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The conduction pathway in the heart is shown in Figure Electrical activity in the heart can be picked up by electrodes placed on the skin and recorded as the familiar electrocardiogram. The ECG is a record of the sum of all action potentials in the heart as it contracts.

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Consequently, there is no specific formulary or list of medicines for supplementary prescribing. Provided the medicines are prescribable by a doctor or dentist at NHS expense, and are referred to in the patients CMP, supplementary prescribers are able to prescribe from the complete BNF.

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An understanding of their pharmacology, drug interactions and pharmacokinetics is essential for safe and effective use, which should be under specialist guidance of an oncologist. There are six groups of drugs used in cancer chemotherapy. The first four are all cytotoxic, which means they cause cell death. There are many drugs in each group. The descriptions that follow are not intended to give a comprehensive account of all anti-cancer drugs available, rather to explain the modes of action and to give examples from each group.


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