A 76-year-old man complained about progressive dull feelings and weakness of the distal lower limbs that gradually progressed over a couple of months to the proximal legs and the hands. In addition, there was minor myalgia in the proximal muscles. He had had a myocardial infarction with cardiac arrhythmia three years earlier. He was treated with amiodarone afterwards. He did not have visual complaints and was otherwise healthy. He did not drink alcohol or use other drugs. He had not been treated with cytostatic drugs.

Topical applications of drugs onto the corneal surface will act directly on the neuromuscular junction of the iris muscles. The responses are dramatic, except for a few drugs that are metabolized by enzymes in the anterior chamber. This method was essential toward our understanding of how drugs act to produce their pharmacological effects. The action of systemically administered drugs is complicated by side effects of sedation and arousal. Pupillary reflexes have been proposed as a method to evaluate drug intoxications.

Trained in addictions in Edinburgh, perhaps an easier specialty given personal experience. Then obtained a consultant post in the Scottish Borders, and a year later one in Edinburgh.

This chapter reviews current options for pharmacological interventions for treating dementia and MCI. For the last 20 years, ACHe inhibitors have been the main option for symptomatic treatment of dementia. The evidence base for their effectiveness is considered. More recent developments are reviewed for pharmacological interventions intended to be disease-modifying. These aim to remove beta amyloid protein, which is the hallmark of Alzheimer’s disease, with the aim of halting the disease’s progress. This is an emerging field, with an evidence base which is still developing, but represents an exciting development.

This chapter provides an overview of the antiviral drugs currently available, including maraviroc, aciclovir, penciclovir, ganciclovir, amantadine, zydovudine, adefovir, ribavirin, indinavir , oseltamivir, zanamivir, interferon alpha, rituximab , palivizumab, cidofovir, brincidofovir, foscarnet, remdesivir and paxlovid with an indication of their modes of action for treating virus infections, including HIV, herpes viruses, respiratory viruses, HBV, HCV, CMV, adenoviruses , BK, EBV (especially for PTLD), RSV, poxviruses and SARS-CoV-2.

Alcohol and drug misuse are no longer confined to younger people, as the baby boomer cohort of older people shows the fastest rise in rates of mortality from drugs and from alcohol. This chapter provides an overview of substance misuse in older people, starting with its terminological, epidemiological, and pharmacological aspects. It goes on to detail clinical aspects that include screening, diagnosis, and presentations such as alcohol withdrawal, self-harm, drug intoxication, overdose, drug withdrawal, and psychosis.

Particular attention is paid to age-related syndromes such as alcohol-related brain damage – amnestic syndrome and alcohol-related dementia. The chapter also considers the relevance of comorbid physical disorders that can affect a range of pathologies and dysfunctions, particularly in gastro-intestinal, respiratory, cardiovascular, and neurological systems.

The organisation of care is also discussed, in order to highlight the importance of multi-agency working to provide a range of interventions that include liaison old age psychiatry and hepatology. The chapter goes on to cover medico-legal aspects as well as substance misuse and driving. It concludes with a section on discharge planning, emphasising the role of multidisciplinary teams in harm reduction – as well that of carers, non-statutory organisations, medical, and mental health services.

This chapter discusses the pharmaceutical industry, with specific attention given to the role of intellectual property and R&D. The chapter also explains (broadly) the process by which a new drug is approved by the Food and Drug Administration. The key concept in the chapter is the tradeoff inherent in intellectual property protections: stronger protections spur more innovation but at the cost of higher prices for a longer period of time. On the other hand, weaker protections allow for more affordable products more quickly, but at the cost of reduced innovation. The end of chapter supplement explores the role of international trade agreements in solving research and development coordination problems.

When grappling with the extremely uncertain world in which they lived, Byzantine people felt able to choose within a pluralistic mixture of practices and a distinctly diverse set of attitudes, theories, and methodologies. Thinking about ‘drugs’ in Byzantine magic thus involves an exploration of one small part of the fluid spectrum of possible responses that were open to people faced with ill health. Although modern scholars may once have considered these responses under such discrete headings as rational, spiritual, and magical, it is now widely recognised that such distinctions are not applicable. What constituted a drug for the Byzantines, how it was thought to work, and how it might be administered seem to have involved a considerably broader conceptual framework and range of practice than our own. Looking at specific examples of the use of ‘therapeutic substances’ in later Byzantine magic may help us understand this difference.

This chapter introduces the contents of this volume and provides a critical overview of medieval pharmacology with a focus on the Mediterranean from the ninth/tenth century to the fifteenth. It emphasises the importance of drawing evidence from various cultures (Byzantine, Islamicate, Jewish, Latin) and disciplines (history, art history, manuscript studies, and archaeology) in order to discuss topics of broader significance for the global Middle Ages, such as the transfer of medical and pharmacological knowledge. It also shows how our understanding of medieval pharmacology can be significantly expanded by the study of evidence from other areas, such as alchemy, cooking, diplomacy, magic, religion, and philosophy.

Self-reported wellbeing is correlated with activity in a number of brain areas. The sensation of pain is most clearly experienced in the anterior cingulate cortex which registers both physical pain and social pain.

The mind affects the body and vice versa. Wellbeing predicts mortality as well as smoking does. Prolonged psychological stress leads to excessive production of adrenaline/epinephrine and cortisol, over-activity of the immune system and to excessive inflammation in the body. Equally, the body affects the mind. This is obvious in the effects of drugs, recreational and psychiatric.

Our genes have important effects on our wellbeing. We know this in two ways. Identical twins (who have identical genes) are much more similar to each other in their wellbeing than are non-identical twins. Adopted children are more similar in mental health to their biological parents than to the parents who raised them. It is however not possible to neatly separate the effects of the genes and the environment for two reasons: (1) Genes and environment often interact in their effects on wellbeing. (2) Genes and the environment are correlated.