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One of your patients, with a learning disability, is due to have a minor operation. She has never had an operation before, is feeling quite nervous about the prospect and has many concerns she would like to discuss with you. She has been told that she will have a premedication and asks you what this is for. What can you tell her.

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Ibuprofen, fenbrufen, naproxen and diclofenac all have similar actions and are generally well tolerated. They have a lower incidence of side effects than aspirin, but are more expensive and probably no more effective. Mefenamic acid, and piroxicam and tenoxicam have a spectrum of side effects between that of aspirin and the ibuprofen type. 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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Supplementary prescribing is defined as a voluntary prescribing partnership between an independent prescriber and a supplementary prescriber to implement an agreed patientspecific CMP with the patients agreement. There are a number of criteria that must be met for supplementary prescribing to occur (www. gov. ukenPublicationandstatistics). For instance, the independent prescriber must be a doctor or dentist; the supplementary prescriber must be from a professional group that is legally allowed to be a supplementary prescriber (such as radiographer, nurse, pharmacist, chiropodist, physiotherapist, optometrist); and there must a written CMP relating to a named patient and their specific condition(s).

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When a neurotransmitter or hormone binds with its receptor, the α subunit of the G-protein combined with GTP detaches and activates an effector in the cell. The process stops when the GTP has been hydrolysed to GDP and the subunit recombines with the others. A single neurotransmitter or hormone molecule can activate several G-protein molecules so amplification of effect is achieved. Activation of effector mechanisms results in a product being produced. The product is often a second messenger. Second messengers are intracellular molecules that bring about the effect of the original neurotransmitter or hormone through activation of cellular enzymes.

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Authored by Dr. Michelle Lynn Kaplan, MD


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Non-medical prescribing is now the term applied to prescribing by members of the health care professions who are not medically qualified. Prescribing can be described in the following three ways: of any medicine at public expense; and therefore with no written prescription.

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