Posts Tagged ‘system stimulant’

cytarabine A cytotoxic agent that prevents cell development by inhibiting the formation of nucleic acid. It is used mainly in the control of acute mycloblastic leukaemia.
Dose: 0.5-3 mg/kg daily by i.v. or s.c. injection. Close haematological control is essential as the drug is a powerful myclodepressant. Other side-effects are those of the cytotoxic drugs, generally, but fever, myalgia and bone pain may also occur. Alexan; Cv cos: r).
Dose:    nig/kg, daily for 10 days, repeated after 4 weeks. Side-effects are severe nausea, bone marrow depression and an influenza-like syndrome. The drug should be handled with care, as it is a tissue irritant. (DTIC).
dactinomycin See actinomycin D.
dalteparin A low-molecular weight heparin given by s.c. injection for pre- and postoperative thrombo-embolic prophylaxis. Dose: 2500 units daily for 5 (lays. (Fragmin). See enoxaprin and tinzaparin.
cytotoxic drugs A term applied to drugs that can kill cancer cells. In practice, many factors influence their therapeutic value. They are rarely selective, and therapeutic doses usually have a toxic effect on sonic normal cells. They may attack cancer cells at different stages of development, as actively dividing cells are more susceptible than resting cells. They may not reach the cancer cells in adequate concentration, or resistance to the drug may develop. The dose may also depend to some extent on the patient’s tolerance of the drug, and combined treatment with two or more drugs may have the advantages of increased potency with reduced toxicity. All cytotoxic drugs, with the exception of bleomycin and vincristine, bring about a depression of the bone marrow, which may be severe, and some degree of hair loss, which is usually reversible. Severe nausea and vomiting are also common, and early use of powerful antiemetics is essential. Many cytotoxic agents are tissue irritants, and with i.v. treatment great care must be taken to avoid extravasation, as severe local tissue damage can occur. See alkylating agents and antimetabolites. See page 122.
clacarbazine A cytotoxic drug that appears to depress purine metabolism and the formation of DNA. It is used mainly in malignant melanoma, and in combination with other agents it is of value in other malignant conditions.
clanazol A derivative of ethisterone that inhibits the release of pituitary gonadotrophins. Used in conditions such as endometriosis and gynaecomastia. Dose: 200-800 ing daily, starting during menstruation. Side-effects are nausea, dizziness, rash, flushing and hair loss. Care is necessary in cardiac, renal or hepatic impairment, and in epilepsy and diabetes. (Danol).
danthron A synthetic anthraquinone laxative used mainly for constipation in the aged, and in drug-induced constipation in the terminally ill. Not suitable for routine use by other patients.
Dose: given in doses of 25–25 mg as codanthramer, and acts within 6-12 hours. the urine may be coloured red.
dantrolene A skeletal muscle relaxant that acts on the muscle fibre, and not at the myoneural junction. The action may be linked with an interference with the movement of calcium ions. It is used in the severe and chronic spastic states that occur after stroke, spinal cord injury, and in multiple sclerosis.
Dose: 21 ing daily initially, increased at weekly intervals up to a maximum of 400 mg daily, as the response is slow and May be inadequate. The side-effects of weakness and Gangue are mild, and often transient, but liver function tests during treatment are essential. Dantrolene is also of value in malignant hyperthermia, a rare but serious complication of anaesthesia, and is given in doses of I mg/kg by i.v. injection as soon as the condition is diagnosed,

dapsone A sulphone compound used in the ti,atnient of leprosy.
Dose: 25-400 mg orally twice weekly and continued for some years. Resistance to dapsone may occur, and combined treatment with clofazimitic and rifarnpicin may lie necessary. Dapsone is sometimes given with pyrimetharnine in chlotoquine-resistaut malaria. Side-effects are nausea, rash, neuropathy and myelodepression.
duration of action. Used in the diagnosis and control of diabetes insipidus, and in the treatment of nocturnal eneuresis. Dose: 10-20pg intranasally once or twice
a day; 1-4 pg daily by injection. IMAM.
desoxymethasone A corticosteroid, for local application in acute inflammatory and allergic skin conditions. Used as oily cream 0.25%. (Stiedex).
daunorubicin See doxorubicin.
debrisoquine An adrenergic neurone blocking agent with the actions, uses and side-effects of guanethidine, except that it is less likely to cause diarrhoea. It is used mainly in resistant hypertension, in association with other drugs. (Declinax).
See page 148 and Table 21.
deflazacort A glucocorticoid with the actions and uses of related drugs, and comparable in activity with prednisolone. Dose: initially in acute conditions up to 120 mg daily; maintenance dose 3-18 mg daily. (Calcort). See hydrocortisone, page 55 and Table 36.
demeclocycline An antibiotic with the actions, uses and side-effects of tetracycline, but more likely to cause photo-allergic reactions.
Dose: 600 mg daily. Used occasionally in hyponatraemia due to overactivity of the antidiuretic hormone. (Ledermycin).
desferrioxamine A chelating agent that combines with iron salts to form a soluble non-toxic complex. Of great value in acute ferrous sulphate poisoning in children. Dose: 2 g immediately by i.m. injection, together with gastric lavage (2 g of desferrioxamine/1) followed by a single oral dose of 10 g. It may also be given by continuous i.v. infusion, 15 mg/kg hourly up to a maximum of 80 mg/kg. It may cause hypotension if the infusion is given too rapidly. It is also useful in the treatment of iron-overload caused by repeated blood transfusions, and for aluminium overload in patients On dialysis. (Desferal).
desflurane An inhalation anaesthetic
similar to CuflUrane. (Suprane).
desmopressin A derivative of vasopressin, with increased potency and longer
dexamethasone A potent synthetic corticosteroid, with reduced salt-retaining properties. Useful in all conditions requiring systemic corticosteroid therapy (except Addison’s disease), including inflammatory and allergic disorders, shock, cerebral oedema and adrenal hyperplasia.
Dose: 0.5-2 mg daily up to a MaXiMUM Of’ 15 mg daily; in shock, 5-20 mg by slow i.v. injection or infusion; in cerebral oedema, 10 ing initially by i.v. injection, followed by 4 mg i.m. 6-hourly. Dexamethasone is also given by infra-articular injection for local inflammation of joints in doses of
0.4-4 mg. It is also used as eye drops (0.1%)
in uveitis, but care is necessary with prolonged treatment as with some patients a ’steroid glaucoma’ may be precipitated. (Decadron). See page M and Table 36.
dexamphetamine sulphate A central nervous system stimulant. It is used in the treatment of narcolepsy and, paradoxically, it is sometimes useful in hyperkinesia in children.
Dose: in narcolepsy, 20-60 mg daily; in hyperkinesia 2.5 mg initially, slowly increased up to a maximunl’of 20 mg daily. Side-effects are insomnia, anorexia and agitation. Dependence and tolerance may occur early. (Dexedrine).
dextran A blood-plasma substitute
obtained from sucrose solutions by bacterial action, and used as solutions of varying molecular weight (dextran 40, 70). Dextran 70 is used as a blood volume expander by i.v. injection in some cases of shock; dextran 40 is used mainly to improve postoperative peripheral circulation, reduce blood viscosity, and to prevent thrombo-embolism. Care must be taken to adjust dose to avoid overloading the circulation. Any blood-matching should be carried out before giving dextran. (Gentran; Macrodex; Rheomacroclex).

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).

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.