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Peripheral actions include nausea, vomiting and postural hypotension, although these are lessened by the use of carbidopa. Central side effects with long-term therapy of levodopa can be serious enough for treatment to be stopped. These include dyskinesias, restlessness, anxiety, confusion, disorientation, insomnia or a schizophrenia-like syndrome. Dyskinesias can be particularly severe, involving unusual writhing movements of the limbs and grimacing and chewing movements of the face. After five years of treatment about half of patients will experience the drug becoming less effective and a gradual recurrence of symptoms, especially hypokinesia, occurs.
Secondary hypertension has a definable cause, which can be secondary to another disorder or can be drug induced. Examples of secondary causes are Cushings syndrome, phaeochromocytoma, hyperaldosteronism, renal disease or use of oral contraceptives and corticosteroids. (Phaeochromocytoma is a benign tumour of the adrenal glands resulting in excessive secretion of adrenaline and noradrenaline. Once the secondary cause has been identified, it should be treated rather than the hypertension itself. Essential hypertension describes raised blood pressure of unknown cause.
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Clinical circumstances will dictate when each would be used and a rule of thumb could be the following. Minor professional latitude is required for one-off events (for example the use of x-ray contrast agents for pre-treatment imaging associated with planning). PGDs would be appropriate in these situations. Broader professional latitude is required so as to be more sensitive to patients on a serialchronic basis.
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General treatment includes relief of pain, treatment of arrhythmia, treatment of shock and correction of heart failure. Anticoagulant therapy is also recommended as prophylaxis against further infarctions. Death may result from ventricular fibrillation, heart block or asystole (see below under arrhythmias). Disorders of the conduction system through the heart are known as arrhythmias (or dysrhythmias), because the inherent rhythm of the heart is disturbed. There are different kinds of arrhythmia depending on which part of the heart is affected.
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Given the increase in dose, what are the side effects Pete might experience. Several months later Pete is still taking amitriptyline, which seems to be having a positive effect but he is found to have signs of liver disease.
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- The only evidence used to support this is that some peers do this in other Trusts.
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Job satisfaction for the physiotherapist may be improved through increased independent working while enhancing skills and knowledge. Other benefits may be had through increased direct patient contact, and the opportunity to expand services to patients.
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The regulations define classes of people who are authorized to supply and possess controlled drugs during the course of their professional activities.
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