It also has an analgesic action and is used as a analgesia without loss of consciousness during labour and manipulations of injured body parts. Adverse effects of nitrous oxide are the risk of bone marrow depression with repeated or prolonged use and megaloblastic anaemia due to interference with the actions of vitamin B The mechanism of action of intravenous anaesthetics is thought to be by enhancement of inhibitory pathways or inhibition of excitatory pathways in the brain. Enhancement of the actions of GABA or inhibition at glutamate receptors seems most important, although modulation of other receptors may play a role as well.

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Hypersensitivity may require withdrawal of treatment. Griseofulvin is an antifungal drug that works by interacting with microtubules to stop mitosis in fungal cells. The drug is used to treat fungal infections of the skin and nails. It is available as a Griseofulvin spray has recently been added to the list of medicines that registered podiatrists can access and supply. Oral griseofulvin is prescription-only and is indicated where topical therapy is ineffective but it has largely been replaced by the newer imidazole antifungals. Griseofulvin should be taken with or after fatty food for adequate absorption.

Certain drugs are excreted via expiration; the rate of excretion depends on plasma concentration, alveolar air concentration and blood-gas partition. Anaesthetic gases are the only group of drugs that are significantly excreted in expired air. A small amount of alcohol is excreted in this way but this accounts for only a small proportion of the overall elimination. Loss of drugs in sweat and breast milk occurs, but is of minor importance although the appearance of drugs in breast milk can have serious consequences for the nursing baby.

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