Posts Tagged ‘pituitary function’

triamcinolone A glucocorticosteroid with the actions, uses and side-effects of hydrocortisone, but differing by promoting sodium excretion, and so is of no value in adrenal cortex deficiency states. It is used in a wide range of inflammatory, allergic and respiratory states, and in inflammatory skin conditions.
Dose: 8-24 mg daily. It is also given as triamcinolone acetonide in doses of 40 ing by deep i.m. injection for a depot action. The acetonide is also given by iniraarticular injection in doses of 2.5-40 mg in local inflammation of the joints, and by intra-lesional injection in doses of 2-3 mg at any one site for the treatment of skin lesions. Triamcinolone actonide is also used as a 1% cream or ointment in severe inflammatory skin conditions. The side-effects are those of the corticosteroids (see hydrocortisone), but triamcinolone may also cause myopathy with high dose treatment. (Kenalog; Ledercort).
triamterene A potassium sparing diuretic, used mainly in association with more powerful drugs. It is indicated in oedematous conditions generally, and, as it causes some retention of potassium, its use avoids the need for supplementary potassium therapy.
Dose: 150-250 mg daily, with lower doses for the elderly and when given in association with other diuretics. Rash .ind gastrointestinal disturbances are ,ide-effects. (Dytac). See page 148 and Kahle 21.
tribavarin An inhibitor of viral replication used in severe viral bronchiolitis in infants.
Dose: by aerosol inhalation of a solution (20 ing/ml) for 12-18 hours daily liar 3-7 days, together with supportive therapy. (Viravid).
triclofos A derivative of chloral, with the sedative properties of the parent drug, but less irritant to the gastric mucosa.
Dose: I 2gdaily.
alternative to penicillamine in other conditions. The main side-effect is nausea.
trifluoperazine A powerful tranquillizing drug of the chlorpromazine type. It is used mainly in schizophrenia and similar psychoses, and in severe anxiety.
Dose: 10-20 nig or more daily according to need. In severe anxiety, 2-6 ing daily. In acute conditions, 1-3 mg daily by deep i.m. injection. As an antiemetic, it is given in doses of 2-4 mg or 1-3 ing by injection. The side-effects are similar to those of chlorpromazine, including extra-pyramidal symptoms, but the anticholinergic and sedative side-effects are less severe. (Stelayine). See page 168 and Table 30.
tri-iodothyronine See liothyronine.
trilostane An inhibitor of enzyme systems concerned with production of mineraloand glucocorticosteroids by the adrenal cortex, and so resembles metyrapone to some extent. It is used to control adrenal cortex hyperfunction and the excessive production of aldosterone.
Dose: 240 ing daily initially, adjusted tip to a maximum of 480 mg daily, according to the plasma corticosteroid levels. Care is necessary in liver and kidney dysfunction. (Modrenal).
trimeprazine A sedative antihistamine used in the treatment of pruritus and allergic itching conditions, and for premedication.
Dose: 30-100nig daily; pre-medication dose: 3 mg/kg. (Vallergan).
trimetaphan A short-acting ganglionic-blocking agent. It is used to produce a controllable reduction in blood pressure (luring neuro- and vascular surgery when a relatively bloodless field is necessary. Dose: by i.v. infusion, 3-4 nighnin initially, with subsequent doses carefully adjusted to the response. Side-effects are tachycardia and respiratory depression. Frequent determination of blood pressure during use is essential.
triclosan A chlorinated phenolic antiseptic, used mainly in surgical scrubs and similar preparations. (Manusept; Ster-Zac).
trientine A copper-chelating agent used in Wilson’s disease, but only for patients unable to tolerate penicillamine.
Dose: 1.2 -2.4 g daily. It is not an
trimethoprim An antibacterial agent similar in action to the sulphonamides. It is used in the prophylaxis and treatment of urinary tract and respiratory infections due to sensitive bacteria.
Dose: in chronic infections, 200-400 nig daily; prophylactic dose, 100mg daily. In severe infections, 130-250 mg twice daily by slow i.v. injection. Side-effects are nausea, vomiting,rash and pruritus, and possible bone marrow depression. (lpral;
Monotrim). See co-trimoxaole.
trimetrexateV An antibacterial agent used like atovaquone in AIDS patients with Pnettinocystis carinii pneumonia.
Dose: 45 ing/nidaily by i.v. infusion for 21 (lays, followed by calcium folinate 80 nighty daily for 28 days, orally or i.v. (Neutrexin).
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oral antidiabetic drugs by increasing the sensitivity to endogenous insulin, and so acts as an insulin enhancer.
Dose: 200 mg daily with breakfast, increased if required by 200 mg at intervals of 2-4 weeks up to 600 mg daily. Side-effects are diarrhoea, fatigue and malaise. (Romozin). See page 131 and Table 13.
tropicamide A short-acting mydriatic agent similar to homatropine. Used as 0.5% and I% solution.
trimipramine A sedative anti-depressant with the action and side-effects of amitriptyline. It is valuable in depression complicated by anxiety.
Dose: 75-300 mg daily. (Surmontil).
triple vaccine Diphtheria, tetanus and pertussis vaccine for the primary ininitinization ofchildren.
Dose: 0.5 ml by i.m. or deep s.c. injection.
triptorelin A synthetic form of gonadorelin, used in the treatment of advanced prostatic cancer. Such cancers are testosterone-dependent, and triptorelin acts by depressing pituitary function, and so indirectly reduces the plasma level of testosterone.
Dose: It has been formulated so that a single i.m. injection of 4.2 ing depresses testosterone production for 28 days. Initially there may be a temporary flare-up of symptoms, which can be prevented by giving an anti-androgen for 3 days before treatment, and continued for 2-3 weeks. Patients should be monitored for uleric obstruction and spinal cord compression during the first months of treatment. DecapepivI Sr). See page 122.
tropisetron A 5–HT.,-receptor antagonist, similar to ondansetron bill with a longer action. It is used to control the nausea and vomiting induced by cancer chemotherapy.
Dose: initially as a 5 mg dose i.v. shortly before such therapy, and followed 1)), oral doses of 5 mg daily, I hour before food, for 5 days. Side-effects are dizziness, headache and gastrointestinal disturbance. (Navoban). See page 122.
tryparsamide Used in late trypansomiasis when the CNS is involved.
Dose: 1-3 g by injection weekly, up to a maximum Lill) of 24 g. May damage optic nerves.
tryptophan\7 An amino acid involved in the biosynthesis of serotonin. It is used in specialist centres for the treatment of severe and prolonged depression resistant to other drugs, and where a deficiency of serotonin may be a factor. (Optimax). See page 128 and Table 11.
tuberculin A product obtained from cultures of Mycobacterium tuberculosis. It is used in the diagnosis of tuberculosis. See BGC vaccine.
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trisodium edetate A chelating or binding agent that is sometimes used in hypercalcaernia. The calcium complex so formed is excreted in the urine.
Dose: slow i.v. infusion tip to 70 rng1kg daily according to need and response, as shown by plasma calcium measurement. It is also used as a 0.4% solution for
ophthalmic use in lime burns of the eyes. Side-effects after injection are nausea, diarrhoea and cramp. Contraindicated in renal impairment. (Limclair).
troglitazone A new drug for non-insulin dependent diabetes. It differs from other
tulobuterol A selective beta,-adrenergic agonist of the salbutamol type, used in the prophylaxis and treatment of bronchospasm in asthma and related conditions. Dose: 4-6 mg daily. (Respacal). See page 118 and’fable 6.
tyrothricin A minor antibiotic used as
lozenges for mouth infections.

undecenoic acid An organic acid with useful antimycotic properties. It is used mainly as powder or ointment (5%), often with zinc undecenoate in the treatment of athlete’s foot and associated conditions.
urea An osmotic diuretic. It has been used orally in doses of 5-15 g. Applied locally as a 10% solution, it promotes granulation and reduces odour front•    foul ulcers.
urofollitrophin A preparation of human lollide-stimulating hormone (FSH) used with nienotrophin for the induction of ovulation. Dose and duration of treatment require careful control to avoid Over-stimulation. (Metrodin; Orgafol).
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allergen vaccines, used for desensitization to various allergens such as grass pollens, arc not true vaccines, but weak solutions of allergen extracts. They may precipitate allergic reactions in susceptible patients, and should be used only when emergency resuscitation measures are immediately available.
valaciclovirV A pro-drug of acyclovir used in herpes zoster. It is well absorbed orally, and quickly converted to the parent drug and promotes an improved response.
Dose: 3 g daily for 7 days, reduce([ in severe renal impairment. Dose in herpes simplex I g daily. Side-effects are headache and nausea. (Valtrcx). See page 144 and Table 19.
valproic acid (Convulex). See sodium valproate.
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urokinase A plasmin activator obtained from human urine. It is used mainly in the thrombolysis of blocked i.v. shunts, and in the lysis of blood clots in the eye. Dose: 5000-37 500 units, instilled into the shunt; similar doses are injected into the anterior chamber of the eye for the resolution ofl)l blood clots. (Ukidan).
ursodeoxycholic acid The acid appears to be a solvent of cholesterol, and is given orally to promote the dissolution of cholesterol-containing gall stones.
Dose: 8-12 mg/kg as a single daily dose, hut prolonged treatment is required, which should be continued after the dissolution of the stones to inhibit recurrence. The dissolution of calcium-containing or radio-opaque stones is unlikely to occur. (Destolit; Ursofalk).
valsartan An angiotensin II receptor antagonist used in hypertension. It has a more selective action than the ACE-inhibitors. Dose: 80 mg daily. Combined treatment with a potassium-sparing diuretic is not advisable. (Diovan). See page 148 and Table 21.
vancomycin An antibiotic used in severe antibiotic-associated staphylococcal colitis ( pseudomembranous colitis).
Dose: 0.5 g daily for i-10 days. It is also given by injection in resistant bacterial endocarditis; I g twice a day by slow i.v. infusion over 1-2 hours, as rapid injection may cause anaphylactic shock. Blood concentrations of the antibiotic should be monitored, as the many side-effects include renal damage, ototoxicity and ncutropenia. Pruritus and upper body flushing may occur, and tinnitus is an indication that the drug should be withdrawn. (Vancocin).
vaccines Bacterial vaccines are suspensions or extracts of dead bacteria, but sonic anti-viral vaccines are also available. They may be given by s.c. or i.m. injection, and are used mainly for prophylaxis against a particular infection. The most commonly used vaccines include those for typhoid, cholera, diphtheria, influenza, tetanus and polio. Protection against mumps, measles, pertussis, rubella, yellow fever and hepatitis can also be obtained. The so-called
vasoconstrictors Drugs such as noradrenaline that constrict the peripheral vessels, and so cause a temporary rise in blood pressure. They are useful in hypotensive conditions when the blood volume is still adequate, and in controlling the fall in blood pressure that occurs in spinal and general anaesthesia.

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.