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Should this be a cause for concern. Digoxin is a drug with a narrow therapeutic ratio, which means therapeutic doses are very close to those that can cause toxic effects. Would you recognize signs of digoxin toxicity and would you know what to do if Mr Frobisher showed these signs. This is a case study of a patient who might be seen in a podiatry clinic. Mr Buckley is sore on the upper surface of the third toe on his right foot. On examination, you find that this sore has all the characteristics of an ulcer.

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Some of them are of particular significance to podiatric practice. A basic knowledge of the clotting mechanism, the causes and consequences of anaemia and lipid metabolism is needed in order to appreciate how these conditions can be treated. Haemostasis is a protective mechanism to stop bleeding from damaged blood vessels. The normal homeostatic control of bleeding consists of three components. If there is a defect in any of these then bleeding will result.

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An example is moclobemide. Nevertheless, MAOIs should be regarded as second line drugs and are indicated when the patient is safe to buy generic viagra online to other therapy, or is phobic, hysterical or has other atypical symptoms. All patients taking MAOIs should carry a warning card highlighting the potential dangers of interaction with other drugs and food substances. Lithium is used for the prophylactic control of mania and hypomania and bipolar depression. It also has a use in unipolar depression that is unresponsive to other antidepressants. Lithium is similar to sodium in that it forms positive ions and can pass through sodium ion channels in neuronal cell membranes.

Corticosteroids suppress all phases of the inflammatory response, including the early swelling, redness and pain and the later stages seen in chronic inflammation. Circulating lymphocytes and macrophages are reduced in number and the formation of prostaglandins and leukotrienes is inhibited via inhibition of phospholipase A enzyme that converts cell membrane phospholipids into arachidonic acid. Prednisolone is used for most rheumatoid disease. It is not the most potent of the corticosteroids available, but it has the advantage of allowing fine adjustment of doses. To minimize side effects the maintenance dose of prednisolone should be kept as low as possible.

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