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Drugs can be metabolized in several ways: • Most drugs are metabolized into inactive metabolites (products of metabolism) levothroid 200mcg line thyroid symptoms mayo, which are then excreted purchase levothroid 50mcg fast delivery thyroid overmedication symptoms. Active metabolites may undergo further metabolism or may be excreted from the body unchanged. If I’m not Where metabolism happens working right, a The majority of drugs are metabolized by enzymes in the liver; drug doesn’t however, metabolism can also occur in the plasma, kidneys, and get metabolized membranes of the intestines. This accumulation in- creases the potential for an adverse reaction or drug toxicity. These include liver dis- eases such as cirrhosis as well as heart failure, which reduces cir- culation to the liver. Gene machine Genetics allows some people to metabolize drugs rapidly and oth- ers to metabolize them more slowly. For example, ciga- rette smoke may affect the rate of metabolism of some drugs; a stressful situation or event, such as prolonged illness, surgery, or injury, can also change how a person metabolizes drugs. For in- stance, infants have immature livers that reduce the rate of metab- olism, and elderly patients experience a decline in liver size, blood Remember flow, and enzyme production that also slows metabolism. Drugs can also be excreted through the lungs, ex- ocrine (sweat, salivary, or mammary) glands, skin, and intestinal tract. Half-life = half the drug The half-life of a drug is the time it takes for one-half of the drug to be eliminated by the body. Factors that affect a drug’s half-life include its rate of absorption, metabolism, and excretion. Know- ing how long a drug remains in the body helps determine how fre- quently it should be administered. A drug that’s given only once is eliminated from the body al- most completely after four or five half-lives. A drug that’s adminis- tered at regular intervals, however, reaches a steady concentra- tion (or steady state) after about four or five half-lives. Steady state occurs when the rate of drug administration equals the rate of drug excretion. Onset, peak, and duration In addition to absorption, distribution, metabolism, and excretion, three other factors play important roles in a drug’s pharmacoki- netics: • onset of action • peak concentration • duration of action. The onset of action refers to the time interval from when the drug is administered to when its therapeutic effect actually begins. Rate of onset varies depending on the route of administration and other pharmacokinetic properties. Sticking around The duration of action is the length of time the drug produces its therapeutic effect. Pharmacodynamics is the study of the drug mechanisms that pro- duce biochemical or physiologic changes in the body. The inter- action at the cellular level between a drug and cellular compo- nents, such as the complex proteins that make up the cell mem- brane, enzymes, or target receptors, represents drug action. It’s the cell that matters A drug can modify cell function or rate of function, but it can’t impart a new function to a cell or to target tissue. Therefore, the drug effect depends on what the cell is capable of accomplish- ing. A drug can alter the target cell’s function by: • modifying the cell’s physical or chemical environment • interacting with a receptor (a specialized location on a cell membrane or inside a cell). When a drug displays an affinity for a receptor and stimulates it, the drug acts as an agonist. This ability to initiate a response after bind- ing with the receptor is referred to as intrinsic activity. Antagonist drugs If a drug has an affinity for a receptor but displays little or no in- trinsic activity, it’s called an antagonist. Because this type of antagonist binds reversibly to the re- ceptor site, administering larger doses of an agonist can overcome the antagonist’s effects. Administering larger doses of the ago- Stimulate nist can’t reverse the antagonist’s action. If a drug acts on a variety of receptors, it’s said to be nonselective and can cause multiple and widespread effects. For exam- ple, beta receptors typically produce increased heart rate and bronchial relaxation as well as other systemic effects.

Before prescribing laxatves 200mcg levothroid fast delivery thyroid veins, it is important to be sure that the patent is constpated and that the constpaton is not secondary to an underlying undiagnosed complaint generic 200mcg levothroid thyroid cancer follow up. It is also important that the patent understands that bowel habit can vary considerably in frequency without doing harm. For example, some people consider themselves constpated if they do not have a bowel movement each day. A useful defniton of constpaton is the passage of hard stools less frequently than the patent’s own normal patern and this should be explained to the patent since misconceptons about bowel habits have led to excessive laxatve use which in turn has led to hypokalaemia and an atonic non-functoning colon. Laxatves should generally be avoided except where straining will exacerbate a conditon such as angina or increase the risk of rectal bleeding as in haemorrhoids. Laxatves are of value in drug-induced constpaton, for the expulsion of parasites afer anthelminthic treatment and to clear the alimentary tract before surgery and radiological procedures. Prolonged treat- ment of constpaton is rarely, necessary except occasionally in the elderly. These include bulk-forming laxatves which relieve constpaton by increasing faecal mass and stmulatng peristalsis, stmulant laxatves which increase intestnal motlity and ofen cause abdominal cramp, faecal sofeners which lubricate and sofen impacted faeces and osmotc laxatves which act by retaining fuid in the bowel by osmosis. Bowel cleansing solutons are used before colonic surgery, colonoscopy or radiological examinaton to ensure that the bowel is free of solid contents; they are not a treat- ment for constpaton. Contraindicatons Intestnal obstructon (causes abdominal cramps), acute surgical abdominal conditons, acute infammatory bowel disease, severe dehydraton; faecal impacton, chronic use. Precautons Excessive use of stmulant laxatves can cause diarrhoea and related efects such as hypokalaemia; however, prolonged use may be justfable in some circumstances; don’t give antacid within 1 hour, pregnancy (Appendix 7c), infammatory bowel disease, pre-existng heart disease or bowel disease, allergies, interactons (Appendix 6d). Adverse Efects Tablets- griping; suppositories-local irritaton; faintng, dizziness, soreness in anal region due to suppository leakage; abdominal discomfort, electrolyte imbalance, hypokalaemia. Contraindicatons Galactosemia, intestnal obstructon, patents on low galactose diet. Adverse efects Diarrhoea (dose related), nausea, vomitng, hypokalaemia; dehydraton; hypernatremia; bloatng and abdominal cramps. Dose Oral Adult- 2 to 4 tablets, usually at night; inital dose should be low, then gradually increased. Precautons Avoid prolonged use unless indicated for preventon of faecal impacton; pregnancy (Appendix 7c), lactaton (Appendix 7b); hypersensitvity, undiagnosed abdominal pain, intestnal blockage. Adverse Efects Abdominal discomfort; atonic non- functoning colon and hypokalaemia (with prolonged use or overdosage); red or yellow brown urine, diarrhoea, nausea, vomitng, bloatng. Severely dehydrated patents must be treated initally with intravenous fuids untl they are able to take fuids by mouth. For oral rehydraton it is important to administer the soluton in small amounts at regular intervals as indicated below. Plan A: No dehydraton: Nutritonal advice and increased fuid intake are sufcient (soup, rice, water and yoghurt, or even water). For infants aged under 6 months who have not yet started taking solids, oral rehydraton soluton must be presented before ofering milk. In the case of mixed breast-milk/formula feeding, the contributon of lactaton must be increased. Plan B: Moderate dehydraton: Whatever the child’s age, a 4-h treatment plan is applied to avoid short-term problems. It is recom- mended that parents are shown how to give approximately 75 ml/kg of oral rehydraton soluton with a spoon over a 4-h period and it is suggested that parents should be watched to see how they cope at the beginning of the treatment. A larger amount of soluton can be given if the child contnues to have frequent stools. In case of vomitng, rehydraton must be discontnued for 10 min and then resumed at a slower rate (about one teaspoonful every 2 min). The child’s status must be re-assessed afer 4 h to decide on the most appropriate subsequent treatment. Oral rehydraton soluton should contnue to be ofered once dehydraton has been controlled, for as long as the child contnues to have diarrhoea. Plan C: Severe dehydraton: Hospitalizaton is necessary, but the most urgent priority is to start rehydraton.

The report starts by examining the scale of the problem cheap levothroid 50mcg with visa thyroid gland questions, the harms associated with drug use – for both the individual and society – and influences on illicit drug use cheap levothroid 50 mcg without prescription zazzle thyroid cancer. The development of drug policy in Britain is then presented, followed by a chapter discussing the particular harms to the individual and society that are associated with the prohibitionist legal framework controlling drug use. Interventions to reduce the harms associated with illicit drug use are then discussed, followed by three chapters that examine the doctor’s role in the medical management of drug dependence and the ethical challenges of working within the criminal justice system. Medical practitioners are ideally placed to encourage a refocusing of debate on policies for supporting and treating the physical and mental health needs of illicit drug users. The final chapter examines their role, both as individuals and as a profession, in relation to illicit drug use. Introduction • Substance use describes a wide range of different patterns of use, from harmless recreational use to life-threatening dependence. These factors create a framework within which an individual’s predisposing, precipitating, perpetuating and protective elements can be used to plan the most effective treatments. Less than 10 per cent of pupils interviewed in England in 2010 thought use of any illicit drugs was acceptable. The burden of illicit drug use • The use of illicit drugs is associated with a range of physical, psychological and social harms. These are affected by the dosage of drug, the pattern of drug use and the mode of administration. The vast majority of these deaths are in men and many are associated with polydrug or polysubstance use. Ecstasy-related deaths are very rare and deaths from cannabis overdose do not occur. These can result from the illegality of the drugs, or from factors such as the psychopharmacological effects of the drug. They have associated costs for the individual related to loss of earnings, reduced educational attainment and damage to personal relationships. High levels of drug use in a community are linked to unsafe communities because of the associated social problems. The relative levels of harm for the different drugs correlate poorly with the legal classification of drugs. The economic and social costs of Class A drug use in 2003-2004 in England and Wales were estimated to be £15. Influences on illicit drug use • 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. The Rolleston Report in 1926 affirmed the right of doctors to prescribe controlled drugs to addicts in defined circumstances and set the scene for a balanced medical approach within a penal framework. This Act also set up the Advisory Council on the Misuse of Drugs, to keep the drug situation under review and advise the Government. The emphasis is on people in drug treatment achieving recovery, rather than aiming to simply engage and retain them in treatment. Controlling illicit drug use • For the last half century, prohibition and criminalisation has been the dominant policy for drug control, both nationally and internationally. Among this latter group of commentators, the lack of research into the effects of criminalising illicit drug use and possession does not, in itself, lead to the position that new or amended regulations are required. Delaying initiation and minimising the use of illicit drugs • Current prevention strategies aim to reduce drug use by influencing attitudes and behaviour, in order to prevent or delay the initiation of drug use. Secondary prevention interventions, such as harm-prevention strategies, are yet to receive much in the way of attention. These programmes improve young people’s knowledge about drug use, and have a small impact, notably in delaying the onset of use.