Posts Tagged ‘prophylactically’

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.

nisoldipine A calcium channel blocking agent of the nifedipine type. Used in mild to moderate hypertension pertension and in the prophylaxis of chronic angina.
Dose: 10 ing once daily before breakfast with adequate fluid, slowly increased as required up to 40 mg daily. Tablets to be swallowed whole, not chewed or crushed. It may react with sonic other drugs in common use, and grapefruit juice should be avoided. (Syscor). See pages 114 & 148, and ‘Fables 4 & 21.
nitrazepam A benzodiazepine used as a mild hypnotic when some degree of daytime sedation is acceptable.
Dose: 5-10 mg at night, with reduced doses for elderly patients, and in renal and’ hepatic dysfunction. Care is necessary in respiratory depression. Some dependence on nitrazepam may occur, so extended treatment should be avoided. The combined use of alcohol increases the hypnotic action. (Mogadon; Remnos). Set: page 152 and Table 22.
Nitrocine A solution of glyceryl trinitrate, for i.v. infusion in myocardial ischaemia and refractory angina.
nitrofurantoin An antibacterial agent with a wide range of activity against the majority of urinary pathogens. It is of value in cystitis and pyelitis, and in renal infections that have become resistant to other drugs. It is also used prophylactically but extended use requires care.
Dose: 400 mg daily; 50-100 mg at night for prophylaxis. It is ineffective in an alkaline urine. Nausea, rash and peripheral neuropathy are side-effects, and acute and chronic pulmonary reactions have been reported. (Furadantin; Macrobid).
nitroglycerine See glyceryl trinitrate. nitroprusside See sodium nitroprusside.
nitrous oxide The oldest inhalation anaesthetic. Supplied in blue cylinders, it is widely used for induction and as part of a mixed anaesthetic system. It is also used as
a 50% oxygen mixture as an inhalation analgesic in obstetrics.
nizatidine A potent and selective H,-receptor antagonist chemically distinct from cimetidine or ranitidine.
Dose: in the treatment of benign duodenal and gastric ulcer, single doses of 300 mg daily, taken in the evening, or 150 mg twice a day, and continued for 4 weeks, or for s weeks in gastric ulcer including non-steroidal anti-inflammatory agent (NSAID) -induced ulceration. Occasionally given by i.v. infusion in doses of300mg daily. For prophylactic maintenance, doses of 150 mg daily may be given for up to a year. Reduced doses should be given in renal impairment. Side-effects include headache, niyalgia, cough, pruritus and abnormal dreams. (Axi& Zinga). See page 162 and “Fable 27.
non-steroidal anti-inflammatory drugs (NSAIDs) A group of drugs with analgesic anti-inflammatory properties widely used in arthritic, rheumatoid and related conditions. The response to a NSAID and the incidence and severity of side-effects such as gastric irritation and renal toxicity vary considerably, and the best NSAID for an individual patient is the one that gives optimum relief with minimal side-effects. The NSAIDs, of which aspirin is the oldest example, act by interrupting the biosynthesis of prostaglandins from arachidonic acid, in which process the enzyme cycleoxygenase (COX) plays a key role. It is now known that COX exists in two forms identified as COX-1 and COX-2. The anti-inflammatory action of the NSAIDs appears to be linked with the inhibition of COX-2, whereas the unwanted side-effects are associated with COX- I inhibition. Different NSAIDs have varying degrees of activity against the different forms of COX, which may explain the differences in the therapeutic response and the incidence of side-effects. Recently, a NSAID (meloxicain) has been introduced that has a more selective inhibitory action on COX-2, with which the incidence of side-effects appears to be lower than with the older drugs, and so may have therapeutic advantages. In general, the response to a NSAID may take 1-3 weeks to develop fully, but monitoring for gastrointestinal bleeding may be advisable if treatment is extended. A NSAID should not be given to a patient with a history of asthma or hypersensitivity, nor when peptic ulcer is suspected or present. In all cases, treatment should be commenced with the lowest recommended dose, and caution is necessary in the elderly, and when renal or hepatic function is impaired. See page 165 and Table 29.
Dose: 20 100 mg daily. It is given in nocturnal enuresis in doses of 10-20 mg nightly, but the duration of treatment should not exceed 3 months. (Allcgron). See page 128 and Table 11.
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noradrenaline (norepinephrine) The pressor hormone released at sympathetic nerve endings when such nerves are stimulated. It is also present with adrenaline in the medulla of the adrenal gland. It raises blood pressure mainly by a general vasoconstriction, whereas adrenaline acts by constricting the peripheral vessels and increasing the cardiac output. Noradrenaline is given by slow i.v. infusion in the treatment of shock, peripheral failure, and low blood pressure states, but the response may fluctuate with small variations in dose. The value of vasoconstrictors in shock is now questioned, as in shock the peripheral resistance may well be high, and the blood supply to essential organs such as the kidneys may be reduced.
Dose: 2-20 pg/niin, based on need and response. Great care must be taken to avoid extra-venous injection. (Levophed).
norethisterone An orally active progestogen. Used in amenorrhoea, functional uterine bleeding and dysmenorrhoea. Dose: 5-20 mg daily. In breast cancer, large doses up to 60 mg daily have been used. To postpone menstruation, 15 mg daily for 3 days have been used. In small doses, and in association with an oestrogen, norethisterone and related drugs are widely used as oral contraceptives. See page 264.
norfloxacin A quinolone antibacterial with the actions, uses and side-effects of cinoxacin and other quinolones.
Dose: in acute urinary tract infections, 801) mg daily for 3-10 days: in chronic infections continued for up to 12 weeks. ( I Itinor).
norgestrel (levonorgestrel) An orally active progesterone-like drug and inhibitor of ovulation. Used as a constituent of mixed oral contraceptive products, and as a ‘progestogen -only’ oral contraceptive. See page 264.
nortriptyline A tricyclic antidepressant with actions, uses and side-effects similar to those of amitriptyline, but with a reduced sedative activity.
NSAIDs See non-steroidal anti-inflamma-
tory drugs, page 168 and Table 29.
nystatin A fungicidal antibiotic, used in the treatment of intestinal, vaginal and superficial candidiasis. Oral tablets contain 500 000 units, pessaries contain 100 000 units; cream and ointment 1%. Dose: (oral) 2 million units daily. It is also used as pastilles of 100000 units for mouth infections.
octreotide A synthetic compound that inhibits the release of the growth hormone. It is used in acromegaly, which is caused by an overproduction of the growth hormone by a pituitary tumour and it is given in doses of 100-200pg 8-hourly by s.c. injection. It is also used in the symptomatic treatment of the carcinoid syndrome, in which the release of vasoactive substances by a gastro- pancreatic tumour causes flushing and severe diarrhoea.
Dose: 30 pg by s.c. injection, increased as needed up to 600 pg daily. It has no action on the cause of the syndrome. It is used occasionally in terminal care to reduce intestinal secretions and vomiting. Dose: 300-600 pg by s.c. infusion. (Sandostatin).
oestradloIlThe oestrogenic hormone controlling ovulation and menstruation. It has been used to control menopausal symptoms in doses of 10-20pg daily, but skin patches are now preferred for hormone replacement therapy (HRT). It is used occasionally as s.c. implants for long-term treatment. Oestradiol is also present in some cream preparations for menopausal atrophic vaginitis.
oestriol A natural oestrogen used in intravaginal cream to relieve the atrophic vaginitis and kraurosis vulvae associated with the menopause. Also given in doses of 1-32 mg daily for the genito-urinary symptoms linked with infections in oestrogen deficiency states. (Ovestin).

ofloxacin A fluorinated quinolone with the actions, uses and side-effects of other quinolones such as ciprofloxacin and norfloxacin. It is used mainly in urinary and lower respiratory tract infections. Dose: wii nig daily as a single morning dose. Dose in severe infections 200-400 mg daily by i.v. injection. An occasional side-effect is tendon damage with pain and inflammation, which requires immediate withdrawal of the drug. Exposure to strong sunlight should be avoided. (Tarivid). Also used as eye drops (0.3%) for superficial eye infections. (Exocin).
olanzapineV An antipsychotic agent for the treatment of schizophrenia. It has a more selective action on certain 5-H’I'- receptors, and is less likely to cause extra-pyramidal side-effects.
Dose: 10 mg as a single daily dose, slowly increased as required. Maintenance dose 5-20 mg daily. Side-effects include
sedation and weight gain. (Zyprexa). See page 168 and Table 30.
olsalazine A compound formed from mesalazine, and used in the treatment of ulcerative colitis. It is more slowly
absorbed, and reaches the colon largely unchanged, where it is broken down by intestinal bacteria to release the active metabolite mesalazine.
Dose: 1-3 g daily in acute mild ulcerative colitis; I g daily for maintenance, often for long periods. The common side-effect is a watery diarrhoea. Salicylate sensitivity is a contraindication. Patients are now advised to report any bruising, bleeding or
malaise. I( a blood dyscrasia is suspected, a blood count should be made -,in(] the drug withdrawn. (Dipentuni). See page 172 and Table 32.
ondansetron A potent antiemetic, of value in the nausea and vomiting associated with cancer chemotherapy. Such vomiting appears to be induced by the release of serotonin, which acts on receptors in the gut as well as stimulating the chernoreceptor trigger zone in the brain. Ondansetron is a specific (5—HT,) serotonin blocking agent, and is given before the commencement of cytotoxic treatment or radiotherapy.
Dose: 24 mg daily; in severe vomiting an initial dose of 8 ing is given by slow i.v. injection, followed by I ing/hrly for 24 hours by continuous i.v. infusion, followed by oral therapy. Side-effects are an initial sense of warmth, headache an(] constipation. (Zofran). See page 158.
topium The dried juice from the capsules of the opium poppy. See morphine.
orciprenaline A synipathomimetic agent with the bronchodilator properties of isoprenaline. It is used for the relief of obstructive airway conditions, although more selective drugs of the salbutarnol type are often preferred.
Dose: up to 80 ang daily; by aerosol inhalation up to 12 puffs (9mg) daily. Side-effects include tremor and tachycardia. (Ahiperil). See page 118 and Table 6.
orphenadrine A spasmolytic drug, used in the treatment of parkinsonism, and for the relief of voluntary muscle spasm. Dose: 150-400 nig daily. It may also be given by i.m. injection in doses of 60 mg. In parkinsonism it tends to control the rigidity more than the tremor. Side-effects are anticholinergic and include dryness of the mouth, dizziness and visual disturbances. Weight gain has occurred with high doses. (Disipal; Norflex). See
page 160 and Table 26.
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omeprazole An inhibitor of the enzyme I I*K’A'I’Pase.’rhat enzyme controls the final stage of gastric acid production, and its inhibition by omeprazole is of value in peptic ulcer resistant to H, receptor antagonists, and in reflux oesophagitis, where such agents are not always effective. Dose: in benign gastric and duodenal ulcer, 20-40 ing as it single daily dose for 4-8 weeks. Larger doses may be required in the Zollinger—Ellison syndrome. Side-effects such as nausea, gasiro-intestinal disturbances and headaches are usually mild. (Losec). See page 162 and Table 27.
oxazepam A benzodiazepine with the actions, uses and side-effects of diazepam. It is useful in acute anxiety and panic states.
Dose: 45-120 mg daily. See page 117 and Table 5.
oxerutins A mixture of rutosides (flavonoid derivatives) which is claimed to reduce capillary fragility and permeability. It has been used in venous disorders of the lower limbs.
Dose: 750-1000 nig daily. (Paroven).

co-fluampicil -tablets of flucloxacillin and ampicillin
co-flumactone Tablets of spironolactone and hydrochlorothiazide.
colchicine The alkaloid obtained from meadow saffron. It is used in acute gout. Dose: 500mg every 2 hours until relief is obtained. A total dose of 10mg should not be exceeded, but relief of pain or the onset of vomiting or diarrhoea usually renders full doses unnecessary. It is also used prophylactically in doses ol’500pg 2 or 3 times a day during early treatment with allopurinol, probericcid and sulphiripyrazone. Gire is necessary in the elderly, and in renal impairment. See page 140 and’I'able 17.
corticotrophin The adrenocorticotrophic hormone of the anterior pituitary gland. It stimulates the production of corticosteroid hormones by the adrenal cortex. It is now used mainly as a test of adrenocortical function. See tetracosactrin.
Hydrocortisone.
cortisone one of the corticosteroids secreted by the adrenal cortex. Although it is rapidly absorbed orally, it is inactive until converted in the liver to hydrocortisone. It therefore has the actions, uses and side-effects of hydrocortisone, which is often the preferred corticosteroid. It should be noted that cortisone is of no value for topical application. See hydrocortisone, page 250 and Table 36.
colestipol An exchange resin used in hyperlipidaemia that acts by binding with bile salts in the gut and preventing their reabsorption, and so indirectly lowers the plasma level of cholesterol.
Dose: 10-30g daily. May interfere with the absorption of many drugs. (Colostid). See page 146 and Table 20.
colfoseeril A pulmonary surfactant used in the respiratory distress syndrome of the new-born. (Exosurf). See beractant.
colistin An antibiotic used mainly for bowel sterilization.
Dose: 4.5-9 mega-units daily. In systemic gram-negative infections 2 mega-units 8-hourly by injection have been used, but less toxic antibiotics are now preferred. Colonlycin).
collodion When applied to the skin, it dries to form a flexible film, and is used as a vehicle for the extended local application of drugs such as salicylic acid.
co-phenotrope tablets of diphenoxylate
and atropine. (Lomotil; Tropergen).
co-prenozide Tablets of oxprenolol and cyclopenthiazide. (Trasidex).
co-proxamol Tablets  and paracetamol. (Distalgesic).
corticosteroids Hormones secreted by the cortex of the suprarenal gland. The principal hormone is hydrocortisone but more potent synthetic derivatives such as dexamethasone are also in use.
co-tenidone Tablets of atenolol and chlorthaliclone. (Tenoretic).
co-triamterzide Tablets of hydrochlorothiazide and triannerine. (Diazide).
co-trimoxazole A mixture of trimethoprini and sulpliaiiietlioxazole. Trimethoprim, like the sulphonamides, interferes with the folic acid cycle of bacterial metabolism, but at a different point, and the mixture has an increased antibacterial action. It was once widely used, but is now advised only for Prieunjocystis carinii pneumonia. Occasionally given in acute bronchitis and urinary infections when no other drug is acceptable.
Dose: 120 nig/kf; daily lot- 14 days; 960 ing 12-hourly by i.v. infusion. (Bactrin); Septrin).
coumarins Compounds that depress the formation in the liver of prothrombin and other blood coagulation factors. See warfarin and phenindione.
counter-irritants Substances, also referred to as rubifacients, that, when applied to the skin, produce a mild, local irritation and inflammation, and give symptomatic relief in painful conditions of the muscles and joints. Creams and liniments containing methyl salicylate, turpentine, capsicum resin and menthol are examples of rubifacients.
crisantaspase Asparagine is an aminoacid essential for the development of some malignant cells. Crisantaspase is an enzyme, also known as asparaginase, that breaks down asparagine, and so has an indirect cytotoxic action. It is used to induce remission in acute lymphoblastic leukaemia in children.
Dose: (after pre-treatment with other drugs): 1000 units/kg by slow i.v. injection daily for 10 days. Side-effects include anaphylactic reactions, and skin tests to detect hypersensitivity
are essential before initial and re-treatment. (Erwinase).
crotamiton An ascaricide and antipruritiL. Used by local application as cream or lotion (10%) in the treatment of scabies and itching conditions. (Eurax).
crystal violet A dyestuffwith a selective action against Gram-positive organisms and yeasts. Used as a 0.5% solution for infected skin conditions, and for skin
preparation.
cyanocobalamin The anti-anaemic factor present III liver. It is specific in the treatment of pernicious anaemia and its neurological complications, and of value in some other anaernias due to nutritional deficiencies.
Dose: in pernicious anaemia, I Ing by i.m. injection at monthly intervals. It has been largely replaced by hydroxocobalamin, which has a more prolonged action. (Cytanien). See page 112 and’I'able 3.
cyclizine An antihistamine, used mainly in I ravel sickness and nausea generally. Also useful in vertigo.
Dose: 100-150 mg daily. Side-effects include dryness of the mouth, headache and drowsiness. (%Ialoid).
cyclopenthiazide A thiazide diuretic with the actions, uses and side-effects of bend roll tiazide.
Dose: I mg initially, 250-500mg daily or on alternate days, in the morning, according to need. (Navidrex). See page 148 and Table 21.
cyclopentolate An anticholinergic agent use(] to produce cycloplegia and mydriasis. The action is more rapid and less prolonged than atropine, particularly in children. (Mydrilate).
cyclophosphamide A widely used alkylating
cytotoxic agent, active orally and by injec-
tion. Used in I lodgkin’s disease, chronic
lymphocytic leukaemia and lymphomas. Dose: 100-300 Ing daily, orally or i.v., or 300 mg-1 g weekly. A high fluid intake is necessary, as a metabolite may cause hacm- ( )rrhagic cystitis, and it is sometimes used with mesna to reduce the risk of such cystitis. Nausea and vomiting are common side-effects, as is epilation with high doses. (Endoxana). See page 122 and Table 8.
cyclopropane An inhalation anaesthetic of high potency with which induction and recovery are rapid. It causes some respiratory depression and cardiac irregularities, and its administration requires care. It is used with closed-circuit apparatus as it forms an explosive mixture with air and oxygen. Supplied in orange-coloured cylinders.
cycloserine An antibiotic used in
pulmonary tuberculosis when standard drugs are ineffective. Occasionally used in urinary infections.
Dose: 250-750 mg daily. Side-effects include drowsiness, vertigo and rash. See page 170 and Table 31.
cyclosporin An antibiotic with a powerful inuininosuppressant action. It is used under expert control to prevent graft rejection in organ and bone marrow transplantation, and in the prevention of graft-versus-host disease (GVI-ID). Prolonged therapy over some months may be required. Side-effects may include tremor, gastrointestinal disturbance, hypertrichosis and nephrotoxicity (Neural; Sandinimun).
cyproheptadine A compound with antihistamine and antiserotonin properties. Sonic allergic reactions are due not only to histamine, but also to serotonin, and cyproheptadine is useful in conditions not responding completely to an antihistamine. Dose: 4-20 ing daily. It has been used as an appetile stimulant in doses of 12 mg daily and in refractory migraine. (11criactin). See page 110 and Table 2.
cyproterone An anti-androgen used to reduce libido in sexual deviants. Dose: 50-100 nig daily. It is also used in the palliative treatment of prostatic carcinoma, particularly in advanced cases that have become resistant to other therapy. Dose: 300 mg daily.