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Long-term use of corticosteroids leads to serious nizagara tablet effects, including suppression of the pituitary-adrenal axis, immunosuppression, muscle wasting, osteoporosis and impaired wound healing. Immunosuppressants such as azathioprine are used when other forms of treatment fail to control the progression of myasthenia gravis. They have severe side effects including bone marrow suppression, gastrointestinal disturbances and hair loss. Strictly speaking, motor neuron disease and multiple sclerosis are diseases of the nervous system, rather than the musculoskeletal system. However, although these conditions are relatively rare, they are included here because the consequences of them affect skeletal muscle function and because health care professionals are likely to be involved in the care of patients with these two conditions.

What are the podiatric consequences of Mr Buckleys current drug treatment. Apart from symptomatic treatment, what would you advise the patient to do. How would you hope that the drug therapy of this patient could be altered to maximize the natural healing properties of the patient. You should be able to answer these review questions from the material in the preceding chapter.

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An example is propranolol. Second generation β-blockers have greater cardio-selectivity and are less likely to cause bronchoconstriction. Examples are atenolol and bisoprolol. Third generation β-blockers also cause peripheral vasodilation and do not adversely affect plasma lipid profiles.

Vitamin A is known to affect normal cell differentiation. Retinoids bind directly to retinoic acid receptors in the cell nucleus and reduce cell proliferation in the skin. Acitretin is currently the only retinoid licensed in the United Kingdom for the treatment of psoriasis and is only available for treatment of patients in hospitals. It is given orally and has anti-inflammatory and cytostatic actions.

Immunocompromized individuals are susceptible to opportunistic infection with fungi that normally would not be pathogenic, or would easily be eliminated with antifungal drugs. Fungal skin infections are considered in Chapter podiatrists. Systemic fungal infections are very serious and can be difficult to treat. Examples of fungal infections are candidiasis, aspergillosis and cryptococcus.

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