These drugs all have serious side effects and must be used under specialist supervision. Viral warts are common, particularly in children. Without treatment, warts will eventually disappear due to actions of the immune system. There are treatments available, but their use can be tedious, painful and prolonged. Many chemical treatments containing keratolytics are sold as over-the-counter preparations.

Keratolytics break down keratin and soften skin, which improves penetration of other treatments. Salicylic acid ointment is most frequently used either on its own or in combination with coal tar or dithranol. Phototherapy is the use of ultraviolet light, which produces improvement in most patients with psoriasis but should only be done under supervision of a dermatologist. UVB is useful if patients have extensive small plaques of psoriasis resistant to topical treatment. Ultraviolet A requires more specialized equipment and prior administration of an oral or topical photosensitizing drug called psoralen, in which case the treatment is known as photochemotherapy. The combination of psoralen with UVA is known as PUVA. After absorption, psoralen is distributed throughout the body and is activated in the skin by absorbing the energy of UVA radiation.

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The term generalized anxiety disorder is used to describe persistent anxiety with three or more of the following symptoms: increased motor activity; autonomic hyperactivity (sweating, increased heart rate, difficulty breathing, dizziness and gastrointestinal disturbances); apprehension; insomnia; fatigue; loss of appetite; lack of concentration. Symptoms like these are familiar to most people and do not constitute an anxiety syndrome providing they are mild, short-lived and for a reason. In such cases, drug therapy is not usually necessary. For anxiety due to fear of flying or after dinner speaking for example a one-off treatment with a benzodiazepine or a β-blocker may be justified. It is generally acknowledged that treatment of bereavement with antianxiety drugs is not appropriate.

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A type A adverse drug reaction is a possibility if a patient is given a higher than recommended dose for any particular route of administration due to practitioner error. In order to avoid this it is good clinical practice for drug dosages to be checked by another member of staff prior to administration. Where this is not possible, or impracticable, extreme care must be taken to ensure that a patient receives the right dose of the correct medicine by the route intended. Overdose is also possible if the correct dosage of a drug is administered via the wrong route. For example, a local anaesthetic injected into a blood vessel rather than into the tissues produces a rapid rise in blood level and this increases the risk of unwanted effects of the drug. Age can affect the response to drugs, because in the old and the very young metabolism and excretion are not as efficient in comparison to the young healthy adult.

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An example of a fibrate is bezafibrate. A serious side effect or fibrates is a myositis-like syndrome, which is made worse by concurrent use of statins. Such a combination is not recommended except in cases of severe familial hyperlipidaemia. Nicotinic acid derivatives reduce the release of VLDLs from the liver and the removal of triglycerides from them in adipose tissue. This results in a fall in circulating LDL levels. An example is acipimox.

The disease is rarely seen before the age of approximately that is often without symptoms and progresses slowly over many years, being discovered during other investigations in approximately one-fifth of those diagnosed. In Pagets disease, osteoclasts, the cells that digest bone during the normal bone remodelling process, become hyperactive and osteoblasts, the cells that form new bone are unable to replace bone at the same rate. Instead affected bones develop fibrous tissue and become enlarged, which may cause pressure on nerves and result in bone pain and neurological complications. The fibrous tissue reduces the strength of the bone and may lead to stress fractures, which are notoriously difficult to heal. Deformity of the bone(s) is common and may result in an alteration in gait. There is an increased risk of bone tumour, which occurs in approximately age of The majority of patients require no treatment for the disease.

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Examples are atenolol and bisoprolol. Third generation β-blockers also cause peripheral vasodilation and do not adversely affect plasma lipid profiles. An example is celiprolol. Calcium channel blockers are used to treat ischaemic heart disease, arrhythmia and hypertension. This is a diverse group of drugs, which fall into three classes.

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Treatment of other lung diseases, for example lung cancer, is beyond the scope of this book. The following case study is of a patient who might be seen in a podiatry clinic and who might be a suitable case for supplementary prescribing under a clinical management plan. You may need to refer to Chapter and the use of clinical management plans. She sees the practice nurse in between who does the breathing test with her but has to get the doctor to sign the repeat prescription. She confides in you that she very much does not like taking steroids because she has heard bad things about them.

The epiglottis is a flap of cartilage that closes the trachea during swallowing. The larynx is situated in the pharynx at the top of the trachea. It contains membranes called vocal cords, which vibrate when air passes over them to produce sounds, thus allowing speech. The trachea is a short tube supported by incomplete rings of cartilage, which keep the trachea open despite pressure changes that occur during breathing and prevent kinking when the head is turned. The cartilage rings are incomplete to allow for swallowing.

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