UTILITY OF SENSITIVITY TESTS

1
??? ???? ?????? ??????
2
Drug dependence
3
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.

4
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.

5
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

6
(No Transcript)
7
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 .

8
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.

9
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.

10
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.

11
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.

12
(No Transcript)
13
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

14
Drugs causing dependence

• Amphetamine and related compounds.
• Tranquillizers.
• Volatile solvents e.g. acetone, toluene and
  carbon tetrachloride.
• Anabolic-Androgenic Steroids
• Designer drugs .
• Nicotine.

15
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.

16
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.

17

• 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

18
Treatment

• Gradual withdrawal
• Abrupt withdrawal
• Symptomatic treatment
• Psychiatric therapy
• Social measurements

19
(No Transcript)
20
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

21
Methods of uses
22
Cerebral hemorrhage due to cocaine dependence
23
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

24
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.

25
Alcoholic Liver cirrhosis
26
4-BARBITURATE DEPENDENCE

• Short acting barbiturates are used by the addicts
  due to rapid effect
• Barbiturates dependence is very serious as heroin
  dependence

27
Clinical picture

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

28
2- Neurological signs

• Tremors
• Thick slurred speech.
• Ataxia
• Nystagmus.
• Dysdiadochokinesis.

29
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

30
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.

31
Withdrawal symptoms

• Somnolence
• Tremors.
• Sever fatigue.
• Risk of suicide.
• Abrupt withdrawal.
• Sedation with phenobarbitone or chlorpromazine.

32
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

33
(No Transcript)
34
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.

35
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.

36
THEY MAY PRESENT LATER WITH

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

37
(No Transcript)
38
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.

39
Other abused substances

• 8-ANABOLIC-ANDROGENIC STEROIDS
• 9- DESIGNER DRUGS
• 10- NICOTINE

40