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Warfarin is an anticoagulant, which binds extensively to plasma proteins, and this is taken into account when dosages are worked out. Aspirin taken with warfarin competes for the same protein binding sites, which means that they each displace the other and the amount of free drug in the plasma is increased for both drugs. Patients stabilized on warfarin should never take aspirin because the effect of increased free plasma concentration of warfarin can be severe haemorrhaging. Coincidental increased activity of aspirin is not as serious. Lipid-soluble drugs enter cells readily.
Hypersecretion of aldosterone (Conns syndrome) is treated with an aldosterone antagonist. Hypersecretion of cortisol (Cushings syndrome) and testosterone are managed with surgery or irradiation. Hyposecretion of aldosterone and cortisol is life threatening and must be treated with replacement therapy of both hormones. Diabetes mellitus is due to either absolute deficiency of insulin or insulin resistance and reduced insulin secretion.
An overall understanding of major body systems and common medications used in those systems is recommended. There is a case for the physiotherapy profession to have an exemption order to the Medicines Act similar to that enjoyed by podiatrists. Exemptions to the Prescription Only Medicines to administer medicines from a specified list to patients on their own initiative. Development of this for physiotherapy would involve drawing up of a list of medications most used by physiotherapists for their patients, which would then have to be put on an exemption schedule through a change in legislation. A suggestion for the exemption list has been made for the use of corticosteroids in acute musculoskeletal treatment, which would allow non-prescribing physiotherapists to inject joints and tendons without always having to refer to a doctor or a PGD.
In males, the testes also secrete testosterone. Disorders of all parts of the adrenal glands are possible. The pancreas is a large organ containing exocrine and endocrine tissue.
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NSAIDs are often needed for pain control and corticosteroids can be useful for reducing exacerbations of inflammation. Corticosteroids should not be used long term because of adverse effects, the most serious being suppression of the pituitary-adrenal axis. Newer drugs are cytokine inhibitors and monoclonal antibodies.
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Stable angina is a condition that is predictable and results from exertion or stress. Symptoms recede when the stress or exertion ceases. This type of angina is usually due to severe chronic coronary artery disease. Unstable angina is often unpredictable and occurs at rest or because of minor exertion.
Authored by Tony Buoncristiani, MD, FAAOS
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There are no effective therapies for Alzheimers disease and no cure. Treatment aims to enhance cholinergic transmission.
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Benedikt
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You should be able to offer general professional advice to patients similar to these. The sixth case study is a patient who might be seen in the podiatry clinic and requires more depth of consideration.
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Siegrid
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Other signs of toxicity are nausea, vomiting and confusion.
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