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The immobilization significantly reduced the GC S The muscle plasticity is the inherent capacity of the skeletal muscle to adapt to different stimuli. Multiple situations can promote these changes, surch as muscle disuse models, hormonal alterations, nutrition, neuromuscular electrical stimulation, among others deserve emphasis Salvini, In this regard, it is known that the muscular hypotrophy induced by the muscle disuse occurs in association with the orthopedic diseases, such as immobilization in the treatment of fractures, chronic osteoarthritis, and in the treatment with glucocorticoids, or in the situations of maintenance by the prolonged bed rest Reardon et al. The muscle disuse produced by the conditions of prolonged inactivity, limb immobilization or microgravity, induces a condition of insulin resistance in the skeletal muscle, thus increasing its catabolic state Ploug et al. It has been reported that the reduction in the neuromuscular junction activity caused by the forced inactivity or muscle disuse promotes a reduction in the effectiveness of the insulin signaling pathways, in the GLUT4 population, as well as in its genetic expression, compromising energy homeostasis and speeding up the development of insulin resistance Fushiki et al. Moreover, a significant reduction was noted in the muscular weight and the fiber area, and an increase in the area occupied by the connective tissue Durigan et al.

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It is therefore good practice when taking a patients history to ask about incidents of adverse reactions to drugs or allergies in the family. There is a yellow card scheme to notify the Medicines and Healthcare Products Regulatory Agency or the Commission on Human Medicines (CHM; formerly the Committee on Safety of Medicines) of unexpected adverse reactions. This is especially important for new drugs as adverse reactions can be missed during clinical trials. Patients as well as health care professionals can use the yellow card scheme. A new system of reporting adverse reactions, the National Reporting and Learning System has recently been set up by the National Patient Safety Agency. Any health care professional who becomes a supplementary prescriber or an independent prescriber would be expected to contribute to these schemes.

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