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Cautious use of contrast agents is indicated in patients with epilepsy, hepato-renal syndrome, severe respiratory disease and diabetes. They should not be administered to patients who are taking metformin for Type agents can increase the risk of lactic acidosis. Adverse reactions to iodine contrast agents are rare, especially with the newer non-ionic dimers of low osmolality. Adverse reactions range from mild effects, such as nausea and vomiting, to moderate effects, such as erythema and chest pain. Severe adverse reactions, for example bronchospasm and anaphylactic shock, always need emergency treatment. Nephrotoxicity is a risk with frequent administration of contrast agents.

The term parasite can be applied to any organism that causes disease. A basic knowledge of the characteristics of these organisms is needed in order to understand how they differ from human cells and how these differences can be exploited in chemotherapy. Bacteria are single cell organisms, which can be rod-shaped or spherical. Spherical bacteria are known as cocci, and they can be single or double, in strings or in clumps. Bacteria have a cell wall, DNA and the means to synthesize proteins, but no nucleus.

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PGDs are not suitable where patients need a range of different medicines at the same time. The use of PGDs must be authorized by the National Health Service Trust, Health Authority or Primary Care Trust. An example of PGD use is in accident and emergency analgesia, where a nurse or physiotherapist would be allowed to administer an analgesic before a patient has been seen by a doctor. Another example would be the administration of local anaesthetics and anti-inflammatory corticosteroids by intra- and extra-articular injections by physiotherapists involved in the ongoing management of rheumatology patients. Radiographers have been trained since and management of side effects of radiotherapy under PGDs.


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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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