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UTILITY OF SENSITIVITY TESTS

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Title: UTILITY OF SENSITIVITY TESTS Author: cora Last modified by: kabbash Created Date: 12/28/2003 8:08:52 AM Document presentation format: On-screen Show – PowerPoint PPT presentation

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Title: UTILITY OF SENSITIVITY TESTS


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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

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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.

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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.

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  • 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

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

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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
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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.

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Alcoholic Liver cirrhosis
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4-BARBITURATE DEPENDENCE
  • Short acting barbiturates are used by the addicts
    due to rapid effect
  • Barbiturates dependence is very serious as heroin
    dependence

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

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2- Neurological signs
  • Tremors
  • Thick slurred speech.
  • Ataxia
  • Nystagmus.
  • Dysdiadochokinesis.

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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

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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

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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.

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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

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