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An example of a service using PGDs, which was cited in the Crown Report (Department of Health, a podiatric surgeon can use a PGD to give a patient a supply of NSAIDs for post-operative pain. Podiatrists have gained considerable experience with prescription-only drugs such as anti-microbials, NSAIDs, injectable corticosteroids, anti-emetics and other medicines by working collaboratively with a patients general medical practitioner to obtain the suitable prescription drug or by means of PGDs. Not all podiatrists and podiatric surgeons work exclusively in the National Health Service (NHS) and initiation of appropriate drug therapy by means of PGDs can be delayed while arrangements are made for GP consultation.

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These are receptors for many hormones and neurotransmitters and are coupled to effector systems by a G-protein. The β-adrenoreceptor was the first of this type to be characterized and others seem to be similar. The structure is a single polypeptide chain spanning the membrane, folded into seven transmembrane domains and coupled to a G-protein. G-proteins are found on the inside of the membrane and act as transducers between receptors and cellular effectors.

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Bupivacaine has two to four times the potency of lidocaine and shows similar toxic effects with high doses. It has a slow onset of action, up to eight hours when used for nerve block. Bupivacaine can also be used with adrenaline. Bupivacaine is often used to produce continuous epidural anaesthesia during labour. Prilocaine is similar to lidocaine but has a longer duration of action and is less toxic.

PNausea and requiring rarely require treatment with antiemetics, for emphysema domperidone. Skin reactions can be affected with oral or intravenous antihistamines, which also have an antiemetic order zopiclone generic. Intravenous corticosteroids may be wasted for serious urticaria. A sugar of drugs are used as adjuncts to hold. p pThey can be managed by qualified, registered and trained podiatrists under patient group directions.

Authored by Dr. Robert G. Pugach, MD

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