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This patient of neurocysticercosis is suitable for treatment with anthelmintic drug, because there are multiple active parenchymal cysticerci in the cerebral cortex which in addition to seizures can cause other focal reactions in the brain. Planned killing of the cysticerci under corticosteroid cover may prevent future episodes of the reaction and may abolish the cause of seizures, so that long term antiseizure therapy can be avoided. The preferred drug is carbamazepine; start with 200 mg 3 times a day, increase by 200 mg/day if the seizures recur till they are fully suppressed or a maximum of 1200 mg/day dose is reached. To this patient, it should be given in a dose of 400 mg twice daily with milk or fat-rich food (to enhance absorption) for 15 days. Carbamazepine induces praziquantel metabolism and lowers its blood level, but not that of albendazole. Dexamethasone (which has to be given) also lowers praziquantel blood levels, but increases albendazole absorption. This is essential to suppress the inflammatory reaction to the dying cysticerci killed by albendazole therapy. Possible harm to the foetus by the administered drug ha~ to be weighed against hann to both mother and the baby due 10 untremed disease. There 1s pauciiy ofdaw about safety of majority of drugs during pregnancy: largely because prospective drug trials in pregnant women arc fraught with ethical. The list is not exhaustive and manufacturers literature/ package inserts or other authoritative texts should be consulted. Pnnc1plos of proscribing during prcgmmcy Where possible use nondrug therapy Prescribe drugs only when definitely needed. Avoid newer drugs, unless safety is clearty established Over-the-counter drugs cannot be assvmed to be safe. Use the lowest effective dose Use drugs for the shortest penod necessary If possable. Cold-cough remedies Xylometazoline Oxymetazoline Budesonide Chlorpheniramine Promethazine Nasal drops 7. Antimalarial Isoniazid, Rifampicin, Ethambutol Diloxanide furoate, Paromomycin Chloroquine, Mefloquine, Proguanil Quinine (only in 1st trimester), Pyrimethamine + Sulfadoxine (only single dose) Piperazine Niclosamide Praziquantel Clotrimazole Nystatin Tolnaftate 12. Anthelmintic Albendazole (X), Mebendazole (X) Ivermectin, Pyrantel pamoate, Diethylcarbamazine (X) Amphotericin B (X), Fluconazole Itraconazole (X), Ketoconazole (X) Griseofulvin (X), Terbinafine 13. Estrogens (in oral contraceptives) and bromocriptine (D2 agonist) decrease milk production. Toxic effects on the infant are largely dependent on entry of the drug in milk in pharmacologically significant amounts. Maternal medication or breastfeeding should not be interfered in case of such drugs. However, currently available data are insufficient to make specific recommendations in the case of many drugs and the list given below is not exhaustive. Drugs whose amount in milk is too small to be harmful to the infant, or those found to be safe in ordinary doses Insulins Ipratropium Br. Vitamins (maintenance dose) Warfarin Acetazolamide Albendazole Antacids Antifungal drugs (topical) Aspirin (low dose) Baclofen Beclomethasone (Inhaled) Benzyl benzoate (topical) Bupivacaine Buprenorphine Cephalosporins Cloxacillin Codeine Cromoglycate sod. Fenfluramine Dexfenfluramine Terfenadine Astemizole Phenformin Rofecoxib Valdecoxib Rimonabant Rosiglitazone Nimesulide formulations for children below 12 years age Cisapride Phenylpropanolamine* Sibutramine and R-Sibutramine Gatifloxacin Tegaserod Human placental extract formulations, except for: i. Halogenated hydroxyquinolines in liquid oral antidiarrhoeals or any other dosage form for pediatric use. Corticosteroids with any other drug for internal use, except for metered dose inhalers and dry powder inhalers. Crude ergot with any drug except preparations containing ergotamine, caffeine, analgesics, antihistamines for treatment of migraine, headache. H2 receptor antagonists with Antacids (except those combinations approved by Drugs Controller, India). Salbutamol (or any other bronchodilator) with centrally acting Antitussive and/or an Antihistamine.

The resulting hypoxia, called diffusion hypoxia, is not of much consequence if cardiopulmonary reserve is normal, but may be dangerous if it is low. Diffusion hypoxia can be prevented by continuing 100% O2 inhalation for a few minutes after discontinuing N2O, instead of straight away switching over to air. Diffusion hypoxia is not significant with other anaesthetics, because they are administered at low concentrations (0. Open drop method Liquid anaesthetic is poured over a mask with gauze and its vapour is inhaled with air. A lot of anaesthetic vapour escapes in the surroundings and the concentration of anaesthetic breathed by the patient cannot be determined. Through anaesthetic machines Use is made of gas cylinders, specialized graduated vaporisers, flow meters, unidirectional valves, corrugated rubber tubing and reservoir bag. The gases are delivered to the patient through a tightly fitting face mask or endotracheal tube. Administration of the anaesthetic can be more precisely controlled and in many situations its concentration estimated. However, predetermined O2 and anaesthetic concentration can be accurately delivered. Only as much O 2 and anaesthetic as have been taken up by the patient are added to the circuit. This is especially useful for expensive and explosive agents (little anaesthetic escapes in the surrounding air). The important physical and anaesthetic properties of inhalational anaesthetics are presented in Table 27. For the patient It should be pleasant, nonirritating, should not cause nausea or vomiting. For the surgeon It should provide adequate analgesia, immobility and muscle relaxation. For the anaesthetist Its administration should be easy, controllable and versatile. As the sole agent, N2O (50%) has been used with O2 for dental and obstetric analgesia. However, prolonged N2O anaesthesia has the potential to depress bone marrow and cause peripheral neuropathy. Ether (Diethyl ether) It is a highly volatile liquid, produces irritating vapours which are inflammable and explosive. Diazepam Propofol Lorazepam Etomidate Midazolam Dissociative anaesthesia Ketamine Opioid analgesia Fentanyl Cyclopropane, trichloroethylene, methoxyflurane and enflurane are no longer used. Nitrous oxide (N2O) It is a colourless, odourless, heavier than air, noninflammable gas supplied under pressure in steel cylinders. Patients maintained on 70% N2O + 30% O2 along with muscle relaxants often recall the events during anaesthesia, but some lose awareness completely. Nitrous oxide is a good analgesic; even 20% produces analgesia equivalent to that produced by conventional doses of morphine. Onset of N2O action is quick and smooth (but thiopentone is often used for induction), recovery is rapid, because of its low blood solubility. It tends to increase sympathetic tone which counteracts weak direct depressant action on heart and circulation. In this way concentration of the other anaesthetic can be reduced to 1/3 for the same level of anaesthesia. Induction is prolonged and unpleasant with struggling, breathholding, salivation and marked respiratory secretions (atropine must be given as premedication to prevent the patient from drowning in his own secretions). Ether is not used now in developed countries because of its unpleasant and inflammable properties. However, it is still used in developing countries, particularly in peripheral areas because it is-cheap, can be given by open drop method (though congestion of eye, soreness of trachea and ether burns on face can occur) without the need for any equipment, and is relatively safe even in inexperienced hands. Urine formation is decreased during halothane anaesthesia-primarily due to low g.

Docetaxel is formulated in polysorbate medium which produces less acute hypersensitivity reactions. Estramustine It is a complex of estradiol with a nitrogen mustard normustine, which has weak estrogenic but no alkylating property. However, it binds to -tubulin and interferes with its organization into microtubules exerting antimitotic action. Estramustine gets concentrated in prostate and the only indication is advanced or metastatic prostate cancer that is nonresponsive to hormone therapy. It is orally active, undergoes first pass metabolism in liver into active as well as inactive metabolites, which are mainly eliminated in faeces. A small amount is hydrolysed into estradiol and normustine producing myelosuppression and estrogenic adverse effects, viz. Irinotecan is primarily indicated in metastatic/advanced colorectal carcinoma; also in cancer lung/cervix/ ovary and stomach. Neutropenia, thrombocytopenia, haemorrhage, bodyache and weakness are the other adverse effects. Prominent adverse effects are vomiting, stomatitis, diarrhoea, erythema and desquamation of skin, alopecia and bone marrow depression. Maximum action is exerted at S phase, but toxicity is usually exhibited in G2 phase. Marrow depression, alopecia, stomatitis, vomiting and local tissue damage (on extravasation) are other adverse effects. Epirubicin has been primarily used as a component of regimen for adjuvant therapy of breast carcinoma. Other indications are gastroesophageal, pancreatic, hepatic and bladder carcinoma. Alopecia, hyperpigmentation of skin and oral mucosa, painful oral ulcers, fever and g. Daunorubicin (Rubidomycin), Doxorubicin these are anthracycline antibiotics having antitumour activity. However, utility of daunorubicin is limited to acute myeloid as well as lymphoblastic leukaemia (in which it is highly active), while doxorubicin, in addition, is effective in many Mitoxantrone It is an anthracycline derivative related to doxorubicin with lower cardiotoxicity, probably because it does not produce quinone type free radicals. Clinical utility is relatively narrow, restricted mostly to acute myeloid leukaemia, advanced hormone refractory prostate cancer and occasionally in breast and hepatic carcinoma, non-Hodgkin lymphoma. Though cardiomyopathy can occur, major toxicity is marrow depression and mucosal inflammation. Its primary therapeutic value is in chronic myeloid leukaemia, psoriasis, polycythaemia vera and occasionally in some solid tumours. It is also employed as a radiosensitizer before radiotherapy, and is a first-line drug for sickle cell disease in adults. Gastrointestinal disturbances and cutaneous reactions including pigmentation also occur. Bleomycin this is a mixture of closely related glycopeptide antibiotics having potent antitumour activity. Rate of fluid collection in malignant pleural or peritoneal effusion can be reduced by intrapleural/intraperitoneal injection of bleomycin. Mucocutaneous toxicity and pulmonary fibrosis, but minimal myelosuppression are the special features. Superficial bladder tumours are treated by intravesical instillation of mitomycin C. L-asparaginase is a component of regimen for inducing remission in acute lymphoblastic leukaemia along with Mtx. A significant number of recipients develop allergic reactions (urticaria, chills, fever, rash), including anaphylaxis; deaths are reported.

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