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Sympathomimetic drugs such as xylometazoline can be used as decongestants. Antihistamines are used in the treatment of allergic rhinitis and hay fever. They reduce symptoms such as runny nose and sneezing, but are less effective for nasal congestion. There are many antihistamines available and they differ in their duration of action, anticholinergic effects and incidence of drowsiness. Older antihistamines are the most likely to cause drowsiness.
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) Useful substances are reabsorbed from the kidney tubules back into plasma by diffusion or active transport. Much of this occurs early on in the nephron at the proximal convoluted tubule but also at the distal convoluted tubule where tubular filtrate concentration is high.
- Its mode of action is by enhancing GABA mediated inhibition at the neuromuscular junction.
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An example is bromocriptine. Dopamine receptor agonists can be used alone in newly diagnosed patients, but are most often used together with levodopa in the later stages of Parkinsonism. This combination reduces some of the problems seen in long-term therapy with levodopa. Apomorphine is a potent dopamine receptor agonist used in advanced disease. It has to be administered by subcutaneous injection and causes such severe nausea and vomiting that an antiemetic has to be administered for two days prior to treatment. Dopamine receptor agonists have similar, but less severe, central side effects to levodopa.
Health care professionals play an important role in improving compliance. This is particularly important if a drug is for serious conditions like epilepsy, glaucoma or hypertension, or is for infection because of the problem of drug resistance. Well-informed patients are more likely to be compliant. It is worth spending time explaining what the medication is, how it is taken and why, how long it is to be used for, what adverse effects to look out for and any alternatives if appropriate. The importance of the drug therapy can be explained and what might happen if the patient did not comply. Aids to help compliance can be suggested, for example packaging of daily doses can be arranged with pharmacists, special containers can be obtained, the help of relatives can be sought, suitable time of day for administration can be chosen and provision of written information can all help.
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