Posts Tagged ‘parkinsonism’

salbutamol A selective beta,- adrenoceptor  It is widely used to relieve bronchospasm in airway obstruction, including bronchial asthma and status astliniaticus, with the advantage of being largely free from cardiac side-effects. Dose: up to 16 ing orally daily; by aerosol inhalation (in which patients should be carefully instructed) 100-200 pg ( 1-2 puffs) Lip to 4 times a day; by s.c. or i.m. injection 500 pg as required; 250 pg by i.v. injection. Salbutamol also, relaxes uterine muscle, and is given in premature labour in doses of 10 pg/inin initially by i.v. infusion, increased to 45 pg/min until contractions have ceased, when oral therapy may be given. Side-effects include tremor, headache, peripheral vasodilation and tachycardia. Care is necessary in ischacinic heart disease, hypertension pertension and hyperthyroidism. (Ventolin). See page 118 and Table 6.
salcatonin A synthetic form of calcitonin, preferred for extended use, as it is less likely to provoke allergic reactions. Dose: in hypercalcaemia, 5-10 units/kg ,fail), 1)), s.c. or Lin. injection according to need; in Paget’s disease 60 units 3 times a week up to 100 units daily. It is also used in post - menopausal osteoporosis and for the bone pain of malignancy. (C.alcynar; Miacalcic).
salicylic acid Etas useful keratolytic and fungicidal properties. Used as ointment (2%) for skin conditions, and as ointments and plasters (up to 40%) for corns and warts.
salmeterol A beta,-adrenoceptor stimulant of the salbutamol type, but with a longer action. It is used for the extended prophylaxis of asthma, bronchitis and other forms of obstructive airway disease, and together with corticosteroid therapy if required. It is not indicated in acute conditions.
Dose: 50 pg twice daily, either from a metered dose aerosol or by a ‘Disklialer’. salmeterol is well tolerated, but headache, tremor and tachycardia may occur with doses above 200 pg daily. (Serovent). See page 118 and,rable 6.
saquinavirV An antiviral agent that inhibits the enzyme HIV-protease, and prevents the development of immature virus particles into the infective virus. Used in HIV
infection together with it nucleoside analogue that has a different action.
Dose: 1.8g (laity. (Invirase). See page 1+1 ;111,1 TAIle 19.
scopolamine See hyoscine.
selective serotonin re-uptake inhibitors (SSRIS) A small group of drugs that inhibit the re-uptake ofserotonin in the central nervous system, and are used in the treatment of depression. They differ from the tricyclic antidepressants in being less likely to cause sedation or cardiac disturbances, or have anticholinergic side-effects. Care remains necessary with machine-related activities, and before and after monoamine oxidase inhibitors (MAOI) therapy. See page 128 and Table 11.
selegiline A selective enzyme inhibitor that prevents the inactivation of dopamine in the brain. It is used to supplement the action of levodopa in the treatment of parkinsonism, and combined use may give a smoother response, and permit a reduction in the dose of levodopa.
Dose: 5-10111g daily. It may cause nausea and hypotension, and may possibly increase the side-effects of levodopa. (Eldepryl). See page 160 and Table 26.
selenium sulphide Used as a shampoo in the treatment ofdandrull’. Prolonged use may cause alopecia. (Selsun).
senna The leaves and pods of Cassia sp., used as a purgative. Standardized preparations such as Senokot are now preferred.
sermorelinV A synthetic analogue of soniatorelin, the growth hormone releasing factor (GHRH). It is used in the diagnosis of growth hormone deficiency as a single i.v. dose of I pg/kg. (Geref 50).
sertindoleV An antipsychotic agent with a selective action on the limbic system, and used in acute and chronic schizophrenia. Dose: 4 nig once (laity initially, increased alter 2-4 days up to 20 mg daily according to need. Blood pressure should he monitored initially as hypotension may occur.  Contraindicated in patients receiving itraconazole, ketoconazole,  terfanidine, or any drug known to affect the QT interval. (Serdolect). See page 168 and Table 30.

serotonin A substance present in many body cells, which also acts as a neurotransmitter in the central nervous system. A reduction in the brain serotonin levels may be associated with depression and the cranial
vasodilation associated with migraine. (See page 154). Some allergic reactions may also be linked with the action of serotonin on sensitized cells (see cyproheptadine).
I Sod
colic and vomiting, but death from adder bite is very rare. If the reaction to an adder bite is severe, European viper anti-venom, if available, should be given by i.v. infu-
sion within 4 hours of the bite.
soda-lime A mixture of calcium and sodium hydroxides, used in closed-circuit anaesthetic apparatus to remove carbon dioxide.
sertraline A selective serotonin-re-uptake inhibitor (SSRI) antidepressant used both for the treatment oftlepression and the prevention of relapse.
Dose: 50 rig daily initially with food, increased at weekly intervals tip to a maximum of 2(0 mg daily. Not to be given with nionoanlilic oxidase inhibitors (MAOls). Side-effects are tremor and a dry mouth. (usual). See page 128 and Table 11.
silicones Synthetic water-repellent substances present in barrier creams and other skin protective products. Dimethicone is a silicone used as an anti-foaming agent in some antacid preparations.
silver nitrate Used mainly as silver nitrate sticks (caustic points) for cauterizing warts. It has also been used as a 0.5% lotion for suppurating lesions. It was once used prophylactically as eye drops (0.1%0) in the newborn, and is still used for that purpose in the USA.
silver sulphadiazine Sulphadiazine combined with silver. It is used topically as a I% cream for its wide-range antibacterial properties in burns and infected skin conditions, especially when an extended action is required. It is active against Pseudornonas aertiginosta and other Cram- negative organisms. (Flamazine).
simvastatin A selective inhibitor of a specific enzyme (I-IMGCOA reductase) concerned with the synthesis of cholesterol in the liver. It is used in the treatment of primary hypercholesterolaernia in patients not responding to other drugs. Dose: 10-40 mg at night. Liver function tests should be carried out regularly. Side effects include gastrointestinal disturbances. (Zocor). See page Wand Table 20.
snake-bite antivenom A bite from an adder, the only poisonous snake indigenous to the UK, can cause local pain and swelling as well as systemic effects such as
sodium acetrizoate An iodine compound used as a contrast agent in i.v. pyelography.
sodium aurothiomalate A gold compound used in the treatment of active rheumatoid arthritis. It is no value in other forms of the disease, or where bone change has already occurred.
Dose: 10 mg by deep Lin. injection weekly initially, slowly increased to 50 mg weekly. and continued until a remission occurs, or until a total dose of I g has been given.
Blood and urine tests are essential after each injection. After remission, 20-50 mg may be given every 2-1 weeks for many months. Side-effects are common, and include blood disorders, skin reactions, mouth ulcers and oedenia, anti may require withdrawal of the drug. It is contraindicated in renal and hepatic disease, blood dyscrasias and hypertension. (Myocrisin). See auranoran,
page 165 and Table 29.
sodium bicarbonate A soluble antacid, often used in association with less soluble antacids such as magnesium carbonate or trisilicate.
Dose: 1-4 g. In severe metabolic acidosis it is given by slow i.v. injection as an 8.4% solution. For alkalization of the urine, up to 3 g orally 2-hourly with further 10 g
doses daily as required.
sodium calcium edetate A chelating or binding agent used in poisoning by lead and other heavy metals.
Dose: 80 mg/kg daily by i.v. infusion in glucose/saline solution. Nausea and cramp are side-effects, and care is necessary in renal impairment. Medclair).
sodium cellulose phosphate An ion-exchange compound that binds with calcium in the intestines, and so reduces calcium absorption. Used in the oral treatment of hypercalcaemia and renal stones, and as an adjunct to low-calcium diets. Dose: 15 g daily. Diarrhoea is an occasional side-effect. (Calcisorb)•

sodium chloride An important constituent of blood and tissues. It is widely used by i.v. infusion as normal saline solution (0.9%), or as glucose-saline in the treatment of dehydration, shock and other conditions of sodium depletion. It is also useful when given orally as Sodium Chloride with Glucose Oral Powder (BNF) (after solution in water), for children with diarrhoea to offset any loss of salt. Its use as an emetic in the treatment of poisoning is no longer recommended. It is used externally as saline solution when a simple cleansing lotion is required.
sodium citrate An alkaline diuretic similar to potassium citrate and given for similar purposes.
Dose: 1-4 g. For citrating milk, 100 mg to each feed may be used. A 3% solution is used by bladder irrigation for the dissolution of blood clots.
sodium clodronate See clodronate, editronate and pamidronate.
sodium cromoglycate An antiallergic agent with a specific action and used for the prophylactic treatment of asthma by inhalation. It stabilizes mast cells and inhibits the release of histamine and other spasmogens that cause bronchospasm. Dose: by powder inhalation from a `Spinhaler* 20 mg up to 9 times a day; by aerosol inhalation, 10 mg (2 puffs) up to 8 times a day. Dose in the treatment for food allergy associated with local inflammation, 800 mg daily orally. It is also of value as eye drops (2%) and eye ointment (40/4) in allergic conjunctivitis, and as nasal drops or spray (2%) in the prophylaxis of allergic rhinitis. (Intal, Rvilacrom). See page I I O and Table 2.
sodium fluoride The fluoride present in dentifrices used to reduce dental caries. It may also be given orally when more intensive treatment is required.
Dose: 250-5001igdaily.
daily by i.v. infusion. Side-effects include nausea, rash and jaundice. Liver function tests should be carried out during treatment. (Fucidiu).
sodium hypochlorite A weak solution of sodium hypochlorite containing 0.25% of available chlorine is used as eusol, for the cleansing of wounds and ulcers. The
Solution is unstable and should be freshly prepared. Its value has recently been questioned. Stronger, stabilized solutions are used for the general disinfection of surfaces contaminated with blood and other body fluids. Their use reduces the risk of transmission of hepatitis and other viral infections.
sodium ironedetate (sodium feredetate) A soluble iron complex available as a solution containing 27.5 mg of iron per 5 nil. It is used in the oral treatment of iron-deficiency anaemias, and is of value when other iron preparations are not tolerated. Dose: 15-30 nil daily. (Sytron). See page 112 and Table 3.
sodium lactate Has been used as M/6 solution, or as Hartmann’s solution, by i.v. infusion for metabolic acidosis, but sodium bicarbonate is now preferred.
sodium nitrite A cyanide antidote.
Dose: as it 30/b solution by i.v. injection of 10 nil, followed by the slow injection of 25 nil of sodium thiosulphate solution (50%). Early treatment is essential. See kelocyanor.
sodium nitroprusside A short-acting arteriovenous vasodilator used in hypertensive crisis and for controlled hypotension during anaesthesia.
Dose: by i.v. infusion, 0.3-1 pg1kg/juin, the lower doses being used to obtain hy
, poten-
sion during surgery. It is also used in acute heart failure in doses of 10-1 5 pg/niin, increased as required to 2001ighnin.
sodium fusidate An antibiotic used mainly in penicillin- resistant staphylococcal infections, although a secondary anti-staphylococcal antibiotic is often given to increase the response and inhibit drug-resistance. It is useful in osteomyelitis and similar conditions as it penetrates into bone tissues.
Dose: 2 g daily. In severe infections, 1.5 g
sodium perborate White powder soluble in water, with antiseptic and deodorant properties similar to hydrogen peroxide. A 2% solution is used as a mouthwash.
sodium phosphate A solution of sodium phosphate with sodium acid phosphate is sometimes used by enema as a laxative.

dimethicone Activated dimethicone is an antifoaming agent, said to reduce flatulence and protect mucous
membranes. It is a constituent of many antacid preparations. It is also present in some water-repellent skin creams.
dipipanana A rapidly acting morphine-like analgesic of value in the sever rain 4 to -1 dk–
Dose: 30-3450 mg (fail),, but it is usually• given in association with cyclizine as Diconal. The side-effects are similar to those of morphine.
dipivefrine A pro-drug that is converted into adrenaline after absorption. It is used
in chronic open angled- glaucoma as eye
drops (0.1%). (Propine). See page 138 and Table 16.
dimethylsulphoxide (DMSO) An organic liquid, it has been used for the symptomatic relief of interstitial cystitis
(Hunner’s ulcer) by the bladder instillation of 50 ml of a 50% solution. (Rimso-50).
dinoprost Prostaglandin F,.. It has actions and uses similar to dinoprostone.
(Prostin 112).
dinoprostone A synthetic form of prostaglandin E,. It has been used to initiate contractions of the pregnant uterus. Dose: 500 pg orally to induce labour, repeated if necessary at hourly intervals; as vaginal tablets or gel, 3 mg. Side-effects are nausea, diarrhoea, shivering and dizziness. (Prostin E2; Prepidil).
dioctyl sodium sulphosuccinate See dOCUSalC.
diodone injection A solution of a complex organic iodine compound, used as a contrast agent in X-ray examination of kidneys and ureters.
diphenhydramine One of the early antihistamines, with a more sedative action, and use(] in the temporary relief of insomnia. Dose: 10-25 trig. (Medinex. Nytol). It is also present in some cough preparations and nasal decongestants.
diphenoxylate A derivative that resembles codeine III reducing intestinal activity. It is used for the symptomatic relief of diarrhoea, and is usually given with a small dose of atropine to discourage excessive dosage and to reduce the risk of dependence. Dose: 10 mg initially, then 5 nig every 6 hours as required. (Lomotil;’Fropergen).
diphenylpyraline An antihistamine used as .I decongestant in colds and sinusitis. Present in Eskornadc.
dipyridamole An inhibitor of thrombus formation by reducing the adhesiveness of blood platelets in the arterial circulation. Dose: 300-600 mg daily before food. s I
ide-effects include nausea, diarrhoea and headache. (Persantill).
disodium cromoglycate See sodium cromoglycatc.
disodium etidronate See etidronate. disodium pamidronate See pamidronate.
disopyramide A quinidine-like drug used in the treatment of cardiac arrhythmias especially after myocardial infarction. Dose: 300-800 mg daily; dose by slow i.v. injection under ECG cover, 2 nig/kg up to 150 mg, followed by oral therapy as soon as possible. By its anticholinergic action care is necessary in glaucoma and prostatic enlargement. Contraindicated in heart block. (Dirythmin; Rythmodan). See page 1;6 and “fable 24.
distigmine An inhibitor of cholinesterase similar to neostigmine but with a longer action.
Dose: in the control of myasthenia gravis 5-20 mg as a single morning dose before breakfast; in urinary retention after surgery, 5 trig daily. It is sometimes used in neurogenic bladder disorders. Side-effects are nausea, abdominal cramp, diarrhoea and weakness. (Ubretid).
disulfiram When taken with even small amounts of alcohol, disulfiram permits the accumulation of acetaldehyde in the body, with side-effects such a flushing, giddiness, vomiting and headache that may be severe. Distilfiram is used in chronic alcoholism, but prolonged treatment and co-operation of the patient are essential.

Dose: after at least 24 alcohol free hours: 800 nig on the first day, falling over 5 days to 100-200 mg daily. Acute confusion may occur if given at the same time as tucLro-
llidazole. (Antabuse).
dithranol Synthetic compound used locally in the treatment of psoriasis. It is a powerful irritant, and treatment should be commenced with a simple ointment or zinc paste containing 0.1% ofdithranol, gradually increased to 1% if well tolerated. Higher concentrations are sometimes used in ’short -contact -time’ therapy.
Dose: 100 mg/m’ by i.v. infusion over
I hour. Rapid and severe hypersensitivity reactions (hypotension, bronchospasm) may occur, and treatment must be irrnediat4y available. Reaction risks may be reduced by premedication with jexalnetha&one given the day before treatment and continued for 5 days. Rash, pruritus and neutropenia may occur, and blood counts and liver function tests are necessary. (Taxotere). See page 122 and Table 8.
docusate A surface-active agent used as a faeces -softening laxative.
Dose: ill, to 500 nig daily. (Dioctyl).
diuretics The most widely used group of diuretics is the thiazides, represented by bendrofluazide (see page 14I ). They act mainly by increasing the excretion of
sodium by inhibiting its re-absorption by the distal tubule of the kidney, and evoke a rapid response which may persist over 12-24 hours, although some, such as chlorthalidone, have a still longer action. They are given in mild cardiac failure, oedema and in hypertension, but in more severe conditions, and in pulmonary occlema, the more powerful ‘loop’ diuretics, such as frusemide, which act at a different point, are preferred. A side-effect of some thiazides is an increase in the excretion of potassium which may require the use of potassium supplements or a change to a potassium sparing diuretic such as trianiterene. Spironolactone, an aldosterone antagonist, is a more powerful diuretic, of value in resistant oedema. Osmotic diuretics such as mannitol are used mainly in cerebral oedema. Simple diuretics such as potas slum citrate arc mainly used to alkalize the urine and promote diuresis in cystitis and similar conditions. See page 141 and Table 18.
dobutamine A sympathomimetic agent similar to isoprenaline, but with a more selective stimulant action on the beta, receptors in the heart. It increases cardiac contractility but is less likely to cause tachycardia. Useful in acute heart failure and cardiogenic and septic shock. Dose: 2.5-5 pg/kg/min by i.v, infusion, carefully adjusted to need. (Dobutr= Posiject). See page 141 and Table 18.
docetaxel A potent cytotoxic agent derived from the Pacific Yew. Used in advanced breast cancer resistant to other therapy.
domperidone An antiemetic that functions as a dopamine antagonist, as it prevents dopamine from reaching the receptors in the chemoreceptor trigger zone (see antiemetics). It is mainly of value in the severe nausea and vomiting caused by cytotoxic drugs, and is also useful in fum clonal dyspepsia. It is of little value in postoperative and travel sickness.
Dose: 10-20 mg 4-8-hourly; 30-60 nig by suppository. Sedative side-effects are infrequent, as domperidone does not cross the blood-brain barrier. (Motilium). See page 77.
donepezil A reversible inhibitor of anti-cholinesterase. Alzheimer’s disease is linked with a deficiency of acetylcholine in the brain, and donepezil may relieve sonic of the symptoms of that disease by increasing brain acetylcholine.
Dose: 5-10 mg at night. Diarrhoea and muscle cramps are side-effects. (Aricept ).
dopamine A sympathomimetic agent with actions and uses similar to dobutamine. Dose: 2.5-10 pg/kg/min by slow i.v. infusion. Careful control ofdose is essential, as dopamine may cause vasoconstriction with higher doses and increase the risk of heart failure. (Intropin). Dopamine is also a central neurotransinifter, and a deficiency is associated with parkinsonism. See levodopa, page 141 and “table 18.
dopexamine A short-acting drug of the dopamine type but with a more powerful action on the 0,-receptors. It is used in heart failure during cardiac surgery.

butobarbitone A barbiturate of medium clisityand rapidity of onset.
Dose: 60-200 mg. (Soneryl).
cabergoline A dopamine similar to bromocriptine, but with a longer .1, 1 ioli.
Dose: for suppression of lactation I mg, followed by doses of 0.25 ing for 2 days. Nausea, dizziness and breast pain are side effects. (Cabaser; Dostinex).
cadexomer iodine A modified starch powder containing 0.9% of iodine in a slow release form. It is used as an antiseptic application for venous ulcers and pressure sores. It should not be used during prenancy or lactation, during thyroid investigations or in patients sensitive to iodine. (lodosorb).
caffeine The central nervous system stimulant present in tea and coffee. It is used with paracetamol and other mild analgesics.
calamine Zinc carbonate. It has a mild astringent and soothing action and is widely used as Calamine Lotion for skin irritation and as Oily Calamine Lotion in eczema.
calciferol (vitamin D 2) form of vitamin 1) used in the prophylaxis and treatment of deficiency states such as rickets in children and osteomalacia in adults, and in other bone disorders. Dose: prophylactic 800 units daily; therapeutic 5000-50 000 units daily. In resistant rickets and parathyroid deficiency, higher doses may be required, but such therapy requires care, as hypercalcaemia percalcaernia and irreversible renal damage may occur. See ako alfacalcidol and calcitriol.
calcipotriol An analogue of vitamin D with a selective inhibitory action on the proliferation of keratinocytes. Used in the treatment of psoriasis as a 0.005% cream or ointment twice a day. Not more than 100 g/week. (Dovonex).
calcitonin Pork-derived calcitonin is a hormone that has an action similar to that
of the parathyroid gland in regulating blood calcium levels. It is used in the hypercalcaemia associated with malignancy, and in osteoporosis. It is also of value in Paget’s disease of bone, in which it relieves bone pain and reduces the neurological symptoms.
Dose: 10-160 units daily by s.c. or i.m. injection according to need and response. In Paget’s disease, prolonged treatment for some months may he required. Side-effects are nausea, flushing and paraesthesia, and local reactions may also occur. (Calcynar; Calcitare; Miacalcic). See salcatonin.
calcitrol The metabolite formed in the kidney from calciferol. It is the most powerful and rapidly acting metabolite with vitamin L) activity. It is of value in chronic renal deficiency states when the normal metabolism of calcium and phosphorus is impaired, as in renal osteodystrophy. Dose: 1-2 pg daily under biochemical control. Side-effects, such as hypercal-
caemia and hypercalciuria, are usually , P
reversible on withdrawing the drug. (Rocaltrol).
calcium channel blocking agents The movement of calcium ions through the calcium channels of the myocardium plays an essential role in cardiac activity. The inhibition of such movement by channel blocking agents reduces myocardial contractility and lowers the tone of the cardiovascular system. Such a reduction is of value in angina, hypertension and cardiac arrhythmias, and can be obtained by the use of calcium channel blocking agents such as diltiazem, felodipine, isradipine, nicardipine, nifedipine, nimidopine and verapamil. These compounds exhibit certain differences in action and in therapeutic applications, and their use requires care. Nifedipine and veraparail have been used in the prophylactic treatment of migraine. Their side-effects include nausea, oedema, rash and bradycardia. See pages 114 & 148, and Tables 4 & 21.
calcium carbonate A time honoured antacid now used less frequently. It also acts as a phosphate binder, and is used in hyperphosphatacinia.
calcium chloride The calcium salt present In various intravenous electrolyte solutions.

calcium folinate See folinic acid.
calcium gluconate A soluble and well-tolerated calcium salt used in many condi- tions associated with calcium deficiency such &i rickets, coeliac disease and parathyroid deficiency; also during pregnancy and lactation often in association with vitamin D. Calcium gluconate is also given in chilblains, urticaria and allergic reactions. Dose: usually given in (loses of 0.5-2g, but ill hypocalcaemic tetany it is given by slow i.v. injection in doses of 10 ml of a 100% solution, with laboratory control of the blood calcium levels. Calcium gluconate is also given i.v. in the early
treatment of toxic hyperkalaemia.
calcium lactate The calcium salt most commonly given orally in mild deficiency states.
Dose: 1-5 g.
Calcium Resonium An ion-exchange resin that take, up potassium in exchange for calcium. Used in hyperkailatentia associated with anuria and haernodialysis. Should be used only when potassium and calcium serum levels are under biochemical control. Dose: 15- 30g 3 or 4 times a day. In children, 0.5-1 g/kg daily. It is sometimes given as a retention enema.
are given in heart failure. Side-effects include proteinuria, neutropenia, agranulocytosis, rash and loss of taste. (Acepril; Capotin). See ACE inhibitors, page 148 and Table 21.
carbachol A parasympathomimetic agent used orally and by injection in the treatment of postoperative atony and retention of urine, and occasionally as eye drops (3%) in i the treatment ofglaucoma. Dose: 2-4 ing orally, 250 pg by s.c. injection. Side-effects include nausea, bradycardia and colic.
carbamazepine An anticonvulsant effective in all types of epilepsy except petit mat (absence seizures). It is also of value in trigeminal neuralgia and is given prophylactically in manic-depressive states. Dose: 200-400 ing daily initially, slowly increased up to 1.8 g daily if required. Suppositories of 125-250 mg are available. Carbamazepine has some antidiuretic properties, and has been used in diabetes insipidus in doses of 100-2M mg daily. Side-effects include dizziness, gastrointestinal disturbances and all erythematous rash. (Tegretol). See page 136 andTable 15.
carbaryl An insecticide used as it lotion and shampoo in pediculosis.
canrenoate A steroid-derived aldosterone antagonist with the actions and uses of spironolactone.
Dose: given in oedema by slow i.v, inject ion or infusion in doses of 200-400 mg daily. Nausea and vomiting are high-dose side-effects. (Spiroctan-M).
capreomycin An antibiotic of value in resistant i uberculosis or when other drugs are not tolerated.
Dose: I g daily by i.m. injection. It may cause tinnitus, deafness, renal damage and allergic reactions. (Capastat).
captopril An inhibitor of the angiownsin converting enzyme. It is used in the treatment of hypertension, including that resistant to other therapy, but care is necessary as the initial dose may cause marked hypotension, and so is best taken ill bed. It is often given with a thiazide diuretic to improve the response, and with a beta-blacker to maintain the effect. Dose: 25 mg initially, slowly increased, as required, up to 450 mg daily. Similar doses
carbenoxcilone A cytoprotectant derived front liquorice, used for mouth ulcers. (Bioplex; Bioral). See Table 27.
carbidopa An enzyme inhibitor used with ievodopa in parkinsonism. It prevents the breakdown of levodopa, thus permitting a larger amount to reach the brain. See
page 160.
carbimazole An antithyroid drug. It inhibits the formation of thyroxine and is valuable in the treatment of thyrotoxicosis and in preparation for thyroidectomy. Dose: 30-60 mg, daily initially; maintenance dose, 5-20 ing daily. It is sometimes given together with thyroxine it) the’blockage replacement’ treatment of hyperthyroidism. Side-effects are nausea, rash and pruritus; alopecia and agranulcytosis have been reported. (Neo-Mercazole).
carbocisteine A mucolytic agent used to reduce the production and viscosity of sputum in respiratory disorders.
Dose: 1.5 g daily. (Mucodyne).

bezafibrate A plasma-lipid regulating agent with an action similar to clofibrate, and used in the treatment of hyperlipidaemia not responding to diet.
Dose:daily with food. Contraindicated in renal or hepatic dysfunction. May potentiate oral anticoagulants. Side-effects are nausea, pruritus and urticaria. (Bezalip). See page 146 and Table 20.
Dose: It is given in hypertension and angina in doses of 5-20 nig daily. (Enicor; Monocor). See pages 114 & 148, and fables 4 & 21.
bisphosphonates Substances used in Paget’s disease of bone and hypercalcaemia of malignancy. See alendronate, disodium etidronate, disodium pamidronate and sodium clodronate.
bicalutamide A nonsteroidal anti-androgen that binds, selectively with androgen receptors. It is used with an LH-111-1 analogue such as goserelin in advanced prostatic cancer in doses of 50 mg daily. (Casodex). See page 122 and Table 8.
bipetiden An antispasmodic and parasympatholytic drug used chiefly to control the rigidity and excessive salivation of parkinsonism. It has less effect on tremor.
Dose: 2 ing daily initially, increased, as required, up to 0 mg or more daily. If necessary it may be given by i.m. or slow i.v. injection in doses of 5-20 mg daily. Side-effects include dizziness, blurred vision and drowsiness. (Akineton). See page 160 and Table 26.
BIPP A mixture of bismuth subnitrate, iodoform and liquid paraffin, used occasionally as an antiseptic dressing.
bisacodyl A synthetic laxative that exerts its action by a direct stimulating effect on Ilse nerve endings of the colon.
Dose: 10 mg orally, or as a suppository. Abdominal cramp is an occasional side-effect. It should not be used in intestinal obstruction.
bismuth chelate A potassium-bismuthcitrate complex used to promote the healing of peptic ulcers, mainly by a protective action.
Dose: 480 nig daily for 28 days, repeated if* necessary at monthly intervals. Not to be given with food. It may blacken the faeces. (Dc-NoltalO.
bismuth subgallate A yellow insoluble powder with astringent properties. Used as dusting powder, and as suppositories for rectal conditions.
bisoprolol A beta-blocking agent with the actions, uses and side-effects of propranolol.
bleomycin A cytotoxic antibiotic, exceptional in causing little or any disturbance of bone marrow activity. Used mainly in skin tumours, lymphomas and mycosis fungoides.
Dose: 15-30 ing twice-weekly by i.m. or i.v. injection up to a total dose of 500 ing. The onset of stomatitis is an indication of the maximum tolerated close. Pigmentation of the skin may occur, but a severe close-related, delayed reaction is
pulmonary fibrosis, requiring immediate withdrawal of the drug. There is a risk of respiratory failure during general anaesthesia associated with a high oxygen intake. See page 122 and ‘rable 8.
botulinum toxin complex Botulinuin toxin causes severe respiratory muscle paralysis, but a modified form has a local action. The complex is used in severe blepharospasm and given by injection into the ocular muscle. Response is slow (1-2 weeks) and treatment may need to be repeated at intervals of 8 weeks. (Botox; Dysport).
bretylium An antihypertensive agent, now used on[), in the control of resistant ventricular arrhythmias.
Dose: i mg/kg, i.m., 6-8-hourly. It may also be given by slow i.v. injection in doses of 5-10 mg/kg, repeated as required. Side-effects include nausea, vomiting and severe hypotension. (Bretylate).
brimonidine A selective alpha,-andrenergic receptor agonist. It is used in the treatment of glaucoma when bcta-blockers are not suitable or not tolerated.
Dose: one drop of a 0.2% solution in the eye or eyes twice daily. Some initial burning and stinging may occur, and an ocular allergic reaction may occur with prolonged therapy. (Alphagan).
bromazepam A benzodiampine used mainly
in the short-term treatment of anxiety.

Dose: 9-18 mg daily. Contraindicated in respiratory depression and phobic states. (I-exotan). See page 117 and fable 5.
bromocriptine An inhibitor of the release of prolactin from the pituitary gland. It is used to prevent or suppress lactation when other measures have failed.
Dose: 1-1.5 mg daily initially for a few days, then twice daily for 14 days. It also stimulates dopamine receptors in the brain and is used in parkinsonism, mainly in patients unable to tolerate levodopa, to stimulate any surviving dopamine receptors. Dose: 1.25 mg at night initially, with food, slowly increased according to response up to 40 mg. The use of the drug requires care, as it has many side-effects, including early hypotensive reactions. Bromocriptine is also used in some condi- tions of pituitary dysfunction such as acromegaly. (Pardolcl). See page 160 an(] Table 26.
brompheniramine An antihistamine similar to promethazine, but with shorter action and reduced side-effects. It also has some antitussive properties.
Dose: 12-32 mg daily. (Dimotane). See pate 110 and Table 2.
budesonide A steroid similar to beclomethasone, and used by oral aerosol inhalation in chronic airway obstruction and other asthmatic conditions.
Dose: 200800 pglkg (1-4 puffs) according it) need. A long-acting form (Entocort) is used in the treatment of Crohn’s disease. Dose: 9 nig daily before breakfast for up to 8 weeks. Also used locally as a cream (0.025%) in eczema, psoriasis and
dermatitis. (Pulmocort; Preferid).
bumetanide A rapidly acting loop diuretic similar to frusemide, with comparable actions, uses and side-effects.
Dose: 1-5 mg daily. Much larger doses may be needed when renal function is impaired. In acute pulmonary and cardiac oedema, 1-2 mg may be given i.v. Morirxx). See page 148 and “fable 21.
bupivacaine A local anaesthetic related to lignocaine but characterized by its increased potency and long duration of action which may be tip to 8 hours when used for nerve blocks. It is also of value in continuous epidural analgesia. It is used as a 0.25% to 0.5% solution in doses
according to requirements with or without adrenaline. The side-effects are those of lignocaine, but it may cause more severe myocardial depression. (Marcain).
bupronorphine A powerful analgesic, related to morphine, but less likely to cause dependence. Valuable in pain of terminal cancer, after operation or myocardial infarction.
Dose: 200-100 Vg 6-8-hourly as sublingual tablets, or 300-600 pg by i. in. or slow i.v. injection at intervals of 6-8 hours according to need. Side-effects include drowsiness, nausea and dizziness. Naxolone is only a partial antagonist. f *1 enigesic).
buserelin A synthetic gonadotrophinreleasing hormone that indirectly depresses androgen and oestrogen synthesis. It is used in the treatment of testosterone-sensitive prostatic carcinoma.
Dose: 500 Vg by s.c. injection 8-hourly for 7 clays, followed of    bv intranasal mainte- nonce dosesdoseso100 pg’6 times a day. Patients should be warned that an
increase in pain may occur initially. Side-effects are hot flushes and loss of libido. (Suprefact). It is also used its a nasal spray in the long-term treatment of endometriosis in doses of 900 pg daily. Side-effects are menstrual-like bleeding and mood changes. (Suprecur). See goserelin, lcuprorelin and nafarelin.
buspirone A drug for the treatment of anxiety. It acts more selectively than the benzod iazepi ties on serotonin receptors in the brain, but the full response may take 1-2 weeks.
Dose: 10-15 mg daily initially, slowly
in, ceased as required up to a maximum of 45 mg daily. Side-effects are nausea, dizziness and drowsiness. Benzod  must be withdrawn slowly before transfer to buspirone. ( Ruspar). See page 117 and “fable 5.
busulphan A cytotoxic compound used in the palliative treatment of chronic myeloid leukaemia. Close haernatological control is essential during treatment as remission of symptoms may not be complete for some weeks and overdose may cause irreversible myelodepression.
Dose: 0.5-4 mg daily. Side-el’16:ts include pigmentation of the skin. (vIvIeran).

bendrofluazide A widely used diuretic of the thiazide group, with a powerful and prolonged action. It is used in congestive heart failure, oedema and mild hypertension. In more severe hypertension it is given together with other drugs to increase the overall response.
Dose: 2.5-10 ing daily. It causes some loss of potassium, so potassium supplements are required if treatment is prolonged. Side-CffeCtS include rash and thrombocytopenia. Renal failure is a contraindication. (Aprin= Neo-Naclex). See page 1,18 and fable 21.
benorylate A compound of aspirin and paracetamol, with the general properties of both drugs, but generally better tolerated than aspirin. Used in arthritic conditions and for the relief of painful musculoskeletal disorders.
Dose: 3-6 g daily. Like aspirin, it may cause gastrointestinal disturbances and increase the action of oral anticoagulants. (Benoral).
benperidol A tranquillizer of the haloperidol type with similar side-effects, but used to control antisocial sexual behaviour in adults.
Dose: 0.25-1.5ingdaily. (Anquil).
benserazide An enzyme inhibitor used with Ivvodopa in parkinsonism. It inhibits the breakdown of levodopa to dopamine, enabling large amounts to reach the brain, and so permits a reduction in dose and a smoother response. Some of the side-effects of levodopa, such as nausea and vomiting, may also be reduced, although the incidence of involuntary movements may increase.
Dose: 12.5 mg with 50 ing of levodopa. (N-ladopan). See page 160 and Table 26.
benzalkonium chloride A detergent with antiseptic properties present in various skin preparations. It is also used as a preservative in cyc drops.
benzhexol A spasmolytic drug used mainly to relieve the tremor and rigidity of parkinsonism.
Dose: I mg initially, slowly increased to 5-15 mg daily according to need. Side-effects include mouth dryness, dizziness and blurred vision. Care is necessary with high doses as some psychiatric disturbances may occur anti    withdrawal of the
drug, but abrupt discontinuance of treatment should be avoided. Benzhexol should be used with care in cases of glaucoma, hepatic and cardiac disease or urinary disturbances. (Arcane; Broflex). See
page 160 and Table 26.
benzocaine A local anaesthetic for topical .ipplication. Used as lozenges (100 mg) for painful oral conditions; ointment
(5- 1 0(y.); suppositories 200 mg.
benzodiazepines A widely used group of drugs with a powerful action on the central nervous system. ‘rhey appear to have a selective action on certain seroionin receptors. The type of action varies within the group, and they may be used as sedatives, hypnotics, anxiolytics, anticonvul&-ints or muscle relaxants. As hypnotics they have virtually replaced the barbiturates, as they have a wide margin of safety and are less dangerous in overdose. Prolonged use should he avoided as dependence remains a possibility. The withdrawal of treatment with benzodiazepines should be gradual, as otherwise confusion, convulsions and toxic psychoses may occur. Nitrazepam has a relatively long action as a hypnotic, whereas flunitrazepam has a shorter action. Diazepam is the preferred drug for controlling the spasms of tetanus. Hypnotic pnotic benzodiazepines include flunitrazepam, flurazepam, loprazolam, lormetazepam, nitrazeparnand temazepam.Those used as anxiolytics are alprazolam, bromazepam, chlordiazepoxide, clobazam, clorampate, diazepam, ketazolam, lorazepam, medazepam and oxazepam. Most of these diazepines are referred to briefly under the above names. See page 117 and,rable 5.
benzoic acid It has fungistatic properties similar to salicylic acid, and has been used as Whitfield’s ointment (Compound Benzoic Acid Ointment) for the treatment of ringworm.
bemoan A balsamic resin used mainly as Compound Tincture of Bemoan for pressure sores and stoma care.
benzoyl peroxide An antifungal agent used locally for superficial fungal infections. It is also used, together with sulphur, as a cream or gel for acne.
benzthiazide A thiazide diuretic present with trianiterene in Dytide.

benztropine An anticholinergic drug, used to relieve the rigidity, tremor and salivation of Parkinson’s disease. It also has some sedative action, and in some cases may be preferred to benzhexol. Like benzhexol, it is sometimes useful in the control of drug-induced extrapyramidal svillptoms.
Dose: 0.5-6 mg daily. In severe conditions, it may be given by injection of
1-2 mg, repeated according to response. The side-effects are those of the anticholinergic drugs generally. (Cogentin). See page 160 and Table 26.
benzydamine A mild analgesic used as a mouthwash (0.15%) for painful conditions of the mouth and throat, and as a cream (31YO for musculoskeletal pain.
benzyl benzoate A clear liquid with an aromatic odour. It is used as an emulsion in the treatment of scabies by two applications to the whole of the body except the head.
benzyl penicillin See penicillin.
beta-Mockers in cardiac failure, heart block and bradycardia. See pages 114 & 148, and Tables 4 & 21.
betahistine A vasodilator with some of the properties of histamine. Used to reduce the vertigo of N!6ni&e’s disease. Should be used with care in asthmatics and in peptic ulcer.
Dose: 16-48 ing daily. (Sere).
betarnethasone A corticosteroid characterized by its low dose, increased anti-inflammatory action, and reduced side-effects. It has virtually no salt-retaining properties, and causes little increase in the urinary excretion of potassium. It is indicated in all inflammatory, allergic and other conditions requiring corticosteroid therapy - with the exception of Addison’s disease and after adrenalectomy when a salt-retaining steroid is required.
Dose: 0.5-5 mg daily; in cerebral oedema, 5 20 mg by Lin. or i.v. injection. In asthmatic states, oral aerosol inhalation of M)pg (eight puffs) daily; for inflaninialory conditions of the eye, car and nose, a 0, PN, solution is used locally. (Belnesol).
beractant A pulmonary surfactant used in the respiratory distress syndrome of premature infants, by endotracheal tubing within 8 hours of birth. Monitor heart rate and arterial oxygenation. (Survanta). See also colfesceril, poractant and pumactant.
beta-adrenoceptor blocking agents Adrenaline and related catecholamines are released into the circulation during exercise and stress, and stimulate cardiac output by acting oil the beta-adrenoceptor sites in the heart. When such stimulation is excessive the increased oxygen demand of the heart may cause myocardial insufficiency and angina. Drugs such as propranolol block these receptor sites and so indirectly reduce cardiac stimulation, and are of value in the control of angina, cardiac arrhythmias and hypertension. Some blocking agents also act on other receptor sites and may cause bronchospasm by releasing histamine. Newer drugs, represented by acebutolol and nicroprolol, are more cardioselective, and others such as sotalol are of more value in hypertension. Sonic of these blocking agents,such as atenolol, are less likely to reach the central nervous system and so may cause fewer sleep disturbances. By their nature and depressant action on the myocardium, care is necessary when giving
betaxolol A beta-adrenoceptor blocking agent of the propranolol type, with similar properties and side-effects, but with a more cardioselective action. It is used mainly in the treatment of hypertension. Dose: 20 mg once daily. Betaxolol is also used as eye drops (0.5%) in ocular hypertension and glaucoma. (Betoptic-, Kerlone). See page 148 and Table 21.
bethanechol A parasympathominictic agent used in reflex oesophagitis, paralytic ileus and postoperative urinary retention. Dose: 30-120 mg daily before food. Side-effects are nausea, bradycardia and colic. Care is necessary in asthma and cardiovasculardiscase. (Myotoninc).
bethanidine A blocking agent that has an anfihypcttcnsivc action by inhibiting the release of noradrenaline from post-ganglionic adrenergic nerve endings. It is useful in resistant hypertension, and when other agents are not well tolerated, and is usually given in association with a thiazide diuretic or a beta-Mocker.
Dose: 20-200 ing daily. Postural hypotension, nasal congestion and diarrhoea are side-effects. (Bendogen).