Posts Tagged ‘plasma concentration’

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.

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.