A definition of compliance in this context is the extent to which the behaviour of the patient coincides with the clinical prescription. Although miscompliance is an avoidable error, as many as their medicines as intended. Factors affecting compliance in older people are many and include the complexity of multiple therapy, possible difficulty in understanding instructions, ambiguous or unclear patient information or labelling, preconceived ideas about medicines and their benefits, previous bad experience, difficult dosing regimes, unpalatable formulations and real or imagined side effects.

A small-scale analysis of gastrointestinal practitioners within the northwest of England revealed marked differences between them, the most notable being in the detail included in PGDs and in practitioner understanding about PGDs. Some PGDs were superficial, others were quite in-depth. Discussions with those holding responsibility for creating the PGDs revealed that there was no mechanism for sharing paperwork between Trusts. It is not surprising, therefore, that PGDs for the same application can look remarkably different in different Trusts. A further consequence is that considerable time can be wasted by people repeating the same development work time and time again.

Methotrexate is the most common treatment for resistant and widespread psoriasis. Its main actions are cytotoxic and immunosuppressant. Methotrexate inhibits an enzyme (dihydrofolate reductase) necessary for the synthesis of purine nucleotides (adenine and guanine), which are components of DNA. This results in a reduction in DNA synthesis and particularly affects rapidly dividing cells. Methotrexate is prescribed for oral administration once a week and it is extremely important the patients understand this.

Gabapentin was designed as a GABA analogue and is an effective anticonvulsant but it does not work on GABA receptors. The mode of action remains unknown. Gabapentin is used in partial epilepsy together with other drugs that have failed to provide control alone.

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In both types metabolic disturbances of carbohydrates, proteins and lipids occur with serious long-term consequences including atheroma, micro-angiopathy and neuropathy. Careful control of glucose levels either with insulin replacement by injection or with oral hypoglycaemics together with lifestyle and dietary changes can help avoid long-term complications. This is a hypothetical patient, who might be seen by any health care professional for whatever reason. You are asked to discuss how you would answer the patients questions about his condition, general lifestyle and medication. Mr Qureshi, aged has been prescribed an oral hypoglycaemic drug, gliclazide, by his GP.

Depot preparations are sometimes used for such patients. Older anti-psychotic drugs are classified according to their chemical structure, while the newer ones are known as atypical anti-psychotics. The main distinction is that the newer drugs produce fewer motor side effects. Phenothiazines were developed after it was noticed that the antihistamine, promethazine had a sedative action. Chlorpromazine is the most well known and is the standard against which all other anti-psychotics are compared.

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Cigarette smokers appear to be at a reduced risk of developing Parkinsons disease. The reasons for this are not know, but suggestions include nicotine induction of detoxifying enzymes, inhibition of harmful enzymes or stimulation of factors that protect neurons. Treatment of Parkinsons disease is not usually started until symptoms are interfering with daily life and should be initiated under supervision of a specialist. The aim of drug therapy is to slow progression of the disease, but there is no cure.

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Lidocaine is ineffective orally and its use is restricted to preventing and treating ventricular arrhythmia after myocardial infarction. (Lidocaine by virtue of the same mechanism of action is used as a local anaesthetic. Adverse effects of lidocaine are drowsiness, slurred speech, paraesthesia (pins and needles) and convulsions. Flecainide is an alternative to lidocaine for the treatment of ventricular arrhythmia and can be used orally for disabling paroxysmal atrial fibrillation. Adverse effects of flecainide are nausea, vomiting and precipitation of arrythmias.

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