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For example PGDs are used for the provision of medicines to counter the side effects of contrast agents used in diagnostic radiography. Further developments in prescribing for health care professionals came with the advent of supplementary prescribing in Medicines Order and NHS Regulations, podiatrists, physiotherapists and radiographers can now train to prescribe in partnership with and independent prescriber (a doctor or dentist) according to an agreed CMP. The initial take up of supplementary prescribing has been slow in the three health care professions. However, it seems that supplementary prescribing is appropriate for long-term management of disease in the community and for the management of chronic conditions and rehabilitation in community and hospital settings. Many health care professionals would eventually like to move towards independent prescribing, although it is acknowledged that non-medical prescribing in its various forms will continue to have different applications in different situations.

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The expectation was that extending prescribing would optimize the use of resources, enhance professional relationships and improve patient access to care. The report defined mechanisms for what were to become supplementary prescribing and independent prescribing, and recommended that other groups of professionals should be able to legally prescribe. A process was outlined by which the professional bodies might make a case for their members and recommendations were also made about what was to become PGDs. Arising from the two Crown reports, there are currently four ways in which non-doctors non-dentists can prescribesupplyadminister medicines (there are exemptions not covered here). The majority of prescription, supply and administration of medicines should be provided on a named patient basis. Under a PGD, the supply and administration of medicine should apply only when this route offers advantages to the patient without compromising safety. Only specific professional groups can work within a PGD, including radiographers, paramedics, nurses, podiatrists, physiotherapists, speech therapists and pharmacists. If a non-permitted professional group uses a PGD then they will break the law.

Fibrates suppress endogenous cholesterol synthesis by a mechanism not fully understood but which leads to lower levels of circulating VLDLs and LDLs. There is also an increase in LDL receptors on liver cells, which would encourage removal of LDLs from the circulation by liver cells. Fibrates also increase the activity of lipoprotein lipase, which normally breaks down lipoproteins in muscle cells. An example of a fibrate is bezafibrate. A serious side effect or fibrates is a myositis-like syndrome, which is made worse by concurrent use of statins.

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In these cases symptoms may be produced through stimulation of irritant receptors and release of mediators from sensory neurones. Treatment of asthma of whatever cause is by use of bronchodilators to reverse the bronchospasm of the immediate phase and by anti-inflammatory drugs to inhibit or prevent the development of the late phase. Chronic bronchitis is characterized by hypertrophy of the glands of the airway and excessive production of mucus. In some cases, the disease is rapidly progressive and may proceed to fatality within five years of symptoms appearing. In most other cases, there is only a slow progression towards respiratory failure. Symptoms start initially with a winter-only productive cough through to a persistent productive cough often associated with frequent respiratory infection.

It is an overview of a few disorders of the CNS, rather than an attempt to cover them all comprehensively. The emphasis is on conditions and drugs likely to be encountered in general practice. Disorders of the CNS can be divided into psychiatric disorders and neurological disorders, although the distinction is not always clear. Psychiatric disorders include types of depression, schizophrenia, anxiety and insomnia and attention deficit hyperactivity disorder. Neurological disorders include epilepsy and Parkinsons disease, dementia and Alzheimers disease. In order to have some understanding of the nature of diseases of the CNS and the treatments available, it is necessary to have a basic knowledge of the brain and neurotransmitters that are involved in the transmission of information within the nervous system.

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Skin infections should respond within six weeks and onychomycoses within weeks. Infections of the large toenail may take six months or longer to respond. Terbinafine tablets may produce mild to moderate gastrointestinal disturbance, for example anorexia, loss of taste, nausea and diarrhoea, and occasionally urticaria. Cimetidine interacts with terbinafine to increase its plasma concentration. Adjustment of the dose of oral terbinafine may be necessary if the two drugs are taken together.

Crisantaspase breaks down asparagine, which some tumour cells cannot synthesize. Normal cells can synthesize asparagine; therefore the drug is selective for certain tumours. Biological response modifiers are drugs that enhance the patients natural response to cancer. They are used only in specific types of cancer, usually if more conventional chemotherapy has failed. Interferons are produced by many cells of the immune system and some have anti-tumour effects. Interleukin- killer cells.

The Medicines Act secondary legislation since then, provides a legal framework for the manufacture, licensing, prescription, dispensing and administration of medicines. An exemption to the Medicines Act allows certain professionals, including podiatrists, access to specified prescription-only medicines, providing they are appropriately registered with the Health Professions Council. The use of patient group directions allows diazepam 0 2 mg health care professionals to administer prescription-only medicines to specific groups of patients without a normal prescription. Podiatrists, radiographers and physiotherapists are now included in the list of health care professionals who can train to prescribe medicines alongside doctors as supplementary prescribers. Prior to medicinal products in the United Kingdom.

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