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Adverse reactions are headache, dizziness and hypotension. Beta blockers are used to treat ischaemic heart disease, arrhythmia and hypertension. These drugs exert their effect in exercise-induced angina by reducing the increase in heart rate and force of contraction in response to exercise, thereby reducing the oxygen demand of the myocardium. β-blockers may be used prophylactically in the treatment of stable angina. They appear to have little effect on the coronary blood vessels, causing slight constriction if anything.

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The symptoms are systemic oedema, particularly of the legs and ankles. Biventricular failure often follows left ventricular failure and consequently oedema develops in the peripheral tissues, causing swelling of the legs, and in the lungs, causing breathlessness. There are no drugs to cure cardiac failure but the condition can be controlled by drug therapy. Drug groups used to control cardiac failure are cardiac glycosides, diuretics, ACE inhibitors and angiotensin II receptor antagonists. Ischaemic heart disease arises if one or more of the coronary arteries become partially occluded. This leads to reduction in blood flow to the myocardium. Angina pectoris strictly translated is pain in the pectoral region of the chest. Usually this is referred to simply as angina and the typical presentation is that of a crushing pain in the upper left side of the chest which may radiate into the neck or down the left arm. The pain is usually severe and often produces significant distress in the sufferer.

Hypomania is a milder form of mania and may not require drug therapy. Bipolar depression is depression that alternates with periods of mania. Patients with bipolar depression are generally younger at the outset than those with unipolar depression and are less likely to suffer from agitation and anxiety, suggesting a different biochemical abnormality to unipolar depression. Bipolar depression tends to run in families, so there may be a genetic element to its aetiology. First-degree relatives of patients with bipolar depression are more likely to develop mood disorders than relatives of those who do not have bipolar depression. Twin studies have shown concordance rates for bipolar depression of more than twins.

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Toxoplasma encephalitis is a common complication of HIV infection. Pneumocystis pneumonia is an opportunistic lung infection almost exclusively seen in patients with HIV. It is often the presenting symptom and a leading cause of death in patients with HIV. An organism called Pneumocystis cariniiwhich used to be classified as a protozoan, causes this type of pneumonia. However, the organism appears to have characteristics of both protozoa and fungi so its classification is currently uncertain.

Although the brain has a very good blood supply, distribution of drugs into the central nervous system is restricted. This is because of the so-called blood-brain barrier. This is not an anatomical barrier as such, rather a combination of the tight junctions between endothelial cells of brain capillaries and the close association of glial cells with the outside of the capillaries. This arrangement makes diffusion of lipid-soluble drugs into the brain difficult and diffusion of fosamax 20mg xr drugs almost impossible. A large number of drugs have a high affinity for albumin and other plasma proteins. Binding to plasma protein inhibits distribution outside the blood since only unbound drug will be further distributed.

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Many drugs are given by inhalation and may be intended to have a local or systemic effect. The lungs are adapted for absorption of oxygen having a large surface area for diffusion and a good blood supply. Particle size is a major determinant of absorption from this site of administration. Small particle size favours systemic absorption whereas large particle size discourages absorption into the fosamax 20mg xr circulation. A drug commonly given by inhalation for a local effect is salbutamol, used to treat asthma.

The use of broad-spectrum antibiotics can reduce populations of normal flora (the resident harmless bacteria that we all have), which can cause adverse effects mestinon 60 mg tablet superinfections of fungi and other drug-resistant micro-organisms. Bacteriostatic antibiotics inhibit bacterial growth and proliferation, while bactericidal antibiotics actually kill bacteria. Many antibiotics are bacteriostatic at low concentrations and bactericidal at higher concentrations. This distinction is often not important clinically. If bacteria are prevented from multiplying, they will eventually be destroyed by the normal immune reaction of the host.

There is no cure for Alzheimers disease, but treatment with central acetylcholinesterase inhibitors aims to enhance cholinergic transmission and glutamate blocking drugs reduce the possibly damaging effects of glutamate. This is a long chapter and as such warrants several case studies. The following case studies are of patients with Alzheimers disease, Parkinsons disease, depression, bipolar disorder and epilepsy. Case study The following case study is of a patient that any health care professional might see on a regular basis for whatever reason. Mr Jones, so far is relatively mild, being mainly increased forgetfulness.