Addiction to Drugs or abusive Use of Drugs.


Drug Abuse

Addiction to drugs or abusive use of drugs is a matter of concern in modern societies. This problem is acute among the young people.
Drug abuse is the excessive or addictive use of drugs for non-medical purposes. Abused substances include such agents as anabolic steroids, which are used by some athletes to accelerate muscular development and increase strength and which can cause heart disease, liver damage, and other physical problems; and psychotropic agents, changes in mood, feeling, and perception. The latter category has a much longer history of abuse. This category includes opium, marijuana, ganja, heroin, hallucinogens, barbiturates, cocaine, amphetamines, tranquilizers, hashish, and alcohol.
The history of non medical drug consumption is ancient. The discovery of the mood-altering qualities of fermented fruits and substances such as opium has led to their use and, often, acceptance into society. Just as alcohol has a recognized social place in the West, so many other psychotropics have been accepted in different societies.
Drugs that either depress or stimulate the central nervous system have long been used for nonmedical reasons. Depressants include all sedatives and hypnotics such as barbiturates and benzodiazepines. These are usually taken by mouth but can be injected. The main stimulants are amphetamines or their derivatives and cocaine, a natural component of the leaves of the coca plat. Amphetamines can be taken by mouth or injected; cocaine is either injected or inhaled through the nose one form of cocaine is generally smoked. Other drugs that are frequently abused include cannabis, PCP, and such hallucinogens or psychedelics, as LSD and mescaline.
Drug addiction causes serious damages to different limbs of the body. Some of them are given below:
a.       Nerve System: Causes mental illness and reduces memory.
b.      Eye: Diminishes eyesight gradually.
c.       Blood Circulation: Causes anemia and reduces resistance to diseases.
d.      Heart: Reduces effectiveness of heart and enlarges the heart.
e.      Liver: Jaundice, Hepatitis, Liver Sirrocis, cancer.
f.        Digestive System: Reduce digestive power, causes ulcer, acidity and constipation.
g.       Kidney: Gradually damages the kidneys completely.
h.      Genital Organs: Reduces sexual power, gives birth to weak disabled children.
i.         Skin: Makes the skin rough, causes scabies, itching, boil and infection.
Drug abuse leads a man to dire consequences. It has many physical side effects.
1.       A man who takes drug for intoxication cannot lead a normal life. He loses control over himself and the intake of drugs. As a result he loses his dependability and cannot get engaged in any responsible job.
2.       Drugs like ganja, marihuana, and heroin are very costly. A person who gets addicted to such drugs often becomes disqualified to get any income generating activities. As he cannot earn his livelihood or the cost of his drugs he gets involved in theft, mugging, snatching robbing or other criminal activities.
3.       The effects of drug abuse on the family and society is not insignificant. An addicted person is a burden to the family and society. He causes endless trouble and suffering for the members of his family. He is considered a bad element in the society and puts an evil impact on the society by committing criminal activities and destroying the peaceful environment of the society. He becomes like a devil incarnated in a human body as an intoxicated man gradually loses his good senses, conscience and control over the beast in him.
4.       Drug addiction leads a man to ultimate death. Continuous intake of intoxicating drugs makes a slave to drugs out of a man. It causes terrible harm to a man’s body. His body parts like kidneys, hearts, stomach etc. start shutting down gradually.
5.       Drug addiction is also harmful to the economy and the nation. Drug addiction makes people inactive and incapable of responsible work. This is a big wastage of national resources. The deterioration of law and order situation also casts a pall on the economic development of the region and the country.
One of the main reasons for drug abuse among youths is mental pressure and turbulence put on the youths of the broken families. When the parents get divorced or separated children cannot accept such things. They feel certain anger towards everything and begin to pity themselves. In most of the cases they are neglected or cannot adjust with the new condition. As a result they get frustrated very easily and fall a victim to drug addiction. Some youths also become addicted to narcotics due to bad company and very often such addiction start from just a little dose out of curiosity which leads to complete submission to addiction.
Certain habits of both or any  of the parents such as excessive smoking of cigarettes and taking alcohol can also make youths attracted to taking drugs. Because when children see their parents smoking cigarettes one after another or taking liquor regularly, such habits and action seem natural to them and they can easily become addicted to more harmful drugs.
Another reason for drug addiction, as cited by many people, is lack of healthy social life. This is also mostly a consequence of small, self-centered families of modern time. In the course of industrialization and urbanization, traditional joint families began to break up. Families consisting of only father, mother and children began to relocate themselves in urban and industrial areas in search of jobs. In such families children usually suffer from loneliness as they do not find close relatives like grandparents, uncles, aunts and cousins nearby. Things like TV, movies, video games computer games, CD player and indoors games become the main sources of entertainment instead of outdoor games, conversation and interactions in family atmosphere. Such children get frustrated easily and become vulnerable to drug addiction. The media also play a role in spreading drug addiction. When children find TV and movie stars take drug or smoke cigarettes in moves or TV programmers, they also become attracted to such drugs and get addicted.
As far as I am concerned, certain things can be done to save the youths from harmful drug abuse. First of all interaction with the youths and supervision over them from the families will have to be ensured. Parents have to grow friendly relationship with their children and make sure that they do not get frustrated. Parents should also check into the friends of their children so that their children do not maintain bad company. It has also become necessary to guide the youths in watching TV and movies. The government may help the situation by strictly imposing censorship on injurious materials in movies and TV programmers.
Drug addiction causes irreparable loss to one’s personal life as well as the social life. So, everybody should remain alert to avoid drug addiction. Moreover, social awareness should be created against drug abuse and addiction.

Reasons of smoking and how to prevent it
Smoking is one of the most injurious habits. Nowadays smoking is common all over the world. This habit has been found to spread among people of all ages over the decades.
Smoking can cause serious health hazards. Tobacco has injurious substances including nicotine. When somebody smokes, nicotine enters into his lungs and gets mixed with his blood. Then it spreads throughout the whole body through blood circulation. Smoking of cigarettes can cause serious harm to ones lungs and larynx. It is the main cause of lung cancer. It also causes diseases like asthma, bronchitis, gastric, ulcer, and heart disease. Smoking can harm not only the person smoking cigarettes, but also people around him. Smoke released by a smoker is inhaled by people in close proximity. It is called passive smoking. Passive smoking is no less harmful than active smoking and all the dangers of smoke are also associated with passive smoking.
There are some intoxicating materials like nicotine in tobacco. They cause addiction. People get attracted to tobacco smoking indifferent ways. First of all, advertisements by tobacco companies attract people to tobacco smoking. Secondly, smoking by actors and actresses in movies, dramas and TV programmes also attracts people to smoking. They consider smoking as a matter of smartness. Thirdly, youths and youngsters smoke being influenced by evil company. Usually it starts out of curiosity and then becomes a lasting habit. Lastly, children are also influenced by their smoker parents. They form acceptance to smoking in their mind and do not consider it as something harmful.
Smoking has been accepted as a harmful habit by governments worldwide. Many preventive measures have been undertaken in this respect by the countries all over the world. Such measures include:
1.       Banning cigarette smoking in public spaces like bus stations, railway stations, subway stations, market places, museums, zoos auditoriums etc. and on public transports such as buses, trains, launches, steamers, ships etc.
2.       Restricting buying and selling of cigarettes publicly. Also banning sale of cigarettes to minors.
3.       In Bangladesh the government has enacted laws banning advertisement of cigarettes, buying and selling cigarettes publicly and smoking cigarettes in public places. The government has also imposed fines and penalties for the violation of these laws.
4.       The government has also passed laws requiring cigarette companies to print warning signs on the packets of cigarettes.
What else needed are a greater degree of awareness among people and a strong will to stop smoking? Besides, censorship should be imposed on TV programmes, dramas and movies having scenes of smoking.
There is no doubt that the habit of smoking can cause great harm to a person. It is harmful not only to him but also for his family and people around him. So, everybody should try seriously to avoid smoking.

Drug Induced Acute Renal Failure in Pregnancy –Management.


Drug Induced Acute Renal Failure in Pregnancy –Management.

The goal of treatment is to identify the drug which may cause acute renal failure and treat any reversible causes of the kidney failure such as use of kidney-toxic medications.
                Treatment also focuses on preventing excess accumulation of fluids and wastes, while allowing the kidneys to heal and gradually resume their normal function. Hospitalization is required for treatment and monitoring.
It is dividing into
A.      Medical Management
B.      Obstetrical Management

Medical Management

Reversible Prerenal acute Renal Failure
a.       Establish and correct the underlying cause of ARF
b.      Hypovolemia if present restore blood volume as rapidly as possible depending on what is lost
c.       Optimize systemic hemodynamic. Measurement of central venous pressure or pulmonary wedge pressure as adjunct to clinical examination may aid in determining the rate of administration of fluid.
d.      Correct metabolic acidosis- restoration of blood volume will correct acidosis by restoring kidney function, isotonic sodium bicarbonate may be used
e.      Recent trials do not support use of low dose dopamine in severely ill patients at risk of ARF.
Re-established Acute Renal Failure
Emergency Resuscitation
a.       Hyperkalemia should be corrected immediately
b.      Circulating blood volume should be optimized to ensure adequate renal perfusion
c.       Severe acidosis can be ameliorated with isotonic sodium bicarbonate.
Fluid and Electrolyte Balance
a.       Daily fluid intake should be equal to urine output, plus additional 500 ml to cover insensible losses
b.      Measurement of fluid intake and output should be weighed daily
c.       Since sodium, potassium are retained hence intake of these substances should be restricted.
Protein and Energy intake
It’s important to give energy and nitrogen to hyper catabolic patients in adequate.
Infection Control
Regular clinical examination and microbiological investigation should be done to reduce any complication.
Drugs
NSAID and ACE inhibitors may prolong ARF hence temporary withdrawal should be considered.
Hemodialysis
Dialysis may be used to remove excess waste and fluids. This often makes the person feel better and may make the kidney failure easier to control. Dialysis may not be necessary for all people, but is frequently lifesaving, particularly if serum potassium is dangerously high.
Hemofiltration
Used to remove excess of body water along with electrolytes across high flux semi permeable membrane.
Peritoneal Dialysis
This can correct electrolyte imbalance and equally effective as hemodialysis.
Supportive Therapy
a.       To control infection if indicated
b.      Vitamins
c.       Blood transfusion
d.      Control of hyperphoshatemia
Phase of Diuresis
a.       Intake and output chart should be maintained and serum electrolytes are monitored
b.      To control fluid balance
c.       To control electrolyte balance
d.      Supplementation of salt-5 gm sodium chloride for each liter of urine passed.
Phase of Recovery
Clinical improvement along with increased amount of urine with more and more concentrating power is evidenced with diurnal variation of specific gravity between 1002-1020 were observed. Diet and food as per patient’s desire.

Obstetrical Management

Prerenal-any condition leads to hypovolemis, hypotension, volume contraction and low cardiac output.
Early Pregnancy
a.       Severe dehydration due to Hyperamesis gravidarum and acute pyelonephritis = replacement of fluid along with electrolye, and monitoring of kidney function
b.      Severe infection due to septic abortion = antibiotic metrogyl, laparotomy if indicated
c.       Acute and massive blood loss due to abortion, ectopic pregnancy and hydatidiform mole = surgical management
Mid Pregnancy
a.       APH-abruptio placenta, placenta previa = immediate surgical intervention
b.      Pre-eclampsia and eclampsia and HELLP syndrome =antihypertensive, anticonvulsion along with other medical management.
Late pregnancy and labor
a.       Severe uterine infection due to intrauterine death of fetus, or chorioamnonities = antibiotic
b.      PPH = medical and surgical management
c.       Traumatic delivery- surgical management.
Immediate postpartum
a.       Puerperal sepsis due to chorioamnonitis- treated by antibiotics
b.      Drug sensitivity due to ergot treatment of hypersensitivity
c.       Consumptive coagulopathy- by fresh blood transfusion, plasma or platelet transfusion heparin, etc.
Prognosis
Although acute renal failure is potentially life-threatening and may require intensive treatment, it usually reverses within several weeks to a few months after the underlying cause been treated.
                Conservative management when failed, may progress to chronic renal failure and/or end-stage renal disease. Death is most common when the cause of kidney failure is related to surgery or trauma or when it occurs in people with coexisting heart disease, lung disease or recent stroke. Old age, infection, loss of blood from the GI tract, and progression of the kidney failure also increase the risk of death.

Used During Labor –Effects on the Baby


Systemic Analgesics Drugs Used During Labor –Effects on the Baby

There is no single ideal analgesic agent for use in labor. All analgesic drugs cross the placenta and depress the fetus. The degree of depression will depend on the dose of the drug the length of time of exposure and the maturity and well- being of the fetus.
                Although the opiates are the most effective analgesic drugs available, their use in obstetrics is losing favor because of the depressant effect on the neonate, the effect of the mother’s psyche, making her less aware of her experience of childbirth, and because in doses that minimize side effects the pain relief is poor.            
                The most commonly used opiate in labor is pethidine, although diamorphine and fetanyl are also used. The maternal side effects of narcotics are dose related and include hypoventilation, postural hypotension, postural pypotension and loss of consciousness. Emetic effects of all opiates are also dose-related but this varies in individual paticents. Grastric motility is decrease by narcotics and stomach emptying may b de3layed for up to 12 hours. Opiates are reported to shorten labor, and correct in co-ordinate uterine action. But the mechanism appears to be the relief of pain and anxiety rather than any direction action of the uterine muscle.
                Placental transfer of all the opiates takes place rapidly and equilibration between maternal and fetal blood is completed within a short time. The effects of ethidine on the fetus that can be demonstrated in utero are a decrease in beat-to-beat variability on the cadiotocograph and altered fetal electroencephalogram. The neonatal effects of maternal opiates are a decrease Apgar score, a prolonged time to achieve regular respiration, lower oxygen saturation, decreased minute volume, hypercapnia and abnormal neurobehavioural scores. All these effects are related and can persist in the neonate for several days since the half-life of the opiates in the neonate is four to five times longer than that in the adult.
 Opiate effects and side effects can all be antagonized by naloxone –a pure opiate antagonist. There is no purpose in giving any combination of opiate plus antagonist to the mother in pain, as all the actions, including the analgesic action, will be reserved. If the mother has received opiates in labor naloxone should be given to those neonates who are depressed and do not breathe following initial resuscitation.

General Anesthetic Drugs Used during Labor –Effects on the baby


General Anesthetic Drugs  –Effects on the baby

Neonatal drug depression is minimized by keeping drug dosage levels low in the mother and by keeping the induction delivery interval as short as possible. Avoiding aortocaval compression, hypotension or hypoxia in the mother ensures that the infant is not hypoxic.
                Maternal safety during general anesthesia remains unpredictable. The danger of inhalation of stomach contents, especially in patients undergoing emergency cesarean section, continues to be a significant cause of maternal death. For this reason conduction anesthesia for surgical delivery of patients in labor is gaining popularity. However, general anesthesia remains essential for a small number of obstetric patients.
                The intravenous induction agents that are in widespread use in obstetric anesthesia, thiopentone, methohexitone and althesin, cross placenta so rapidly that it is not possible to deliver the baby before some quantity of the drug has been transferred; detectable levels occur within 30 seconds of an intravenous dose. However, the newborn appears not to be affected with these levels since the drugs, after crossing the placenta from the umbilical vein, pass through the fetal liver where some is metabolized. /the drug level in the infant’s brain is further lowered by dilution with less contaminated blood from the fetal legs and abdomen. The drug concentration very rapidly declines in the mother after a single dose as the drug I redistributed throughout her circulation. This ensures that the level continues to fall in the fetus.
                Volatile anesthetic agents are generally added to the inspired mixture to ensure maternal unawareness. The halogenated agents, halothanes, methoxyflurane and enflurane allow the mother a 50% oxygen proportion in the inspired air and may improve uterine blood flow. These agents do not increase postpartum uterine bleeding unless used in very high doses. They do not depress the newborn.
                Muscle relaxants cross the placenta in clinically insignificant amounts; succinyl choline I very rapidly metabolized by the pseudocholinesterase in the mother’s plasma. The non-depolarizing. Longer acting relaxants are very large molecules that are highly ionized and so are unable to cross the placenta.
                Nitrous oxide used intermittently or continuously for pain relief in normal labor does not cause maternal cardiovascular depression or alters uterine contractility, and it is safe for the fetus in concentrations of up to 50% in inspired air. However, nitrous oxide ad oxygen, when used alone for cesarean section without supplementary inhalational agents, has resulted in neonatal depression. This is possibly caused by decrease uterine perfusion following high endogenous catecholamine levels that are associated with this very light anesthesia.
                The premixed cylinders of 50% nitrous oxide and oxygen have been shown to give considerable analgesia. But timing of administrations is not easy when they are used intermittently, and thus analgesia is less efficacious than continuously inhaled self- administered nitrous oxide.

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