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Corticosteroids suppress all phases of the inflammatory response, including the early swelling, redness and pain and the later stages seen in chronic inflammation. Circulating lymphocytes and macrophages are reduced in number and the formation of prostaglandins and leukotrienes is inhibited via inhibition of phospholipase A enzyme that converts cell membrane phospholipids into arachidonic acid. Prednisolone is used for most rheumatoid disease. It is not the most potent of the corticosteroids available, but it has the advantage of allowing fine adjustment of doses.
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Non-compliance and reasons why patients do not always take drugs as prescribed should be appreciated. Some common reasons for non-compliance are that the patient has doubts about a drugs effectiveness, they believe they are cured, they misunderstand instructions, dosage regimes are too complicated, or they experience unacceptable side effects.
If a non-permitted professional group uses a PGD then they will break the law. The mechanism for creating and approving a PGD is rigorous, requiring formal input from the Trust as a whole (through Trust medicines management processes).
The Act exempts various activities of professionals, thus allowing doctors to prescribe and pharmacists to dispense. The law says who can and cannot prescribe medicines. It also allows local arrangements to be developed so medicines can be administered to certain types of patients in certain circumstances, for example PSDs and PGDs. Podiatrists and some other health care professionals are specifically mentioned in the Act as being exempt from some of its provisions.
PGDs will continue to be used where large groups of patients undergo imaging procedures that routinely require medicinal administration in a set format, as indicated earlier. This method of working minimizes the need to train large groups of staff to a high level while still maintaining sensitivity to individual patient needs. The majority of radiographer administrations will employ this route, with practitioners, advanced practitioners and consultant practitioners all using this form of administration. Supplementary prescribing will have a limited range of applications because of the reasons indicated above.
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Authored by Gary Young, MD