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When a nerve impulse arrives at a synapse, chemical substances are released. These are neurotransmitters, which are stored in pre-synaptic vesicles. On release they cross the synaptic cleft and bind to receptors on the post-synaptic neuron. Binding of neurotransmitter with its receptor is very brief, but it brings about stimulation or inhibition of the post-synaptic neuron. See Figure transmission.
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Beta blockers are also useful in treating hypertensive patients who do not respond adequately to other antihypertensive drugs, and some types of arrhythmia because they slow the heart rate. While class I calcium channel blockers are used to treat atrial arrhythmia, class II and class III calcium channel blockers are now considered first-line therapy for many patients with hypertension. Resistant hypertension can be treated with add-on drugs α Arrhythmias can also be treated with membrane stabilizers and amiodarone. Disorders of coagulation, anaemia and hyperlipidaemia are relatively common, particularly in older patients. Anticoagulant therapy, chiefly warfarin, and platelet inhibitors, such as aspirin, are used prophylactically to prevent thromboembolic disease while fibrinolytic drugs can be used to destroy thrombi already formed and can be life saving after a myocardial infarction or stroke.
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Although the context of practice may change and improve, it is likely that most radiotherapy services will continue to be organized in such a way that the patients needs will be partly met through the use of PGDs and partly through supplementary prescribing. Clinical circumstances will dictate when each would be used and a rule of thumb could be the following. Minor professional latitude is required for one-off events (for example the use of x-ray contrast agents for pre-treatment imaging associated with planning). PGDs would be appropriate in these situations. Broader professional latitude is required so as to be more sensitive to patients on a serialchronic basis. Supplementary prescribing would be appropriate in these situations.
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Treatment of osteomalacia and rickets is by vitamin D supplements. Some drugs, for example anticonvulsants phenytoin, phenobarbital and corticosteroids can lead to osteomalacia and rickets by depressing vitamin D dependent calcium uptake in the intestine.
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In addition, there may be an abnormality of serotonin pathways that interact with dopamine. Most drugs effective in the treatment of schizophrenia block dopamine receptors and some of the newer ones block serotonin receptors.
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Unstable angina is often unpredictable and occurs at rest or because of minor exertion.
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Adverse reactions to drugs can be divided into type A and type B (bizarre). These adverse drug reactions are generally dose-related and most can be predicted.
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