Posts Tagged ‘skin infections’

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.

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.