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Flecainide is an alternative to lidocaine for the treatment of ventricular arrhythmia and can be used orally for disabling paroxysmal atrial fibrillation. Adverse effects of flecainide are nausea, vomiting and precipitation of arrythmias. Quinidine can suppress all types of arrhythmia, but also cause them. Because of this, it is rarely used without specialist guidance. Adverse effects of quinidine are nausea, vomiting, diarrhoea, blurred vision, cardiac depression and arrhythmia.
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Intravenous corticosteroids may be required for serious urticaria. A number of drugs are used as adjuncts to radiography. They can be administered by qualified, registered and trained radiographers under patient group directions. Analgesia may be necessary for the after-effects of venepuncture or following therapeutic radiographic procedures. Peripherally acting analgesics, for example paracetamol, aspirin or ibuprofen should be sufficient.
The absorbing membrane for nutrients and drugs is the mucous membrane of the epithelial cells lining the gastrointestinal tract. General factors affecting diffusion across cell membranes, considered above, apply in addition to the pH of gastrointestinal contents: surface area of the gastrointestinal tract; gastric emptying and intestinal transit time; blood flow from the gastrointestinal tract; plasma protein binding; active transport mechanisms and drug formulation.
This is known as first pass metabolism, which can result in considerable loss of activity for some drugs on first pass through the liver. Some drugs are recycled by enterohepatic shunting. Enterohepatic shunting describes the process whereby a drug is first metabolized and then excreted into the intestine via bile. Once in the intestine gut bacteria or intestinal enzymes convert the drug back to its original form, which is then reabsorbed.
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Warfarin is an anticoagulant, which binds extensively to plasma proteins, and this is taken into account when dosages are worked out. Aspirin taken with warfarin competes for the same protein binding sites, which means that they each displace the other and the amount of free drug in the plasma is increased for both drugs. Patients stabilized on warfarin should never take aspirin because the effect of increased free plasma concentration of warfarin can be severe haemorrhaging.
Coincidental increased activity of aspirin is not as serious. Lipid-soluble drugs enter cells readily. Distribution of such drugs is widespread unless plasma protein binding is extensive.
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Treatment of osteoporosis is essentially the same regardless of whether the cause is post-menopausal or corticosteroid-induced or simply due to old age. Bisphosphonates and calcitonin can be used in osteoporosis, when they have an action similar to that described under Pagets disease.
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Skin infections should respond within six weeks and onychomycoses within weeks.
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In these cases, specialist treatment with drugs that suppress the immune system may be required.
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In order to understand diseases of the respiratory system and how they can be treated, it is necessary to have an overview of the normal function of the respiratory system; that is the structures involved, the mechanism of breathing and gas exchange and the control and variation of breathing rate.
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The fungal cell membrane contains a sterol called ergosterolwhich keeps the membrane stable.
Hydroxyurea inhibits ribonucleotide reductase, which is necessary for the conversion of ribonucleotides into deoxyribonucleotides. Crisantaspase breaks down asparagine, which some tumour cells cannot synthesize.
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In cardiac failure, cardiac output is reduced. This means initially that with exercise the organs and tissues do not have an adequate blood supply.
Cimetidine, a drug used to treat stomach ulcers, can inhibit the metabolism of several potentially toxic drugs such as phenytoin and theophylline. Erythromycin, an antibiotic, similarly increases the activity of theophylline, warfarin and digoxin. Response to drugs varies between individuals and although the reasons are often multifactorial there are cases where gene polymorphism is responsible.
There are some well-known examples of individual variation in response to drugs. Propranolol is a drug commonly used to treat high blood pressure.
Anxiety can be a reaction to major life events, such as moving house, changing jobs or bereavement. As such, it is a normal, but short-lived response to a potentially threatening event. Anxiety becomes a medical problem when it is excessive, long lasting or inappropriate and incapacitating. Then it can be called anxiety neurosis, or an anxiety syndrome.
According to the DSM-IVanxiety syndromes are obsessive-compulsive disorder, panic attacks for no apparent reason, phobias and post-traumatic stress disorder.