A COMPEDIUM OF DRUGS: STEROIDS
Cortisone-like drugs (steroids), such as prednisone, are also used for inflammatory diseases. These medications have many serious side effects, but their use may at times be necessary and even life saving. Their administration must be carefully supervised by a physician.
For special kinds of arthritis, such as gout or pseudo-gout, other medications may be useful that are not effective for other arthritic conditions. Colchicine is often taken orally or by injection during an acute attack of gout. It can cause diarrhea, but this improves as soon as the dosage is decreased. After an acute episode of gout is treated with colchicine or other antiinflammatory medication, further attacks may be prevented with allopurinol, which decreases the formation of uric acid. On rare occasions this drug can cause a severe skin rash, but this usually improves when the drug is stopped. An acute attack of gout may also be treated with a nonsteroidal antiinflammatory agent.
Medications to treat heart disease are commonly prescribed for older individuals. The main disorders of the heart are those of abnormal rhythms, poor oxygen supply, and failure of the heart to pump effectively. The drugs that regulate these disorders fall into various categories; some have multiple effects and are often used in combination with others.
The most commonly prescribed drug for the heart is di-goxin. In most countries only one manufacturer markets di-goxin because in the past there was a problem in the drug’s consistency when it was produced by different companies.
The generic name is digoxin, but its trade name is Lanoxin®. This drug has a number of effects on the heart. It improves the pumping strength and therefore is useful in treating heart failure. In addition, it affects the heart’s rhythm and is often used to control certain types of abnormal and irregular heart rhythms. Sometimes both effects are needed simultaneously.
Digoxin can have serious side effects. The amount required for older people and those with kidney disorders is often less than in younger individuals. The first side effect of excessive dosage is nausea and impaired appetite, and occasionally mental confusion. In addition, some older men may experience a swelling of the breasts. However, the most serious complication is a toxic abnormality of the heart’s rhythm different from those it is used to treat. Therefore, this drug must be used only under careful medical supervision. You should never take an extra dose on your own.
Abnormal heart rhythms can cause many symptoms in the elderly. In addition to digoxin, quinidine is also effective for their control. Its side effects include nausea, vomiting, diarrhea, dizziness, and sometimes blood disorders, and many older people cannot tolerate it at all. Procainamide, used in the same fashion, can cause similar problems and must be taken even more frequently. It is often inconvenient for an older person because a nighttime dose is usually necessary for the drug to be effective. However, a long-acting preparation is now available, which may make it more useful, as the doses can be given less often.
Disopyramide is effective for certain heart rhythm disorders. It has fewer side effects than quinidine, but it often causes an uncomfortable dryness in the mouth. In men, especially if they have prostate problems, it may cause the flow of urine to decrease or sometimes stop. However, this is usually reversible when the drug is discontinued. Other medications with similar effects on abnormal heart rhythms include tocainide, flecanide, and mexiletine.
A number of medications used for the treatment of angina pectoris work by increasing the efficiency of the heart and decreasing its need for oxygen. Some drugs also cause some of the coronary blood vessels to dilate and thereby carry more blood. Nitroglycerin was the first drug in the famfly of nitrates that was used for angina pectoris. It is placed under the tongue, where it dissolves, and usually it is taken every few hours or when symptoms of angina pectoris (heart pain) occur. Allowing a tablet of nitroglycerin to dissolve before physical activity rather than after will often prevent an attack of chest pain. A nitroglycerin spray is now available which may be easier to use and be more effective for some older people, especially if they have difficulty using the small nitroglycerin tablets or if the tablets do not dissolve well because of a dry mouth.
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