December 2017

The adrenal cortex normally secretes hydrocortisone (cortisol) which has glucocorticoid activity and weak mineralocorticoid activity. It also secretes the mineralocorticoid aldosterone. In deficiency states, physiological replacement is best achieved with a combination of hydrocortisone and the mineralocorticoid fludrocortisone; hydrocortisone alone does not usually provide sufficient mineralocorticoid activity for complete replacement.

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Thyroid hormones are used in hypothyroidism (myxoedema), and also in diffuse non-toxic goitre, Hashimoto’s thyroiditis (lymphadenoid goitre), and thyroid carcinoma. Neonatal hypothyroidism requires prompt treatment for normal development. Levothyroxine sodium (thyroxine sodium) is the treatment of choice for maintenance therapy. In infants and children with congenital hypothyroidism and juvenile myxoedema, the dose of levothyroxine should be titrated according to clinical response, growth assessment, and measurements of plasma thyroxine and thyroid-stimulating hormone.

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Diabetes mellitus occurs because of a lack of insulin or resistance to its action. It is diagnosed by measuring fasting or random blood-glucose concentration (and occasionally by glucose tolerance test). Although there are many subtypes, the two principal classes of diabetes are type 1 diabetes and type 2 diabetes. Type 1 diabetes, also referred to as insulin-dependent diabetes mellitus (IDDM), occurs as a result of a deficiency of insulin following autoimmune destruction of pancreatic beta cells. Patients with type 1 diabetes require administration of insulin. Type 2 diabetes, also referred to as non-insulin-dependent diabetes (NIDDM), is due either to reduced secretion of insulin or to peripheral resistance to the action of insulin. Although patients may be controlled on diet alone, many also require oral antidiabetic drugs or insulin (or both) to maintain satisfactory control.

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The majority of virus infections resolve spontaneously in immunocompetent subjects. A number of specific treatments for viral infections are available, particularly for the immunocompromised.

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Before selecting an antibacterial the clinician must first consider two factors—the patient and the known or likely causative organism. Factors related to the patient which must be considered include a history of allergy, renal and hepatic function, susceptibility to infection, ability to tolerate drugs by mouth, severity of illness, ethnic origin, age, whether taking other medication and, if female, whether pregnant, breast-feeding or taking an oral contraceptive. The known or likely organism and its antibacterial sensitivity, in association with the above factors, will suggest one or more antibacterial, the final choice depending on the microbiological, pharmacological, and toxicological properties.

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Drugs for dementia
RIVASTIGMINE:
Indications: mild to moderate dementia in Alzheimer’s disease or in Parkinson’s disease.
Contraindications: breast-feeding.
Dose and Administration: Initially 1.5 mg twice daily, increased in steps of 1.5 mg twice daily at intervals of at least 2 weeks according to response and tolerance; usual range 3–6 mg twice daily; max. 6 mg twice daily.
MEMANTINE HYDROCHLORIDE:
Indications: moderate to severe dementia in Alzheimer’s disease.
Contraindications: breast-feeding.
Dose and Administration: Initially 5 mg in the morning, increased in steps of 5 mg at weekly intervals, up to max. 10 mg twice daily; doses over 5 mg given in 2 divided doses.

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In idiopathic Parkinson’s disease, the progressive degeneration of pigmented neurones in the substantia nigra leads to a deficiency of the neurotransmitter dopamine. The resulting neurochemical imbalance in the basal ganglia causes the characteristic signs and symptoms of the illness. Drug therapy does not prevent disease progression, but it improves most patients’ quality of life. Treatment is usually not started until symptoms cause significant disruption of daily activities.

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