Since a shopping expedition at the weekend, the patient has noticed pain and swelling of the left knee. In addition, the patient has slight impairment of vision and high levels of anxiety, which causes her to rush. The following case study shows a situation where it would be appropriate for a physiotherapist supplementary prescriber to prescribe medication for a patient. A a six month history of low back pain and leg pain for pain management. The patient was triaged to the physiotherapy practitioner for assessment for pain management. Surgery has been excluded for this patient by an orthopaedic surgeon. The patient was diagnosed by the physiotherapy practitioner as having nociceptive low back pain and neuropathic leg pain, which was confirmed by very mild nerve root compression as seen on magnetic resonance imaging scan.

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Silver sulfadiazine is used topically to treat infected wounds ( Sulphonamides inhibit an enzyme, dihydropteroate synthatase, used in the production of folic acid in many bacterial cells. Folic acid is the starting point for a cofactor necessary for DNA synthesis in both bacterial and human cells. However, in susceptible bacterial cells, folic acid must be synthesized, whereas in humans it is provided preformed in the diet. Sulphonamides interact with warfarin by enhancing the actions of these drugs. The most important adverse effects of sulphonamides are rashes, renal failure and various blood disorders. Trimethoprim inhibits another enzyme, dihydrofolate reductase, in the same folic acid metabolic pathway. Folic acid is converted into folate, which then has to be converted into an activated form by dihydrofolate reductase. In this way, trimethoprim interferes with the conversion of folate into its activated form, which is a cofactor in the synthesis of bacterial DNA.

This in turn reduces peripheral vascular resistance and they are generic xanax bars for sale to reduce blood pressure. Examples are amlodipine and nifedipine. Nifedipine also has a use in the treatment of Raynauds disease. In Raynauds disease, there is inappropriate vasoconstriction in the fingers and toes, usually in response to cold. The condition can be mild or severe leading to ulceration and possibly gangrene of the digits.

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There are many antihistamines available and they differ in their duration of action, anticholinergic effects and incidence of drowsiness. Older antihistamines are the most likely to cause drowsiness. Newer ones, for example acrivastine, are preferred because they penetrate the blood-brain barrier less easily and cause less sedation. Nevertheless, all antihistamines should be labelled with a warning that they may cause drowsiness and patients should not drive or operate machinery when taking them. Antihistamines should be used with caution in people with epilepsy, enlargement of the prostate, urinary retention, glaucoma and hepatic disease. Children and older people are more susceptible to the adverse effects.

Cardiac glycosides interact with many other drugs; some increase the risk of toxicity (for example amiodarone and verapamil) and others reduce it (for example cholestyramine, colestipol and antacids), but also reduce therapeutic effect. Diuretics are used to treat cardiac failure and hypertension. Because cardiac failure results in hypertension and leads to oedema, diuretics are used in both cases because they encourage water loss and therefore produce a reduction in circulating blood volume. This lowers blood pressure, reduces the work the heart has to do and improves oedema by generic xanax bars for sale the movement of fluid from the tissues into the circulation. Of the different types of diuretics, the ones used in cardiac failure and hypertension are thiazide diuretics and loop diuretics. Thiazide diuretics work by inhibiting sodium and chloride ion transport in the distal convoluted tubule of the kidney and therefore limit water reabsorption.

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Depending on the precipitating factors, cardiac failure can affect either side of the heart or both. Left ventricular failure can occur due to hypertension, aortic valve disease or coronary artery disease. The symptoms are pulmonary oedema and breathlessness. Right ventricular failure can occur due to chronic lung disease, pulmonary valve disease and congenital defects. The symptoms are systemic oedema, particularly of the legs and ankles.

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The atrium contracts and from generic xanax bars for sale the blood passes through the tricuspid valve to the right ventricle. The ventricle contracts and blood flows through the pulmonary valve and pulmonary arteries to the lungs. Blood comes back from the lungs in the pulmonary veins into the left atrium. The atrium contracts and blood passes through the bicuspid valve into the left ventricle. As the ventricle contracts blood leaves via the aorta passing through the aortic valve.

A community physiotherapist treating a patient in a remote location who is not responding well to medicines prescribed by a consultant could, under a CMP, alter dosages for that patients benefit. Specialist knowledge allows the physiotherapist to explain to patients in these situations how to take their medication for generic xanax bars for sale effect and could help improve compliance. A GP or a consultant, whichever is relevant, would have to be involved in the initial development of a CMP and review process so that physiotherapist could prescribe medication as appropriate for individual patients. Extended scope practitioners are clinical physiotherapy specialists with extended roles who see patients referred for assessment, clinical diagnosis and management. Their work often encompasses tasks that may previously have been undertaken by a medical practitioner. Areas of extended scope practice include rheumatology, paediatrics, orthopaedics, neurology, respiratory care and musculoskeletal medicine.

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