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The role of the podiatric surgeon is to provide specialist management of foot pathology by surgery and alternative measures, either directly or by referral to podiatrists or other healthcare professionals. In the United Kingdom, podiatrists have had access to a range of POMs by means of an exemption order (since administered local anaesthetics) for administration, sale or supply (and recently, November a number of antibiotics and some NSAIDs.

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Each chapter is followed by one or more case studies to illustrate the clinical use of drugs and problems that may arise from drugdrug interactions and adverse reactions. The situations are not based on any particular individuals; rather information has been gathered from many sources including my colleagues in physiotherapy and podiatry and used to construct the cases.

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The care of patients in pre-treatment (for example contrast-based X-ray examinations) also offers scope for the use of PGDs similar to those for diagnostic radiographers, but again it is not known how widespread this is. The philosophy of supplementary prescribing is well suited to the management of therapy patients. Cancer is a cheap soma on line condition and it is highly feasible to set up a CMP between the independent prescriber and supplementary prescriber (therapy radiographer). In many respects, supplementary prescribing is better than PGDs and the values of this mechanism with respect to toxicity management are indicated below: PGDs are inflexible, being restricted to specific medicines at specific doses. Doses cannot be altered and medication cannot be changed to an alternative medicine (within a specific PGD); PGDs require regular updating in accordance with Trust policies, and the associated processes can be labour intensive; supplementary prescribing allows therapy radiographers to have broad professional latitude within their competence in the medicines they prescribe and the amount they administer. This allows for more responsive and individualized care and management.

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Alternative approaches include counselling and relaxation training and avoiding stimulants, alcohol and exercise late in the evening. Psychiatric disorders such as anxiety, depression and abuse of drugs and alcohol should be treated rather than the insomnia. Use of hypnotics is justified to treat insomnia in the short-term if no obvious reasons for it can be found. However, the use of hypnotics rarely benefits chronic insomnia. Long-acting benzodiazepines such as nitrazepam are no longer used as hypnotics because of the hangover effects, which may affect the ability to drive or operate machinery. Loprazolam, lormetazepam and temazepam have a shorter duration of action and little or no hangover effect.


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The development of non-medical prescribing, from recognition of need to widespread availability, took several years. In Baroness Julia Cumberleges report, Neighbourhood Nursing, she noted that patient care was often complicated by the nurses inability, following a full assessment, to prescribe the evidence-based treatment for the GP to follow-up.

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