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In substantial overdose, severe, life-threatening liver damage is likely to occur due to excessive production of a toxic metabolite. There is an antidote to paracetamol overdose (acetylcysteine) and provided it is given within eight hours a complete recovery can be made. In the liver, acetylcysteine is converted to glutathione, which forms a harmless conjugate with paracetamol. Centrally acting analgesics are also known as narcotics or opioids. Strictly speaking, narcotic refers to the ability of a drug to induce sleep, which drugs in this group do in high dosage, but the term can be misleading and is best avoided.

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Viscous secretion is treated with vigorous physiotherapy and the use of mucolytics. Infections in cystic fibrosis are often due to Staphylococcus aureus, Haemophilus influenzae or Pseudomonas aeruginosa. Infecting organisms need to be identified so that the most appropriate antibiotics can be used. Antibiotics used to treat respiratory infections in cystic fibrosis commonly include ciprofloxacin, erythromycin, flucloxacillin and amoxicillin.

Griseofulvin enhances the effects of alcohol and reduces the effectiveness of oral contraceptive pills. Griseofulvin should not be used in patients with systemic lupus erythematosus or with liver disease, because it can worsen both of these conditions. Impetigo on small areas of skin can be treated with topical application of fusidic acid. Extensive impetigo needs treating with a systemic antibacterial such as flucloxacillin.

Antiviral drugs are discussed in Chapter Organisms called dermatophytes cause the majority of superficial fungal infections of the skin, hair and nails. The most common dermatophytes that infect humans belong to the trichophyton, epidermophyton and microsporum families. These fungi are commonly occurring in the environment and they thrive in tissues that contain keratin. Such fungal infections of the skin are known as tinea: Tinea pedis is infection of the foot (athletes foot); tinea corporis is infection on the body and tinea capitis is infection of the scalp. Fungal infection of the nails is known as tinea unguium or onychomycosis.

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Other causes are factors such as stress and excessive noise, jet lag, shift work, physical illness and pain, stimulants, sleep apnoea or poor habits at bedtime. Cost of metformin nhs insomnia is insomnia of no obvious cause. An anxiolytic is a drug that reduces feelings of anxiety, whereas a hypnotic is a drug that induces sleep. The two terms are interchangeable in the sense that most anxiolytics will induce sleep when given at night and most hypnotics will cause sedation when given during the day.

Response to infection can be severely impaired as a result of inhibition of the activity of leukocytes and reduction in their numbers. Infections such as tuberculosis can spread extensively before they are discovered. Prolonged use of anti-inflammatory corticosteroids can also impair the function of fibroblasts, which reduces the ability of wounds to heal. In addition, changes in the synthesis of collagen occur resulting in thinning and loss of the mechanical resistance in the skin. On cessation of corticosteroid use, the structure of the skin may recover to a degree but there may be permanent damage in the form of striae particularly at sites of fat accumulation or oedema.

DMARDs can be used in rheumatoid conditions when treatment with NSAIDs alone does not give adequate benefit, or in patients who are taking excessive doses of corticosteroids. Since DMARDs are toxic and the course of rheumatoid arthritis can be unpredictable, their use may be delayed in order to ascertain that severe symptoms are persisting. However, treatment with DMARDs is now recommended as early as possible. This is because it is now known that joint damage occurs within the first onset of symptoms. In use DMARDs reduce the symptoms and signs of inflammatory joint disease and also improve systemic effects such as vasculitis.

Aqueous solubility affects distribution because water-soluble drugs have difficulty crossing cell membranes and therefore tend to remain in the circulation. Consequently, water-soluble drugs are not well distributed throughout the body. They exist in large amounts in the plasma or tissue fluid and are rapidly cleared by the liver or kidney. In practice, such drugs have little therapeutic use.

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Symptoms are hyperthermia, fluctuating level of consciousness, muscular rigidity and autonomic dysfunction and can last five to seven days after withdrawal of the drug. Actions on D the prevention of nausea and vomiting, particularly in patients being treated with cancer chemotherapy or radiotherapy. Anxiety and insomnia are discussed together because the drugs used to treat them are often the same.

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