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Cough
Cough is an explosive exptiation of air from the lungs, and is a protectiv-e–! mechanism to expel excessive exudate or foreign bodies from the respiratory tract,
but other irritant factors may also stimulate the cough reflex. Productive cough
should not be suppressed without good cause, such as when the patient finds
cough exhausting or prevents sleep, but suppression may then have the
undesirable effect of causing retention of sputum. On the other hand, suppression
of the dry, useless or unproductive cough may have corresponding advantages.
Many soothing and demulcent preparations represented by simple linctus have
been used for the symptomatic relief of cough, and another traditional remedy is
steam inhalation, assisted by the addition of Friar’s balsam and menthol.
Expectorant products such as ammonia and ipecacuanha mixture are also used,-,—,–.
even though pharmacological proof of their efficacy may be lacking. Cough
suppressants, represented by codeine, have a central depressant action on the
cough centre, but effective doses may have the disadvantage of causin
Extended use should be avoided because of the possible risk of
habituation. The treatment of severe cough in terminal lung cancer is with more     potent cough suppressants such as diamorphine or methadone.
Approved names    Brand names
codeine linctus    Galcodine
pholcodine linctus
Table 9 Cough suppressants.
Galenophol, Pavocol D, Pholcomed

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The treatment of cancer is difficult because cancer cells are cells that have escaped from the controls that govern normal cell growth and differentiation of function. As a result, uncoordinated growth may develop rapidly, and cancer cells may migrate and invade other tissues. Any anti-cancer drug is therefore likely to damage normal cells, particularly actively growing cells such as those of the bone marrow, and the dose of a cytotoxic agent is often a compromise between that having the desired anti-cancer action and that causing toxicity.
The drugs used in the treatment of cancer can be divided into four main groups, which attack the cells at different points. The alkylating agents interfere with the replication and function of DNA, modify protein synthesis, and have correspondingly wide effects. The antimetabolites interfere with cell metabolism by combining with cell enzymes, or by forming abnormal proteins, or otherwise inhibiting normal development. The cytotoxic antibiotics have an action similar to that of the antimetabolites, but they also have radiomimetic properties, and combined radiotherapy may increase the risks of damage to normal cells. These antibiotics, with the exceptions of dactinomycin and bleomycin, also have undesirable cardiotoxic properties, and dosage requires careful control. Amsacrine is a synthetic cytotoxic agent with some of the properties of the antibiotic group. Some recently introduced drugs include docetaxel, gemcitabine, letrozole, paclitaxel, raltitrexed and topotecan.
The vinca alkaloids are a class apart, as they are plant substances, and act at the metaphase stage of cell division. They are used mainly in acute leukaemias and some lymphomas. Vincristine is almost free from any depressive effects on bone marrow function, vinblastine has some degree of myelosuppressive activity but is less neurotoxic. Vindesine occupies an intermediate position. Etoposide is a synthetic drug with some of the properties of the vinca alkaloids. Other and unclassified cytotoxic agents include the platinum complexes carboplatin and cisplatin, used mainly in ovarian cancer, and the enzyme crisantaspase used in acute lymphoblastic leukaemia. Some cancers are hormone dependent, and the symptoms may be controlled by suitable hormone antagonists. Breast cancer for example may respond to aminoglutethimide, anastrozole, formestane, letrozole and toremifene. Prostatic cancer can be treated with anti-androgens such as fosfesterol, bicalutamidc, cyproterone and flutamide. Certain hormone analogues such as buserelin, goserelin, leuprorelin and triptorelin are also used in cancer of the prostate. A distressing side-effect of high-dose cytotoxic chemotherapy was severe and intractable nausea and vomiting, which could be so intense that patients have been known to refuse further anti-cancer treatment. The problem has since been resolved by the introduction of potent antierneties of the ondansetron type.

Myleran
carmustine    BiCNU
chlorambucil    Leukeran
cyclophosphamide    Endoxana
estramustine    Estracyt
ifosfamide    Mitoxana
lomustine    CCNU
melphalan    Alkeran
mustine    Mustine
thiotepa    Thiotepa
treosulphan    Treosulfan
cladribine    Leustat
gemcitabine mercaptopurine methotrexate
thioguanine    Lanvis
cytarabine    Alexan, Cytosar
fludarabine    Fludara
fluorouracil    Fluoro-Uracil, Efudix
Gemzar Puri-Nethol
Maxtrex

raltitrexed    Tomudex
bleomycin    Bleomycin
dactinomycin    Cosmegen
daunorubicin    DaunoXome
doxorubicin    Doxorubicin
epirubicin    Pharmarubicin
idarubicin    Zavedos
mitomycin    Mitomycin C
mitozantrone    Novantrone
vinblastine    Velbe
vincristine    Oncovin
vindesine    Eldesine
vinorelbine    Navelbine
aldesleukin
amsacrine
bicalutamide
carboplatin
dacarbazine
Proleukin
Amsidine
Casodex
Paraplatin
DTIC
cisplatin    Cisplatin
docetaxel    Taxotere

etoposide
Vepesid
hydroxyurea
Hydrea
iritotecan
Campto
letrozole
Ferrara
octreotide
Sandostatin
paclitaxel
Taxol
pentostatin
Nipent
procarbazine
Natulan
razoxane
Razoxin
topotecan
Hycamptin
tretinoin
Vesanoid
aminoglutethimide
Orimeten
anastrozole
Armidex
buserelin
Suprefact
Cyprostat
Drogenil
flutamide
Lentaron
formestane
goserelin
Zoladex
tamoxifen
Torero
torasemide
Casodex
Emblon, Nottam, Notwadex, Tamofen
bicalutamide
cyproterone

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Bell’s palsy
Bell’s palsy is a unilateral facial paralysis, characterizedby sudden onset and pain, usually behind the ear. The cause is unknown, but the symptoms are thought to be due to local swelling and a compression of the facial nerve. Patients should be reassured that the paralysis is unrelated to stroke and spontaneous recovery usually occurs after some weeks. Corticosteroids are effective if the condition is diagnosed early, and prednisolone is given initially in doses of 60-80 mg daily, decreasing by 10 mg every 2 days for about a week. As the palsy may prevent closure of the affected eye, local treatment with artificial tears or liquid paraffin may be required.
Approved names    Brand names
hypromellose    Tears Naturelle
(artificial tears)    Isopto Alkaline & Plain
prednisolone Deltacortril, Deltastab, Precortisyl, Prednesol
liquid paraffin
Lacri-Lube
polyvinyl alcohol
Hypotears

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