Docstoc

drug

Document Sample
drug Powered By Docstoc
					‫بسم هللا الرحمن الرحيم‬
Drug dependence
Introduction

• The non - medical use of drugs is a
  worldwide problem that has reached
  almost epidemic proportions.
• A drug is any substance that, when
  introduced into the living organism, may
  modify one or more of its function.
Introduction cont.

• However, the non-medical use of certain
 groups of drugs, particularly those to
 which dependence will develop, is a major
 problem of concern.

• The health of the drug dependant will be
 adversely affected and his behavior may
 become antisocial and bring him into
 conflict with the law.
Introduction cont.
• Drug dependence is one aspect of the
  wider problems of non-medical use of
  drugs and is a problem with serious
  implications for the user and the society in
  which he lives.
• Drug dependence is best defined as a
  physical and psychic state resulting from
  the repeated (chronic) interaction
  between a living organism and a drug,
  characterized by:
Definition:
1- Irresistible desire to take the drug.
2- Tolerance:
3- Physical and physiological dependence
4- Withdrawal symptoms .
5- Harmful effects to the individual and
  society .
Drug habituation:

• A condition in which the individual feels a
 desire for the drug, without suffering any
 ill-effects when such drug is not taken.
 Thus in case of habituation the desire is
 only emotional (psychic), there is no
 withdrawal symptoms, no tolerance and
 no physical dependence on the drug.
Diagnosis of dependence
1- History from the addict, his relatives or
  friends.
2- Drowsiness, inability to concentrate and
  sometimes itching over the injection sites.
3- Scars of injection along the veins of
  forearm, abscesses, ulcers and
  thrombophlebitis.
4- Appearance of withdrawal symptoms if
  the drug was not taken in the last 24 Hs.
Diagnosis:
5- Constriction of the pupils in case of
  opiates or dilatation after amphetamine
  and cannabis.

6- Nalline test for opiates: Injection of 3 mg
  Nalline leads to rapid dilatation of pupils.

7- Urine and blood analysis for the detection
  of the drug.
CROSS- DEPENDENCE:
• The ability of one drug to suppress
 the manifestations of physical
 dependence produced by another and
 to maintain the physically dependent
 state. It may be partial or complete
 and the degree is more closely
 related to pharmacological effects
 than to chemical similarities.
Drugs causing dependence
* Drug to which dependence may develop
  all act on the central nervous system,
  some are more depressant, others more
  stimulant. The drugs include:
• Opiates and their synthetic analogues
• Coca leaves and cocaine.
• Ethyl alcohol.
• Barbiturates and other sedatives
Drugs causing dependence
• Amphetamine and related
  compounds.
• Tranquillizers.
• Volatile solvents e.g. acetone,
  toluene and carbon tetrachloride.
• Anabolic-Androgenic Steroids
• Designer drugs .
• Nicotine.
1- Opium dependence
• The condition may follow the repeated medicinal
  use of the drug. Addicts take the drug either by
  mouth, by smoking or by injection.
• The patient becomes careless, unreliable
 and dishonest, but no much harm results
 from him.
• Loss of weight, anorexia and chronic
 constipation.
• PPP.
Withdrawal symptoms
(Abstinence):
• They usually start after 12-24 hours from
  the last dose, and then the symptoms
  disappear gradually within 7-10 days.
  They disappear on the spot if morphine is
  given.
• Increased secretions
• Increased respiratory and pulse rate.
• General muscular twitches and abdominal
  cramps.
• Neonates from drug-dependent mothers
  may show withdrawal symptoms up to 56
  hours from birth and will require therapy.
Treatment :
• The addict should be treated as a patient not
  as a criminal .
• Needing careful and continuous medical
  attention for several months in special hospitals
  or sanatoria.
• The success of treatment of addiction in
  general depends on the patient's intention and
  his co-operation
Treatment :

• Gradual withdrawal :
• Abrupt withdrawal :
• Symptomatic treatment :
• Psychiatric therapy:
• Social measurements
2- COCAINE DEPENDENCE
• Clinical picture
1-Anorexia, vomiting and loss of weight.
2- Tremors, convulsions and toxic psychosis.
3- Nasal septal perforation if taken as snuff.
4- Tactile hallucinations
Methods of uses
Cerebral hemorrhage due to cocaine dependence
 3- ALCOHOL DEPENDENCE
1-   General appearance
2-   Conjunctivitis and bronchitis
3-   Chronic gastritis with hypochlorhydria
4-    Liver cirrhosis
5-   Fine tremors and sensory neuritis.
6-   Alcoholic paranoid states & Korsakoff's psychosis.
7- The addict becomes selfish and jealous
 Treatment:
• Diazepam or chlorpromazine if there is convulsion.

• Mannitol for cerebral edema

• Lumbar puncture for delirium tremens

• Ant abuse (disulfuram):

• Vitamin B and liver supports.
Alcoholic Liver cirrhosis
4-BARBITURATE DEPENDENCE

• Short acting barbiturates are used by the
 addicts due to rapid effect

• Barbiturates dependence is very serious as
 heroin dependence
Clinical picture:

1- Physical signs:
• Anorexia,
• constipation.
• Anemia.
• Cyanosis.
• Renal manifestation.
2- Neurological signs :

• Tremors
• Thick slurred speech.
• Ataxia
• Nystagmus.
• Dysdiadochokinesis.
3- Mental disorders :

• Poor memory
• Mental confusion.
• Negligence of personal appearance.

* Abrupt withdrawal is dangerous.
* Gradual withdrawal is the ideal method.
  complete in 2-3 week
5- AMPHETAMINES DEPENDENCE
• marked stimulant effect on the CNS including
  a sense of alertness and well -being.
Clinical picture:
• Anxiety
• Tremors .
• Visual and auditory hallucinations.
• Shock or collapse
• antisocial activities.
Withdrawal symptoms:
•   Somnolence
•   Tremors.
•   Sever fatigue.
•   Risk of suicide.

• Abrupt withdrawal.
• Sedation with phenobarbitone or chlorpromazine.
6- TRANQUILIZERS DEPENDENCE
• Prolonged use of minor tranquilizer may lead to
  addiction e.g. valium .

** Clinical Picture
• Depression,
• Masked Face, and
• Dry Mouth
• Dilated pupils
• Hypothermia
7- VOLATILE SOLVENT INHALATION
• Solvent abuse,
• Solvent sniffing
• Glue sniffing

** The inhalation of volatile organic solvents
  Acetone, carbon tetrachloride, chloroform,
  ether, Toluene, n-Hexane) for pleasurable
  effects is most commonly in poor.
Why there is a rapid effects ?

• These compounds are highly lipid soluble
 and therefore have marked effects on
 nervous tissue .

• Snuffers are unlikely to come to medical
attention but they develop some serious
  acute complication such as deep coma.
THEY MAY PRESENT LATER WITH:

• Jaundice
• Renal failure
• Acute encephalopathy
• Cerebellar degeneration.
• Mixed polyneuropathy.
Treatment

• Stopping solvent inhalation.
• Sedation in a state of panic.
• Patient in coma require supportive
• Renal and hepatic damage may be
  reversible but neurological no improve
• Abstinence from further solvent abuse is
  vitally important.
Other abused substances

8-ANABOLIC-ANDROGENIC STEROIDS

9- DESIGNER DRUGS

10- NICOTINE

				
DOCUMENT INFO
Shared By:
Categories:
Tags:
Stats:
views:8
posted:8/28/2012
language:English
pages:40