Parkinsons disease was the first neurological disorder to be associated with deficiency of a specific neurotransmitter. In Parkinsons disease, there is a deficiency of dopamine in the basal nuclei, which leads to overactivity of cholinergic pathways and the characteristic hypokinesia, rigidity and tremor. Drugs used to treat Parkinsons disease aim to replace dopamine; stimulate dopamine receptors or the release of remaining dopamine; reduce breakdown of dopamine or reduce excessive parasympathetic activity. More recently, attempts have been made to replace dopamine-secreting cells by transplantation of fetal brain tssue. Epilepsy is caused by abnormal high-frequency firing of neurons, either in the whole of the cerebral cortex or in discrete areas of the cerebral cortex (partial epilepsy).

Adrenergic neurone blockers are used rarely to treat hypertension that is resistant to other drugs. They block release of noradrenaline at sympathetic nerve endings and therefore cause vasodilation and reduced peripheral vascular resistance. An example of an adrenergic neurone blocker is guanethidine. Adverse effects include postural hypotension, bradycardia and fluid retention.

The Department of Health has commissioned CPD support for supplementary prescribers through the National Prescribing Centre. In light of the recent extension to the exemptions list with regards to local anaesthetics, it has also been highlighted that podiatrists and podiatric surgeons also require keeping up to date with their resuscitation skills, with immediate life support being the minimum level. For further details of how supplementary prescribing will work and information about which health care professionals can undertake supplementary prescribing, which medicines can be prescribed under supplementary prescribing arrangements and training, see Chapter Acknowledgements I would like to take this opportunity to thank Mr Thomas Galloway, Consultant Podiatric Surgeon, Hereford PCT for his input in helping me produce this section. References Department of Health Review of Prescribing, Supply and Administration of Medicines, Department of Health London.

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