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Side effects associated with long-term oral therapy and high-dose inhaled therapy are moon face, obesity, purple skin striae, hypertension, osteoporosis, diabetes mellitus, susceptibility to infection and adrenal suppression. Long-term side effects of corticosteroid use are discussed in Chapter Regular users of corticosteroids should carry a steroid card. These are of doubtful therapeutic value, yet bring relief to many patients particularly those with COPD.
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The key to safe and effective supplementary prescribing is the relationship between the individual independent prescriber and the individual supplementary prescriber. There are likely to be many nurses, pharmacists and other health care professionals who meet the criteria for training to become supplementary prescribers. The four key principles that should be used to prioritize potential applicants are: access to medicines for them; All health care professionals who are involved with supplementary prescribing will require continuing professional development.
Practitioners have a responsibility to keep themselves up to date with clinical and professional developments.
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It does this by acting on GABA receptors, which causes the opening of chloride channels and hyperpolarization of muscle cells in the worm. This causes paralysis of the worm. Piperazine has few side effects, mainly gastrointestinal disturbances.
This is usually an age-related process that is accelerated in post-menopausal women due to oestrogen deficiency. Oestrogen normally plays a role in the inhibition of bone digestion and this protection is lost after the menopause. Osteoporosis may also occur due to hormone imbalances or chronic hormone therapy.
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In the treatment of chronic pain, a number of drugs may be tried until one is found that produces the most acceptable result to the patient. Aspirin, is often the first choice of analgesia for mild to moderate pain in adults. In large doses, aspirin has anti-inflammatory effects and has a role in the treatment of chronic inflammatory disease. Aspirin also reduces the adhesive and aggregative properties of platelets thereby decreasing the tendency of thrombi formation.
Use is made of this in the treatment of thromboembolic disease.
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An inhibitor of GABA has not been identified, but it has been tentatively called GABA modulin. It is possible that the RAS can be activated through pathways from the cerebral cortex if a situation is perceived as being threatening.
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Guidelines on the management of chronic asthma and COPD are produced by the British Thoracic Society and published in the BNF and MIMS.
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Interferon О has been used for patients with relapsing intermittent multiple sclerosis who can walk unaided.
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For pain that is more severe codeine may be necessary.
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Other areas of care suitable for supplementary prescribing are the treatment of musculoskeletal pain in chronic conditions such as rheumatic diseases or in neuro-rehabilitation, womenвs health and mental health.
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The oxicams have a markedly longer duration of action than the majority of other NSAIDs and are therefore useful in chronic pain.
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They are part of the immune system and help protect the skin from microbial infection.
Based on anecdotal information, the following anomalies have been noted. 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.
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Imipramine was found to inhibit neuronal uptake of noradrenaline and serotonin by pre-synaptic neurons in the brain. Iproniazid was found to inhibit monoamine oxidase, the enzyme that breaks down monoamines.