acid essential for nutrition. It is used mainly in paracetamol poisoning, often with acetyl cysteine, and given within 10-12 hours.
Dose: 2.5 g 4-hourly up to a total of [0 g.
methocarbamol A skeletal muscle relaxant used in muscle injury and spasm.
Dose: 6g daily orally; 1-3 g daily by slow i.v. injection. It may cause drowsiness, dizziness and allergic rash. Contraindicated in epilepsy and myasthenia gravis. (Robaxin).
methohexitone A short-acting i.v. anaesthetic similar to thiopentone. It is used mainly for the induction and maintenance of anaesthesia for short operative procedures, when the quick recovery may be an advantage. (Brietal).
methotrexate A cytotoxic agent that acts by inhibiting the synthesis of purines, and so indirectly interferes with cell proliferation. It is used chiefly for maintenance therapy in the remission of acute lymphoblastic leukaemia in children, but it has been used in choriocarcinoma as well as some lymphomas and solid tumours.
Dose: in children, I5 mg/in' weekly. It is sometimes effective in resistant psoriasis, and is given in oral doses of 10-25 nig weekly under specialist supervision. It is occasionally used in severe rheumatoid arthritis not responding to other treatment in doses of 7.5 mg once weekly. Side-effects are those of gastrointestinal toxicity, niyelodepression, rash and cirrhosis. Blood counts and liver function tests during treatment are essential. Cough and dyspnea may indicate pulmonary toxicity. Aspirin and non-steroidal anti-inflaniniatory drugs (NSAIDs) should be avoided, as they delay the excretion of methotrexate and increase its toxicity. See page 122 and Table 8.
methotrimeprazine An antipsychotic agent of the chlorpromazine type, with similar actions, Uses and side-effects. It is used in schizophrenia when a sedative effect is also required.
Dose: 25 -50 mg daily, but much larger doses, up to 1 g daily, may be required, particularly for bedfast patients. It is of value as an adjunct to other therapy in terminal illness and is sometimes given by continuous s.c. infusion in doses of 25-200 ing over 24 hours. Postural hypotension may occur in elderly ambulant patients. (Nozinan). See page 168 and Table 30.
methoxamine A sympathomimetic agent that increases the blood pressure by constriction of the peripheral vessels. It is used in the hypotension following spinal anaesthesia; to correct an excessive response to antihypertensive drugs; and to arrest supraventricular tachycardia. Dose: 5-20 mg by i.m. injection; 5-10 mg by slow i.v. injection. Care is necessary in preexisting hypertension and cardiov.iwular disease (Vasoxine).
methyl cellulose A derivative of cellulose that is used as an emulsifying agent and bulk laxative.
Dose: 1.5-6g with water, but not at night. It is sometimes given in diarrhoea, with a minimum amount of water.
methyl salicylate A pale yellow liquid with a characteristic odour. It has long been used as wintergreen liniment and ointment for the local relief of muscle pain and rheumatic conditions, but is now less popular.

methylated spirit Alcohol containing 5% of wood naphtha. Used for skin preparation and alcoholic applications. The methylated spirit used domestically differs, and is coloured violet to indicate its unsuitability for medicinal use.
methylcysteine A sputum-liquefier claimed to be of value in respiratory conditions where the sputum is viscid. Dose: 600 ing daily. (Visclair).
! Met
other pressor amines. It is used mainly in the preoperative control of adrenaline-producing tumours (pliaeochrornocytoma), and in the long-term treatment of patients unsuitable for surgery.
Dose: I g daily initially, increased if necessary up t(') 4g daily. An adequate fluid intake is essential. Side-effects include sedation, which may be marked initially, diarrhoea, which maybe severe, depression and confusion. (Dernser).
so
methyidopa A centrally acting antihypertensive drug, usually given together with a diuretic. It has the advantage of being relatively safe in asthma, heart failure and pregnancy.
Dose: 750 ing-3 g daily; 250-500 mg by i.v. infusion. Side-effects are drowsiness, depression and diarrhoea. A systemic lupus crytheinatostis-like syndrome may also occur, and active liver disease is a contraindication. (Alcloinet). See page 148 an(] Table 21.
tmethylphenidate A central stimulant used occasionally under strict supervision for the treatment of hyperactive children. Dose: 5-10 mg daily. Witalin).
metoclopramide A stimulant of gastric and small intestine transport. It is used in the treatment of nausea and vomiting generally, including that induced by drugs or migraine, in non-ulcer dyspepsia, and in accelerating the passage of a barium meal.
Dose: 15-30 ing daily orally or by Lin. or i.v. injection. A single dose of 10-20 mg is given by injection 10 minutes before radiological examination. Side-effects include extra-pyramidal reactions, facial sprints and oculogyric crises, mainly in voting persons, and it is best avoided in patient., under 20 years of age. (Maxolon). Some long-acting products are also available. See page 158 and Table 25.
tmethylphenobarbitone An anticonvulsant with the actions, uses and side-effects of phenobarbitone.
Dose: in epilepsy, 100-600 ing daily. (Prominal). See page 136 and Table 15.
methylprednisolone A corticosteroid with the actions, uses and side-effects of prednisolone, and given in similar doses. (Medrone).
methysergide A synthetic drug related to ergonicirine and used in the prevention of severe and recurrent migraine not responding to other drugs.
Dose: 2-6 ing daily. It is also given fur the symptomatic treatment of the carcinoid syndrome in (loses of 12-20 ing daily. Mcthvsergide has many side-effects, including retroperitoneal and cardiac fibrosis, and its use requires expert supervision. (Des-A-ril)-See page 154 and] able 23.
metipranolol A beta-adrenoceptor blocking agent used as eye drops 0.1-0.6% for the treatment of chronic glaucoma.
metirosine An enzyme inhibitor that interferes with the synthesis of adrenaline and
metolazone A diuretic with the actions, uses and side-effects of bendrofluazide.
Dose: in hypertension, 5 mg daily I p
initially; in oedematous statcs,5-20ingor more daily may be given. The diuresis is increased by combined treatment with a loop diuretic such as ffl,lsemide, but monitoring of the response is necessary. (NIctinex). See page 148 and Table 21.
metoprolol A beta-blocking agent used in the control of angina, but also of value in hypertension and the prophylaxis of migraine.
Dose: in angina, 100-300 mg daily; in hypertension, 100-400 ing daily; in migraine prophylaxis and thyrotoxicosis 200 ing daily. It is occasionally given by slow i.v. injection in acute cardiac arrhythinias; dose 1-2 nighnin tip to a total of 10-15 mg. Care is necessary in heart block, bradycardia and pulmonary disease. (Betaloc; Lopresor). See page 114 and Table 4.
metriphonate An organophosphorus schistosornicide, but used only in infections of the hookworm Schistosonia haemobitim, which is found in the genitourinary veins.

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.
61
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.

A-Z Principal Drugs (amorolfine - antibiotics )

amorolfine An antimycotic used in the treatment of fungal infections of the nails. It is applied to the nails as a lacquer (5%), but prolonged treatment at weekly
intervals for some months is required until the nails are regenerated. Also cream 5% for skin infections. (1-oceryl).
amoxapine A tricyclic antidepressant with the actions, uses and side-effects of imipramine, but giving a more rapid initial response.
Dose: 10(1-250 mg daily, with half dose [or elderly patients. The side-effects of drowsiness may be reduced by giving a single daily dose at night. (Asendis). See page 128 and Table 11.
annoxycillin An orally active penicillin very similar to ampicillin, but absorption is less influenced by food. It is active against a wide range of organisms and is used in the treatment of respiratory, urinary and soft-tissue infections, and also in typhoid fever. Dose: 750 mg-1.5g daily. In severe infections doses up to 4 g daily by i.v. infusion. In simple, acute, urinary infections 2 oral doses of 3 g with 12 hours between doses.
In the prophylaxis of bacterial endocarditis I or 2 (loses of 3 g. The activity against penicillinase-producing organisms is increased by the combined use of clavulanic acid. (Amoxil).
amphetamine sulphate A powerful central nervous system stimulant. It is now rarely prescribed because of the high risk of dependence. See dexamphetamine.
amphotericin An antifungal antibiotic, effective in systemic as well as superficial infections.
Dose: for systemic use, 250 pgikg daily in 5% glucose solution by i.v. infusion, and increased if tolerated to a maximum of I mg/kg daily. Side-effects, often severe, are numerous and include vomiting, fever, cardio- and nephrotoxicity. (Abelcet and Ambisone are modified products with reduced toxicity.) For intestinal candidiasis, doses of 400-800 mg daily are given orally. For superficial infections 31% ointment is applied locally. (AmBisonc; Fungicillin).
ampicillin An acid-stable and orally active penicillin. It is inactivated by penicillinaseproducing organisms and most staphylococci are now resistant to ampicillin. It is used in chronic bronchitis, ear infections, and infections of the biliary and urinary tracts.
Dose: 1-2 g orally or by i.m. injection; in severe infections, up to 4 g daily by i.v.
infusion. In urinary infections, doses of 1.5 g daily are given, but in gonorrhoea, a single dose of 2 g with I g of probenecid is often effective. Skin reactions are relatively common but the urticarial type is indicative of penicillin allergy, and requires a change of treatment. A macro-papular rash is frequent with patients with infective mono-nucleosis and treatment with ampicillin should be discontinued. (Anifipen; Peribritin).
arnpiclox A mixed product containing .ampicillin 250 mg and cloxacillin 250 mg.
amsacrine A synthetic cytotoxic agent similar in action to doxorubicin but less cardiotoxic.
Dose: in refractory myeloid leukaemia 90 niginidaily for 5 days by i.v. infusion. Subsequent doses at intervals of 2-4 weeks according to response. Strict control is
essential as hypokalaemia with fatal arrhythmia has occurred. Side-effects include nausea, stomatitis, alopecia, myelosuppression and epileptiform seizures. (Am,idinc). Svc page 112 and Table 8.
amylobarbitone A barbiturate of medium intensity.
Dose: 100-200 mg. Sodium derivative is more rapid in action, but the effect less prolonged; it has been given i.v. for the control of convulsions and in epilepsy. (Amytal). See page 152.
anabolic steroids Compounds related to testosterone with similar protein- building properties but reduced virilizing effects. They have been used to stimulate protein synthesis after major surgery and in
wasting disease, but the response is often disappointing. They are sometimes used to relieve the itching of chronic biliary obstruction, but may exacerbate the associated jaundice. Some anabolic steroids have been used in high doses in aplastic
anaemia, and as palliatives in breast cancer. Side-effects are oedema and jaundice, and hepatic impairment is a contraindication. They should not be given to children as they may cause premature closing of the epiphyses. See nandrolone; stanozolol.
anastrozole An inhibitor of aroniata,-ic, the enzyme involved in the conversion of androgens to oestrogens by the adrenal gland. Used in post-menopausal oestrogen-dependent breast cancer as it reduces the plasma level of oestrogens.

Dose: J mg as a single daily (lose. Supplementary steroid therapy is unnecessary. Side-effects are hot flushes, vaginal dryness and hair thinning. (Arimidex). See
page 122 and Table 8.
aneurine hydrochloride See thiamine.
angiotensin converting enzyme
inhibitors (ACE) I )rugs which inhibit the conversion of angiotensin I (secreted by the kidney) to angiotensin 11 (a powerful hypertensive) and thus, indirectly, lower blood pressure. ACI: ‘inhibitors are used in the treatment of hypertension, especially in severe conditions that have not responded to other therapy, and also in congestive heart failure. Initial therapy requires care, as a marked first-dose fall in blood pressure may occur. The first dose is best given at night, with the patient in bed, and if possible any diuretic treatment should have beets    for a few days. Renal function should be monitored during ACE inhibitor therapy, as these drugs may cause a progressive and sometimes severe renal impairment. See page 148 and Table 21.
anistreplase A complex of streptokinase with human plasminogen, used to restore blood flow after myocardial infarction. It binds with the fibrin of blood clots, and is slowly metabolized to release the active fibrinolytic agent plasmin. It is given by i.v. infusion as a single dose of 30 units, within 6 hours of infarction up to a total dose of 100 mg over 3 hours. Side-effects include transient hypotension, nausea, flushing and allergic reactions. (Eininase).
antazoline A mild antihistamine, used with the vasoconstrictor naphazoline as a nasal spray to reduce local congestion in sinusitis and rhinitis, and as eye drops in allergic conjunctivitis. (Otrivine).
action are represented by aurcomycin,    15 chloramphenicol, the tetracyclines, and the cephalosporins. The aniinoglycoside antibiotics represented by gentamicin are used mainly in infections due to Gram-negative organisms, but are more toxic than the penicillins or related drugs. Rifampicin is an antibiotic used mainly in tuberculosis. Broad-spectrum antibiotics should not be given for more than
5-10 days, to prevent disturbance of normal bacterial flora in the gut leading to overgrowth of other organisms such as candida. Certain antibiotics, including neomycin and bacitracin, are too toxic for systemic use but may be useful in the treatment of infected skin conditions.
A few antibiotics such as actinomycin, bleomycin, doxorubicin, mitomycin and aclarubicin have cytotoxic properties. Others, such as griseofulvin, have only an antifungal action.
anticholinergic agents (antimuscarinics) Drugs like atropine that inhibit the activity of the neurotransmitter acetylcholine. They are used as smooth muscle relaxants, as inhibitors of gastric secretion, and to reduce the excessive cholinergic activity associated with Parkinson’s disease. By their nature, they have side-effects such as dryness of the mouth and blurred vision, and are contraindicated in glaucoma. See page 160 and Table 26.
anticoagulants Blood clots consisting mainly of fibrin may form in the venous circulation, and heparin and warfarin are used as anti-coagulants in deep vein thrombosis. Heparin is also used prophylactically against postoperative thrombosis and during renal dialysis, and in low doses to reduce the risks of pulmonary
embolism.
antibiotics Antibacterial substances which occur as by-products of the growth of certain moulds. The term now includes sonic synthetic derivatives. The first to be discovered was penicillin, but some penicillin derivatives (amoxycillin, ampicillin and pivampicillin) have a wider range of activity; others (cloxacillin and flucloxacillin) are effective against resistant staphylococci. Azlocillin, carfecillin, piperacillin and ticarcillin are more effective against Pseudomortas aeruginosa. Antibiotics with a more extensive range of
anticonvulsants Also known as anti-epileptics, these are used to control the convulsions of epilepsy. The main types of convulsions or seizures are grand mat and petit mat (absence seizures) but atypical and myoclonic seizures may also occur. Some drugs are effective in most types of seizure, others are more selective in action, but in all cases dosage must be adjusted to need and response. Any change of treatment requires care with overlapping doses to avoid loss of control. Paradoxically, young children may require relatively high doses. See page 136 and Table 15.

A-Z Principal Drugs (Alprazolam - Aminophylline)

alprazolam

A benzodiazepine used in the shors-term treatment of anxiety and anxiety with depression.
Dose: 0.75-3 mg daily. Side-effects include dizziness and ataxia. Care is necessary in pulmonary insufficiency. (Xanax). See page H 7 and Table 5.
alprostadil A preparation of prostaglandin li, for i.v. use in maintaining the patency of the ductus arteriosus in neonates with congenital heart lesions requiring surgical correction. The improvement in circulation so obtained permits diagnosis while surgery is being considered.
Dose: 50-100 ng/kg/min i.v. under strict control. Apnoea may occur, usually within an hour of the injection, requiring immediate ventilatory assistance. Bradycardia and hypotension may also occur. (Prostin VR).
alteplase A form of human plasminogen activator with a selective fibrinolytic action on blood-clot-bound plasminogen. It is of value in the early treatment (6 hours) of acute thrombosis, myocardial infarction and pulmonary embolism.
Dose: 10 mg initially by slow i.v. injection; then 90 mg over 3 hours by i.v. infusion. Side-effects are nausea, vomiting and local bleeding. (Actilyse). See streptokinase.
aluminium The powdered metal is used as a skin protective in ileostomy, as Baltimore paste, also known as Compound Aluminium Paste.
aluminium acetate An astringent used as an 8% solution for ear drops in otitis externs. A weak solution (0.65%) is used as a lotion in exudative eczematous states and in suppurative conditions.
aluminium chloride An antiperspirant used in the treatment of axillary hyperhydrosis by the local application of a 20% alcoholic solution. Over-use may cause skin irritation. (Anhydrol; Driclor).
aluminium hydroxide An antacid with a prolonged action.
Dose: as a gel, 7.4-15 ml, or as 500 mg tablets, to be chewed or crushed before swallowing. Best given between meals and at night. May interfere with the absorption of some other drugs. (Aludrox).
alverine An antispasmodic with a local action on intestinal smooth muscle.
Dose: used in irritable bowel syndrome in doses of 60-360 ing daily. (Spasmonal). See page 134 and “Cable 14.
amantadine An antiviral drug thought to act by inhibiting the penetration of the virus into the host cell, and used for the prophylaxis and treatment of influenza. It is also used with levodopa in the treatment of parkinsonism, but it may relieve the rigidity more than the tremor.
Dose: 200 mg daily. Many side-effects are dose-related. (Synimetrel). See page 160 and Table 26.
amethocaine Powerful local anaesthetic, used [or anaesthetic of mucous
membranes 1-2% solution, eve drops 0.25-1 %. As spray for throat before endoscopy, etc, a 0.5% solution may be used. Hypersensitivity and allergic reactions may occur as with other local anaesthetics. Also used as 1% cream for pruritus ,i nd other skin conditions.
amifostine An organic thiophosphoric acid used to reduce neut ropen ia -associated risks of infection after cyclophosphamide and platinum treatment of ovarian cancer. Dose: by i.v. infusion 910 mg/m: daily .10 minutes before chemotherapy.
I lypotension is a side-effect that may limit treatment. (Ethyol).
amikacin A semi-synthetic antibiotic similar in actions and uses to gentamicin, but more resistant to enzyme inactivation. Mainly used in the short-term treatment of serious infections due to Gram-negative, gen tain ici it -resistant organisms.
Dose: 15 ing/kg daily by i.m. injection or i.v. infusion, up to a total treatment dose of 15 g. Side-effects include ototoxicity, drug fever, rash and nausea. Dose should be reduced in renal impairment. (Amikin).
amiloride A potassium-conserving diuretic ,,uh an action on the distal tubule similar to that of spironolactone, although it is not an inhibitor of aldosterone. It is used in
hypertension and heart failure, often with a thiazide diuretic to obtain a more balanced response.
Dose: 5-20 ing daily. Rash is an occasional side effect. See page 148 and Table 2I.
amino acids Certain amino acids are essential for the formation of protein. When oral nutrition is not possible, amino acid preparations may be given by i.v. i ritusion. and such therapy call be extended if necessary to provide total parenteral nutrition by the addition of glucose, electrolytes, fats and vitamins as specially prepared solutions. [it hospitals, a 24-hour supply for total parenteral nutrition can be provided in a single large container and patients may be taught to administer total parenteral nutrition at home. Representative amino-acid products for i.v. infusion are Aminoplex, Perfusin, Synthamin and Varnin.
arninobenzoic acid An absorbent of some of Elie erythema-producing ultra-violet light waves of sunlight. it is present in sonic suit screen preparations.
aminoglutethimide An inhibitor of adrenal steroid and oestrogen biosynthesis. It is used in the control of post-menopausal oestrogen-dependent mammary carcinoma and in the treatment of advanced prostatic carcinoma.
Dose: 250 mg daily, increased, if necessary, to I g daily. Supplementary corticosteroid therapy is essential. Side-effects include drowsiness, rash and drug fever. (()j iineten). See page 122 and Table 8.
aminoglycosides A group of antibiotics that includes amikacin, gentamicin, netilmicin, lobramycin, kanamycin, streptomycin, neomycin and framycetin. They act mainly against Gram-negative bacilli, although they are also active against some Gram-positive organisms. Kanamycin and streptomycin are also active against Mycobacterhan tuberciaosis.'rhe aminoglycosides are not absorbed orally and when injected they are more toxic than most other antibiotics, and in renal impairment care is necessary, as the plasma concentration of the antibiotic may rise to an ototoxic or nephrotoxic level. The toxicity may also be increased by diuretics of the frusemide type. Measurement of plasma levels is essential in high dosage or continued therapy. Gentamicin is the most widely used aminoglycoside for systemic infections, and neomycin and framycetin, being too toxic for systemic use, are of value in skin infections.
may be given by slow i.v. injection. It is not suitable for Liu. administration. Sustained release oral products available cause less gastric disturbance. (Pecram; I'llyllocontin). See page 118 and 'rable 6.
amiodarone An iodine-containing anti-arrhythmic agent of value in all types of paroxysmal tachycardia, especially when the condition is resistant to other drugs. Dose: 600 ing daily for I week; maintenance (lose: 200 ing or less daily. When a rapid response is required, 5 mg/kg may be given by i.v. infusion under cardiac monitoring. it is contraindicated in bradycardia, pregnancy and thyroid disorders, and care is necessary in hepatic impairment. Pulmonary alveolitis, corneal microdeposits and photosensitivity have been reported as side-effects. (Cordarone).
amitriptyline A tricyclic antidepressant similar in action to imipramine, but it also has anxiolytic and sedative properties. Dose: in depression complicated by anxiety, 30-150 mg daily initially; maintenance dose: 20-100 mg daily; sometimes as a single nightly dose to reduce daytime sedation. Lower doses are often adequate in elderly patients. Dose by injection, 40-80 nig daily. Full benefit may not be achieved for some weeks and prolonged therapy may be necessary to avoid relapse. Withdrawal of the drug should be gradual. Atnitriptyline is also used in nocturnal eneuresis in children. Dose: 25-50 mg daily. Side-effects include dryness of the mouth, sedation and cardiac arrhythinias. It is contraindicated in glaucoma, prostatic hypertrophy and after recent myocardial infarction. Mcnti7o];Tryptizol). See page 128 and Table 11.
amlodipine A calcium channel blocking agent used in hypertension and myocardial ischaemia associated with angina.
Dose: 5-10 mg as a single daily (lose. Side-effects are headache, dizziness, flushing and oedema. Care is necessary in renal impair nient. (Istin). See page 148 and Table 21.
ammonium chloride A mild expectorant present in Ammonia and Ipecacuanha Mixture.
aminophylline A derivative of theophylline with a similar bronchodilater action. It i,, used chiefly in asthma, cardiac oedema and congestive heart failure.
Dose: 300 nig-1.2g orally daily; 5 nig/kg