A. Lares. International College.
Her boyfriend Leo blames her for taking the drugs generic rocaltrol 0.25 mcg with visa, and himself for supplying them safe rocaltrol 0.25mcg. Gabby says she can’t think straight and wants Leo to ask the doctors for some drugs so she can say yes to turning off the life support machine discount rocaltrol online american express. Leo says that he cannot believe she is more bothered about her next fix than her dying baby. Source: Ofcom (2005) Smoking, alcohol and drugs on television: a content analysis. Music is related to personal identity, and people often model themselves after musical figures, in terms of dress, behaviour and identity. Reference to drug use in certain types of music is common, and appears to influence drug use. Due to the increasingly globalised trends in music in developed countries, there is a large degree of international crossover in styles of music. Research has suggested that exposure to drug references in music influences cannabis use. American research from 2010 looked specifically at cannabis exposure in popular music and current cannabis use among students aged 14 to 15 years. Public knowledge of the personal lives of media personalities is greater today than it has ever been. Given the relative paucity of evidence examining the frequency of video game use, and how this impacts on behaviour, it is not clear whether video games affect drug use. One American research study has suggested that video game use is positively related to drug use. It is not possible to determine whether use of video games plays a direct role in use of drugs, or if it impacts drug use indirectly, by taking time away from activities that have been shown to have a protective influence on drug use. A 2009 piece of exploratory analysis on drug website viewing among 12 to 18 year olds in America, found that 5. From the limited available evidence, it appears that internet use may influence drug use in a more complex manner than is seen with other forms of popular media. When the internet is mainly used for chat rooms, shopping, entertainment and pornography, an increase in the use of drugs has been found. Summary • Drug use is widely held to be a multifaceted biopsychosocial phenomenon. No single biological, psychological or social factor is exclusively responsible for drug use. Comorbid psychiatric illness and personality type have also been shown to be strongly linked to drug use. The use of drugs activates the mesolimbic dopamine system in the brain, strengthening neural connections, which influences the repetition of drug-related behaviours. Living in a single-parent or step family, substance use among family members, family conflict and poor parental supervision are all indicators for drug use in young people. As discussed in Chapter 6, a key question is what the primary aim of drug policy and legislation should be. At one end of the spectrum, it could simply be to reduce or eliminate illegal drug use, while at the other end it would focus entirely on the health and social problems of the individual drug user, by considering drug dependence as a chronic medical disorder. These are two examples of possible foci: the question is discussed in detail in Chapter 6. Current policy in Britain takes account of both viewpoints, as well as the wider social and economic factors associated with illicit drug use (see Chapters 3 and 6). This chapter examines the development of drug policy in Britain since the mid-19th century and the rationale behind current policy. Opium, and its derivative morphine, were available as patent medicines, in tinctures and other commercial products that were readily accessible through chemists and herbalists. The use of these products declined after the 1868 Pharmacy Act restricted opium sales to the pharmacist’s shop, with the Act requiring pharmacists to keep records of the purchasers. The later 1908 Pharmacy Act moved morphine, cocaine, opium and derivatives containing more than 1 per cent morphine into part one of the poisons schedule. At this point, control was on availability and sale and was largely based on self-regulation by pharmacists, with little Government intervention. There was a small population of morphine-using addicts and some opium and cannabis smoking among artistic, mystic and bohemian circles but the population of drug users at the beginning of the 20th century was relatively small. At the same time, British pharmacists and physicians had nearly 40 years’ experience of dispensing opiates and attempting to control their use. Britain became committed to a drug control policy as a result of the international narcotics control system established in the early 20th century. A series of international meetings, largely prompted by American concern about Far Eastern opiate use, laid the bases of the system. Britain’s involvement in the Indian opium trade with China through the 19th century was brought to an end by the Anglo-Chinese opium agreement. There was some domestic pressure for drug control, with public and press concern about cocaine smuggling to India and opium and morphine smuggling to the Far East, some of which involved British ships. This was of particular concern in the wartime emergency situation of 1915-1916 and was compounded by reports of cocaine use among soldiers, especially those on leave in London, which was seen as compromising army efficiency. In 1916, the Army Council issued an order prohibiting the gift or sale of cocaine and other drugs to soldiers, except on prescription. This was the first time that a doctor’s prescription was required by law for the purchase of specified drugs. The regulation made it an offence for anyone except physicians, pharmacists and vets to be in possession of, to sell or give cocaine. This Convention was the first global attempt at drug control and aimed to reduce the use of morphine and cocaine by restricting the manufacture of, trade in, distribution and use of, these drugs to ‘legitimate’ scientific and medical purposes only. Although it did not specify limiting the use of opium to scientific and medical purposes (and this was, essentially, not covered until 1961 – see Section 5. The Dangerous Drugs Act laid the foundation of further legislation and control policy in Britain and consolidated the precedence of the Home Office over the Ministry of Health in the area of drug policy. The Act generated little debate at large, with recent sensational accounts of recreational drug use among bohemian circles prompting a political and press demand for a penal approach to drug control. The population of opiate users at this time was small, largely middle class, addicted to morphine and in the medical and allied professions, or had become dependent in the course of medical treatment. At the suggestion of the Home Office, the Ministry of Health convened an expert committee (Departmental Committee on Morphine and Heroin Addiction) chaired by Sir Humphrey Rolleston, then President of the Royal College of Physicians, to consider and advise on the circumstances in which it was medically advisable to prescribe heroin or morphine to addicts. The report produced by the committee (usually known as the Rolleston Report),3 reaffirmed the doctor’s freedom to prescribe regular supplies of opioid drugs to certain addicted patients in defined circumstances that the committee regarded as ‘treatment’ rather than the ‘gratification of addiction’. While the possession of dangerous drugs without a prescription was still the subject of the criminal law, addiction to opioid drugs was recognised as the legitimate domain of medical practice (and hence prescribing). This balance of a medical approach within a penal framework became a hallmark of British drug control and has been called the ‘British System’ by commentators. The League of Nations was established after the First World War and provided a centralised body for administration of international drug control.
Intramuscular route or subcutaneous Premedicaton (30 to 60 min before inducton of anaesthesia): 300 to 600 µg 0.25 mcg rocaltrol sale. Precautons Down syndrome; children; elderly; ulceratve colits; diarrhoea; hyperthyroidism; heart failure; hypertension; patents with atrial fbrillaton or futer; lactaton (Appendix 7b); interactons (Appendix 6a); pregnancy (Appendix 7c) discount rocaltrol 0.25 mcg with amex. Since atropine has a shorter duraton of acton than neostgmine; late unopposed bradycardia may result; close monitoring of the patent is necessary cheap rocaltrol 0.25mcg with visa. Adverse Efects Dry mouth; blurred vision; photophobia; fushing and dryness of skin; rash; difculty in micturiton; less commonly arrhythmias; tachycardia; palpitatons; confusion (partcularly in elderly); heat prostraton and convulsions; ventricular fbrillaton; hallucinatons; dilated pupils; psychosis. Dose Oral Adult- 5 mg on night before surgery or minor procedure; thereafer 5 mg for 2h before procedures. Precautons Respiratory disease; muscle weakness; history of alcohol or drug abuse; marked personality disorder; elderly or debilitated patents (adverse efects more common in these groups); hepatc impairment (Appendix 7a) or renal failure; lactaton (monitoring for adverse efcts required Appendix 7b); porphyria; interactons (Appendix 6a, 6c); organic cerebral changes; epileptc patents. Warn patent not to perform skilled tasks; for example operatng machinery; driving for 24 h. Adverse Efects Central nervous system efects common and include drowsiness; sedaton; confusion; amnesia; vertgo and ataxia; hypotension; bradycardia; or cardiac arrest; partcularly in elderly or severely ill patents; also paradoxical reactons; including irritability; excitability; hallucinatons; sleep disturbances; pain and thromboembolism on intravenous injecton. Dose Slow intravenous injecton Adult- Conscious sedaton: approximately 2 mg/min; 5 to 10 min before procedure; initally 2 to 2. Intramuscular injecton Adult- Sedaton in combined anaesthesia: 30 to 100 µg/kg repeated as required by contnuous intravenous infusion 30 to 100 µg/ kg/h (lower doses in elderly). Contraindicatons Acute narrow angle glaucoma; comatose patents; shock; acute alcohol intoxicaton; for intrathecal and epidural use; acute pulmonary insufciency; myasthenia gravis. Precautons Chronic renal failure; cardiac disease; open angle glaucoma; respiratory disorders; neonates; prolonged use and abrupt withdrawal should be avoided; hepatc impairment; pregnancy (Appendix 7c) and lactaton; interactons (Appendix 6a, 6c). Dose Subcutaneous or intramuscular injecton Adult- Preoperatve medicaton before procedure: up to 10 mg; 60 to 90 min before procedure; 20 to 30 mg per 12 h depending on patent weight. Child- (By intramuscular injecton) Preopera- tve medicaton before procedure: 150 µg/kg. Postoperatve analgesia: 8 to10 mg over 30 min (slow intravenous infusion); then 2 to 2. Child- Intra-operatve analgesia: 100 µg/kg; repeated every 40 to 60 min as required. Contraindicatons Patents with acute respiratory depression and when there is risk of paralytc ileus; conditons associated with raised intracranial pressure and in head injury (they interfere with pupilary responses vital for neurological assessment); comatose patents; acute asthma; acute liver disease; acute alcoholism; pulmonary oedema; interactons (Appendix 6a, 6c, 6d); lactaton (Appendix 7b); hepatc impairment (Appendix 7a). Precautons Patents with impaired respiratory functon (avoid in chronic obstructve pulmonary disease) and asthma (avoid during an acute atack); hypotension; myasthenia gravis; prostatc hypertrophy and hyperplasia; obstructve or infammatory bowel disorders; disease of the biliary tract and convulsive disorders; pancreatts; cardiac arrhythmias; hypothyroidism; head injury; circulatory shock; lactaton; pregnancy (Appendix 7c). Adverse Efects Nausea and vomitng (partcularly in inital stages); constpaton; dry mouth and biliary spasm; larger doses produce muscle rigidity; hypotension and respiratory depression; bradycardia; paralytc ileus; abdominal pain; anorexia; dyspepsia; exacerbaton of pancreatts; taste disturbance; hypertension; hypothermia; syncope; bronchospasm; inhibiton of cough refex; restlessness; seizures; paraesthesis; asthenia; malaise; disorientaton; excitaton; agitaton; delirium; raised intracranial pressure; amenorrhoea; myoclonus; muscle fasciculaton and rhabdomyolysis. Contraindicatons Child under 1 year; impaired consciousness due to cerebral depressants or of other origin; porphyria. Precautons Prostatc hypertrophy; urinary retenton; glaucoma; epilepsy; hepatc impairment (Appendix 7a); lactaton (Appendix 7b); interactons (Appendix 6a); pregnancy (Appendix 7c). Warn patent not to perform skilled tasks; for example operatng machinery, driving for 24 h. Adverse Efects Drowsiness (rarely, paradoxical stmulaton in children); headache; antcholinergic efects such as dry mouth; blurred vision; urinary retenton. Drugs for Infammatory Bowel Disease Ulceratve colits and Crohn’s disease are infammatory diseases of the intestnal tract. Ulceratve Colits: Acute atacks of ulceratve colits require treatment with local cortcosteroids such as hydrocortsone in the form of suppositories or retenton enemas. Because of the risk of intestnal perforaton, rectal administraton of hydrocort- sone must be used with extreme cauton in patents with severe ulceratve disease and should not be given to such patents without conductng a thorough proctological exami- naton. More extensive disease requires oral cortcosteroid treatment and severe extensive or fulminant disease needs hospital admission and intravenous cortcosteroid admin- istraton; other therapy may include intravenous fuid and electrolyte replacement, blood transfusion and possibly parenteral nutriton and antbiotcs. The aminosalicylate sulfasalazine is useful in the treatment of symptomatc disease. It also has value in the mainte- nance of remission in ulceratve colits for which cortcos- teroid treatment is unsuitable because of adverse efects. Antmotlity drugs such as codeine and antspasmodic drugs should not be used in actve ulceratve colits because they can precipitate para- lytc ileus and megacolon. Diarrhoea resultng from reduced bile salt absorpton may improve with cholestyramine. Irritable bowel syndrome during remission of ulceratve colits requires avoidance of a high-fbre diet and possibly treatment with an antspasmodic. Crohn’s Disease: Treatment of Crohn’s disease of the colon is similar to that of ulceratve colits. Symptoms and infammaton associated with disease exacerbaton are suppressed by oral cortcosteroids such as prednisolone. Other antbacterials should be given if specif- cally indicated (for example, sepsis associated with fstulas and perianal disease) and for managing bacterial overgrowth in the small bowel. Contraindicatons Glaucoma, refux oesophagits, myasthenia gravis, lactaton, intestnal obstructon. Adverse efects Dry mouth; nausea; vomitng; constpaton; taste loss; anorexia; dizziness; dyskinesia; lethargy, respiratory arrest; drowsiness; photophobia, blurred vision; increased ocular pressure; tachycardia; urinary retenton. Storage Injecton: Store protected from light, in single dose or multple dose containers. Dose Rectal (suppositories) Adult- Ulceratve colits, proctts: 25 mg twice daily for 2 weeks; may be increased to 25 mg 3 tmes daily or 50 mg twice daily in severe cases; in facttal proctts treatment may be required for 6 to 8 weeks. Contraindicatons Use of enemas in bowel obstructon, bowel perforaton, or extensive fstulas; untreated infectons. Precautons Proctological examinaton required before treatment; systemic absorpton may occur; prolonged use should be avoided; lactaton (Appendix 7b); interactons (Appendix 6d); pregnancy (Appendix 7c). Adverse Efects Local pain or burning sensaton; rectal bleeding (reported with use of enema); exacerbaton of untreated infectons; suppositories may stain fabrics; systemic adverse efects. Dose Oral Adult- Ulceratve colits: 1 to 2g 4 tmes daily in acute atack untl remission, reducing to maintenance dose of 500 mg 4 tmes daily. Child- Ulceratve colits: over 2 years; 40 to 60 mg/kg daily in acute atack, reducing to maintenance dose of 20–30 mg/kg daily. Patents should be advised to report any unexplained bleeding, bruising, purpura, sore throat, fever or malaise occurring during treatment; blood count should be performed and sulfasalazine stopped immediately if there is suspicion or evidence of blood disorder; pregnancy (Appendix 7c). Adverse Efects Nausea, exacerbaton of colits; diarrhoea, loss of appette, fever; blood disorders (including Heinz body anaemia, megaloblast- ic anaemia, leukopenia, neutropenia, throm- bocytopenia); hypersensitvity reactons (in- cluding rash, urtcaria, Stevens-Johnson syn- drome (erythema multforme), exfoliatve dermatts, epidermal necrolysis, pruritus, photosensitzaton, anaphylaxis, serum sick- ness, intersttal nephrits, lupus erythema- tosus-like syndrome); lung complicatons (including eosinophilia, fbrosing alveolits); ocular complicatons (including periorbital oedema); stomatts, parotts; ataxia, asep- tc meningits, vertgo, tnnitus, alopecia, pe- ripheral neuropathy, insomnia, depression, headache, hallucinatons; kidney reactons (including proteinuria, crystalluria, haema- turia); oligospermia; rarely, acute pancreat- ts, hepatts; urine may be coloured orange; some sof contact lenses may be stained. Drugs for Myasthenia Gravis Myasthenia gravis is a rare autoimmune neuromuscular disorder of peripheral nerves characterized by variable weak- ness of voluntary muscles. It occurs when normal communicaton between the nerve and the muscle is inter- rupted at the neuromuscular juncton. Contraindicatons Hypersensitvity, pregnancy (Appendix 7c); lactaton (Appendix 7b).
Oligonucleotide-loaded nanogel particles are small (<100 nm in diam- eter) order genuine rocaltrol line, stable in aqueous dispersions buy rocaltrol 0.25 mcg overnight delivery, show no agglomeration with time purchase rocaltrol without prescription, cross the intestinal cell layers, and affect gene transcription in a sequence-speciﬁc manner (8,16). The nanogels form a protective coating around the oligonucleotides and pre- vent their degradation. They are composed of three func- tional units: the inner core, the internal shell containing the repetitive units, and the terminal functional groups (18). They can be synthesized by divergent approach (starting from the central core and proceeding toward the outermost periphery), a reverse convergent approach, or by covalent attachment or self-assembly of dendrons (18,19). Apparent similarities of dendrimer architecture with “rigidiﬁed micelles” make them attractive candidates for drug and gene delivery. Smaller drug moieties can be encapsulated in the inner core, whereas oligonucleotides can form complex with cationic surface groups (19). The drug is dissolved or encapsulated or attached to the nanoparticles and, depending on the methods used for preparation, one can get nanospheres, nanocapsules, or aquasomes (16). Nanospheres are spheri- cal particles composed of natural polymers such as gum, chitosan, gelatin, albumin, or collagen and the drug or gene is uniformly dispersed in it (7,16). Nanocapsules are vesicular materials in which the drug or gene is encased in a cavity surrounded by a polymeric material (16). Aquasomes are spherical particles composed of cal- cium phosphate or ceramic diamond covered with a polyhydroxyl oligomeric ﬁlm (7). Recently, biodegradable polymeric nanoparticles, consisting of poly(glycolide) or poly(lactide-co-glycolide), are attracting considerable attention as potential gene delivery vehicles, as they are able to deliver peptides and genes through a peroral route of administration (16). Application of nanotechnology in cancer research: Review of progress in the National Cancer Institute’s Alliance for Nanotechnology. Scientiﬁc community worldwide has been working toward discovering “nanoscale” solutions to treat these diseases by using nanoparticle-based drug delivery systems. The applications of such sys- tems for cancer treatment are discussed in the following sections. Surgical treatment (excision of the tumor) is usually the ﬁrst choice of treatment preferred by physi- cians. However, surgical excision is not effective when the cancer cells have inﬁl- trated the nearby vital organs or have spread to distant parts of the body (metas- tasis). Cryosurgery is another surgical technique that is used for freezing and killing the tumor cells. It is an alternative to surgical excision and is used to treat tumors that have not spread to distant organs and for the treatment of precancerous or noncancerous lesions. Chemother- apeutic drugs may destroy healthy tissue along with cancer cells and carcinoma- tous tissue (cytotoxicity). The cytotoxic effect of chemotherapeutic drugs is highest in bone marrow, gonads, hair follicles, and digestive tract, all of which contain rapidly proliferating cells. The adverse effects of chemotherapy include fatigue, nausea, vomiting, alopecia (loss of hair), gastrointestinal disturbance, impaired fer- tility, impaired ovarian function, and bone marrow suppression resulting in ane- mia, leucopenia, and thrombocytopenia (3,4). Another technique of cancer treat- ment is radiation therapy, which uses radiation energy to destroy cancer cells and reduce the size of tumors. Bone marrow transplantation and peripheral blood stem cell transplantation are done to restore stem cells that are destroyed by high doses of radiation or chemotherapy. Recent research work has been focused on studying gene therapy for cancer treatment. Gene therapy is an experimental treatment that involves introducing genetic material into the cancer cells to destroy the cells (6). Angiogen- esis plays an important role in the growth and spread of cancer cells (7). New blood vessels act as a source of oxygen and nutrients to the cancer cells, allowing these cells to grow, invade nearby tissue, spread to other parts of human body, and form new colonies of cancer cells. Angiogenesis inhibitors are used to prevent the for- mation of blood vessels, thereby depleting the cancer cells of oxygen and nutrients. Hyperthermia (also called thermal therapy or thermotherapy) is a type of cancer treatment technique in which the cancer cells are exposed to high temperatures (up to 113◦F). Research has shown that high temperatures can damage and kill cancer cells with minimal injury to normal tissues (8). By damaging proteins and func- tional structures within cells, hyperthermia destroys cancer cells (9). Hyperthermia may make some cancer cells more sensitive to radiation or harm other cancer cells that radiation cannot damage. Thus, it is almost used with other forms of cancer therapy, such as radiation and chemotherapy (10). Laser therapy is most commonly used to treat super- ﬁcial tumors on the surface of the body or the lining of internal organs. Photody- namic therapy is a type of cancer treatment that uses a drug called a photosensitizer or photosensitizing agent (12). When photosensitizers are exposed to this speciﬁc wavelength, they produce singlet oxygen, which destroys cancer cells. Targeted cancer therapy uses target-speciﬁc drugs that invade cancer cells and block the growth and metasta- sis of cancer cells by interfering with speciﬁc molecules involved in carcinogenesis and tumor growth (13). To overcome the disadvantages of current cancer treatment techniques, the scientiﬁc community has turned toward nanotechnology to develop newer and more effective drug carrier systems to safely shepherd the anticancer drugs to the cancer cells. Examples of drugs in this class include methotrexate, ﬂuorouracil, hydroxyurea, and mercaptopurine. A few examples of drugs in this class include cisplatin and antibiotics such as daunorubicin, doxorubicin, and etoposide. Disruption of Synthesis or Breakdown of Mitotic Spindles Mitotic spindles serve as molecular railroads with “north and south poles” in the cell when it starts to divide. These drugs disrupt the formation of these spindles and therefore interrupt cell division. Classic examples of drugs in this class of mitotic disrupters include vinblastine, vincristine, and paclitaxel. The applications of nanoparticles as carriers for these anticancer drugs are discussed in the following sections. Results of numerous scientiﬁc research studies done in nanotech- nology and nanomedicine are inspiring the scientiﬁc community to discover new, innovative, noninvasive tools at the nanoscale level for such purposes. Nanoscale cantilevers (15) and quantum dots (16,17) are being studied as cancer detection tools at the cellular level. If the tumor has not been detected in its early stage, treatment methods should be devised to eradicate the fully developed cancer cells without harming the normal, healthy cells of human body. The various types of nanoparticles that are currently studied for their use as drug delivery systems are polymeric micelles, magnetic nanoparticles, colloidal gold nanoparticles, and ceramic nanoparticles (18–20). These nanoparticulate-based drug delivery systems can be characterized for their localization in tumor cells by coating them with tumor-speciﬁc antibodies, peptides, sugars, hormones, and anticarcinogenic drugs. These nanoparticles have been effectively coupled with the abovementioned anti- carcinogenic chemotherapeutic agents and have been tested for their target speci- ﬁcity. These nanoparticles are superior over conventionally available drug delivery systems, as the chemotherapeutic agents can be targeted to a speciﬁed area of the human body by adding nanoscale surface receptors.