Posts Tagged ‘renal damage’

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.

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

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