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The ECG is a record of the sum of all buy caverta cheap potentials in the heart as it contracts. Action potentials are generated by depolarization followed by repolarization of the cardiac muscle cell membrane. Depolarization is initiated by an influx of sodium ions into the cardiac muscle cells, followed by an influx of calcium ions. Repolarization is brought about by efflux of potassium ions. The phases of a cardiac action potential are shown in Figure change in resting membrane potential of cardiac muscle cells from This is due to influx of sodium ions followed by influx of calcium ions. Contraction of the myocardium follows depolarization.

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HIV infection leads to AIDS when sufficient T lymphocytes have been destroyed and it is diagnosed when there is the presence buy cipro xr 500mg opportunistic infections. These are many and include atypical tuberculosis, herpes, chicken pox and shingles, cytomegalovirus, candida and other fungal infections and protozoan infections including pneumocystis and toxoplasma. There is no cure for HIV infection. The aim of drug therapy is to slow or stop disease progression by using a combination of different antiviral drugs. Treatment should start as early as possible, before the immune system is irreversibly damaged.

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I am grateful to Alison Barlow and Peter Bowden for their helpful ideas with matters relating to podiatry and Louise Stuart, MBE for an insight into supplementary prescribing; to Jan Dodgeon for help with topics relevant to radiography and Chris Frames and Chris ONeal for their help with devising physiotherapy case studies. Special thanks are due to those who contributed to Chapter Peter Hogg and his co-authors, and Anthony Waddington (Podiatric Surgeon). Without their experience in practice this book would have had far less relevance to the health care professionals for whom it was written. I have to thank students past and present for their inspiration, comments and suggestions over the years and I hope future students and practitioners will benefit from this. Thanks to staff at Wiley, to Neil Manley for creating the index, and to Wendy Mould, who copyedited the book. Finally, thanks to Alex for his understanding and patience.

Some drugs need conversion by an enzyme from an inactive pro-drug into an active form before they can be of therapeutic use. Methyldopa, above, could be said to be a prodrug and methylnoradrenaline the active drug. Drugs are capable of producing adverse reactions as well as beneficial therapeutic effects. Adverse reactions can occur by a variety of mechanisms and some of them are well known. Type A adverse reactions are dose-related and can be predicted to occur through accidental overdose, individual differences due to age, disease or genetics or drugdrug interactions. Type B adverse reactions are rarer but potentially more serious.

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