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Glutamate acts on N-methyl-d-aspartate receptors in the brain. Drugs have been developed to block these receptors. An example is memantine. There are many disorders of the CNS. Psychiatric disorders include types of depression, psychosis and anxiety. Neurological disorders include Parkinsons disease, epilepsy and Alzheimers disease.

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  • Buscopan is given intravenously.
  • At present, even in the NHS, with good cooperation of all concerned there can be delays in providing necessary POM, due to problems in liaison or communication.
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Other known toxic causes include Wilsons disease, where there is deposition of copper in the basal nuclei, and mercury and manganese poisoning. Environmental factors that may play a role in the aetiology of Parkinsons disease include: living in a rural environment; using well water; exposure to pesticides; a diet high in animal fats or carbohydrates; or low consumption of foods rich in antioxidants such as vitamin C and E.

These drugs therefore act to slow the rate of depolarization, which is more marked in ectopic pacemakers, allowing the SA node to regain control of cardiac rhythm. 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.

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Cardiac failure can result if the myocardium is damaged by ischaemia, if the heart is inefficient due to valve disease or because of excessive peripheral vascular resistance and hypertension. Depending on the precipitating factors, cardiac failure can affect either side of the heart or both. Left ventricular failure can occur due to hypertension, aortic valve disease or coronary artery disease. The symptoms are pulmonary oedema and breathlessness. Right ventricular failure can occur due to chronic lung disease, pulmonary valve disease and congenital defects. The symptoms are systemic oedema, particularly of the legs and ankles.


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