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  • Classes of antidepressants Tricyclic antidepressants were named after their characteristic chemical structure, although a number of the newer drugs in this group have a different chemical structure but still share similar pharmacological profiles.
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Insomnia is sleep disturbance and can be manifest as difficulty falling asleep, poor quality of sleep or premature awakening. Insomnia can be secondary to other conditions, for example anxiety or depression.

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In addition, drugs that reduce the availability of monoamines cause symptoms of depression. From such observations the monoamine theory of depression and mania was formed: Depression is due to an absolute or relative decrease in monoamines, or a decrease in receptor sensitivity, at certain receptor sites in the brain.

There are several techniques used to administer local anaesthetics: topical, infiltration and nerve block are techniques that can be used by qualified, registered podiatrists in the course of their clinical practice. Local anaesthetics prevent nerve transmission by blocking sodium ion channels from the inside of the neuron. Sensory nerves that carry the stimulus of pain are the most sensitive to the actions of local anaesthetics. Accidental overdose can cause systemic effects including cardiorespiratory depression and loss of consciousness. Lidocaine is probably the most commonly used local anaesthetic.

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The aim of drug therapy is to slow progression of the disease, but there is no cure. There are four groups of drugs, which augment the action of the dopaminergic system, plus anti-cholinergic drugs. Levodopa, is the principle drug in this group. Replacement therapy with dopamine itself is not possible because it does not pass the blood-brain barrier. Levodopa is the precursor of dopamine and it does penetrate the brain where it is converted in the neurons to dopamine by decarboxylation.


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Side effects associated with long-term oral therapy and high-dose inhaled therapy are moon face, obesity, purple skin striae, hypertension, osteoporosis, diabetes mellitus, susceptibility to infection and adrenal suppression. Long-term side effects of corticosteroid use are discussed in Chapter Regular users of corticosteroids should carry a steroid card.

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