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This effectively prevents bronchoconstriction in response to parasympathetic stimulation. They may be used in combination with other bronchodilators. Antimuscarinics are of particular use in chronic bronchitis where the airways seem resistant to β because they also reduce mucus secretion. They are most frequently used as aerosol inhalers and in nebulizers. An example of an antimuscarinic bronchodilator is ipratropium. Side effects are rare, but patients may get a dry mouth, urinary retention and constipation, all of which are typical effects of parasympathetic inhibition.

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Penicillins were first used in the antibiotics despite the production of many other antibiotics since, and new penicillin derivatives continue to be developed. Penicillins bind to the cell wall of bacteria and prevent cross-linking of proteoglycan chains that stabilize the cell wall. They are bactericidal and most effective on rapidly dividing bacteria. Human cells have membranes rather than cell walls and so are unaffected by penicillins. Many bacteria produce an enzyme called penicillinase, which destroys some penicillins.


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CMPs should be kept as simple as possible. The list below shows what a CMP must include.

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Bacterial infections are treated with antibiotics.

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Ropivacaine is similar, less potent than bupivacaine but less cardiotoxic and with a longer duration of action.

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Exemptions (to the Medicines Act, prescribing and possibly independent prescribing in the future may be better for others. There is a feeling in the podiatry profession that ultimately independent prescribing would allow them to provide the best care in many situations.

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Dr June Crowns working partys second report considered who else should be able to take on prescribing responsibilities. The expectation was that extending prescribing would optimize the use of resources, enhance professional relationships and improve patient access to care.

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