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  • Retinoids bind directly to retinoic acid receptors in the cell nucleus and reduce cell proliferation in the skin.
  • 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.
  • Erythromycin in particular can increase the risk of myopathy if taken in combination with lipid-lowering statins.
  • These are of doubtful therapeutic value, yet bring relief to many patients particularly those with COPD.
  • Aspirin is an exception and safe to use with lithium.

Drugs taken orally are also subjected to these processes. The digestive system consists of the mouth, oesophagus, stomach, small intestine, large intestine, rectum and anus together with the liver and pancreas.

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They also seem to make tissues more sensitive to insulin by an unknown mechanism. Examples of sulfonylureas are gliclazide, glipizide and glibenclamide.

Oral benzodiazepines, such as diazepam or midazolam are commonly used. These drugs also reduce muscle tone, which is useful during surgery. They have no analgesic effect, so may be used together with opioid analgesics. As a side effect benzodiazepine sedatives produce a degree of respiratory depression. Antimuscarinic drugs are used as premedication to prevent salivation and bronchial secretions during an operation and to protect the heart from arrhythmias caused by inhalation anaesthetics such as halothane and propofol.

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The combination of psoralen with UVA is known as PUVA. After absorption, psoralen is distributed throughout the body and is activated in the skin by absorbing the energy of UVA radiation. Activated psoralen probably acts by locating between base pairs in the DNA helix and thereby inhibiting replication. PUVA has also been shown to cause alteration in the immune response, which may play a role in reducing inflammation. PUVA treatment is usually reserved for severe, resistant psoriasis, when there is a high success rate, often as high as is seen.


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The extent to which a drug is ionized depends on the pH of the local environment and the pKa of the drug. pH is a measure of hydrogen ion concentration the lower the pH, the higher the hydrogen ion concentration and the greater the acidity of a solution.

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Contrast agents are used to enhance radiological examination of the body. Although air and gas can be used to provide negative contrast, positive contrast agents are most commonly used.

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Human cells have membranes rather than cell walls and so are unaffected by penicillins. Many bacteria produce an enzyme called penicillinase, which destroys some penicillins.

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