Only a few human parasitic worms are common in the United Kingdom, for example threadworms and round worms. In tropical and subtropical parts of the world, where abundant water and high temperatures provide an optimal environment for the larvae and intermediate hosts, parasitic worms are common and widespread. The nervous system in helminths has important differences from that of humans and these differences form the basis of the selective toxicity of most drugs used to treat such infections.
For example, nematode muscles have both excitatory and inhibitory neuromuscular junctions. The neurotransmitters are acetylcholine and gamma-aminobutyric acid, respectively.
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Vitamin K is essential for successful formation of many clotting factors so lack of vitamin K can cause a coagulation disorder. Normal bile acid production is necessary for absorption of vitamin K from the small intestine. Although lack of vitamin K is rare, because it is present in green leafy vegetables and synthesized by intestinal bacteria, it may occur with a combination of poor diet and long-term use of antibiotics.
Deficiency may also occur because of malabsorption secondary to other conditions such as coeliac disease, or due to lack of bile secretion as in obstructive jaundice. Deficiency is treated with oral vitamin K or synthetic analogues such as phytomenadione. In the absence of bile, vitamin K replacement has to be given by intramuscular or intravenous injection. Vitamin K can be used to counteract the effects of warfarin in the event of excessive bleeding.
They are used in cases of asthma where there is a poor response to bronchodilators alone. Current examples are montelukast and zafirlukast, both of which are given orally, either alone or in combination with corticosteroids. They are not recommended for use in chronic bronchitis. Side effects of leukotriene receptor antagonists are gastrointestinal disturbances and headache.
Corticosteroids are anti-inflammatory drugs that can be used in asthma to reduce airway hyper-responsiveness and to decrease bronchial oedema and mucus secretion. They are effective in the late phase reaction and reduce the intensity of allergic reactions.
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Lidocaine is the most commonly used local anaesthetic. It acts rapidly and is more stable than most others are. It has a duration of action of about Repeated injections have been shown to produce tachyphylaxis; that is successive administration produces a reduced effect. Lidocaine may be used with adrenaline to increase its speed of onset and prolong its duration of action.
The most common side effect is transient drowsiness.
It is an antimetabolite that is converted to an enzyme necessary for DNA synthesis. Adverse effects of flucytosine are gastrointestinal upset, anaemia, neutropenia, thrombocytopenia and alopecia, all mild and reversible. This group of drugs inhibits an enzyme necessary for ergosterol synthesis. Some of these drugs are used orally to treat systemic fungal infections; others are used topically to treat skin and nail infection.
Adverse effects of these drugs taken orally are generally mild such as gastrointestinal upset, headache and pruritis.
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It acts rapidly and is more stable than most others are. It has a duration of action of about Repeated injections have been shown to produce tachyphylaxis; that is successive administration produces a reduced effect. Lidocaine may be used with adrenaline to increase its speed of onset and prolong its duration of action. The most common side effect is transient drowsiness. Allergy can occur in susceptible individuals.
Lidocaine should not be used in patients with hypovolaemia, as this would result in higher plasma levels and consequent increase in risk of toxic effects, or in bradycardia, because there may be further slowing of the heart.
Treatment repeated at three-week intervals. Painful. Laser Carbon dioxide laser used to vaporize persistent warts. Repeated treatment is often necessary and can be painful. One preparation contains podophyllum, which is a cytotoxic drug and must not be used in patients who are pregnant or considering pregnancy or breast-feeding. Podophyllum inhibits cell division in virally infected cells.
Interferons are cytokines that are produced naturally by virally infected cells. They act to prevent infection of other cells by increasing the synthesis of enzymes that can destroy viral RNA. This interferes with the synthesis of viral proteins and reduces the production of virus particles. Interferon is used to treat chronic hepatitis C infection. Adverse effects of interferon are fever, lethargy, headache and myalgia.