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It is used for the short-term and symptomatic relief of sleep disturbances. It is a cyclopyrrolone, which increases the normal transmission of the neurotransmitter GABA in the central nervous system.

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Allergy can occur in susceptible individuals. Lidocaine should not be used in patients with hypovolaemia, as this would result in higher plasma levels and consequent increase in risk of toxic effects, or in bradycardia, because there may be further slowing of the heart. 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.

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There is a typical stance with the head flexed on the chest, body bowed, arms, wrists and knees bent. The centre of gravity is forward and the patient walks on the front of the feet with quick short steps.

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Knowledge of the possible reasons, together with consideration of the problems and changes caused by the ageing process, means that many of the adverse affects could be avoided or at least reduced in intensity. The lower the TR of a drug, the more important these considerations become.

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Opioids are drugs that have morphine-like actions and the name comes from the source of morphine and opium, the opium poppy, Papaver somniferum. Opium itself is a mixture of substances that occur in the sap of the opium poppy.

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Cortisol has a complex role in the body, being able to increase circulating glucose levels and mobilize amino acids and fatty acids in response to stress and trauma. Cortisol derived drugs are used therapeutically for their anti-inflammatory and immunosuppressant actions. There are several disorders of the adrenal glands. Hypersecretion of aldosterone (Conns syndrome) is treated with an aldosterone antagonist. Hypersecretion of cortisol (Cushings syndrome) and testosterone are managed with surgery or irradiation.


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Disorders of the CNS can be divided into psychiatric disorders and neurological disorders, although the distinction is not always clear. Psychiatric disorders include types of depression, schizophrenia, anxiety and insomnia and attention deficit hyperactivity disorder.

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Side effects of acitretin include dryness of mucous membranes and skin with localized exfoliation of the palms and plantar surface of the feet, skin and nail erosion and transient thinning of hair. These effects are dose-dependent and reversible.

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