By the time cancer has been diagnosed, cell growth and spread of malignant cells has probably occurred. In order to understand how drugs used to treat cancer work, an overview of DNA structure and replication and the process of protein synthesis is necessary. There follows a brief outline of these processes. DNA is a large molecule arranged in two long strands coiled around each other to form the double helix. Each strand is composed of millions of nucleotides.

Knowledge of the possible reasons, together with consideration of the problems and changes caused by the ageing process, means that many of the adverse affects could be avoided or at least reduced in intensity. The lower the TR of a drug, the more important these considerations become. Drug absorption can be altered in older people for a number of reasons. The ability of parietal cells in the stomach to produce hydrochloric acid reduces with age. This may result in increased gastric pH, which could cause a slight delay in the absorption of orally administered acidic drugs.

As a tumour gets larger growth slows down, partly because it outgrows its blood supply and partly because not all cells in the tumour divide continuously. Cells in a solid tumour can be in three different states: those that are dividing, possibly in continuous cell cycle; those that are resting in the G those that are no longer able to divide. Cells that are dividing are the best targets for chemotherapy, but they may only represent but cells that are resting are often resistant to cytotoxic drugs and can re-enter the cell cycle after a course of chemotherapy. Drugs used to treat cancer act on some stage in the cell cycle, either on DNA synthesis or spindle formation; or cause damage to preformed DNA. Phase-specific drugs act at a particular point in the cycle, usually S phase or M phase.

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An example of a proto-oncogene is the ras gene. This gene codes for a protein called Ras. Mutation of the ras gene leads to production of abnormal Ras, which activates cell division.

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Intolerance reactions are often unpredictable with no family history of similar events. Generally, the sick, frail, aged and malnourished are price of lasix 40 mg likely to experience adverse effects in response to usual doses. Allergy to local anaesthetics is possible, although this is not common. It is most likely in people who have regular contact with local anaesthetics such as dentists and anaesthetists. Local anaesthetics used in podiatry are all readily absorbed from their sites of administration into the bloodstream, so potentially they can have systemic side effects.

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Ischaemic heart disease can be treated with nitrates, potassium channel activators, β-blockers and calcium channel blockers. All these drugs either improve the blood supply to the myocardium or reduce its metabolic demand for oxygen, or both. Beta blockers are also useful in treating hypertensive patients who do not respond adequately to other antihypertensive drugs, and some types of arrhythmia because they furosemide price in uk the heart rate. While class I calcium channel blockers are used to treat atrial arrhythmia, class II and class III calcium channel blockers are now considered first-line therapy for many patients with hypertension.

Ivermectin is mostly used to treat filariasis and onchocerciasis, which are parasitic worm infections not seen in the United Kingdom. Filariasis causes elephantiasis (blockage of lymphatics and swelling of the limbs) and onchocerciasis causes river blindness in tropical and subtropical countries. Ivermectin has occasional use against round worms, furosemide 40mg tablets and whip worms and is available on a named-patient basis in the United Kingdom. Its mode of action is by enhancing GABA mediated inhibition at the neuromuscular junction.

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