Posts Tagged ‘Principal’

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.

mupirocin An antibacterial agent that is effective against most of the pathogens responsible for skin infections. It is used as a 2% ointment in impetigo, folliculitis and similar conditions. It should not be used for longer than 10 days to avoid the development of resistance. (Bactroban).
mustine A cytotoxic drug used mainly in the treatment of Hodgkin’s disease and related conditions.
Dose: 0.1 mg/kg daily for 3 days as a fast-running i.v. infusion, or as a single dose of oA ing/kg. The solution is highly irritant, and extra venous injection causes very severe local necrosis. Side-effects include severe vomiting, bone marrow depression and alopecia. Close haematologicalcontrol during treatment is essential. Now in less frequent use. See page 122 and Tabl’. 8.
nabumetone A non-acidic anti-inflammatory agent of the naproxen type. It is effective in rheumatoid and osteoarthritis and has reduced gastric irritant properties. Dose: I g at night. Reduced closes are necessary in renal impairment, and the dose of any oral anticoagulant or hypoglycaemic agent may require adjustment. (Relifex). See page 165 and Table 29.
nadolol A beta-blocking agent with the
actions and uses of propranolol.
Dose: in angina, 40 mg daily, or more; in hypertension, 80 mg daily, increased slowly as required; in the prophylaxis and treatment of migraine, 80-160 mg daily. Maximum daily dose 240 mg. (Corgard). See pages 114 & 148, and Tables 4 & 21.
nafarelin A synthetic suppressant of steroid production by the gonads, and used in the treatment of endometriosis.
Dose: given as it once-only course of treatment by nasal spray in doses of 200 pg twice a day, starting between 2 and 4 days of the menstrual cycle, and continued for up to 6 months. Side-effects are numerous and of the menopausal type. (Synarel). See buserelin, goserelin and leuprorelin.
mycophenolate mofetil An immunosuppressant used together with cyclosporin and corticosteroids to prevent acute renal transplant rejection. It acts on a specific enzyme concerned with”]’- and B-lymphocyte proliferation, as well as inhibiting antibody formation.
Dose: 2 g daily, starting within 24 hours (d transplantation. Blood counts are necessary during treatment, and, as with other immunosuppressants, there is an increased risk of opportunistic infection. (CellCept).
nabilone A cannabinoid antiemetic used in the treatment of nausea and vomiting associated with cancer chemotherapy. Dose: 2-4 ing daily, beginning the day before cytotoxic treatment is commenced, and continued for a day after the end of the course. Side-effects are drowsiness, confusion and tremor. Care is necessary in liver dysfunction or any history of psychotic illness. See page 158.
naftidrofuryl A peripheral and cerebral vasodilator. Claimed to be of value in cerebrovascular disorders.
Dose: 300-600 ing daily. (Praxilene).
nalbuphine An opioid analgesic, comparable with morphine in potency, but with reduced side-effects and a reduced dependence potential.
Dose: by injection, 10-20 ingas required. It may cause nausea and dizziness, and care is necessary in respiratory, renal or hepatic dysfunction. (Nubain).
nalidixic acid A quinolone antibacterial agent used in cystitis and infections of the lower urinary tract, especially those due to Gram-negative bacteria (except Pseudornoricts). It is not suitable for systemic infections as the blood levels reached with nalidixic acid are too low to be effective.
Dose: 4 g daily for 7 days, with subsequent doses of 2 g daily. Side-effects arc nausea, visual disturbance, rash, jaundice and phototoxicity. Exposure to sunlight should be avoided; epilepsy is a contraindication. (Mictral; Negrain). See ciprotloxacin and norfloxacin.

naloxone A powerful and rapidly acting opioid narcotics antagonist. It is used immediately after operation to reduce any narcotic-induced respiratory depression. Dose: 100-200µg i.v. initially, followed by 100 µg at 2- minute intervals, as required. For neonates, 10 pglkg by iniection are given. In narcotic analgesic overdose, 800 lig-2 nig may be given, 111, to a total dose of 1 0 ing. (Narcan).
naltrexone A long-acting narcotic antagonist used only to prevent relapse and maintain recovery after treatment for opioid addiction. It prevents re-addiction only whilst the drug is being taken. Dose: 25 ing initially, later up to 50 mg daily. It must not be given to patients who are still opioid-dependent as an acute withdrawal syndrome may be precipitated. (Nalorex).
nandrolone An anabolic steroid related to testosterone, with markedly reduced virilizing properties. It has anabolic or tissue-building properties and has been used in postoperative convalescence, osteoporosis and wasting diseases but the response is poor. It is sometimes effective in aplastic anaemia.
Dose: 50 ing by deep Lin. injection every 3 weeks. (Deca-Durabolin).
the prophylactic treatment of asthma, but it is not effective in an established attack. Dose: by aerosol inhalation, 8 mg (4 pulls) daily. Side-effects are transient nausea and headache. (Tiladc). See page 118. It is also used as eye drops in allergic conjunctivitis. (Rapitil). See page 118 and Table 2.
nefazodoneV A new antidepressant of the selective serotonin-re-uptake inhibitor (SSRI) type.
Dose: 200-600 mg daily. (Dutonin).
nefopam An analgesic for moderate, acute and chronic pain before using more potent drugs. Dose: 90-270 ing daily; 20 mg by i.m. injection. Side-effects include drowsiness, headache and tachycardia. Care is necessary in hepatic or renal disease. (Acupan).
neomycin An antibiotic with a wide range of activity against Gram-positive and Gram-negative bacteria, but it is too toxic for systemic use. It is used mainly as an
ointment or cream (0.5%), often with an anti-inflammatory steroid, in infected skin conditions. It is also used locally for ear and eye infections as drops (0.5%), and it is occasionally given orally in doses of 6 g daily before bowel surgery. Extended local use may cause allergic reactions, and occasionally ototoxicity. (Mycifradin; Nivemycin).
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naproxen A widely used non-steroidal anti-inflammatory agent (NSAID) for the relief of rheumatic and musculoskeletal
disorders and acute gout.
Dose: 10-1 g daily, increased up to 2g daily in severe conditions. Suppositories of 500 ing are useful at night to reduce morning stiffness. Side-effects include headache, dizziness, and dyspepsia with occasional bleeding. Blurred vision may also occur, as well as I p hy ersensitivity reactions such as rash and bronchospasm. Care is necessary in renal and hepatic impairment; peptic ulcer is a contraindication. (Naprosyn; Syntlex). See page 165 and Table 29.
naratriptanVA serotonin (5-H’I',) receptor agonist for the treatment of acute migraine. Dose: 2.5 mg. A second dose may be given after at least 4 hours if the symptoms recur. (Nararnig). See page 154 and Table 23.
nedocromil An inhibitor of the release of inflammatory mediators in the respiratory tract. It is used like sodium cromoglycate in
neostigmine An inhibitor of cholinesterase which thus indirectly prolongs the action of acetylcholine released at nerve endings. It is used mainly in the treatment of myasthenia gravis.
Dose: 75-300 mg daily; 1-23 mg by injection. Side-effects are nausea, salivation, diarrhoea and abdominal cramp, and supplementary treatment with an anticholinergic drug may be required. It is also used postoperatively to antagonize the residual effects of muscle relaxants. Dose: 1-5 mg i.v., after a preliminary iniection of 0.3-1 nig of atropine. It is contraindicated in urinary or intestinal obstruction. (Prostiginio).
netilmidn An aminoglycoside antibiotic, less toxic than related drugs. Used mainly in severe infections of the urinary and respiratory tracts that are resistant to gentamicin. Dose: 4-6 mg1kg daily by i.v. injection; in urinary tract infections a single oral daily dose of 150 mg is given for 5 days. Side-’ effects are dizziness, vertigo, malaise and rash; ototoxicity may also occur. (Netillin).

neuromuscular blocking agents Drugs used to induce adequate muscle relaxation under a light plane of anaesthesia to facilitate surgery. The non-depolarizing agents such as vercuronium compete with acetylcholine at the neuromuscular receptor site, and have a relatively long action that can be reversed by neostigmine. The depolarizing relaxants, such as suxamethonium, have an acetylcholine-like action oil the receptor site, but as they are broken down less rapidly than acetylcholine, they delay the return of the ability of the muscle to contract again. The action of suxamethonium cannot be reversed by neostigmine.
niacin See nicotinic acid.
nicardipine A calcium channel blocking agent with it coronary vasodilator action similar to that ofverapaiiiii, but with reduced anti-arrhythmic activity. It is used mainly in angina and hypertension, and unlike verapamil it may be given to patients already receiving beta-blockers. Dose: 60-120 ing daily. Side-effects arc dizziness, flushing, nausea and palpita-
tions. If chest pain occurs early, the drugshould be withdrawn. Marked aortic
stenosis is a contraindication. (Cardene). See page I H and ‘]’able 4.
niclosamide A synthetic anthelmintic of value in the elimination of tapeworm. Dose: after lasting 2 g followed 2 hours later by a purge. The tablets should be chewed or crushed, and taken with a glass of water. Side-effects are nausea and abdominal pain, and occasionally pruritus. (Yoniesan).
nicorandil A cardiac drug that has an action mediated by the activation of potassium channels. It reduces the excitability of cardiac muscle and promotes coronary circulation, and is used in the prophylaxis and treatment of angina.
Dose: 5 10ing twice daily initially, rising to a maxintuin of6onig daily. Side-effects are initial headache, palpitations, dizziness. (lkorel). See page 114 and Table 4.
nicotinarnide A compound derived from nicotinic acid, possessing similar properties, but differing in that it has little vasodilator action. It is useful in
deficiency states as well as in pellagra when the vasodilator action of nicotinic
acid limits the dose. It is also used locally as a 4% gel (Papulex) for the treatment of inflammatory acne vulgaris.
nicotinic acid An essential food factor, occurring in yeast, liver, etc., but now prepared synthetically. It is a specific in the treatment of pellagra. It causes vasodilation, and has been used in Wni&e’s disease and chilblains, but with variable results. In large doses it reduces the plasma levels of some lipoproteins. Dose: 10-30 mg daily for prophylaxis; therapeutic dose in pellagra, 250-500 mg daily. In hyperlipidacinia up to 6 g daily have been given. Side-effects include flushing, dizziness and pruritus, which may sometimes lie reduced by taking aspirin 75 mg half an hour before a dose. See page 146,
nicotinyl alcohol A derivative with the vasodilator properties of nicotinic acid, but they are less intense. Useful in peripheral circulatory disturbances such as Raynaud’s disease and acrocyanosis. Dose: 100-200 mg daily. (Ronicol).
nicournalone A synthetic anti-coagulant similar to warfarin, and used mainly in the treatment of deep-vein thrombosis. Dose: 8-12 ing initially; subsequent doses are based on the response, as shown by determination of the blood prothrombin time, expressed as the International Normalized Ratio (INR). Haemorrhage is a potential side-effect. (Sinthrome).
nifedipine A calcium channel blocking agent similar to verapamil, but with a more powerful peripheral and coronary vasodilator action. It is used in the treatment of angina, hypertension and Raynatid’s disease, and may be given if required in association with a beta-blocking agent.
Dose: in angina, 15-60 mg daily; in hypertension 40-80 mg daily. Side-effects are flushing and headache, which are usually transient, and some ankle oedema may occur. It should be withdrawn if anginal pain develops. Severe aortic stenosis is a contraindication. (Adalat• Coracten; Nifensar). See pages 114 & 148, and “fables 4 & 21.
nimodipine A calcium channel blocking agent that acts preferentially on the cerebral vessels. It is used in subarachnoid haemorrhage to prevent ischaemic sequelae.

chymotrypsin A proteolytic enzyme of the pancreas used in ophthalmology to facilitate intracapsular lens extraction. (Zonulysin).
cidofovir An antiviral agent used in cytomegalovirus retinitis resistant to ganciclivir.
Dose: 5 nig/kg by i.v. infusion every 2 weeks. (Vistide). See page 144 and ‘['able 19.
cilastatin See imipenem.
chlorthalidone A diuretic similar in action and uses to bendrofluazide, but with a longer duration of activity that permits a single morning dose. It is also useful in diabetes insipidus.
Dose: as diuretic 50-100 mg daily or on .illci nale days; in hypertension 25-50 mg; up to 350 mg daily in diabetes insipidus. (I lygrolon ). See page 148 and Table 21.
cholecalciferol See vitamin D.
cholestyramine An exchange resin that binds with bile acids in the intestines and prevents their absorption. Such acids are essential for cholesterol synthesis, and resin-binding leads indirectly to a lowering of plasma cholesterol levels.
Dose: in hyperlipidaemia: 12-24 g daily, wilh water; similar doses in the diarrhoea of Crohn's disease. It is also used in doses of 4-8 g daily to relieve the pruritus
associated with biliary obstruction. Side-effects are rash and gastrointestinal disturbances. Cholestyramine and related agents may interfere with the absorption of anticoagulants and other drugs. iQuestrari). See page 146 and Table 20.
choline theophyllinate A bronchodilator ,ilh the actions, uses and side-effects of anlinophyllille.
Dose: 400-1600 mg daily, after food. (C'I ioledyl). See page 118 and Table 6.
chorionic gonadotrophin A gonad-stimulating hormone prepared from the Urine of pregnancy. It has bten used in anovulalory sterility, metropathia haernorrhagica, habitual abortion and undescended testis.
cilazapril A long-acting ACE inhibitor with the actions, uses and side-effects of that group of drugs.
Dose: in essential hypertension 1 mg daily initially, increased up to 5 mg daily according to need. In renovascular hypertension 0.25-0.5 mg daily. (Vascace). See page 148 and'I'able 21.
cimitidine A selective histamine H, receptor antagonist. Unlike ordinary antihistamines, it inhibits gastric secretion, and is used in the treatment of peptic ulcer and other conditions of gastric hyperacidity. Dose: 8(m) nig daily for at least 4 weeks, doubled in severe conditions. Dose by i.m. or slow i.v. injection 200 mg 4-4-hourly. The dose should be reduce(] in renal impairment. The drug may increase the effects of oral anticoagulants and phenytoi ii. Side-effects include diarrhoea, rash and dizziness. It has some anti-androgen activity, and gynaecomastia is all occasional side-effect with high closes. (Dysparneu Tagarnet; Zila). See page 162 and Table 27.
cinchor-aine A local anaesthetic used as
ointment 1% in haemorrhoids and
pruritus. (Nupercainal).
cinnarizine An antihistamine, chiefly of value in Wniere’s disease, although it is also used in travel sickness and in peripheral vascular disorders.
Dose: 45-90 ing daily. Drowsiness and gastrointestinal disturbances are side-effects. (Stugeron).
cinoxacin A quinolone derivative with actions, uses and side-effects similar to i hose of nalidixic acid.

Dose: in urinary tract infections,  daily; prophylaxis 500mg daily. Contraindicated in severe renal impairment. (Cinobac).
ciprofbrate A blood-lipid lowering agent used in diet-resistant hyperlipidaemia as a single daily dose of 100-200 mg. (Modalim). See page 146 and Table 20.
ciprofloxacin A quinolone with a wide range of activity against both Gram-positive and Gram-negative bacteria, including Pseudomonas and Fronts. It is effective in many systemic infections, as well as in bone, joint and urinary infections, and in gonorrhoea, but is indicated mainly in infections resistant to other antibacterial agents. Dose: 500 mg -1.5 g daily for 5-7 days; in gonorrhoea, a single dose of 250 mg is given. In severe infections 200-400 mg daily by i.v, infusion for 5-7 days. Side-effects include nausea, dizziness, headache, rash and pruritus. plasma levels of theophylline may be increased and should be closely controlled. Care is necessary in convulsive disorders. (Ciproxin).
cisapride A gastrointestinal stimulant given to relieve gastro-oesophageal reflex and delayed gastric emptying.
Dose: .10-40 mg daily before meals, and at night, for some weeks. Side-effects are abdominal pain and diarrhoea. Drugs that delay the excretion of cisapride and may cause arrhythmias are erythromycin and clarithromycin-antigungal agents of the ketoconazole type should also be avoided. Unlike metoclopramide, it has no central antiemetic properties. (Alimix; Prepulsin).
cisatracurium A non-depolarizing neuromuscular blocking agent with an intermediate duration of activity. It is used as a muscle- relaxing adjunct in general anaesthesia, and to facilitate tracheal ininhation. (Nimbly).
cisplatin A cytotoxic agent containing platinum bound in an organic complex. The action is linked with drug-induced changes in DNA structure that inhibit cell development. It is used in ovarian, testicular and other solid tumours, and in resistant malignant conditions, sometimes in association with other antineoplastic agents.
Dose: by i.v.  for 5 days a month, or 15-120 mgIm’ monthly. Blood tests are essential
throughout treatment. Side-effects, which may be severe, include nausea, vomiting, and oto-, nephro- anti
citalopram A selective serotoninreuptake inhibitor (SSRI).
Dose: used in depression in single daily doses of 20 ing, increased up to 40 mg daily. Treatment for at least 6 months necessary to avoid relapse. (Cipraruil). See page 128 and Table 11.
cladribine A new agent used by specialists in hairy cell leukaemia. (Leustat).
clarithronlycin A macrolide antibiotic similar to erythromycin, but with better absorption and reduced gastrointestinal side-effects.
Dose: 250 rug twice a day for 7 days, doubled in severe infections. Care in hepatic an([ renal impairment. It may potentiate the effects of warfarin and digoxin. Should not be given with astemizole or terfenadine (risk of arrhythinias). (Khricid).
clavulanic acid An inhibitor of betalactanlase. Many penicillin-resistant organisms contain that enzyme in the cell wall, which inactivates the penicillin before it call enter the cell and exert its bacterial action. clavulanic acid inhibits such enzyme activity, and so facilitates the penetration of the antibiotic into the bacterial cell. It is used in association with amoxycillin as coamoxiclav (Augmentin) and with ticarcillin as Tinientin, in the treatment of infections due to amoxycillin-resistant bacteria.
clemastine An antihistamine used in allergic rhinitis, urticaria and allergic derniatoses.
Dose: I mg twice a day. In common with other antihistamines, it may cause drowsiness, and anticholinergic side-effects such as dryness of the mouth. H avegil). See
page 110 and Table 2.
clindamycin An antibiotic used mainly in staphylococcal bone and joint infections not responding to other drugs. It is also useful in anaerobic abdominal infections.  A serious side-effect is a potentially fatal pseudomernbranous colitis, and the drug should be withdrawn immediately if diarrhoea occurs. See vancomycin and nietronidazole.

A-Z Principal Drugs (amorolfine - antibiotics )

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

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