In such cases, drug therapy is not usually necessary. For anxiety due to fear of flying or after dinner speaking for example a one-off treatment with a benzodiazepine or a β-blocker may be justified. It is generally acknowledged that treatment of bereavement with antianxiety drugs is not appropriate. Grieving is a natural process that serves a purpose in recovery from loss. It is important to realize that some medical conditions can mimic the symptoms of generalized anxiety disorder, for example hyper- or hypothyroidism, hypoglycaemia, drug or alcohol withdrawal and cardiac arrhythmias.

Toxoplasma infection is common in the United Kingdom and normally causes a mild illness that can go unnoticed. In pregnancy, it can however damage the developing foetus and may cause abortion. In patients with HIV infection, toxoplasma can cause encephalitis. Pneumocystis can cause serious pneumonia, almost exclusively in AIDS patients. Both toxoplasma and pneumocystis are treated with drugs containing sulphonamides. Infection with parasitic worms in the United Kingdom is usually confined to round worms or thread worms. In tropical and subtropical parts of the world, infection with parasitic worms is common and widespread.

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Interleukin- killer cells. Tretinoin is the acid form of vitamin A. It induces differentiation in leukaemic cells. Monoclonal antibodies have been developed recently which cause lysis of B lymphocytes. These drugs are intended to be used in particular types of leukaemia when other forms of treatment have failed to produce a long-lasting remission. The most serious adverse reaction with these drugs is the so-called cytokine release syndrome.

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It may irritate sensitive areas. It is prepared as Whitfields ointment and available as a pharmacy medicine. This group of drugs is effective against many fungi. Imidazoles are often the drugs of first choice for treating tinea because they are more effective than other topical drugs described above. The mode of action of imidazoles is to make fungal cells leaky by inhibiting an enzyme necessary for ergosterol synthesis.

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Less serious allergic rhinitis and hay fever are treated mainly with antihistamines and decongestants. Cystic fibrosis is a serious inherited disorder where abnormally viscous mucus can cause obstruction of bronchioles and lead to frequent infection. Management of cystic fibrosis is through a combination of physiotherapy and antibiotics. It is important to identify infecting micro-organisms for effective individual treatment. Pneumonia can result from infection by bacteria, viruses or fungi. Bacterial pneumonia is treated with antibiotics; viral pneumonia may not need specific drug treatment, but in serious cases antiviral drugs can be used.

Water-soluble iodine contrast agents form the largest group of contrast agents in use today. They were originally developed from mono-iodinated pyridine derivatives (in the reduce toxicity led to tri-iodinated benzene derivatives. Nowadays all such contrast media are derivatives of tri-iodinated benzoic acid. Monomeric contrast agents contain one benzene ring and have been used orally for examination of the gall bladder. Dimeric contrast agents contain two benzene rings and are used intravenously. Dimers are less likely to diffuse out of the blood circulation into tissues and are therefore less likely to cause adverse reactions.

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Amiodarone is used to treat arrhythmia. This drug prolongs the refractory period in cardiac muscle without affecting the rate of depolarization. This means that the interval required for re-excitation is prolonged and arrhythmias are suppressed. Amiodarone is effective in both atrial and ventricular arrhythmias. Adverse effects include photosensitivity and skin reactions and the rare but more serious risk of pulmonary fibrosis.

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Others form polynucleotides, which inhibit transcription of DNA to RNA and therefore suppress protein synthesis. Examples of cytotoxic antibiotics are doxorubicin, dactinomycin and bleomycin. Doxorubicin inhibits an enzyme called topoisomerase. During replication of DNA, this enzyme brings about swivelling of individual strands of DNA so they can be copied without becoming entangled in each other. Doxorubicin prevents this.

Use of hypnotics is justified to treat insomnia in the short-term if no obvious reasons for it can be found. However, the use of hypnotics rarely benefits chronic insomnia. Long-acting benzodiazepines such as nitrazepam are no longer used as hypnotics because of the hangover effects, which may affect the ability to drive or operate machinery. Loprazolam, lormetazepam and temazepam have a shorter duration of action and little or no hangover effect. As a rule, benzodiazepines should be used to treat insomnia only when it is severe, disabling or subjecting the individual to extreme distress.

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