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Intraspinal and epidural injections are given under certain circumstances to have a local effect, either as anaesthesia or to treat infection of the central nervous system. For details of injection techniques, Whatever the route of administration, a drug must reach its site of action.

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An example of a service using PGDs, which was cited in the Crown Report (Department of Health, a podiatric surgeon can use a PGD to give a patient a supply of NSAIDs for post-operative pain. Podiatrists have gained considerable experience with prescription-only drugs such as anti-microbials, NSAIDs, injectable corticosteroids, anti-emetics and other medicines by working collaboratively with a patients general medical practitioner to obtain the suitable prescription drug or by means of PGDs.

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These are written directions made in favour of health care professionals and require the signature of a doctor and a pharmacist. Since podiatrists, dieticians, occupational therapists, orthoptists, paramedics, physiotherapists, prosthetists and orthotists, radiographers and speech and language therapists comprise the list of professionals able to supply medicinal products under PGDs. A PGD can include a variable dose range, so the health care professional can decide on a suitable dose for individual patients. PGDs should only be used where there is clear benefit for patients and by health care professionals with the necessary expertise and competence. PGDs are not suitable where patients need a range of different medicines at the same time. The use of PGDs must be authorized by the National Health Service Trust, Health Authority or Primary Care Trust.


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General anaesthesia involves three main responses of the nervous system: loss of consciousness, loss of motor reflexes and loss of sensory reflexes.

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Benzodiazepines can sometimes cause paradoxical effects such as an increase in hostility and aggression, excessive talkativeness and excitement or increased anxiety and perceptual disorders. These effects can usually be reduced by altering the dose.

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Other drugs, for example phenobarbital, compete for the same liver enzymes.

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Teratogenesis and carcinogenesis can be considered as adverse reactions to drugs.

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