الرحيم الرحمن الله بسم

Ministry of High Education

Almajmaa University College of Medicine

My Objectives

D- describe the pathophysiology of the injury caused by therapeutic drugs and drug of abuse .

Adverse drug reactions Adverse drug reactions (ADRs) are untoward effects of drugs that are given in conventional therapeutic settings. These reactions are extremely common in the practice of medicine and are believed to affect 7% to 8% of patients admitted to a hospital. About 10% of such reactions prove fatal .

Adverse reaction to minocycline, a long-acting tetracycline derivative

Exogenous Estrogens and Oral Contraceptives

Estrogen therapy, once used primarily for distressing menopausal symptoms , with added progestins, to prevent or slow the progression of osteoporosis

endogenous hyperestrinism increases the risk of developing ovarian carcinoma and, probably, breast carcinoma

Risks of estrogen

• increases the risk of endometrial carcinoma • increases the risk of thromboembolism,

including deep vein thrombosis, pulmonary embolism, and stroke .

• Estrogens and progestins increase blood levels of high-density lipoprotein and decrease levels of low-density lipoprotein.

Oral Contraceptives Risks of

• Breast carcinoma• Cervical cancer• Thromboembolism• Cardiovascular disease

Aspirin (Acetylsalicylic Acid)

Aspirin overdose may result from accidental ingestion in young children or suicide attempts in adults

The major untoward consequences are , metabolic respiratory alkalosis develops, followed by a metabolic acidosis that often proves fatal

Fatal doses may be as little as 2 to 4 gm in children and 10 to 30 gm in adults

Chronic aspirin toxicity (salicylism)

develop in persons who take 3 gm or more daily.

Chronic salicylism is manifested by headache, dizziness, ringing in the ears (tinnitus), difficulty in hearing, mental confusion, drowsiness, nausea, vomiting, and diarrhea

The CNS changes may progress to convulsions and coma

Injury by Nontherapeutic Toxic Agents (Drug Abuse)

Drug abuse generally involves the use of mind-altering substances

Drug addiction and overdose are serious public health problems

Considered here are cocaine, heroin, and marijuana

Cocaine In 2008, the National Survey on Drug

Use and Health estimated that there were 1.9 million users of cocaine in the United States.

Cocaine Extracted from the leaves of the coca plant, cocaine usually is prepared as a water-soluble powder .

Cocaine can be snorted, smoked after mixing with tobacco, ingested, or injected subcutaneously or intravenously.

The effects of cocaineCardiovascular effects : tachycardia,

hypertension, and peripheral vasoconstriction. Cocaine also induces myocardial ischemia

CNS effects. The most common CNS findings are hyperpyrexia

Effects on the fetus. In pregnant women, cocaine may cause decreasehypoxiad blood flow to the placenta, resulting in fetal and spontaneous abortion

Heroin• Heroin derived from the

poppy plant and is closely related to morphine. Its effects are even more harmful than those of cocaine.

• estimated that almost 4 million people in the United States have used heroin.

• Effects are varied and include euphoria, hallucinations, somnolence, and sedation.

The effects of Heroin

• Sudden death. Sudden death, usually related to overdose• Pulmonary disease. Pulmonary complications include

edema, septic embolism, lung abscess.• Infections. Infectious complications are common. The sites

most commonly affected are the skin and subcutaneous tissue, heart valves, liver, and lungs Most cases are caused by Staphylococcus aureus Viral hepatitis virus (HIV) infection because sharing of dirty needles .

• Skin lesions abscesses, cellulitis, and ulcerations due to subcutaneous injections. Scarring at injection sites

• Renal problems.

Marijuana

Marijuana, or “pot,” is the most widely used illegal drug .

is made from the leaves of the Cannabis sativa plant, which contain the psychoactive substance Δ9-tetrahydrocannabinol (THC)

The effects of Marijuana

• The lungs are affected by chronic marijuana smoking

• laryngitis, pharyngitis bronchitis

• cough, hoarseness, and asthma

summary

Drug injury may be caused by therapeutic drugs (adverse drug reactions) or non-therapeutic agents (drug abuse).

long-acting tetracyclines and other antibiotics , and aspirin are the drugs most frequently involved.

The common drugs of abuse include Cocaine , Heroin , Marijuana .

Questions?

Resources • basic robbins pathology• Medicine books web site.

Thank you Don by : Mohammed Abdullah Hazazi 2nd year medical student

Supervisor : DR. khwaja amer Assistant Professor of Physiology