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Local anaesthetics can affect both autonomic nerves and the neuromuscular junction. Apart from their local anaesthetic action, local anaesthetics have anticholinergic activity. This is due partly to prevention of acetylcholine release and partly to non-depolarizing competitive block of the acetylcholine receptors on the postsynaptic membrane. The importance of this clinically is that local anaesthetics should be used with great care in patients suffering from myasthenia gravis because of the danger exacerbating the condition and precipitating paralysis, particularly of the respiratory muscles.

 

POM may only be administered by the patient, a practitioner or someone acting in accordance with the directions of a practitioner. The Prescription Only Medicines Order non-injection drugs to the patient for which they are intended and in the manner prescribed. Normally, drugs for injection can only be administered by the patient or by a medical practitioner. However, in an emergency, when used for the purposes of saving life, certain drugs may be administered parenterally by anyone. In addition ambulance paramedics may administer a range of named injections in emergency situations.

 

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Flecainide is an alternative to lidocaine for the treatment of ventricular arrhythmia and can be used orally for disabling paroxysmal atrial fibrillation. Adverse effects of flecainide are nausea, vomiting and precipitation of arrythmias. Quinidine can suppress all types of arrhythmia, but also cause them. Because of this, it is rarely used without specialist guidance. Adverse effects of quinidine are nausea, vomiting, diarrhoea, blurred vision, cardiac depression and arrhythmia.

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