The second case study is a patient who could be seen by any health care professional. The use of drugs to eradicate micro-organisms and parasitic worms in the body is called chemotherapy. Drugs that are used to treat infections with micro-organisms are known as antimicrobial drugs or antibiotics. The first antibiotics were naturally produced by micro-organisms; nowadays many are produced synthetically. Infestations with parasitic worms are treated with drugs called antihelmintics. The success of chemotherapy depends on the drugs being relatively more toxic to the infecting organism than to the cells of the human host. This is known as selective toxicity.

The chief adverse effect of anticoagulants is haemorrhage; hypersensitivity reactions are also possible. Platelet inhibitors are most effective in preventing arterial thrombosis. Aspirin reduces platelet aggregation by inhibiting the enzyme cyclo-oxygenase, which is necessary for the formation of thromboxane A in patients with heart disease such as angina and arrhythmia as well as those with previous thrombotic disease. Dipyridamole has a similar effect on cyclo-oxygenase as aspirin. Clopidrogel is another platelet inhibitor that works by inhibiting ADP-induced aggregation. Apart from haemorrhaging, gastrointestinal irritation and bronchospasm are adverse reactions seen with platelet inhibitors.

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Do you think this patient would be suitable for treatment under patient group directions or supplementary prescribing. You should be able to answer the following review questions from the material presented in this chapter. Radio-opaque substances are used in various ways to facilitate radiological examination of parts of the body. They are known as contrast agents or contrast media and are usually based on iodine, barium or gadolinium containing compounds. These substances are injected, swallowed or introduced rectally. Like all drugs, once they have entered the systemic circulation, contrast agents have the potential to be distributed to all parts of the body, although they do not cross cell membranes easily. They may be metabolized, but most are excreted unchanged via the kidneys. Contrast agents used to visualize the bowel do not usually enter the circulation and are excreted rectally.

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Infestations with parasitic worms are treated with drugs called antihelmintics. The success of chemotherapy depends on the drugs being relatively more toxic to the infecting organism than to the cells of the human host. This is known as selective toxicity. Chemotherapy also applies to treatment of cancers. Cancer cells are similar to normal cells and most anticancer drugs show little selective toxicity and therefore produce serious adverse effects. Conventionally, micro-organisms include bacteria, viruses and fungi; protozoa and parasitic worms are parasites.

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Treatment of thromboembolic disease is with anticoagulants and platelet inhibitors to prevent the formation of thrombi and with fibrinolytic drugs to break down thrombi that have already formed. These are used prophylactically postoperatively and in cost of fluconazole at costco who have already had a thrombotic episode. They are most effective at preventing venous thrombosis. Vitamin K antagonists block the activity of vitamin K resulting in the production of inactive clotting factors by the liver. They take a few days to have effect because circulating clotting factors already in existence have to be used up.

If these do not control symptoms, xanthine bronchodilators may be required in addition to one or both of the other two. Attacks of asthma can be prevented by prophylactic use of cromoglicate, although this drug is of no use in an acute attack or in chronic bronchitis. Leukotriene receptor antagonists can be used to reduce the inflammation of asthma particularly in the late phase. Inhaled corticosteroids are useful for treatment and prophylaxis of asthma and for reducing acute exacerbations of bronchitis. In severe cases oral corticosteroids might be needed, although long-term use is best avoided. Severe acute asthma is treated as an emergency with oxygen, inhalation of salbutamol and possibly inhaled antimuscarinics and intravenous and oral corticosteroids, intravenous salbutamol, aminophylline and antibiotics if necessary.

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Exhaustive regulations govern the safe custody of controlled drugs. Generally controlled drugs are kept in a locked metal, cabinet (with a small number of available keys in practice only one), which is inside another locked cabinet (which usually contains other drugs). Restrictions on the destruction of controlled drugs apply to those who must keep controlled drugs records, for example pharmacists. Individual authorities will have their own codes of conduct or practice in the event of surplus controlled drugs. These are the minimum legal requirements and they are intended for the safety of all concerned.

Apart from the anaesthetic itself, what other types of drugs might be used during the operation. Case study The following case study shows a situation where a physiotherapist working in a pain clinic is involved in the cost of fluconazole at costco of a patient. A six-month history of low back pain and leg pain for pain management. The patient is otherwise fit and well, but has not worked for six months. The patient has been diagnosed as having nociceptive low back pain and neuropathic leg pain, which was confirmed by very mild nerve root compression as seen on the magnetic resonance imaging scan. In conjunction with the consultant pain physician, the patients pain management plan was devised to include listing for epidural therapy, rationalization of his medication and referral to a concurrent pain management programme.

Antihaemophilic globulin and Christmas factor complex are prepared from fresh normal plasma. Replacement therapy is used to treat haemorrhage and prophylactically before surgery or dental treatment. Coagulation disorder can be secondary to liver disease because most clotting factors are synthesized in the liver. Vitamin K is essential for successful formation of many clotting factors so lack of vitamin K can cause a coagulation disorder. Normal bile acid production is necessary for absorption of vitamin K from the small intestine. Although lack of vitamin K is rare, because it is present in green leafy vegetables and synthesized by intestinal bacteria, it may occur with a combination of poor diet and long-term use of antibiotics.

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