My Own Pharmacy

VOLATILE SOLVENTS

Tue, 07 Aug 2007 12:33:08 +0000

Since anesthetics administered by inhalation became available, there have been instances of their self-administration, not to produce unconsciousness and anesthesia, but to induce a sense of giddiness, intoxication and sometimes euphoria. Among the agents used in this way are ether, chloroform and nitrous oxide. More recently, certain volatile solvents - such as the acetone found in nail varnish remover, toluene found in the glue used to make models, and petrol - have been used for this purpose. These substances are brain depressants and produce effects somewhat comparable to those produced by alcohol, although the symptoms vary from agent to agent. Initially, there may be mild euphoria and exhilaration, followed by confusion, disorientation and ataxia (disturbed gait), and the user may behave as though drunk.

Some of the substances, including petrol and toluene, may also produce symptoms rather like those sometimes induced by the hallucinogens, such as:

- a marked euphoria
- grandiose delusions
- recklessness
- other delusions and hallucinations
- substantial loss of self-control
- convulsions and coma

Certain of the substances, including petrol, benzene (used in solvents) and carbon tetrachloride (used in dry cleaning), are more likely to result in grave complications, such as liver or kidney damage.
Physical dependence, at least of the magnitude associated with the use of a drug of the alcohol, barbiturate or opium type, does not ordinarily occur. However, abrupt withdrawal after the person has been using substantial amounts may be associated with some degree of lethargy, depression and irritability .
In summary, a number of volatile solvents will produce psychological dependence of varying degrees because of a liking for the effects they produce. Some of these substances will also produce tolerance. The question of physical dependence remains open, but if it occurs, the syndrome is usually less intense than that associated with drugs such as alcohol, barbiturates and opiates.

OPIATES (MORPlllNE)

Tue, 07 Aug 2007 12:29:51 +0000

The outstanding and distinctive characteristic of dependence on opium and morphine-like agents is that the major features - psychological and physical dependence, as well as tolerance - can be initiated by the repeated administration of small doses, and increase in intensity in direct relation to an increase in the dosage. This characteristic implies that dependence on drugs of this generic type may be created within the dosage range generally used for medical purposes, and that the mechanism may be set in motion by the first dose administered. The regular use of opiate-type drugs results in the development of strong physical dependence, and characteristic withdrawal symptoms occur when the narcotic is stopped. With morphine, the abstinence syndrome appears within a few hours of the last dose, reaches a peak within 24 to 48 hours, and subsides spontaneously.

The most severe symptoms usually disappear within 10 days, although a few persist for a much longer period. The time of onset, peak intensity and duration of adverse symptoms vary with the degree of dependence on the drug and with the characteristics of the specific agent involved.
The unique feature of the morphine abstinence syndrome is that it represents changes in all major areas of nervous activity, including alteration in behavior, excitation of the nervous system and depressive effects.

Signs and svmptoms

The following general phenomena may occur:

- anxiety
- restlessness
- generalized body aches
- insomnia
- yawning
- watery eyes
- runny nose
- perspiration
- dilated pupils
- gooseflesh
- hot flushes
- nausea and vomiting
- diarrhea
- elevation of body temperature
- high respiratory rate
- raised blood pressure
- abdominal cramps
- dehydration and loss of appetite
- loss of body weight

A relationship between dose, pharmacological properties and intensity of physical dependence has been mentioned. Taking repeated doses of the drug while the previous doses are still being felt also hastens development of physical dependence.
The time from beginning to take the drug to the appearance of demonstrable physical dependence also varies with the agent. With morphine, this interval (under clinical conditions of administration) is two or three weeks; it is shorter for ketobemidone, probably longer for phenazocine, and definitely longer for co-deine, especially when this is administered by mouth. Finally, with drug dependence of the morphine type, the harm to individuals is, in the main, indirect, arising from their preoccupation with drug-taking: personal neglect, malnutrition and infection. For society, too, the harm resulting from dependence is chiefly related to the preoccupation of the individual with drug-taking; disruption of personal relationships, economic loss and crimes against property are frequent consequences.

Characteristics

• A strong psychological dependence that manifests itself as an overpowering drive or compulsion to continue taking the drug for pleasure or to avoid physical/mental discomfort, and to obtain it by almost any means.

• An early development of physical dependence that increases in intensity, paralleling the increase in dosage; this requires continued administration of the same drug, or of an allied one, to maintain a semblance of equilibrium and to prevent the appearance of the symptoms and signs of withdrawal.

• Both the withdrawal of the drug and the administration of a specific antagonist precipitat definite, characteristic and self-limiting withdrawal symptoms.

• The development of tolerance that requires an increase in dosage to produce the effects obtained initially.

HALLUCINOGENS

Tue, 07 Aug 2007 12:26:30 +0000

Drugs of this type include lysergic acid diethylamide (LSD, “acid”), psilocybin (”magic mushrooms”) and mescaline (peyote). Drugs of the LSD-type induce a state of excitation of the brain that is manifested in a number of ways:

- changes in mood
- anxiety
- distortion in sensory perception
- visual hallucinations
- delusions
- depersonalization
- dilation of the pupils
- increase in body temperature
- rise in blood pressure.

Psychological dependence of drugs of the hallucinogen-type varies greatly, but it is usually not intense. The users may enjoy the effects of these agents and may wish to repeat them, but if such agents are not readily available, these persons will either do without them or accept a substitute. A minority of users may develop strong psychological dependence on these substances. No evidence of physical dependence has been detected when the drugs are withdrawn abruptly. A high degree of tolerance to LSD and to psilocybin develops rapidly and disappears with equal rapidity. Tolerance to mescaline develops more slowly.
Persons who are tolerant to anyone of these drugs will find they are tolerant to the other two. The chief dangers to the individual arise from the psychological effects of hallucinogens. Serious impairment of judgement has led to dangerous decisions and accidents, while a “bad trip” with an associated panic reaction can be a most frightening experience.

Cocaine

Tue, 07 Aug 2007 12:24:16 +0000

Cocaine is the prototype of stimulant drugs that are capable, in high dosages, of inducing euphoric excitement and hallucinatory experiences. Because of these properties, cocaine ranks high in the esteem of experienced drug users, and it can lead to the highest degree of psychological dependence. Cocaine induces feelings of muscular strength and mental alertness, leading individuals to overestimate their capabilities. This, associated with paranoid delusions and auditory, visual and tactile hallucinations, often makes the user very dangerous and capable of serious anti-social acts.

Signs and symptoms
The use of cocaine in large amounts may lead to the following symptoms:
- digestive disorders
- nausea and vomiting
- loss of appetite
- loss of weight
- sleeplessness
- occasional convulsions.
No physical dependence on cocaine develops and, consequently, no characteristic withdrawal symptoms are noted when the drug is stopped abruptly, but

Characteristics
•    A strong psychological dependence.
•    The absence of physical dependence and, therefore, of characteristic withdrawal symptoms.
•    The absence of tolerance; there is, rather, a sensitization to the drug’s effects in some instances.
•    A strong tendency to carry on taking the drug, as found in chewing coca leaves (from which cocaine is derived), or the rapid repetition of doses often observed when injecting the drug is involved.

CANNABIS (MARIJUANA)

Tue, 07 Aug 2007 12:20:36 +0000

CANNABIS (MARIJUANA)

The hemp plant, Cannabis sativa, grows in most temperate to tropical parts of the world. It is used both for its fiber and its psychoactive properties.
Although it is still employed in some traditional systems of medicine, cannabis is of little importance in modem medical practice.
The amount of psychoactive material in a given cannabis preparation is influenced by a number of factors:
- the characteristic of the plant
- the place and circumstances of its
growth
- the nature of the preparation
- the age of the harvested material
- the way in which it is stored.
The usual method of consuming cannabis is by smoking it, but it may be ingested as an ingredient of a food or beverage.
The effects of cannabis appear sooner when it is smoked, and greater amounts are required to produce comparable effects when cannabis is ingested.

Signs and symptoms

The usual immediate symptoms and signs resulting from low to moderate doses, in general order of appearance and increasing dose, may include:
- a mild to marked euphoria
- sensory and perceptual changes
- some decrease in the sense of iden-
tity and reality

- visual, but less often auditory, hallucinations.

Cannabis users often report a sense of increased auditory and visual sensitivity, with an enhanced appreciation of music and works of art. The perceptual changes involve mainly space and time.
At high dosage levels, a state of acute intoxication is usually observed, the major manifestations of which often include:
- paranoid ideas
- illusions and delusions
- depersonalization
- confusion and restlessness
- excitement
- hallucinations.

Inability to walk properly, however, does not normally occur, even after large doses of cannabis. It is possible that some long-term behavioral effects attributed to cannabis use are due largely, or in part, to the socio-cultural setting in which the drug is taken. For example, in a society where the use of cannabis is illegal and generally disapproved of, the user is ipso facto engaged in non-conforming behavior. Drug dependence of the cannabistype is a state arising from the chronic, regular or periodic use of cannabis preparations.

A moderate to strong psychological dependence related to the desired subjective effects.
• Little, if any, physical dependence (some possible withdrawal symptoms have been reported), but there is no evidence that the withdrawal of cannabis, even from an extremely “heavy” user, produces an abstinence syndrome that begins to approach in severity those produced by drugs of the alcohol, barbiturate, and opiate type.
• Perhaps some degree of tolerance as-
sociated with “heavy” use.

BARBITURATES

Mon, 23 Jul 2007 13:44:34 +0000

Drugs producing dependence of the barbiturate-type include not only barbiturates but also some sedatives chemically related to them or to alcohol. In addition, some (but not all) drugs commonly referred to as “tranquillizers” produce dependence of this kind; among those that produce barbituratetype dependence are certain anti-anxiety agents, such as diazepam (Valium) and meprobamate (Equanil, Miltown). Drug dependence of the barbituratetype is a state arising from the repeated administration of drugs of this type on a continuous basis, generally in amounts that exceed the usual prescribed dosages.
There is a strong desire or need to continue the use of the drug, a need that can be satisfied by the drug used initially or by another with barbituratelike properties. There is a psychological dependence on the effects of the drug that is related to the way the individual appreciates those effects. There is physical dependence requiring the presence of the drug for the maintenance of equilibrium and resulting in characteristic physical withdrawal symptoms when the drug is stopped. Tolerance to barbiturate-type drugs does develop and, with relatively low doses, it will become evident within a few days.
However, there is - in contrast to the tolerance to morphine-like drugs - an upper limit to the size of dose to which a person may become tolerant. During the chronic intoxication caused by the continual taking of the drug, there is some persistence of the sedative action, ataxia (unsteady gait), etc., on account of the incomplete development of tolerance; this makes the individual accident-prone. There is also an impairment of mental ability, confusion, increased emotional instability and a risk of sudden overdosage due to the delayed onset of activity, a distorted perception of time, and the relatively limited tolerance to the lethal dose. The withdrawal symptoms are the most characteristic and destructive feature of drug dependence of the barbiturate-type. They begin to appear within the first 24 hours after the cessation of drug-taking, reach a peak of intensity in two to three days, and subside slowly.

Abstinence svndrome

The complex of symptoms that constitutes what is called the “abstinence syndrome,” in their approximate order of appearance, are:
- anxiety
- involuntary twitching of muscles
- tremor of the hand and fingers
- progressive weakness
- dizziness
- distortion in visual perception
- nausea and vomiting
- loss of weight
- precipitous drop in blood pressure
- not infrequently convulsions
- delirium resembling alcoholic delir-
rum
- major psychotic episode.

Convulsions and delirium do not usually occur at the same time; generally, the person may have one or two convulsions during the first 48 hours of withdrawal and then become psychotic during the second or third night. With respect to the psychotic episodes, paranoid reactions, reactions resembling schizophrenia with delusion and hallucinations, a withdrawn stuporous state and panic have all been observed. In a person with a substantial physical dependence on a drug of the barbiturate-type, unsupported withdrawal of the drug is a life-threatening process. Carefully supervised gradual withdrawal is therefore essential.

Characteristics

• A variable, but often marked, psychological dependence related to the desired effects of the drug.

• A marked physical dependence when the dosage levels are substantially above prescribed levels; if the drug is stopped, the resulting withdrawal syndrome can be life-threatening, especially in the absence of appropriate medical treatment.

• The development of an incomplete and variable tolerance to the different pharmacological effects of the drug.

AMPHETAMINES

Mon, 23 Jul 2007 13:41:50 +0000

When this increasing use is carried to an extreme, the psychotoxic effects of large amounts of amphetamine-type drugs may lead to aggressive and dangerous anti-social behavior. Qualitatively, the psychological effects are in many respects similar to those produced by cocaine. It must be emphasized that the effects are dose-related. The occasional, or even the regular, consumption of relatively small doses taken by mouth produces primarily a sense of decreased fatigue, enhanced alertness and wakefulness.

A unique feature of the amphetaminetype drugs is their capacity to induce tolerance, a quality possessed by only a few central nervous system stimulants.

Although tolerance develops slowly when the amount taken is close to the usual therapeutic dosage, a progressive increase eventually permits the taking of amounts several hundred times as great as the original prescribed dose. Although the amphetamines induce little, if any, physical dependence, as measured by the criterion of characteristic physical withdrawal symptoms, it would be inaccurate to state that withdrawal from very large dosages is symptomless. The sudden stopping of a stimulant drug that has masked chronic fatigue, the need for sleep and, perhaps, depression permits these conditions to appear in an exaggerated fashion. Thus, the withdrawal period is characteristically a state of depression, both their previously widespread, but now decreasing, medial use as stimulants and slimming drugs.

Since such therapy commonly involves continuous and prolonged administration, those taking drugs of this kind, for health reasons or otherwise, may develop varying degrees of psychological dependence on them. The stimulation and euphoria induced by drugs of this type lead to their nonmedical use, and the user may increase both the size of the dose and the frequency of administration in order to attain a continuing stimulation and state of elation. When this increasing use is carried to an extreme, the psychotoxic effects of large amounts of amphetamine-type drugs may lead to aggressive and dangerous anti-social behavior. Qualitatively, the psychological effects are in many respects similar to those produced by cocaine. It must be emphasized that the effects are dose-related. The occasional, or even the regular, consumption of relatively small doses taken by mouth produces primarily a sense of decreased fatigue, enhanced alertness and wakefulness. A unique feature of the amphetaminetype drugs is their capacity to induce tolerance, a quality possessed by only a few central nervous system stimulants. Although tolerance develops slowly when the amount taken is close to the usual therapeutic dosage, a progressive increase eventually permits the taking of amounts several hundred times as great as the original prescribed dose.

Although the amphetamines induce little, if any, physical dependence, as measured by the criterion of characteristic physical withdrawal symptoms, it would be inaccurate to state that withdrawal from very large dosages is symptomless. The sudden stopping of a stimulant drug that has masked chronic fatigue, the need for sleep and, perhaps, depression permits these conditions to appear in an exaggerated fashion. Thus, the withdrawal period is characteristically a state of depression, bothpsychological and physical, which probably reinforces the drive to resume using the drug.
Characteristics

• A variable, but sometimes intense, psychological dependence.

• Little, if any, physical dependence and, consequently, no characteristic physical withdrawal symptoms, although withdrawal is followed by a state of mental and physical depression.

• The development of a considerable degree of tolerance to many effects, which is not, however, shared equally by all; nervousness and sleeplessness therefore persist and psychotoxic effects, such as hallucinations and paranoid delusions, may occur.

ALCOHOL

Mon, 23 Jul 2007 13:36:29 +0000

The signs and symptoms of alcohol and of barbiturate intoxication are similar, as are the signs and symptoms of abstinence of these drugs. In addition, barbiturates will suppress the effects of alcohol withdrawal, and alcohol will suppress, at least partially, the symptoms of barbiturate withdrawal. Drug dependence of the alcohol-type may be said to exist when the consumption of alcohol by individuals exceeds the limits that are valid in their culture, if they consume alcohol at times that are deemed inappropriate within that culture, or if their intake of alcohol becomes so great as to injure their health or impair their social relationships. Since the use of alcoholic beverages is a relatively normal part of the cultures of many countries, dependence on alcohol is usually apparent as an exaggeration of culturally accepted drinking patterns.
The manifestations of dependence vary accordingly, depending on how the particular society views the use of alcohol.
Psychological dependence on alcohol occurs in all degrees. In the mildest grade, alcohol is missed or desired if not available at meals or at social functions. A moderate degree of psychological dependence exists when the individual feels compelled to drink in order to work or to participate socially and takes steps to ensure a supply of alcohol for these purposes. Strong dependence is present when amounts are consumed that far exceed the cultural norm, drinking takes place in situations that culturally do not call for it and the person is obsessed with maintaining a supply of alcohol, even to the extent of drinking unusual or poisonous mixtures. Tolerance to alcohol does develop.
During continuous drinking, there is a slight but defmite increase in the amount of ingested alcohol required to maintain a given blood level. In addition, some physiological adaptation occurs so that the alcoholic appears less intoxicated and is less impaired in performance tests at a given concentration of blood alcohol than is a non-alcoholic.

Characteristics
The characteristics of drug dependence of the alcohol-type are:

• Psychological dependence, varying in degree from mild to intense.

• The development of a definite physical dependence that can, however, generally be detected only after the consumption of amounts considerably above the usual socially acceptable levels.

Following the reduction of intake beIowa critical level, characteristic withdrawal symptoms occur that can be largely suppressed by the administration of a barbiturate-like agent.

• The development of tolerance that is irregular and incomplete, so that there is a considerable persistence of disturbances in behavior dependent on the drug effects of the alcohol.

• A frequent consequence of alcoholism is physical illness, particularly of the liver.

Pharmacy Online

Mon, 23 Jul 2007 13:34:56 +0000

The use or abuse of narcotic drugs is characterized by dependence phenomena. Drug dependence is a psychological and sometimes physical state resulting from the interaction between a living organism and a drug, characterized by behavioral and other responses that always include a compulsion to take the drug on a continuous or periodic basis in order to experience its psychological effects and sometimes to avoid the physical/mental discomfort of its absence.
This definition of drug dependence gives only a broad indication of the nature of the phenomena that are, in large measure, common to the various types or groups of drugs.
The characteristics of drug dependence show significant differences from one type of drug to another, a situation that makes it essential to establish clearly the dependence pattern for each type.
Even though some variations occur between individual drugs in each generic group, the consistency of the pattern of pharmacological actions and responses (human-drug interactions) is sufficiently uniform to permit a delineation of the principal types of dependence. Before describing these types, it should be recalled that not all persons who take dependence-producing drugs become dependent on them. It is wellknown, for example, that most users of alcoholic beverages and cannabis preparations do not become dependent on them.

It is, perhaps, not so widely appreciated that the non-medical use of opium and some drugs with similar effects is not always accompanied by the development of dependence.
The risk of such dependence is, however, much greater with drugs of the opiate (morphine) type than with alcoholic beverages and cannabis preparations. The route of administration is also important; administration into a vein involves not only a greater risk of dependence but also of life-threatening complications.

The following factors are important in the development of drug dependency.
- The frequency and regularity of drug use.
- The characteristics and experience of the user.
- The social acceptability of the drug.
- Community attitudes towards intoxication.

HOW TO USE MEDICINES

Mon, 23 Jul 2007 13:29:41 +0000

Important questions to ask your doctor or pharmacist.

(1) What is the name of this medicine or drug?

(2) What results can be expected from taking it?

(3) How long should I wait before reporting if this medicine does not help me?
(4) How does the substance work?

(5) What is the exact dose of the medicine or drug?

(6) What time(s) of the day should I take it?

(7) Can I drink alcoholic beverages while taking this medicine?

(8) Do I have to take special precautions with this medicine in combination with other prescription or non-prescription medicines I am taking?

(9) Do I have to take special precautions with this medicine if I am or want to become pregnant?

(10) Do I have to take special precautions about driving and/or operating machinery while taking this medicine?

(11) Can I take this medicine without regard to whether it is mealtime?

(12) Are there any special instructions I should have about how to use this medicine or drug?

(13) How long should I continue to take this medicine?

(14) Can I have a repeat prescription? (15) Which side effects should I report? (16) Do I have to take all this medicine, or can I stop when symptoms disappear?

(17) Can I save any unused portion of this medicine for future use?

(18) How long can I keep this medicine?

(19) What should I do ifI forget to take a dose of this medicine?

(20) If this medicine is available without a prescription would it be cheaper than the prescription medicine?