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Australian Law¹⁾ relating to prescribing Schedule 4, 8 or 9 poisons by a registered medical practitioner
- MUST NOT issue a prescription unless:
  - the prescription is for the medical treatment of a person other than the practitioner, and,
  - that person is under the practitioner's care, and named in the prescription, and,
  - the practitioner has taken all reasonable steps to ensure a therapeutic need exists for that poison.
in the ED, this would imply that an ED doctor should not write a discharge prescription for a physiotherapy practitioner's patient unless they themseleves have had some degree of personal assessment of that patient

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Mechanisms of action

actions on pathogens
actions on receptors
actions on enzymes
actions on other proteins
actions on cell membranes
actions on intracellular components
actions on the immune system
radioactivity
cytotoxicity
- non-selective - generally destroys the fastest replicating cells such as GIT cells and rapidly replicating tumour cells
- selective / targetted
genetic manipulation
novel methods:
- extracellular vesicles (EVs)
  - derived from mesenchymal stromal cells, carry genomic information or deliver small molecules locally or systemically and can eradicate disease and also deliver next-generation therapeutics
  - have been used to reduce oxidative stress, protein accumulation, pro-inflammatory cytokine expression, and associated neurodegeneration
  - can't cross BBB
- cell-penetrating peptides (CPPs)
  - are positively charged, short sequences of amino acids that can cross the BBB, and penetrate the cornea and skin
  - could translocate nucleic acids and other molecules across cellular membranes
  - use of CPPs has reduced protein aggregation and neuroinflammation, and improved mitochondrial function, restoring functional synapses
  - have low cellular selectivity and transport efficacy but can be combined with EVs, harnessing the natural delivery ability of EVs
  - have poor chemical stability and can be degraded by enzymes
- micro ribonucleic acids (miRNAs)
  - are non-coding, small RNAs, that can mediate cell-to-cell communication and regulate post-transcriptional gene expression
  - can regulate post-transcriptional gene expression of L1CAM, APP, and caspase genes to reduce neurodegeneration
  - miRNAs such as miR-23a can detect cognitive impairments in Alzheimer’s dementia, and altered levels of miR-185-5p and miR-30a-5p are observed in Parkinsons disease
  - low tissue specificity
  - modifying CPPs on EV surfaces to increase arginine enrichment could enhance cell penetration and enable BBB crossing for targeted neuroprotective actions using miRNAs

drugs particularly relevant to emergency medicine

other references

¹⁾

Drugs, Poisons and Controlled Substances Regulations 2017

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pharmacology main index

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Mechanisms of action

drugs particularly relevant to emergency medicine

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