8 A patient requires 4mg of intramuscular morphine sulphate. (2006) Pharmacology, 2nd edn. For example, giving an ACE inhibitor (e.g. Draw up learning objectives and consider how you will evaluate what has been taught. This is the thinking behind acetylcholine antagonists. Basingstoke: Palgrave Macmillan. London: Arnold. Depot injections are usually either solid or oil-based. Examples of medicines that are combined or given with levodopa are carbidopa and benserazide. The person then begins to suffer a series of violent rhythmic jerking movements of the limbs. k Elizabeth Jones is 11 years old and is asthmatic. As with heparin, the most obvious side-effect is bleeding. Alcohol may cause the patient to have an upset stomach and suffer from vomiting, stomach cramps (colic) and sweating. These cells produce a chemical called immunoglobulin E which is a type of antibody. In addition, infections by micro-organisms not sensitive to penicillin can take place. Describe the mode of action of antihistamine medication. Aspirin is another drug which blocks the COX1 pathway, but also inhibits the COX2 pathway. Ø Physiological considerations in absorption are blood flow, total surface area, time of arrival of the drug and time of drug at absorption site. In addition, the cells of the body, and particularly in the periphery, cannot utilize insulin properly. 6 The patient should hold their breath for a count of 10, then remove the inhaler and breathe out slowly. Some writers have likened this to putting 15 metres of cotton material into a matchbox. Sulfonylureos This classification of drug is also used in the treatment of type II diabetes, particularly in people whose diabetes cannot be controlled by diet alone. 117 Chapter 7 Drugs used in chronic conditions the heart rate (tachycardia). Due to the fall in circulating blood volume, peripheral perfusion of tissues is a consideration. 3 If the patient is using the inhaler for the first time or has not used it in the last three days, get them to prime it by pressing down on the canister to release two sprays into the air, away from their face. The causation of hypertension is most likely to be due to a number of interrelated factors which may be genetic or environmental. The chronic complications of diabetes are caused by long-term raised glucose levels in the body. Many microorganisms live either inside or on the outside of the human body. The onset of action is very rapid, while the duration depends on the drug being used, pilocaine having the shortest period of action (15 to 30 minutes), while lignocaine provides a moderate length of anaesthesia (60 minutes). These reactions are not dose dependent and are more rare than augmented ADRs. Therefore potentiation of an inhibitory transmitter channel leads to increased inhibition, or reduced activity at Figure 8.1 Barbituate binding the receptors the chloride ion acts on. As a result, when pain producing products, such as bradykinins, are released, greater pain is felt by the individual. These are mainly plasma, interstitial fluid and intracellular fluid. The drug has a wide distribution in the tissues of the body including the cerebrospinal fluid, around the brain and spinal cord. Gatford, J.D. In some people it is thought that there may not be enough GABA in the brain. 6 You have a vial of gentamycin containing 80mg in 2ml. Both are given orally. 80 Generalized weakness Secondary diabetes Obesity Striae Oedema Poor wound healing Antirheumatoid drugs Arthritis is inflammation of the joints. They have very similar profiles regarding their antidepressant effects and main differences between them lie in their abilities to cause drug interactions and effects. The doctor has diagnosed a viral infection and has refused to prescribe antibiotics. Atypical antipsychotics These drugs, unlike the typical antipsychotics, share very little similarity in structure or chemistry. A number of genes may be related to the function of known neurotransmitters and receptors, suggesting a biological effect. Hence, leflunomide reduces inflammation in the joints, as well as slowing down progressive bone erosion and joint deformity. When giving a controlled drug a particular procedure must be followed. This book has introduced you to the knowledge necessary when engaging in these skills. Drugs used in chronic conditions Learning objectives Introduction Asthma Drugs used in treating asthma Diabetes Medicine management of diabetes Hypertension Parkinson’s disease Epilepsy Case studies Key learning points Calculations Multiple choice questions Recommended further reading 101 102 102 102 103 107 109 114 118 120 124 125 126 127 129 8. This causes a ‘dampening down’ effect for all neuronal activity. No information need be given verbally to the patient about how to take their medication, if printed instructions are issued with their drugs. Indeed, gabapentin, a fairly recent addition to the anticonvulsant range, may have some action on calcium channels. In long-term settings you may also find that photographs of patients are provided on their charts to help ensure that problems of misidentification do not occur. Infection quite often arises after a person has inhaled the fungi. These symptoms are not good news if you happen to be diabetic and have HIV. Here there is complete healing and tissue repair. In 1960 Hornykiewicz demonstrated that the dopamine content of the substantia nigra in post-mortem examination of patients with the disease was extremely low – in some cases 10 per cent less than normal. Ø It is essential for the synthesis of plasma clotting factors. Increased pressure in the blood vessels has a direct effect on the heart and vasculature. iprindole); there is a therapeutic delay of two weeks for the full effects of monoamine antidepressants to be seen. Edinburgh: Churchill Livingstone Elsevier. Some should be taken with food, others after food and still others before food, so it is important that the patient takes their medicines exactly as prescribed to ensure optimum effect. Lapham, R. and Agar, H. (2003) Drug Calculations for Nurses: A Step-by-step Approach, 2nd edn. This leads to damage, particularly to blood vessels and peripheral nerves. Hypertension may be defined as primary or secondary. The effects of SSRIs take up to 14 days to fully Flupentixol: an antipsychotic drug which can be used to treat mild to moderate depression. After being absorbed, cephalosporins are widely distributed in the tissues of the body. Mosby Elsevier. Elizabeth is moving up to high school and is embarrassed about using her inhalers in front of her classmates. Clinical tip Aspirin is no longer routinely used with children due to its link with a condition known as Reyes syndrome. Both have anti-inflammatory and immunosuppressive activity. Wolfe, S. (2006) Respiratory nursing: treatment of allergic rhinitis and asthma, Nursing Times, 102(20): 49–52. Reporting of drug errors Ø Ø Ø Ø An open no-blame culture is important in the reporting of drug errors. Also, as sodium is retained by the body, so is water, therefore increasing blood volume and leading to a hypertensive state. Ø Acute inflammation is characterized by rapid onset and short duration. Therefore it is important not to be patronising and to seek out the patient’s level of knowledge prior to undertaking an educational role. Side-effects are relatively minor but obviously troublesome if you are the one taking the medication. The whole area of giving a medicine is fraught with potential pitfalls. Inhibition of bacterial DNA You will be aware from your non-stop reading of anatomy and physiology texts that DNA stands for deoxyribonucleic acid, which is found in all living cells and carries the organism’s genetic information. They bind to a specific benzodiazepine binding site (or receptor) which is situated on one of the sub-units of the GABA-A receptor. Drugs such as lignocaine are used for minor blocks and have an onset of 5–10 minutes and duration of 1–2 hours. Warfarin and Digoxin); lithium; diuretics; benzodiazepines. Aspirin was the first drug to be discovered in this category. Biotransformation Biotransformation of drugs is the process of metabolizing the parent drug compound and occurs mainly in the liver (hence the term hepatic metabolism) to different compounds called metabolites. This syndrome carries a high mortality rate of 40 per cent. Multiple choice questions 1 2 3 4 5 6 7 8 9 10 B A D A C C D A D B 181 182 Index abciximab, anticoagulant therapy 95 absorption 2–4 children 19–20 interactions 16 acarbose (Glucobay), diabetes 113 ACE inhibitors see angiotensin-converting enzyme inhibitors acetylcholine antagonists, Parkinson’s disease 119, 120 aciclovir (Zovirax), viral disease 56–7 acute inflammation 74–5 adherence, patient concordance 150 adjuvant drugs, opioid antagonists 39 administration alteration of medicines 162–3 antifungal drugs 61 controlled drugs 163–4 correct administration method 161–2 correct dose 160–1 correct medicine 160 correct patient 160 correct site 161–2 covert administration of drugs 162 glucocorticoids 79 legal/professional issues 159–66 local anaesthetics 33–4 routes 2–4, 19 steroids 79 supply and administration of medicines 164–5 adolescents, pharmacokinetic features 19–20 adrenaline, local anaesthetics 32 adverse drug reactions (ADRs) 15–24 see also side-effects age-related 19–20 categories 17–18 children 19–20 defining 17 groups of drugs 18–19 interactions 16–17 minimizing the effects 19 adverse effects, aspirin 78 affinity 7 age, hypertension 117 age-related ADRs 19–20 agonistic drug action 7–8 alpha-adrenoreceptor antagonists, hypertension 116–18 alpha-glucosidase inhibitors, diabetes 113 alteplase, anticoagulant therapy 96 alteration of medicines, legal/professional issues 162–3 amantadine, viral disease 57 aminoglycosides, antibiotics 50 amitryptaline, depression 137 amoeboflagellates, protozoa 64–5 amphotericin, antifungal drugs 59, 61 anaesthetics, local see local anaesthetics analgesic system, body’s 30–1 angiotensin-converting enzyme inhibitors (ACE inhibitors), hypertension 116, 117 answers to questions 175–80 antagonistic drug action 7–8 anti-inflammatory drugs 73–88 antihistamines 78–9 antirheumatoid drugs 80–3 aspirin 77–8 cyclo-oxgenase pathway 2 inhibitors 77 cyclo-oxygenase pathway 76–7 glucocorticoids 79–80 histamine 78–9 inflammation 74–6 NSAIDs 76–9 paracetamol 78 prostaglandins 75, 76–7 steroids 79–80 anti-platelet drugs, anticoagulant therapy 94–5 antibiotics actions 47–8 aminoglycosides 50 beta-lactam antibiotics 48–9 cephalosporins 49 chloramphenicol 50 ciprofloxacin 51–2 clindamycin 51 Clostridium difficile 51 DNA inhibition 51–2 erythromycin 50–1 fluoroquinolones 51–2 folate interference 48 gentamycin 50 isoniazid 52–3 lincosamides 51 macrolides 50–1 penicillins 48–9 protein synthesis interference 49–51 pyrazinamide 53–4 rifampicin 53 tetracyclines 49–50 trimethoprim 48 tuberculosis-treating drugs 52–4 anticholinergic agents, Parkinson’s disease 119 183 Index anticoagulant therapy 89–100 abciximab 95 alteplase 96 anti-platelet drugs 94–5 aspirin 94 blood clotting 90–1 case study 96 clopidogrel 94–5 fibrinolytic drugs 95–6 heparin 92–3 hirudin 93 low molecular weight heparins 92–3 streptokinase 95 vitamin K 92 warfarin 93–4 antidepressants, anxiety 135 antifungal drugs 59–62 administration 61 amphotericin 59, 61 azoles 60 clotrimazole 61 fluconazole 60, 61 flucystosine 61, 62 future 62 griseofulvin 60 ketoconazole 60, 61 miconazole 60, 61 nystatin 59–60, 61 terbinafine 61, 62 antihistamines, anti-inflammatory drugs 78–9 antimicrobials 45–71 antibiotics 46–54 antifungal drugs 59–62 fungal infections 58–62 protozoa 62–5 viral disease 54–8 antipsychotics 140–3 anxiety 135 atypical 141, 142–3 side-effects 143 typical 141–2 antirheumatoid drugs anti-inflammatory drugs 80–3 choloroquine 82 DMARDS 80–3 gold compounds 81–2 leflunomide 83 methotrexate 82 penicillamine 82 sulfasalazine 81 antiviral drugs aciclovir (Zovirax) 56–7 amantadine 57 ganciclovir 57 HIV 54–6 immunoglobulins 58 184 interferons 58 other 56–8 Zovirax (aciclovir) 56–7 anxiety 132–5 antidepressants 135 antipsychotics 135 azaspirodecanediones 134–5 barbiturates 133 benzodiazepines 134 beta adrenergic blockers 134 beta blockers 134 buspirone 134–5 fluoxetine 135 fluvoxamine 135 medicine management 133–5 paroxetine 135 sertraline 135 SSRIs 135 TCAs 135 apicomplexa, protozoa 62–3 aspirin 35–6 adverse effects 78 anti-inflammatory drugs 77–8 anticoagulant therapy 94 children 35 contraindications 35–6 overdose 78 Reyes syndrome 35 asthma 102–7 beclomethasone dipropionate 105 beta 2 adrenoreceptor agonists 103–4 bronchodilators 103–4 budesonide 105 corticosteroids, inhaled 105 cromoglicate 106–7 inhaled corticosteroids 105 ipatropium 104–5 management 106 methylxanthines 104 muscarinic receptor antagonists 104 pathological changes 102–3 salbutamol 103–4 theophylline 104 azaspirodecanediones, anxiety 134–5 azoles, antifungal drugs 60 bacterial infection 46–8 barbiturates anxiety 133 controlled drugs 163–4 beclomethasone dipropionate, asthma 105 bendroflumethiazide, hypertension 115, 117 benzodiazepines anxiety 134 controlled drugs 163–4 beta 2 adrenoreceptor agonists, asthma 103–4 Index beta adrenergic blockers, anxiety 134 beta-adrenoreceptor antagonists, hypertension 115–16, 117 beta blockers anxiety 134 hypertension 115–16, 117 beta-lactam antibiotics 48–9 Biers block 33–4 biguanides, diabetes 112, 113 biological factors, depression 136–7 biotransformation 4–5 bipolar depression 135–6 blood clotting see also anticoagulant therapy processes 90–1 thrombosis development 91 body’s analgesic system 30–1 bronchodilators, asthma 103–4 budesonide, asthma 105 buspirone, anxiety 134–5 calcium antagonists, hypertension 116, 117 calcium channels, epilepsy 122 Candida albicans, fungal infections 59 cannabis, controlled drugs 163–4 captopril, hypertension 116, 117 case study anticoagulant therapy 96 compliance 155 depression 144 legal/professional issues 166 patient concordance 155 schizophrenia 144 caudal anaesthesia 33 cephalosporins, antibiotics 49 children absorption 19–20 ADRs 19–20 distribution 20 EMLA cream 32–3 excretion 20 local anaesthetics 32–3 metabolism 20 pharmacokinetic features 19–20 rectal administration 19 Reyes syndrome 35 chloramphenicol, antibiotics 50 choloroquine, antirheumatoid drugs 82 chronic conditions 101–30 asthma 102–7 diabetes 107–13 epilepsy 120–4 hypertension 114–18 Parkinson’s disease 118–20 chronic inflammation 75–6 ciprofloxacin, antibiotics 51–2 citalopram, depression 137 clindamycin, antibiotics 51 clopidogrel, anticoagulant therapy 94–5 Clostridium difficile, antibiotics 51 clotrimazole, antifungal drugs 61 clozapine 142–3 codeine 38 controlled drugs 163–4 compliance case study 155 patient concordance 150 concordance see patient concordance conduction anaesthesia (nerve blockade) 33 confusion states, patient concordance 152 contraindications, aspirin 35–6 controlled drugs barbiturates 163–4 benzodiazepines 163–4 cannabis 163–4 codeine 163–4 legal/professional issues 163–4 Misuse of Drugs Regulations (2001) 163–4 morphine 163–4 conversions/units 8–10 correct administration method, legal/professional issues 161–2 correct dose, legal/professional issues 160–1 correct medicine, legal/professional issues 160 correct patient, legal/professional issues 160 correct site, legal/professional issues 161–2 corticosteroids, inhaled, asthma 105 covert administration of drugs, legal/professional issues 162 cromoglicate, asthma 106–7 cyclo-oxgenase pathway 2 inhibitors 77 cyclo-oxygenase pathway, anti-inflammatory drugs 76–7 decision-making, patient empowerment 153–4 depression 135–40 biological factors 136–7 bipolar 135–6 case study 144 genetic factors 136 MAOIs 137, 138 medicine management 137–40 psychological factors 136 SSRIs 137, 138–9 symptoms 136 TCAs 137–8 unipolar 135 diabetes 107–13 acarbose (Glucobay) 113 alpha-glucosidase inhibitors 113 biguanides 112, 113 glipizide 112, 113 185 Index glitazones (thiazolidinediones) 112–13 Glucobay (acarbose) 113 insulin 109–11 medicine management 109–13 meglitinides 112, 113 metformin 111–12, 113 nateglinide (Starlix) 112, 113 oral hypoglycaemic agents 111–13 rosiglitazone 112–13 sulfonureas 112, 113 thiazolidinediones (glitazones) 112–13 tolbutamide 112, 113 types 107–9 disease-modifying antirheumatoid drugs (DMARDs) 80–3 distribution 4 children 20 interactions 16 DMARDs see disease-modifying antirheumatoid drugs dopamine receptor agonists, Parkinson’s disease 119, 120 dose, correct, legal/professional issues 160–1 drug action 6–7 dynorphins 31 EMLA cream children 32–3 local anaesthetics 32–3 endorphins 31 enkephalins 31 enzymes 6 epidural anaesthesia 33 epilepsy 120–4 calcium channels 122 ethosuximide 122, 123 GABA action 122–4 generalized seizures 121 partial seizures 120–1 phenytoin 121–2, 123 sodium channels 121–2 sodium valproate 122–4 valproate 122–4 vigabatrin 123, 124 errors, reporting drug 163 erythromycin, antibiotics 50–1 ethosuximide, epilepsy 122, 123 excretion 5 children 20 interactions 17 extradural anaesthesia 33 fibrinolytic drugs, anticoagulant therapy 95–6 first pass metabolism 7 flagellates 63–4 fluconazole, antifungal drugs 60, 61 186 flucystosine, antifungal drugs 61, 62 fluoroquinolones, antibiotics 51–2 fluoxetine, anxiety 135 flupentixol, depression 139 fluvoxamine, anxiety 135 folate interference, antibiotics 48 fungal infections 58–62 Candida albicans 59 moulds 58 yeast-like fungi 59 yeasts 58–9 future, antifungal drugs 62 GABA action, epilepsy 122–4 ganciclovir, viral disease 57 genetic factors, depression 136 gentamycin, antibiotics 50 glipizide, diabetes 112, 113 glitazones (thiazolidinediones), diabetes 112–13 glossary 173–4 Glucobay (acarbose), diabetes 113 glucocorticoids administration 79 anti-inflammatory drugs 79–80 side-effects 79–80 gold compounds, antirheumatoid drugs 81–2 griseofulvin, antifungal drugs 60 heparin, anticoagulant therapy 92–3 hepatic metabolism 5 hirudin, anticoagulant therapy 93 histamine, anti-inflammatory drugs 78–9 human immunodeficiency virus (HIV) 54–6 antiviral therapy 55 life cycle 56 non-nucleoside reverse transcriptase inhibitors 55 nucleoside reverse transcriptase inhibitors 55 protease inhibitors 55–6 hypertension 114–18 ACE inhibitors 116, 117 age 117 alpha-adrenoreceptor antagonists 116–18 angiotensin-converting enzyme inhibitors 116, 117 bendroflumethiazide 115, 117 beta-adrenoreceptor antagonists 115–16, 117 beta blockers 115–16, 117 calcium antagonists 116, 117 captopril 116, 117 thiazide diuretics 115, 117 ibuprofen 36–7 immunoglobulins, viral disease 58 infiltration anaesthesia 32–3 inflammation see also anti-inflammatory drugs acute 74–5 Index chronic 75–6 inhaled (lungs) administration 3 inhaled corticosteroids, asthma 105 insulin diabetes 109–11 intermediate 110, 111 long-acting 110, 111 short-acting 109–10, 111 interactions 15–24 absorption 16 ADRs 16–17 distribution 16 excretion 17 mechanisms 16–17 metabolism 17 patient concordance 152 interferons, viral disease 58 intermediate insulin 110, 111 intramuscular administration 3 intravenous administration 3 local anaesthetics 33–4 ion channels 6 ipatropium, asthma 104–5 isoniazid, antibiotics 52–3 ketoconazole, antifungal drugs 60, 61 leflunomide, antirheumatoid drugs 83 legal/professional issues 159–70 alteration of medicines 162–3 case study 166 controlled drugs 163–4 correct administration method 161–2 correct dose 160–1 correct medicine 160 correct patient 160 correct site 161–2 covert administration of drugs 162 Misuse of Drugs Regulations (2001) 163–4 non-medical prescribing 165–6 Patient Group Direction (PGD) 164–5 prescribing law 165–6 reporting drug errors 163 supply and administration of medicines 164–5 levodopa, Parkinson’s disease 118–20 lincosamides, antibiotics 51 local anaesthetics 31–5 administration 34 adrenaline 32 amides 32 Biers block 33–4 caudal anaesthesia 33 children 32–3 conduction anaesthesia (nerve blockade) 33 EMLA cream 32–3 epidural anaesthesia 33 esters 31 extradural anaesthesia 33 infiltration anaesthesia 32–3 intravenous administration 33–4 mode of action 32 nerve blockade (conduction anaesthesia) 33 preparations 32 spinal anaesthesia 33, 34 topical anaesthesia 32 unwanted effects 34–5 long-acting insulin 110, 111 low molecular weight heparins, anticoagulant therapy 92–3 macrolides, antibiotics 50–1 malaria 62–3 MAOIs see monoamine oxidase inhibitors meglitinides, diabetes 112, 113 metabolism children 20 interactions 17 metformin, diabetes 111–12, 113 methotrexate, antirheumatoid drugs 82 methylxanthines, asthma 104 metronidazole, protozoa 64 miconazole, antifungal drugs 60, 61 mirtazapine, depression 137, 139 Misuse of Drugs Regulations (2001), legal/professional issues 163–4 moclobemide, depression 137 mode of action, local anaesthetics 32 molecular aspects 5–6 monoamine oxidase inhibitors (MAOIs), depression 137, 138 morphine 37–8 controlled drugs 163–4 moulds, fungal infections 58 muscarinic receptor antagonists, asthma 104 naloxone, opioid antagonists 38–9 names of drugs, dual-naming 160 nateglinide (Starlix), diabetes 112, 113 nerve blockade (conduction anaesthesia) 33 nerve impulse 28 neurones 26–7 non-medical prescribing, legal/professional issues 165–6 non-steroidal anti-inflammatory drugs (NSAIDs) 35–7, 76–9 antihistamines 78–9 aspirin 35–6, 77–8 cyclo-oxgenase pathway 2 inhibitors 77 ibuprofen 36–7 paracetamol 36, 78 nystatin, antifungal drugs 59–60, 61 opioid analgesics 37–8 187 Index codeine 38 morphine 37–8 opioid antagonists 38–9 adjuvant drugs 39 naloxone 38–9 oral administration 3 oral hypoglycaemic agents, diabetes 111–13 pain, defining 26 pain pathways 28–31 pain reception 28–30 paracetamol 36 anti-inflammatory drugs 78 Parkinson’s disease 118–20 acetylcholine antagonists 119, 120 anticholinergic agents 119, 120 dopamine receptor agonists 119, 120 levodopa 118–20 selegiline 119, 120 paroxetine, anxiety 135 patient awareness, patient concordance 151 patient concordance 149–58 adherence 150 case study 155 compliance 150 confusion states 152 factors influencing 150–2 interactions 152 patient awareness 151 patient empowerment 152–4 prescription collection 152 product formulation 151–2 product packaging 152 side-effects 151 time of dosing 151 patient, correct, legal/professional issues 160 patient education, patient empowerment 153 patient empowerment decision-making 153–4 patient concordance 152–4 patient education 153 Patient Group Direction (PGD), legal/professional issues 164–5 penicillamine, antirheumatoid drugs 82 penicillins, antibiotics 48–9 PGD see Patient Group Direction pharmacodynamics 2 pharmacokinetic features adolescents 19–20 children 19–20 pharmacokinetics 2 phenelzine, depression 137 phenytoin, epilepsy 121–2, 123 prescribing law legal/professional issues 165–6 non-medical prescribing 165–6 188 prescription collection, patient concordance 152 product formulation, patient concordance 151–2 product packaging, patient concordance 152 professional/legal issues see legal/professional issues prostaglandins 29, 35 anti-inflammatory drugs 75, 76–7 protein synthesis interference, antibiotics 49–51 protozoa amoeboflagellates 64–5 antimicrobials 62–5 apicomplexa 62–3 flagellates 63–4 malaria 62–3 metronidazole 64 quinine 63 tinidazole 64–5 psychological factors, depression 136 psychosis 140–4 schizophrenia 140–4 pyrazinamide, antibiotics 53–4 quinine, protozoa 63 reboxitine, depression 137, 139 receptors 6 rectal administration 3 children 19 reporting drug errors, legal/professional issues 163 reversible inhibitor of monamine oxidase-A (RIMA), depression 137 Reyes syndrome aspirin 35 children 35 rifampicin, antibiotics 53 RIMA see reversible inhibitor of monamine oxidase-A risperadone 143 rosiglitazone, diabetes 112–13 routes, drug administration 2–4 salbutamol, asthma 103–4 schizophrenia 140–4 case study 144 selective serotonin re-uptake inhibitors (SSRIs) anxiety 135 depression 137, 138–9 selegiline, Parkinson’s disease 119, 120 sertraline, anxiety 135 short-acting insulin 109–10, 111 side-effects see also adverse drug reactions (ADRs) antipsychotics 143 glucocorticoids 79–80 patient concordance 151 steroids 79–80 sodium channels, epilepsy 121–2 sodium valproate, epilepsy 122–4 Index spinal anaesthesia 33, 34 spinothalamic tracks 29, 30 SSRIs see selective serotonin re-uptake inhibitors steroids administration 79 anti-inflammatory drugs 79–80 side-effects 79–80 streptokinase, anticoagulant therapy 95 subcutaneous administration 3 sublingual/buccal administration 3 sulfasalazine, antirheumatoid drugs 81 sulfonureas, diabetes 112, 113 sulpiride 143 supply and administration of medicines, legal/ professional issues 164–5 TCAs see tricyclic antidepressants terbinafine, antifungal drugs 61, 62 tetracyclines, antibiotics 49–50 theophylline, asthma 104 thiazide diuretics, hypertension 115, 117 thiazolidinediones (glitazones), diabetes 112–13 thrombosis development, blood clotting 91 time of dosing, patient concordance 151 tinidazole, protozoa 64–5 tolbutamide, diabetes 112, 113 topical anaesthesia 32 transport systems 6 trazodone, depression 137 tricyclic antidepressants (TCAs) anxiety 135 depression 137–8 trimethoprim, antibiotics 48 tryptophan, depression 139 tuberculosis-treating drugs 52–4 unipolar depression 135 units/conversions 8–10 unwanted effects, local anaesthetics 34–5 valproate, epilepsy 122–4 venlafaxine, depression 137, 139 vigabatrin, epilepsy 123, 124 viral disease 54–8 aciclovir (Zovirax) 56–7 amantadine 57 antiviral drugs, HIV 54–6 antiviral drugs, other 56–8 ganciclovir 57 HIV 54–6 immunoglobulins 58 interferons 58 viral mechanisms 54 Zovirax (aciclovir) 56–7 vitamin K, anticoagulant therapy 92 warfarin, anticoagulant therapy 93–4 yeast-like fungi, fungal infections 59 yeasts, fungal infections 58–9 Z track injection method 141 Zovirax (aciclovir), viral disease 56–7 189 ❝This book is great! 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