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Other drugs, for example phenobarbital, compete for the same liver enzymes. Phenytoin induces liver enzymes and can affect the metabolism and activity of other drugs, anticoagulants for example. Liver enzymes can also be saturated which means that plasma levels of phenytoin can rise unpredictably as its inactivation slows down. The therapeutic ratio for phenytoin is very small and can vary from patient to patient. Adverse effects of phenytoin range from mild vertigo, ataxia, headache and nystagmus, to the more serious but reversible confusion and intellectual deterioration. Hyperplasia of the gums and hirsutism can occur.
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Nitrates are used primarily to treat ischaemic heart disease. These drugs are potent coronary vasodilators and can increase blood flow to the myocardium.
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They are most often used for induction because, even the fastest acting inhalation anaesthetics take a few minutes to act and cause excitement before anaesthesia is produced, which would be unpleasant for the patient. It also means that the amount of inhalation anaesthetic can be reduced.
Authored by Naim S Issa, MD
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This requires the action of enzymes. New nucleotides pair C cytosine G guanine T thymine A adenine base sugar base phosphate Figure with the existing bases of each strand: adenine nucleotides pair with thymine; guanine nucleotides pair with cytosine.
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Acid conditions result in increased degree of ionization and reduced diffusion of local anaesthetic into neurons. This makes them less effective anaesthetics.
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