Causing drugs. The body's reaction to repeated administration of drugs. Consequences of cocaine use

Addictive drugs

There are no medications that can be considered absolutely safe. Some of them require precise dosage and careful selection. Others can cause allergies or side effects. Some medications can cause unhealthy addiction, or even full-fledged, real addiction. These are the medications we will talk about.

Drug addiction

Addiction can manifest itself in different ways. Sometimes addiction forms psychological dependence. In this case, the patient experiences psychological discomfort when discontinuing the drug, fear of a return or exacerbation of the disease, he worries until he receives the usual dose of his “favorite medicine.” This is a fairly mild form of addiction. It is worse if uncontrolled use of the medicine causes some pathological changes in the body, which the patient tries to cope with with the same drug, gradually increasing the dose. As a result, you can experience serious disruptions in the functioning of organs and systems, but stopping the medication will allow you to restore impaired functions and restore health. The most dangerous is physical dependence, which develops in cases where the components of the drug are integrated into the metabolic processes of the body. Withdrawal of the drug causes real withdrawal symptoms and withdrawal symptoms, with all the ensuing consequences. To get rid of physical drug addiction, long-term and serious treatment under the supervision of a specialist is required.

Drugs that are addictive and addictive

Laxatives

Women's desire to lose weight sometimes pushes them to take ill-considered actions. For example, for constant use of laxatives. As a result of improper use, the intestines lose the ability to work independently, without a laxative. Stopping the medication causes severe constipation.

How to fix:

switch to proper nutrition, including a sufficient amount of plant fiber, vegetable fats, and fermented milk products. Be sure to monitor the maintenance of water balance: drink enough pure or mineral water. Avoid strong tea and coffee. Do therapeutic exercises, or even better, yoga.

Nasal drops

Drug-induced vasomotor rhinitis is common among those who suffer from allergies. The addiction to the drops develops very quickly, and then the patient for years cannot give up the habit of having a bottle of naphthyzine or galazolin on hand. It seems to him that if he does not drop the treasured drop into his long-suffering nose in time, he will certainly suffocate. Because without a dose of vasoconstrictor medication, the nasopharynx quickly swells, and breathing really becomes difficult. But the cause of breathing difficulties lies precisely in the abuse of medications. It’s not for nothing that the instructions for using drops always say: the course of treatment should not exceed 5-7 days. When this period is exceeded, the mucous membrane begins to change pathologically. It becomes thin, dries out quickly, and ceases to perform its protective functions.

How to fix: overcome psychological dependence.

You can start by diluting the drops with saline or water, gradually reducing the concentration of the drug. Make sure that the air humidity in the room does not fall below 60% - this will make breathing easier. Dry nasopharyngeal mucosa can be moistened with saline or sea water. Gradually the mucous membrane will recover and the drops can be abandoned altogether.

There are special methods for treating vasomotor rhinitis using laser, acupuncture, and physiotherapeutic procedures. But the main thing, after all, is to stop using vasoconstrictor drops, and with the help of a doctor, choose the most appropriate method for restoring health.

Sleeping pills, tranquilizers, antidepressants

Drugs prescribed for depression, insomnia, increased anxiety and overexcitement can be addictive and dependent. Incorrect selection of medication and uncontrolled use are quite capable of leading to the formation of serious dependence, both physical and psychological. This is not drug addiction, but abrupt withdrawal of the drug may well cause withdrawal symptoms and a serious deterioration in the patient’s health, just like in a real drug addict.

Addiction is often associated with the fact that the body stops responding to the initial dose of the drug, and the dosage has to be increased all the time. As a result, the patient develops the belief that he “lives only on pills.” That without the pill he won’t fall asleep, won’t be able to work, won’t be able to cope with anxiety. Mood, worldview, relationships with others begin to depend on taking the medicine.

How to fix:

Be sure to consult a doctor to develop a method for gradually weaning off medications.

To solve problems with insomnia, it is important to eat right and significantly reduce the consumption of caffeinated drinks. You need to try to optimize your work and rest schedule and provide a comfortable sleeping place. It is useful to take a walk before bed, do swimming, yoga, and reduce time watching TV or computer. Automotive training helps with increased anxiety.

Analgesics

It’s not just drugs like morphine that can cause addiction and painful dependence. Residents of megacities are increasingly becoming addicted to non-narcotic analgesics: Nurofen, spasmalgon, etc. In this case, addiction first arises at the psychological level. Most often, middle-aged women suffer from the habit of taking analgesics.

As a rule, medications that contain codeine are addictive. This substance acts similar to morphine, but is much less effective. However, the destructive consequences of addiction are very serious: after just a few years of excessive use of codeine-containing analgesics, disturbances in the functioning of the liver and kidneys appear, and gastric ulcers can develop.

Stopping the medication causes real withdrawal symptoms: weakness, palpitations, nausea, dizziness. The patient prefers to take the pill again rather than endure this torment. Moreover, “it’s just a painkiller”, not some kind of drug... There is always a reason to increase the dose again and again - migraine, PMS, back pain, or anywhere else.

Taking a pill is much easier than going to the doctor or going to the gym. Moreover, in most countries analgesics are sold without a prescription.

How to fix: consult a doctor. You may need the help of a narcologist if you take more than 10 painkillers a day for a long time. You will have to seriously work on yourself: change your lifestyle, endure withdrawal symptoms. And forever give up the habit of taking any medications without a doctor’s prescription.

Karaganda State Medical University

Department of Pharmaceutical Disciplines with a Chemistry Course<#"justify">Completed by: Yulia Gorshkova

Checked by: Piven Lyubov Ivanovna

Karaganda, 2012

Introduction

.Drug addiction - concept

.Types of drug addiction (mental, physical)

.Substance abuse, drug addiction, dependence on sleeping pills

.Withdrawal syndrome

.Diagnosis and treatment of drug addiction

.Social significance for society

Conclusion

Bibliography

Introduction

There are many substances in nature that can have a narcotic effect on humans. A number of substances with narcotic properties are obtained artificially - ethyl alcohol, chloroform, sleeping pills, tranquilizers - sedatives.

Medicines are intended to treat or alleviate the symptoms of a disease. However, these drugs are beneficial only when used wisely and as prescribed by a doctor, otherwise they can become harmful, even deadly. For example, the oldest of drugs - opium - was once discovered by man in the plant world and was initially used in the treatment of a number of diseases. Heroin, now one of the most dangerous drugs, was first proposed as a pain reliever. Unfortunately, the newest drugs of synthetic origin - stimulants, sleeping pills, sedatives - are also becoming potential objects of abuse.

1. Drug addiction

Narcotic substances are quite widely used in modern medicine as painkillers and sedatives. But the effect of drugs on the central nervous system is not limited to this effect. Many of them cause a special mental state of excitement in people - euphoria. Although subjectively attractive, euphoria is an objectively harmful state, since in this case a person is always disconnected from reality to one degree or another. Therefore, he feels the desire to repeat this state again and again. As a result, addiction develops. A person seeks to disconnect from reality. His attitude towards the environment changes sharply, the entire system of value orientation collapses. Drugs destroy the nervous system and negatively affect almost all organs and tissues.

Drug dependence is a mental, or maybe physical, condition that includes an urgent need to take medications that act on the psyche. Long-term use of many medications, especially psychotropic drugs, can be addictive. In case of drug addiction, medications and drugs cease to have their pharmacological effect, and often, on the contrary, lead to a paradoxical result that is opposite to their intended purpose.

There are two types of drug addiction: physical and mental.

Mental dependence- a condition in which a medicinal substance causes a feeling of satisfaction and mental uplift and requires periodic administration of medicinal substances to normalize the mental state. With mental drug dependence, stopping the use of the substance that caused it is accompanied by emotional and psychological discomfort. Mental dependence on drugs arises as a result of a person’s opinion formed at a reflex level that after taking an antidepressant, mental discomfort is eliminated, and it is replaced by a state of calm, positivity and tranquility. There are psychotropic substances (cocaine, Indian hemp preparations, lysergic acid diethylamide) that cause predominantly mental dependence.

The basis for the formation of mental L.Z. is, obviously, the ability of psychotropic substances to change a person’s mental state, since many of them (narcotic analgesics, psychostimulants, sedatives and hypnotics, tranquilizers, alcohol) affect mood, perception, thinking, cause euphoria, reduce anxiety, fear, tension. In this regard, a certain circle of people, due to predisposing psychological, biochemical, genetic, social and situational factors, may develop a certain need for repeated use of any psychotropic drug to achieve a comfortable state, euphoria or reduce fear, anxiety, anxiety. An extreme form of such an artificial need is the formation of a pathological craving for psychoactive compounds with the subsequent development of drug addiction or substance abuse.

Physical dependence- an adaptive condition manifested by severe somatic disorders when the administration of the medicinal substance causing this condition is stopped. In physical drug dependence, withdrawal of the substance or drug that caused it leads to the development of withdrawal syndrome,manifested along with various mental vegetative-somatic and neurological disorders. The development of withdrawal syndrome can also be caused by the administration of antagonists of a substance that causes physical dependence. In the development of physical L.z. In addition to conditioned reflex mechanisms, an important role is probably played by adaptive reactions associated with changes in the organs in the number and sensitivity (affinity) of receptors with which psychotropic substances interact, for example, opiate receptors under the action of morphine-like substances, benzodiazepine receptors under the action of benzodiazepine tranquilizers, etc. . In addition, under the influence of psychotropic drugs in the body, the production of endogenous substances (ligands) that interact with the same type of receptors with which psychotropic drugs interact can change. It is known, for example, that when systematically taking morphine in the body, pronounced shifts occur in the content of endogenous opioid peptides, and when taking phenamine and other psychostimulants, the metabolism of catecholamines increases and the content of cyclic nucleotides in the c changes. n. With. Stopping the administration of psychoactive substances that cause the above-mentioned adaptive changes in neurotransmitter systems leads to the development of withdrawal syndrome, the clinical picture of which is characterized by manifestations that are opposite to the effects of the drug that caused it. psychoactive substance. Thus, with morphinism, withdrawal syndrome is characterized by pain, increased salivation, and diarrhea. Cancellation of barbiturates in case of developed pulmonary disease. leads to convulsive reactions, withdrawal of tranquilizers leads to anxiety, etc.

narcotic drug addiction treatment

3. Substance abuse

(from Greek: poison + madness, insanity) a disease caused by chronic use of psychoactive substances (medicines not considered drugs, chemicals and herbal substances); are characterized by the development of mental and, in some cases, physical dependence, changes in tolerance to the substance consumed, mental and somatic disorders, and personality changes. Mental dependence is manifested by a painful desire (attraction) to continuously or periodically take a psychoactive toxic substance in order to cause certain sensations or relieve mental discomfort. This explains the patient’s purposeful (searching) behavior; its main purpose is to obtain the necessary substance. Physical dependence is characterized by the emergence, after stopping the use of a toxic substance, of a complex of vegetative-neurological and mental disorders, which are referred to as withdrawal syndrome (withdrawal syndrome). Substance abuse is caused by many drugs and substances. First of all, these include drugs that have a sedative and hypnotic effect: derivatives of barbituric acid (with the exception of etaminal sodium and sodium amytal, which are classified as drugs), benzodiazepine tranquilizers (Elenium, Seduxen, phenazepam and others), a number of drugs with a sedative effect ( e.g. meprobamate, sodium hydroxybutyrate). Substance abuse can be caused by the use of antiparkinsonian (cyclodol) and antihistamine (diphenhydramine, pipolfen) drugs, psychostimulants (ephedrine, theophedrine, caffeine, sydnocarb and others), combination drugs (solutan and others), inhalation anesthesia (ether, nitrous oxide). A large group consists of substances that are not classified as drugs, but they are the cause of inhalation substance abuse. These are volatile organic solvents, e.g. toluene, benzene, perchlorethylene, acetone, gasoline, as well as various household chemicals.

Addiction- is a physical and psychological dependence on a certain group of drugs - drugs. Drugs change how you respond to sensations. They also cause mood changes and can lead to loss of consciousness or deep sleep. Examples of drugs are heroin, codeine, morphine and methadone.

Signs of drug addiction may include a decreased desire to work and/or be in society, severe dizziness, impaired ability to concentrate, frequent mood swings, relaxation, personality changes, and decreased appetite. A person who uses drugs tends to be alone and can suddenly and easily disappear. When using crack cocaine, speech impairments are observed. In most cases, the condition of the pupils changes.

Sudden cessation of drug use may occur due to inability to obtain drugs, lack of money, imprisonment or hospitalization. You can also stop taking them in an attempt to get rid of drug addiction.

Dependence on sleeping pills.

Abuse of sleeping pills, which are included in the list of drugs, is considered as drug addiction, other cases as substance abuse. As a rule, substance abuse primarily arises as a result of abuse of barbiturates, and then is supported by the addition of any somnogenic drugs, and in some cases, tranquilizers.

Abuse of sleeping pills, which are included in the list of drugs, is more often observed in people suffering from insomnia and in a bad mood. Sleeping pills initially improve their subjective state, relieve insomnia, smooth out emotional disorders, and reduce the urgency of their experiences. An important role in the development of addiction is played by euphoria, as well as the effect of relieving anxiety, which is often observed already at the first use of sleeping pills. Subsequently, however, patients are forced to increase doses and take sleeping pills during the daytime. Under certain conditions, the effect of barbiturates is similar to alcohol intoxication: euphoria, slurred speech, staggering, disorientation, and slowed reflexes and breathing appear. When barbiturates and alcohol are taken simultaneously, a mutual enhancement of the effect occurs, which can lead to death due to symptoms of respiratory paralysis. Continuous use of drugs for more than three weeks causes anemia in combination with liver dysfunction, leads to severe headaches, and decreased respiratory function. Under certain conditions Under circumstances, these drugs are addictive and can lead to addiction after just two weeks of continuous use.

4. Withdrawal syndrome

If you use drugs for a long time, then addiction develops. If you stop taking drugs, withdrawal syndrome occurs. Drug withdrawal syndrome can cause severe suffering, but does not lead to death. The severity of withdrawal depends on the degree of addiction. You can rate these symptoms on a 4-point scale:

Anxiety and a strong desire to take drugs.

Watery eyes, runny nose and yawning.

The symptoms listed above include dilated pupils, loss of appetite, chills, hot or cold flashes and pain throughout the body.

Severe chills, hot or cold flashes, pain throughout the body, increased blood pressure, fever, rapid pulse and breathing. 4. Diarrhea, vomiting, low blood pressure and dehydration. Successful treatment of withdrawal symptoms is based on the idea of giving the patient a dose of drugs that is sufficient to relieve withdrawal symptoms without causing euphoria.

Symptoms associated with drug withdrawal: headache, insomnia, increased sensitivity to light or noise, diarrhea, feeling hot or cold, excessive sweating, major depression, irritability, behavioral abnormalities, disorientation.

Diagnosing drug dependence can be quite difficult, especially in patients with actual physical illness. The placebo effect can be used as a diagnostic tool. If patients respond to a placebo as if they were to a drug, it is highly likely that they have a psychological dependence on the drug. The presence of physical dependence is indicated by signs of withdrawal syndrome that occurs after drug withdrawal.

Prevention of drug addiction consists of competent selection of the complex and dosage of medications, which should be taken exclusively as prescribed by a doctor and under medical supervision.

Treatment of drug addiction consists of gradually reducing the dosage of the drug taken until completely stopping the drug. Also, as a treatment for drug addiction, the placebo effect or the prescription of a similar but weaker drug can be used.

In severe cases of psychological dependence on drugs, patients must undergo a course of psychotherapy. For example, high internal anxiety or the presence of internal psychological conflict can cause somatic symptoms and provoke the use of medications, or cause an obsessive need to take medication to relieve psychological anxiety directly. Insomnia and abuse of sleeping pills, as a rule, also have a psychogenic origin.

6. Social significance for society

Drug addiction is a socially dangerous phenomenon in the life of society. Drugs not only negatively affect a person’s physiology, but also destroy him as a person. Teenagers and young adults are especially susceptible to drugs. This is confirmed by statistics even for our republic. The increase in the number of street children and low-income and disadvantaged families with drinking parents creates favorable conditions for the growth of drug addiction and substance abuse.

Directly related to drug addiction is the increase in the number of criminal offenses among adolescents and young people, as well as the spread of a fatal infection for humans - AIDS. Along with AIDS, there are a number of other diseases that affect people who use drugs: hepatitis C and sexually transmitted diseases. Drug use is immoral in itself, regardless of its specific complications. For a drug addict, the concepts of goodness and justice lose their significance. Striving for the next use of a narcotic substance, he is ready for any Lie and deception; behavior, as drug addiction deepens, is increasingly directed by narcotic interests and less and less by moral criteria. One cannot expect anything else, since the very essence of drug addiction lies in the destruction of the natural mechanisms for assessing the world around us and one’s place in it, the value system that has developed in the process of upbringing.

Conclusion

Many diseases can be treated with medications, and most of them can be purchased at the pharmacy without a prescription. We know this well, and often prescribe this or that medicine to ourselves. Meanwhile, some drugs contain substances that can cause addiction. You may not even notice how addiction arises. Therefore, the most important prevention for not developing drug addiction is treating the patient under the supervision of a doctor. We must remember that we ourselves are responsible for our health and life.

Bibliography

Shakurova M.V. Methodology and technology of work of a social teacher. M: Publishing center "Academy", 2008-272p.

Kryzhanovsky S.A., Vititnova M.B. Modern medicines. M., 1998

Valdman A.V., Babayan E.A. and 3vartau E.E. Psychopharmacological and medico-legal aspects of substance abuse, M., 1988, bibliogr.;

Drug addiction: condition, trends, ways to overcome: - manuals for teachers and parents. M: Publisher: - Vlados-Press, 2003-352p.

Web site:

Nake A. - Drugs. Publisher: M: Sekachev, 2001-128p.

Web site:

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Plan:

Introduction

1. Drug addiction

2. Mental dependence

3. Drugs that cause drug dependence

Conclusion

List of used literature

Introduction

Drug addiction - mental, there may be a physical condition, including an urgent need to take medications that act on the psyche:

Occurs with repeated administration of drugs;

Requires constant use of medications;

Certain adaptive changes develop.

1. Drug addiction

2. Psychicaladdiction

Mental dependence - a condition in which a medicinal substance causes a feeling of satisfaction and mental uplift and requires periodic administration of medicinal substances to normalize the mental state. narcotic mental addiction medicine

Mental dependence on drugs arises as a result of a person’s opinion formed at a reflex level that after taking an antidepressant, mental discomfort is eliminated, and it is replaced by a state of calm, positivity and tranquility. There are psychotropic substances (cocaine, Indian hemp preparations, lysergic acid diethylamide) that cause predominantly mental dependence.

The basis for the formation of mental drug dependence is, obviously, the ability of psychotropic substances to change a person’s mental state, since many of them (narcotic analgesics, psychostimulants, sedatives and hypnotics, tranquilizers, alcohol) affect mood, perception, thinking, cause euphoria, reduce anxiety, fear, tension. In this regard, a certain circle of people, due to predisposing psychological, biochemical, genetic, social and situational factors, may develop a certain need for repeated use of any psychotropic drug to achieve a comfortable state, euphoria or reduce fear, anxiety, anxiety. An extreme form of such an artificial need is the formation of a pathological craving for psychoactive compounds with the subsequent development of drug addiction or substance abuse.

3. Drugs that cause drug dependence

Many psychoactive substances (morphine, codeine, heroin and other morphine-like substances, barbiturates, alcohol, tranquilizers from the group of benzodiazepine derivatives, etc.) can cause both mental and physical dependence. At the same time, there are psychotropic substances (cocaine, Indian hemp preparations, lysergic acid diethylamide) that cause predominantly mental dependence. Formation of L.z. often accompanied by the development of addiction, which is especially pronounced with the abuse of morphine and other narcotic analgesics. However, in a number of cases, despite the formation of a clear picture of illness, addiction develops slightly (for example, with the abuse of Indian hemp preparations, cocaine).

Drugs that cause addiction can be divided into the following groups: alcohol-barbiturate (ethyl alcohol, phenobarbital); Cannabine (marijuana, hashish); cocaine; ethereal solvents (toluene, acetone, carbon tetrachloride); drugs that cause hallucinations (LSD, mescaline, psilocybin); drugs derived from opium (morphine, codeine, heroin) and their synthetic substitutes (promedol, fentanyl).

Not only tranquilizers, narcotic analgesics, barbiturates, but also hallucinogenic substances and organic solvents cause drug addiction.

Psychostimulants . Medicines in this group, with the exception of caffeine and its derivatives, are not used in pregnant women due to their toxicity

Psychostimulants increase mood, the ability to perceive external stimuli, and psychomotor reactivity. They stimulate intellectual activity, accelerating thinking processes, which is often accompanied by the elimination of fatigue, drowsiness, and suppression of hunger.

Based on their chemical structure, psychostimulants are divided into the following groups:.

I. Phenylalkylamines: phenamine (amphetamine).

II. Sydnonimine derivatives: sydnocarb (mesocarb), sydnofen (feprozid sydnimine).

Sh. Piperidine derivatives (not applicable).

IV. Xanthines: caffeine, caffeine sodium benzoate, etimizol.

V. Benzimidazole derivatives: bemityl.

Tranquilizers -- psychopharmacological agents that relieve anxiety, fear, and emotional tension, while they do not significantly impair cognitive functions. Unlike neuroleptics, tranquilizers do not have the ability to affect delusions, hallucinations, and other psychotic manifestations

Most tranquilizers, when used for a long time, become addictive to taking the drug, so treatment should be carried out in short courses.

Chlordiazepoxide (Librium, Elenium), Diazepam (Seduxen, Relium, Valium), Lorazepam (lorafen), Bromazepam (Lexotan, Lexomil), Atarax (hydroxyzine), Phenazepam, Alprazolam (Xanax), Frizium (clobazam), Oxilidine, Triazolam (halcion ).

The mechanism of action of psychostimulants is apparently associated with their inherent indirect adrenomimetic effect, as a result of which excitatory processes in various parts of the brain are intensified (reticular formation of the brainstem, hypothalamus, hippocampus, cerebral cortex).

Barbiturates - a class of sedatives that have hypnotic, anticonvulsant and narcotic effects due to their inhibitory effect on the central nervous system and are used in medicine to relieve anxiety syndromes, insomnia and convulsive reflexes. All these drugs are derivatives of barbituric acid (CONHCOCH2CONH). Barbiturates are well absorbed in the stomach and small intestine. The duration of action of various barbiturates is not the same, which is due to the peculiarities of their transformation in the body and elimination from it (long-acting barbiturates are eliminated mainly by the kidneys; barbiturates with a short duration of action are destroyed mainly in the liver). To obtain a hypnotic or sedative (1/3-1/4 dose inducing sleep) effect, drugs with long (barbital, phenobarbital, barbital sodium), medium duration (cyclobarbital, barbamyl, etaminal sodium) and short (hexobarbital) action are used , depending on the nature of the sleep disorder.

People who abuse barbiturates prefer barbiturates with short or intermediate effects, namely pentobarbital (Nembutal) and secobarbital (Amytal). Other short- to intermediate-duration barbiturates include butalbital (Fiorinal, Fioricet), butabarbital (Butizol), talbutal (Lotusate), and aprobarbital (Alurate). After using any of these medications orally, the effects begin within 15 to 40 minutes, and the effects last up to 6 hours.

Barbiturates are sleeping pills that become addictive with long-term use. The most widely used in medicine are barbital, barbamyl, phenobarbital (also called luminal) and etaminal sodium. Abuse of barbiturates is typical for patients with alcoholism and opium addiction. This may be due to the fact that the tendency to take barbiturates is inherited by the same mechanism as the tendency to consume alcohol and opiates. In addition to their main medicinal effect, barbiturates cause mild euphoria. This property of theirs increasingly attracts people who abuse sleeping pills, and eventually becomes an end in itself for them. Most people, unaware of the dangers of uncontrolled use of barbiturates, can become physically dependent on them. And this dependence can be expressed in the form of a tenacious withdrawal syndrome. With a severe overdose of barbiturates (more than 4-6 g per dose), deaths are possible due to paralysis of the respiratory center and the development of coma. It should be borne in mind that if barbiturates are taken too often, their doses add up, which creates a serious threat to health even when taking relatively low single doses.

Hallucinogens (asthmatol, cyclodol, diphenhydramine) Hallucinogens are substances that, when taken even in small doses (often milligrams), can cause hallucinations. In pharmacology they are often referred to as psychotomimetics, i.e. means, the action of which causes short-term (“model”) psychoses.

These include derivatives of lysergic acid (for example, LSD), tryptamine (for example, psilocybin), phenylethylamine (mescaline), glycolic acid (dithran, amizil). Cannabinoids (the active principles of hashish), atropine and atropine-like substances, as well as inhalants (gasoline, acetone, etc.) can also have a hallucinatory effect. However, their hallucinogenicity is detected when significantly larger doses are consumed, and, in addition, hallucinations are not always the leading symptom in the clinical picture of intoxication with these substances.

Conclusion

List of used literature

1. Kharkevich D.A. Pharmacology, GEOTAR-MED, 2006.

2. Alyautdin R.N. Pharmacology, GEOTAR-MED, 2005.

3. Lectures on pharmacology edited by Vengerovsky A.I., 2007.

4. Komarov F.I., Rappoport S.I. Chronobiology and chronomedicine, Moscow-Triad-X, 2000.

5. Valdman A.V., Babayan E.A. and Zvartau E.E. Psychopharmacological and medico-legal aspects of substance abuse.

6. Kryzhanovsky S.A., Vititnova M.B. Modern medicines. M., 1998.

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...in some cases, drug-induced myopathy can be catastrophic, causing rhabdomyolysis and myoglobinuria.

Drugs and various chemical agents can cause both local and general damage to skeletal muscles. Let's look at the drugs that most often cause (general) damage to the neuromuscular system, and also consider the possible mechanisms of this damage.

It is known that some drugs can cause generalized muscle weakness, which is more pronounced in the proximal muscles. Drugs that cause damage to the neuromuscular system include corticosteroids, emetine, D-penicillamine, colchicine, cocaine, hydroxychloroquine, zidovudine, clofibrate, lovastatin and other cholesterol-lowering agents, as well as chloroquine and aminoglycosides.

In most cases, the exact mechanism of drug toxicity is unknown. Thus, D-penicillamine causes a condition simulating dermatomyositis and polymyositis. There have been reports of a similar condition occurring after the use of cimetidine. Procainamide can cause myositis as part of a lupus-like reaction. Chloroquine after many months of use leads to clearly defined vacuolar myopathy, sometimes with myocardial damage. Clofibrate causes weakness and muscle pain, sometimes soon after starting treatment and sometimes several months later. An increase in serum criatine kinase activity may be the only manifestation of the negative effect of this drug on muscles. Muscle weakness and necrosis of muscle fibers may develop after several weeks of treatment with emetine hydrochloride (used in the treatment of amebiasis), epsilon-aminocaproic acid (an antifibrolytic agent), and perhexylene (used in angina pectoris). Drug-induced myopathy also occurs during treatment with corticosteroids, and weakness of the proximal muscles is very characteristic.

Let us consider in more detail the damage to the muscle (neuromuscular system) when using glucocorticosteroids and statins.

GLUCOCORTICOSTEROIDS

During treatment with glucocorticoids, changes in the striated muscles are quite often observed. Clinical manifestations of myopathy are expressed in the development of severe fatigue with minimal physical activity (walking on a flat surface, rising from a chair), which is sometimes accompanied by muscle hypotonia. The muscles of the thighs and legs are mainly affected. These changes in striated muscle are called steroid myopathies and may occur during treatment with any glucocorticoid preparation. However, their frequency is highest when using corticosteroids with fluorine in the 9a position; these are triamcinolone, dexamethasone and betamethasone (especially triamcinolone).

In fact, long-term use of all corticosteroids, including prednisone, leads to the development of muscle weakness. Taking these drugs several times a day causes greater muscle weakness than taking them once in the morning. Their one-time use during the day or taking this dose every other day spares the muscular system to a greater extent. The mechanism of development of steroid myopathies is complex. The main role in it is given to factors affecting the metabolism of proteins (increased anti-anabolic and catabolic effects) and potassium (hypokalemia). The results of electromyography are usually within normal limits or nonspecific. When examining muscle biopsy material, atrophy of muscle fibers may be detected, which is nonspecific and is also observed with muscle atrophy from inactivity.

The clinical diagnosis of steroid-induced muscle weakness can be very difficult when corticosteroids are used for inflammatory myopathy. In such situations, corticosteroid-induced muscle weakness is supported by normal serum criatine kinase activity, normal (or minimally myopathic abnormalities) EMG (electromyorrhaphy), and the presence of type II muscle fiber atrophy in the muscle biopsy.

Treatment. To prevent muscle fiber atrophy - this undesirable effect - patients are prescribed a hyperprotein diet and an increase in potassium content in food. Drug treatment is limited to the use of anabolic drugs and the administration of potassium orally. It is advisable to massage muscles that tend to become malnourished. Such patients require exercise therapy, since muscle strengthening exercises help prevent the development of myopathy and improve well-being.

STATINS

One of the main adverse effects of statins is myopathy: muscle pain or weakness combined with an increase in creatine kinase more than 10 times the upper limit of normal. Myopathy with statin monotherapy occurs in approximately 1 in 1000 patients and is also dose related. In this case, symptoms such as fever and general malaise are sometimes observed; these manifestations are more pronounced at elevated serum levels of this drug. If a patient with an unrecognized myopathy continues to take the drug, lysis of striated muscle tissue and acute renal failure may develop. If myopathy is diagnosed on time and the drug is discontinued, then the pathology of muscle tissue is reversible, and the occurrence of acute renal failure is unlikely.

Combining statins with drugs that are CYP3A4 inhibitors or substrates increases the risk of myopathy, possibly by inhibiting the metabolism of statins and increasing their blood concentrations. These drugs are: cyclosporine, erythromycin, clarithromycin, nefazodone, azole antifugals, proteinase inhibitors and mibefradil (when using lovastatin and simvastatin). Fibrates and niacin also increase the likelihood of statin-induced myopathy without increasing statin plasma concentrations. Cases of myopathy have also been described with the use of pravastatin, although it is practically not metabolized via the CYP pathway. Statins, which are or are not metabolized by CYP, are used safely in combination with cyclosporine in patients after heart transplantation. Other risk factors for statin-associated myopathy include liver dysfunction, renal failure, hypothyroidism, advanced age, and severe infections.

Monitor for side effects on the liver and muscles. It is recommended to carry out tests for liver transaminases both before starting treatment and periodically during it. It is also advisable to initially determine the concentration of creatine kinase. Small, clinically insignificant increases in transaminases and creatine kinase are often observed with all statins. Routine monitoring of creatine kinase during treatment is usually not useful, since severe myopathy usually occurs suddenly and is not preceded by a prolonged increase in this enzyme.

Patients should be warned to consult a doctor if they experience muscle pain or weakness, severe malaise, or flu-like symptoms. If such complaints occur, statin therapy should be discontinued and creatine kinase levels should be immediately determined. After creatine kinase concentrations return to normal, many experts say it is possible to try continuing treatment with another statin, starting with low doses and carefully monitoring symptoms and creatine kinase levels.