lecture-3 (HSS 3106)_W2024.pptx

Northern lights from Lofoten islands in Nordland, Norway. Liland, S. (2019, February 11). Northern lights from Lofoten islands. Flickr. https://www.flickr.com/photos/steinliland/40096915883 "You have power over your mind - not outside events. Realize this, and you will find strength.” - Marcus Aurel...

Northern lights from Lofoten islands in Nordland, Norway. Liland, S. (2019, February 11). Northern lights from Lofoten islands. Flickr. https://www.flickr.com/photos/steinliland/40096915883 "You have power over your mind - not outside events. Realize this, and you will find strength.” - Marcus Aurelius « Vous avez du pouvoir sur votre esprit – pas sur les événements extérieurs. Comprenez-le et vous trouverez de la force. » - Marc Aurèle Northern lights from Lofoten islands in Nordland, Norway. Liland, S. (2019, February 11). Northern lights from Lofoten islands. Flickr. https://www.flickr.com/photos/steinliland/40096915883 Unit 1 Schedule HSS3106(A) Dates Tues., Jan 9 Fri., Jan 12 Tues., Jan 16 Fri., Jan 19 Tues., Jan 23 Theory Intro: syllabus Lec-1: introduction to pharmacology Lec-2: drug classes & schedules in Canada, part 1 Lec-3: drug classes & schedules in Canada, part 2 Lec-4: pharmacokinetics and pharmacodynamics +Q1 (5%) Fri., Jan 26 Lec-5: drug effects, adverse reactions and interactions ANS drugs 1 Tues., Jan 30 Lec-6: ANS drugs 2 Fri., Feb 2 Lec-7: CNS drugs 1 Tues., Feb 6 Lec-8: CNS drugs 2 Fri., Feb 9 Lec-9: CNS drugs 2 and Review for midterm test Tues., Feb Midterm Test ( in-class: worth 30% of final grade ) Quiz #1 for HSS3106(A): Jan 23, 2024 Bullen, J. (2012, September 4). Cocaine tooth drops, morphine teething syrup and other Victorian quack cures. The Telegraph. + https://www.telegraph.co.uk/news/health/pictures/9519906/Cocaine-tooth-drops-morphine-teething-syrup-and-other-Victorian-quack-cures.html Pharmacology: Mechanisms and Compliance (HSS 3106) lecture-3: drug classes and schedules in Canada, part 2 An advertisement for cocaine toothache drops, which were available for just 15 cents from all druggists in 1885. Readings Adams, M., Holland, N., Bostwick, P. M., ElHussein, M., & Osuji, J. (2020). Pharmacology for Nurses, Third Canadian Edition.  Chapter 2: Drug Classes and Schedules in Canada Learning Outcomes (3 of 4) 8. Explain the meaning of a controlled substance. 9. Explain the Controlled Drugs and Substances Act (CDSA) of 1997 and the role of the Drug Strategy and Controlled Substances Programme (DSCSP) in controlling drug abuse and misuse. Learning Outcomes (4 of 4) 10.Explain how drugs are scheduled according to Canada’s Food and Drugs Act, the CDSA, and the Narcotics Control Regulations (NCR). 11.Identify the drug schedules and give examples of drugs at each level. Drug Sche dulin g in Cana da Controlled Drugs and Substances Act Some examples of controlled drugs in the CDSA : 1. Hallucinogens 2. Narcotics 3. Stimulants 4. Anabolic steroids 5. Depressants Hallocinogens Hallucinogens  Often derived from plants.  Effect & intensity of response to these drugs varies from person to person.  Affects the user’s perceptions, thinking, Hallucinogens Effects of an overdose include:   heart rate (HR) & blood pressure (BP).  Panic attacks, anxiety, or psychosis. Hallucinogens Drug Characteristics of Drug Overdose MDMA  heart rate (HR) & blood pressure (BP), muscle cramps, (ecstasy) panic attacks, seizures, loss of consciousness, stroke, kidney failure, death. Mescalin Hallucinations, euphoria, dizziness, vomiting,  HR, e dilated pupils, diarrhea, headaches, anxiety, irrationality of thoughts. LSD Dilated pupils, loss of appetite, sleeplessness,  body temperature, increased HR and BP, sweating, dry mouth, tremors, confusion, distortion of reality, and hallucinations. PCP  HR & BP, convulsions, sweating, dizziness, numbness, and possibly death from heart failure. Drowsiness, which can lead to accidents. Users sometimes exhibit psychosis (completely losing touch with reality – can Hallucinogens Common names: Adam, Beans, Clarity, Disco Biscuit, E, Ecstasy, Eve, Go, Hug Drug, Lover’s Speed, Peace, STP, X, and XTC Visible signs: dilated pupils, increased sociability, excessive sweating, teeth grinding, tension of the jaw, Controlled substances: Narcotics  Narcotic = a drug that is meant to sedate or induce sleep.  In less potent forms, this family of drugs is often used as a pain reliever because of its ability to relax muscles & provide relief as a sedative. Controlled substances: Narcotics Drug Opium Characteristics of Drug Overdose Difficulty breathing, low blood pressure (BP), weakness, dizziness, confusion, loss of consciousness, coma, cold clammy skin, small pupils. Heroin Difficulty breathing, low BP, coma, spasms of the Codeine stomach or intestines, constipation, nausea, Morphine vomiting, sleepiness, blue fingernails and lips, death. Methadone Difficulty breathing, drowsiness, coma, low BP, muscle twitches, blue fingernails and lips. Oxycodone Slow difficult breathing, seizures, dizziness, weakness, loss of consciousness, coma, confusion, Controlled substances: Narcotics Heilman, J. (2016, January 8). Naloxone Kit [Digital image]. https://commons.wikimedia.org/wiki/File:NaloxoneKit.jpg Fentanyl 2 mg of fentanyl,1 a lethal dose in most people. Heilman, J. (2016, January 8). Naloxone Kit [Digital image]. https://commons.wikimedia.org/wiki/File:NaloxoneKit.jpg Fentanyl Naloxone kits as distributed in BC, Canada Steele, A. (2017, March 04). The fresh, young face of Ottawa's fentanyl tragedy. http://www.cbc.ca/news/canada/ottawa/opioids-fentanyl-teenagers-ottawa-1.4006568 Fentanyl Grade 9 student Chloe Kotval was found by her mother after overdosing on pills laced with fentanyl on February 12th, 2017. She died in hospital two days later. Ottawa, ON. Controlled substances 1. 2. 3. 4. 5. Hallucinogens Narcotics Stimulants Anabolic steroids Depressants Controlled substances: Stimulants Increases feelings of energy and     alertness. Suppresses appetite. Afterwards, depression often results. Overdose affects include high blood pressure, agitation, confusion, seizures. Controlled substances: Stimulants Drug Cocaine & Crack cocaine Amphetamines (speed) Methamphetamin es Characteristics of Drug Overdose Dangerous rise in body temperature, sweating, tremors, seizures, irregular heartbeats, stroke, confusion, heart attack, bleeding in the brain, death. High blood pressure (BP), rapid heart rate (HR), agitation, irregular heartbeats, stroke, seizures, coma, death. Dangerous rise in body temperature, profuse sweating, confusion, rapid breathing, increased heart rate, dilated pupils, high BP, kidney failure, bleeding in the brain, death. RCMP-GRC. (2015, September 11). Drugs and New Trends - Awareness Tools. http://www.rcmp-grc.gc.ca/qc/pub/sens-awar/drogue-drug/tableau-chart-eng.htm Controlled substances: Stimulants RCMP-GRC. (2015, September 11). Drugs and New Trends - Awareness Tools. http://www.rcmp-grc.gc.ca/qc/pub/sens-awar/drogue-drug/tableau-chart-eng.htm Controlled substances: Stimulants RCMP-GRC. (2015, September 11). Drugs and New Trends - Awareness Tools. http://www.rcmp-grc.gc.ca/qc/pub/sens-awar/drogue-drug/tableau-chart-eng.htm Controlled substances: Stimulants Controlled substances: Cocaine o Powerful Central Nervous System (CNS) stimulant. o Effects last 15 minutes to an hour, depending on method of ingestion. o Increases alertness, feelings of well-being & euphoria, energy & motor activity, feelings of competence & sexuality. o Athletic performance may be enhanced (attention & endurance). Stimulant: Cocaine Bullen, J. (2012, September 4). Cocaine tooth drops, morphine teething syrup and other Victorian quack cures. The Telegraph. https://www.telegraph.co.uk/news/health/pictures/9519906/Cocaine-tooth-drops-morphine-teething-syrup-and-other-Victorian-quack-cures.html An advertisement for cocaine toothache drops, which were available for just 15 cents from all druggists in 1885. These adverts for quack cures - often depicting children - claimed the products would heal a long list of illnesses including cancer, liver disease and coughs. But the miracle cures were often loaded with substances such as cocaine, morphine and alcohol. Lypka, M., & Urata, M. M. (2007). Cocaine-Induced palatal perforation. The New England Journal of Medicine, 357(19), 1956. https://doi.org/10.1056/nejmicm066935 Stimulant: Cocaine Case study: Cocaine-Induced Palatal Perforation A healthy 25-year-old man presented to the surgical clinic with a hole in the roof of his mouth that allowed nasal regurgitation of food when he ate. The hole had been present for a year, and he requested surgical correction. The patient reported a 5-year history of nasal cocaine use from which he had recently abstained. Physical examination revealed a large perforation of the nasal septum and midline palate. Local complications of intranasal cocaine abuse include chronic rhinitis, sinusitis, epistaxis, ossification or necrosis of the nasal septum, and in rare cases, palatal perforation. Use of cocaine, a potent vasoconstrictor, can lead to ischemia, necrosis, and ulceration, as seen in this case. Muirhead, T. T., & Eide, M. J. (2011). Toxic effects of levamisole in a cocaine user. The New England Journal of Medicine, 364(24), e52. https://doi.org/10.1056/nejmicm1008722 Stimulant: Cocaine Case study: Toxic effects of Levamisole in a Cocaine User A 54-year-old woman presented with a 2-day history of a painful, enlarging rash over her face (Panel A), ears (Panel B), breasts, and extremities. Toxicologic screening of the urine was positive for cocaine and opiates. The urine levamisole level 2 days after admission was positive at 920 ng per milliliter. Levamisole, an antihelmintic (deworming) agent for use in animals, is a common additive to cocaine and is speculated to enhance the euphoric effect. Muirhead, T. T., & Eide, M. J. (2011). Toxic effects of levamisole in a cocaine user. The New England Journal of Medicine, 364(24), e52. https://doi.org/10.1056/nejmicm1008722 Stimulant: Cocaine Case study: Toxic effects of Levamisole in a Cocaine User A 54-year-old woman presented with a 2-day history of a painful, enlarging rash over her face (Panel A), ears (Panel B), breasts, and extremities. Toxicologic screening of the urine was positive for cocaine and opiates. The urine levamisole level 2 days after admission was positive at 920 ng per milliliter. Levamisole, an antihelmintic (deworming) agent for use in animals, is a common additive to cocaine and is speculated to enhance the euphoric effect. Mule Medrano, L. (2007, November 1). How do donkeys look like the mule? https://www.quora.com/How-do-donkeys-look-like-the-mule Mule A mule is the offspring of a male donkey (jack) and a female horse (mare). Mule Pack Mule carrying load on Tour de Mont Blanc long distance path. Alps, France. Hyde, A. (n.d.). Pack Mule carrying load [Image]. Retrieved March 16, 2018, from https://alexhyde.photoshelter.com/image/I0000M10jmwR4EJI 1. Flach, P. M., Gascho, D., Fader, R., Martinez, R., Thali, M. J., & Ebert, L. C. (2017). Death by “Snow”! A Fatal Forensic Case of Cocaine Leakage in a “Drug Mule” on Postmortem Computed and Magnetic Resonance Tomography Compared With Autopsy. The American Journal of Forensic Medicine and Pathology, Drug Mule 38(4), 339-344. Death by “Snow”! A Fatal Forensic Case of Cocaine Leakage in a “Drug Mule”1 This forensic case presents unique postmortem imaging of a “drug mule” with fatal intoxication due to cocaine leakage on postmortem computed tomography (PMCT) compared with autopsy. Forensic imaging revealed 91 hyperdense, uniformly shaped body packs with signs of leakage, which was confirmed by autopsy. Toxicology stated the dosage of cocaine intoxication as lethal. 1. Flach, P. M., Gascho, D., Fader, R., Martinez, R., Thali, M. J., & Ebert, L. C. (2017). Death by “Snow”! A Fatal Forensic Case of Cocaine Leakage in a “Drug Mule” on Postmortem Computed and Magnetic Resonance Tomography Compared With Hensley, S. (2011, September 16). Cocaine Mule Busted In Sao Paulo. https://www.npr.org/sections/health-shots/2011/09/16/140531766/cocaine-mule-busted-in-sao-paulo Drug Mule Cocaine Mule busted in Sao Paulo A man arrested at Congonhas Airport in Sao Paulo, Brazil, had quite a bit of undeclared carry-on baggage: 72 bags containing almost a kilogram of cocaine inside his body. Yagoub, M. (2014, April 24). Drug Mules Could Be 'Victims' Under New Ecuador Criminal Code. https://www.insightcrime.org/news/brief/drug-mules-could-be-considered-victims-under-new-ecuador-criminal-code/ Drug Mule Cocaine removed from the stomach of a drug 'mule' Controlled substances: Meth    Methamphetamine = also known as “meth” Highly addictive stimulant drug, affects the central nervous system (CNS). Produced in illegal laboratories. Controlled substances: meth lab American Addiction Centers, Inc. (2013). The Horrors of Methamphetamines (Infographic). https://www.rehabs.com/explore/meth-before-and-after-drugs/infographic.php#.XItVuqfMwn1 Controlled substances: Meth Acne appears or worsens. Obsessive skin-picking often causes meth users faces to be covered in small sores and scarring – the result of a common sensory hallucination of bugs crawling beneath the skin. Meth, like other stimulants, suppresses appetite and can lead to undernourishment due to long periods without eating. Over time the body begins consuming muscle tissue and facial fat, giving users a gaunt, hollowed out appearance. “Meth Mouth” is caused by several factors, tooth enamel is dissolved by the harsh chemical of the drug, the blood vessels contained in healthy gums & teeth shrink, increasing the rate of decay, the production of saliva diminishes, allowing harmful acids to further damage the mouth, cravings for sugary foods increases with meth use, oral hygiene is typically neglected while high, and heavy tooth-grinding is an additional side effect of the drug. Controlled substances 1. 2. 3. 4. 5. Hallucinogens Narcotics Stimulants Anabolic steroids Depressants Controlled substances: steroids o o o A chemical structure similar to testosterone. Promote cell and tissue growth increasing bone mass and body muscle. Popular with weightlifters, bodybuilders, and other athletes. Side effects of anabolic steroid use Headaches Baldness Strokes & blood clots High BP & heart disease Nausea & bloating Impotence Reduced sperm count Aggressive behavior Mood swings Shrinkage of the testicles  Liver damage           Side effects of anabolic steroid use Severe acne on the face Side effects of anabolic steroid use Severe acne Severe acne lesions include papules, pustules, abscesses, & deep ulcerations. Side effects of anabolic steroid use Gynecomastia The patient at the time of his ideal body image; the 21-year-old bodybuilder had a history of anabolicandrogenic steroid abuse. Note the development of breasts = gynecomastia. Klatt, E. C. (2019). Heart with hypertrophy, gross. [Digital image]. https://library.med.utah.edu/WebPath/TUTORIAL/DRUG/DRUG032.html Side effects of anabolic steroid use cardiac hypertrophy (abnormal enlargement, or thickening, of the heart muscle) involving the left ventricle. Cardiac hypertrophy can occur with anabolic androgenic steroid use. Big hearts do not function well, diminishing performance and increasing the risk for sudden death. Büttner, A., & Thieme, D. (2009). Side effects of Anabolic Androgenic Steroids: Pathological Findings and Structure– Activity Relationships. In Handbook of experimental pharmacology (pp. 459–484). https://doi.org/10.1007/978-3-540-79088-4_19 Side effects of anabolic steroid use Liver damage. Anabolic steroids can cause severe liver damage that could result in Liver Cancer (Hepatocellular Carcinoma) Büttner, A., & Thieme, D. (2009). Side effects of Anabolic Androgenic Steroids: Pathological Findings and Structure– Activity Relationships. In Handbook of experimental pharmacology (pp. 459–484). https://doi.org/10.1007/978-3-540-79088-4_19 Side effects of anabolic steroid use Liver adenoma. (benign tumor of the liver) in an anabolic steroid abuser. Büttner, A., & Thieme, D. (2009). Side effects of Anabolic Androgenic Steroids: Pathological Findings and Structure– Activity Relationships. In Handbook of experimental pharmacology (pp. 459–484). https://doi.org/10.1007/978-3-540-79088-4_19 Side effects of anabolic steroid use Testicular atrophy (shrinking) in a 30year-old anabolic steroid abuser (right) compared to normal size (left). Side effects of anabolic steroid use Andreas Münzer  Austrian professional bodybuilder. Side effects of anabolic steroid use  Münzer used a variety of bodybuilding drugs:  anabolic steroids, diuretics, growth hormone, and insulin.  Münzer died in 1996 following a competition due to liver & kidney failure. Side effects of anabolic steroid use  Autopsy findings included:  Extremely muscular physique.  Liver  numerous tumors  Cardiac hypertrophy ( heart size).  Münzer’s electrolytes unbalanced  extremely high potassium levels.  Traces of about 20 different drugs were found in his body. Controlled substances 1. 2. 3. 4. 5. Hallucinogens Narcotics Stimulants Anabolic steroids Depressants Controlled substances: depressants  CNS depressants = Substances that slow down normal brain function.  CNS depressants = sometimes called sedatives or tranquilizers.  Physicians can prescribe some CNS depressants for relief of sleeplessness, anxiety, or tension. Controlled substances: depressants  Barbiturates and benzodiazepines.  Affects the CNS by increasing GABA activity, a neurotransmitter.  Relieves anxiety & produces sleep  Side effects include slurred speech and loss of coordination.  Mixing depressants with alcohol and other drugs increases potency and health risks. Controlled substances: depressants Commonly Prescribed CNS Depress Barbiturates Prescribed for the treatment of anxiety or tension, or for people with sleep disorders. Benzodiazepines Prescribed for patients with more serious anxiety and panic attacks. Chemical Evidence (CE)-2.2 Controlled substances: depressants Controlled substances: depressants Depressants: alcohol Alcoholic drink = a drink that contains a substantial amount of ethanol (a) 341 mL (12 oz) glass of 5% beer, cider or cooler (b) 142 mL (5 oz) glass of 12% wine (c) 43 mL (1.5 oz) shot of 40% hard liquor (vodka, rum, whisky, gin etc.) Depressants: Alcohol CNS Depressant: depression of inhibitory control, vasodilation: warm, flushed, reddish skin, emotional outbursts, decreased memory & concentration, poor judgment, decreased reflexes, decreased sexual response, appetite loss. Chronic consumption of Alcohol o Lost productivity, impaired performance, cost to society o Liver cirrhosis and liver cancer o Pancreatitis (inflammation of the pancreas) & pancreatic cancer Pancreatic cancer is difficult to detect (find) and diagnose early. Why? No noticeable S&S in the early stages of the cancer. S&S of pancreatic cancer, when present, are like the S&S of many other illnesses. Pancreas is deep: hidden behind other GI organs. Pancreatic Cancer Liver Cirrhosis  Advanced liver disease  results in loss of liver function.  Characterized by replacement of liver tissue by fibrosis (scar tissue) and regenerative nodules (lumps that occur due to attempted repair of damaged tissue).  Commonly caused by:  Alcoholism  Hepatitis B and hepatitis C Chemical Evidence (CE)-4 Liver Cirrhosis  ascites Cancers associated with drinking alcohol Liver Cancer  Tumor that grows on the liver.  Responsible for >12,000 deaths per year in the United States  one of the most common cancers in adults. Alcohol during pregnancy For any pregnant woman & baby  Miscarriage  Stillbirth  Prematurity  Sudden infant death syndrome (SIDS)  Fetal alcohol spectrum disorders (FASDs) Riley, E. P., Infante, M. A., & Warren, K. S. (2011). Fetal Alcohol Spectrum Disorders: An Overview. Neuropsychology Review, 21(2), 73–80. https://doi.org/10.1007/s11065-011-9166-x Fetal alcohol spectrum disorder Prenatal & postnatal growth retardation (c) (a) (b) Clinical features of Fetal Alcohol Spectrum Disorders (FASD). (a) Photo of a 4-month old infant with FASD. (b) Photo of the same child at 5 years of age. (c) Drawing showing the major facial characteristics used in the diagnosis of FASD. Carpenter, B. (2011). Pedagogically bereft! Improving learning outcomes for children with foetal alcohol spectrum disorders. British Journal of Special Education, 38(1), 37–43. https://doi.org/10.1111/j.1467-8578.2011.00495.x Fetal alcohol spectrum disorder CNS involvement (a) (b) FASD a) Normal brain of an infant at 6 weeks old. b) Brain of an infant at the same age with high exposure to alcohol during pregnancy. Fetal alcohol spectrum disorder CNS involvement: o Neurological abnormalities o Cognitive delays o Speech & hearing impairment o Learning, attention & memory deficits Developmental delays  alcohol related birth defects Fetal alcohol spectrum disorder Health Canada. (2023, December 22). Horizontal Evaluation of the Canadian Drugs and Substances Strategy: Evaluation Report. Canada.ca. https://www.canada.ca/en/health-canada/corporate/transparency/corporate-management-reporting/evaluation/canadian-drugs-substances-strategy.html Substance use in Canada Total costs (in billions) related to substance use in Canada from 2007 to 2020, by substance and cost type Drug Strategy & Controlled Substances Program  Branch of Health Canada that regulates controlled substances and attempts to reduce or prevent harm associated with these substances.  Provides expert advice, drug analysis and support to enforcement agencies.  Ensures mandate of legislation including CDSA and FDR are carried out. Controlled Drugs and Substances Act  Outlines penalties based on offence related to controlled drug:  Possession  Production  Possession for exportation  Trafficking  Includes Narcotic Control Regulations Drugs and Crime  Almost half of the individuals in federal prisons are there because of drug-related offenses.  More than $600 billion is spent annually on costs related to crime, lost work productivity, and healthcare because of drug abuse.  Continued use of a drug can lead to Drugs and Crime How Portugal won the war on drugs 1. A Stark Difference: Drug-Related Deaths. 2015 data except: U.S. (2016); Belgium, Britain, Denmark, Ireland, Norway, Poland, Spain (2014); France (2013) Source: European Monitoring Center for Drugs and Drug Addiction.1 Kristof, N. (2017, September 22). How to Win a War on Drugs. Portugal treats addiction as a disease, not a crime. The New York Times (Opinion). https://www.nytimes.com/2017/09/22/opinion/sunday/portugal-drug-decriminalization.html A van distributing methadone, an opioid substitute, in the Lumiar neighborhood.1 1. Rodrigues, D. (2017, September 22). A van distributing methadone, an opioid substitute, in the Lumiar neighborhood. [Digital image]. Violent Crime vs. Drug-related crimes Violent Crime vs. Drug-related crimes Brock Turner: Sexually assaulted an incapacitated woman. Jeff Mizanskey: THREE minor cannabisrelated offences. Bernie Sanders said… ACCIDENTAL DRUG OVERDOSES In 2016, singersongwriter Prince Rogers Nelson died from an accidental Fentanyl overdose. Prince was 57. PRINCE ACCIDENTAL DRUG OVERDOSES In 2013, actor Cory Montieth died from a “mixed drug toxicity" consisting of heroin and alcohol. Cory was 31. Cory Monteith ACCIDENTAL DRUG OVERDOSES In 2008, actor Heath Ledger died from an accidental prescription drug overdose. He was 28. Heath Ledger ACCIDENTAL DRUG OVERDOSES In 1976, martial artist, actor, film director, pop culture icon Bruce Lee died from a prescription drug overdose. Lee was 32. Bruce Lee Hummingbird flying amongst some lavender plants. For next class:  Read chapters 3 and 4 Hummingbird flying amongst some lavender plants.