Pharm Spring Class

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Withdrawal symptoms of alcohol

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Mild Withdrawal

Signs and Symptoms

Systolic blood pressure higher than 150 mm Hg, diastolic blood pressure higher than 90 mm Hg, pulse rate higher than 110 beats/min, temperature above 37.7° C (100° F), tremors, insomnia, agitation
-Moderate Withdrawal

Signs and Symptoms

Systolic blood pressure 150-200 mm Hg, diastolic blood pressure 90-140 mm Hg, pulse rate 110-140 beats/min, temperature 37.7°–38.3° C (100°–101° F), tremors, insomnia, agitation
-Severe Withdrawal (Delirium Tremens)*

Signs and Symptoms

Systolic blood pressure higher than 200 mm Hg, diastolic blood pressure higher than 140 mm Hg, pulse rate higher than 140 beats/min, temperature above 38.3° C (101° F), tremors, insomnia, agitation

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“Roofies” or date rape drug

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-Roofies

Pills that are classified as benzodiazepines. They have recently gained popularity as a recreational drug; chemically known as flunitrazepam.
-Flunitrazepam is not legally available for prescription in the United States, but it is legal in over 60 countries for treatment of insomnia. The drug, known as roofies among young people, creates a sleepy, relaxed, drunken feeling that lasts 2 to 8 hours. A single dose costs from $1.50 to $5.00. Roofies are commonly used in combination with alcohol and other drugs. They are sometimes taken to enhance a heroin high or to mellow or ease the experience of coming down from a cocaine or crack high. Used with alcohol, roofies produce disinhibition and amnesia.
-Roofies have recently gained a reputation as a “date rape” drug. Girls and women around the country have reported being raped after being involuntarily sedated with roofies, which were often slipped into their drinks by their attackers. The drug has no taste or odor so the victims do not realize what is happening. About 10 minutes after ingesting the drug, the woman may feel dizzy and disoriented, simultaneously too hot and too cold, and nauseous. She may experience difficulty speaking and moving and then pass out. Such a victim will have no memories of what happened while under the influence of the drug.
-Benzodiazepines and barbiturates work by increasing the action of GABA. GABA is an amino acid in the brain that inhibits nerve transmission in the CNS. The alteration of GABA action in the CNS results in relief of anxiety, sedation, and muscle relaxation

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Affects of stimulants overdose

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Adverse Effects

Both amphetamine and nonamphetamine stimulants have a wide range of adverse effects that most often arise when these drugs are administered at dosages higher than the therapeutic dosages. These drugs tend to “speed up” body systems. For example, effects on the cardiovascular system include increased heart rate and blood pressure. Other adverse effects include, angina, anxiety, insomnia, headache, tremor, blurred vision, increased metabolic rate (beneficial in treatment of obesity), gastrointestinal (GI) distress, and dry mouth.

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Antiabuse therapy and patient teaching

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Disulfiram works by altering the metabolism of alcohol. When ethanol is given to an individual previously treated
with disulfiram, the blood acetaldehyde concentration rises 5 to 10 times higher than in an untreated individual. Within about 5 to 10 minutes of ingesting alcohol, the face feels hot, and soon afterward it is flushed and scarlet. After this, throbbing in the head and neck, nausea, copious vomiting, diaphoresis, dyspnea, hyperventilation, vertigo, blurred vision, and confusion appear. As little as 7 mL of alcohol will cause mild symptoms in a sensitive person. The effects last from 30 minutes to several hours.
-Disulfiram is not a cure for alcoholism; it helps patients who have a sincere desire to stop drinking. The rationale for its use is that patients know that if they are to avoid the devastating experience of the acetaldehyde syndrome, they cannot drink for at least 3 or 4 days after taking disulfiram

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OTC and herbal remedies patient teaching

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With OTC drugs, the most important determinant of safe patient self-administration is whether the patient receives thorough and individualized patient education. Patients need to receive as much information as possible and should understand that although these drugs are nonprescription they are not completely safe and without toxicity. Instructions should include information about safe use, frequency of dosing and dose, specifics of how to take the medication (e.g., with food or at bedtime), and steps the patient may take to prevent complications and toxic effects. Another consideration is the dosage form, because a variety of dosage forms are available, from liquids, tablets, and enteric-coated tablets to patches and gum. Instructions must be provided and the need to recheck dosage emphasized. With many of the patches used today for smoking cessation and for other indications, it is crucial to emphasize the proper use and application of the transdermal patch systems. For patients using herbal products (as for those using OTC drugs and other dietary supplements), education is of utmost importance for safe and effective use. The health care provider must inform the patient that the companies manufacturing herbals and dietary supplements are not required to provide evidence of safety and effectiveness. Unfortunately, many patients believe that no risks exist if a medication is herbal and “natural.” It is important for patients to realize that even if a product is natural, it must be taken as cautiously as any other medication. The health care provider must also emphasize that herbals are not FDA-approved drugs; therefore, their labeling cannot be relied on to provide adequate instructions for use or even warning information. The fact that a drug is an herbal or a dietary supplement does not mean that it can be safely administered to children, infants, pregnant or lactating women, or patients with certain health conditions that put them at risk.

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Antiabuse therapy

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▸ naltrexone hydrochloride

Naltrexone hydrochloride (ReVia, Trexan) is an opioid antagonist used as an adjunct for the maintenance of an opioid-free state in former opioid addicts. The FDA has identified it as a safe and effective adjunct to psychosocial treatments of alcoholism. It is also recommended for reversal of postoperative opioid depression. It is available only in tablet form. Use of naltrexone hydrochloride is contraindicated in patients with hepatitis or liver dysfunction or failure and is also contraindicated in those with drug hypersensitivity. Nausea and tachycardia are the most common adverse effects and are related to reversal of the opioid effect. For dosage information, see the table on page 146.

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Potential drug interaction with garlic

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Possible interference with hypoglycemic therapy

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Gingko biloba and possible drug interactions

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Warfarin, aspirin

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US law and regulation of herbal products

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Federal legislation and the FDA still do not provide safeguards and monitoring of dietary supplements. Currently, only the manufacturing companies are responsible for ensuring that their products are safe before they are put on the market. Unlike prescription drugs, dietary supplements do not have to be proven safe and effective for their intended use before marketing. In fact, the law contains no provisions for the FDA to approve herbals and dietary supplements for safety and effectiveness before these products reach the consumer.

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Herbal remedies and use during pregnancy

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TCAs are effective drugs in the treatment of various affective disorders, but they are also associated with serious adverse effects. Therefore, patients taking them need to be monitored closely. For this reason, all antidepressants are available only with a prescription, with the exception of some herbal products such as St. John's wort (see the Herbal Therapies box on this page). Many drugs in this class are rated as pregnancy category D drugs, making their use by pregnant women relatively more hazardous than most of the NGAs. There are many