 Keywords: narcotics, morphini, dependence, predilection, habituation, Morphinum, narcotics, a morphinism, alkoloid, opiumthe Author: Poljanskaja O.V.NARCOTIC DEPENDENCE ON DERIVATIVES OF MORPHINUM
" At injection of one syringe...
MORPHINUM.Morphinum (Morphinum) - an alkaloid of opium. Has been secured in 1805 and the name has received in honour of the Greek god of dream Morfeja. It was widely used during civil war in America. It daily introduced wounded to facilitate postoperative pains. It invoked habituation and dependence in patients. The morphinism has at that time received the name of " soldier's illness ". Apply Morphinum a hydrochloride (Morphini hydrochloridum). Synonyms: Ìîrphine hydrochloride, Morphinum hydrochloricum. Physical properties. White spicular crystals or a white crystalline powder; turning slightly yellow at storage. We shall slowly dissolve in water, we shall difficultly dissolve in alcohol (1:50). It is incompatible with alkalis. Solutions sterilize at + 100 With during 30 mines, for stabilization add 0,1 n. Solution of Acidum hydrochloricum up to pH 3, About - 3,5. Action on an organism. Morphinum is the basic representative of bunch of narcotic analgethics. It binds mainly the mu - receptors which are taking place in ranges, involved in an analgesia - periakveduktalnom gray matter, rostroventralnom a brain, a back horn of a spinal cord. This receptor participates also in development of euphoria, a miosis, a respiratory depression. The G-proteins which are taking place in the opiate receptor, contact an endocellular opiate and by that provide endocellular activity. Mu - receptors inhibit adenilattsiklazu and activate the potassium channels providing locomotion of a potassium inside of a cell. Morphinum differs strong soothing action. Lowering an excitability of pain centers, it renders also antishock action at traumas. In the big doses invokes somnolent effect which is more expressed at the infringements of dream connected to pain sensations. Morphinum invokes the expressed euphoria, and at its repeated application the pathological addiction (morphinism) quickly educes. Morphinum renders inhibiting influence on conditioned reflexes, lowers integrativnuju ability of a central nervous system, enhances action narcotic, somnolent and anesthetics. It lowers an excitability kashlevogo center. Morphinum invokes also exaltation of center of vagus nerves with appearance of a bradycardia. As a result of an activation of neurones of third cranial nerves under influence of Morphinum people have a miosis. These effects are taken out by Atropinum or others holinolitikami. The vomiting which can be observed at application of Morphinum, is connected to exaltation of receptor starting (trigger) regions of myelencephalon Morphinum oppresses vomitive center, therefore repeated doses of Morphinum and the vomitives introduced after Morphinum, vomitings do not invoke. Under influence of Morphinum tone of a smooth musculation of an internals raises. Rising tone of sphincters of a gastrointestinal path is observed, tone of a musculation of an antral part of a stomach, thin and thick departments of an intestine raises, the peristalsis is relaxed, progression of alimentary masses that results in development of a constipation is slowed down. The spastic stricture of a musculation of pathes removing bile and sphincter Oddi is marked. Tone of sphincters of urinary bladder raises. Tone of a musculation of bronchuses with development bronhiolospazma can increase. Under influence of Morphinum secretory activity of a gastrointestinal path is inhibited. In connection with a stimulation of abjection of antidiuretic hormone probably decrease mocheotdelenija. The basic exchange and a body temperature under influence of Morphinum go down. For action of Morphinum oppression of a respiratory center is characteristic. Small doses invoke urezhenie and augmentation of depth of respiratory locomotions; the big doses provide the further urezhenie and decrease of depth of respiration with downstroke of a lung ventilation. Toxic doses invoke appearance of a periodic breathing such as CHejn-Stoksa and the subsequent apnoea. The opportunity of development of a narcomania and a respiratory depression are the large disadvantages of Morphinum limiting in some cases use its potent analgezirujushchih of properties. Morphinum is quickly soaked up both at intake, and at hypodermic introduction. At introduction inside the level in plasma is enlarged insignificantly as it contacts proteins of plasma, quickly leaves a blood and collect in mild, a liver, a lien, nephroses. Due to the big mass skeletal muscles can be the reservoir for opioids. In a liver opioids are metabolized before polar bonds, then ekskretirujutsja. Morphinum contact a glucuronic acid as contains free gidroksilnye bunches. To Morphinum quickly there is a tolerance, and chronic morphine addicts can receive Morphinum in doses in 20-200 times more therapeutic. Tolerance of an organism to raising doses of narcotic material in many respects are defined by activity of microsomas of hepatocytes which grows many times over. But tolerance never is absolute, there is a limen behind which the dose becomes lethal. Tolerance educes within approximately 3 weeks of the daily use. At hit in an organism Morphinum all over again is absorbed by an outside surface of cells and reacts vozbuzhdajushche, and then inpours inside of cells and invokes depression and habituation. At reception in moderate quantities Morphinum invokes euphoria, the pleasant sleepiness accompanying with sense of slackness and carelessness. Ideas can be very various and substantial, but they cannot be controlled. Decrease of a threshold of inhibition of mental reactions provokes ability to fast decision-making, however such decisions are in the greater degree result of the general logic reasonings, rather than assessments of a concrete situation, therefore can quite be erroneous. The tendency to awake actions further peters, there comes apathy, there is no need for dialogue, visual acuity is reduced, it followed with a state of a lethargy. Psychologic effects are kept at some o'clock longer, than anesthetizing action. Respiration is slowed down, pupils are narrowed, the body temperature, a skin and mucous dry, acyanotic goes down. The hypotension, a bradycardia, rising of tendon jerks is marked. At an overdosage of opiates of psychotic signs, as a rule, does not arise Critical doses can provoke deep hibernation or even mors from a paralysis of a respiratory center. Action educes through 10 - 15 mines after introduction under a skin and through 20 - 30 mines after peroral introduction. Action of a unitary dose proceeds 3 - 5 ch. A single dose for adults - 0.02ã, maximal daily - 0,05. Application. Apply Morphinum as an anaesthetic at traumas and the various diseases accompanying with strong pain sensations (malignant neoplasms, a myocardial infarction, etc.), at a preparation for surgery and in the postoperative season, at a sleeplessness connected to strong pains, sometimes at strong tussis, the strong short wind caused by an acute heart failure. To a labour pain relief Morphinum usually do not apply, as it passes through a placental barrier and can cause a respiratory depression at neonatal. Morphinum sometimes use in radiological practice at research of a stomach, a duodenum, cholic bladder. Introduction of Morphinum raises tone of muscles of a stomach, enhances its peristalsis, accelerates it oporozhnenie and invokes a distention of a duodenum a contrast agent. It promotes revealing of a ulcer and tumours of a stomach, a ulcer of a duodenum. Reduction of a muscle of sphincter Oddi invoked by Morphinum frames congenial conditions for a X-ray inspection of cholic bladder. (Appoint Morphinum under a skin (the adult usually on 1 ml of solution of 1 %), inside (0,01 - 0,02 g in powders or in drops). To children than 2 years are more senior appoint in dependence on age on 0,001 - 0,005 g on reception. To children in the age of till 2 years Morphinum do not appoint. For decrease of by-effects frequently appoint together with Morphinum Atropinum, Methacinum or others holinolitiki. Last years at presence at sick acute and chronic pains began to appoint Morphinum (and other opiates) epiduralno. Introduce (with keeping necessary at this mean of introduction of safety measures) 0,2 - 0,3 - 0,5 ml of solution of Morphinum of 1 % into 10 ml of isotonic solution of a sodium of Sodium chloridum. The effect shows through 10 - 15 mines; through 1 - 2 hours are observed strongly expressed soothing effect retained during 8 - 12 and more hours. There are data on application of an epidural analgesia by Morphinum for patients with an acute myocardial infarction. Introduced pristinely 4 mg of Morphinum into 8 ml of isotonic solution of a sodium of Sodium chloridum, then 2,5 mg of Morphinum in 8 ml of isotonic solution within 7 days. Observed enriching a clinical picture and restriction of region of a necrosis. Morphinum counterindicatives at the general strong attrition, failure of a respiratory center. Guard is necessary at application of Morphinum at patients of senile age (the exchange and deducing of Morphinum time-lapse; higher maintenance of Morphinum in a blood plasma) is observed. Forms of release: tablets on 0,01 g; 1 % solution in ampulas and syringes - tubes on 1 ml. Storage: the list And. In the place protected from light with keeping rules of storage of narcotic materials. THE SPECIFIC FEATURES OF THE PERSON CONTRIBUTING TO DEPENDENCE ON NARCOTICS.There are certain personal qualities which under unfavorable zoetic circumstances can push the person to the use of narcotics. The specific features contributing to abuse with the psychotropic materials are:
These qualities count delicacy and are ashamed of them. Therefore such persons try to seem strong, imposing to anothers the will. Show insufficient stability different failures though carefully mask it. They are not able to be restrained with lesions, easily stimulate and in complex zoetic situations easily run into despondency. To muffle morbid experiences of a dissatisfaction of the needs, they borrow defiantly an aggressive, rebellious, obstinate position or simply avoid difficulties, leave in the private world, being betraid by useless imaginations and dreams, not giving the slightest attention of real life, not doing even attempts to take care of own future. Whence these features?
TERMINOLOGY.Some terms which most are frequently used for the description of the given disease. Mental dependence- the state at which medical products invoke sense of pleasure both mental rise and which demand periodically renewed or constant introduction of a medical product to feel pleasure or to avoid discomfort. Physical dependence- an adaptive state which shows intensive physical distresses when introduction of the conforming medical product stops. Narcotic intoxication- a state arising after reception of narcotics, including the certain mental and somatic signs. Also it is is conditional possible to secure subjective, tasted got drunk exhibitings and the objective attributes of narcotic intoxication recorded by associates. The state of psychics in narcotic intoxication is expressed by euphoria. Euphoria is composed from emotional exhibitings, mental and somatic senses. To each narcotic the special frame of euphoria is peculiar. Thebaic euphoria is composed from sensation of somatic pleasure and an emotional background of rest, pleasure. Distresses of perceptionare characterized by selectivity. Quality of perception variates thereof there are psychosensorial and productive distresses down to hallucinations. Infringement of sensory synthesis is accompanied by sense of a derealization, infringement interoretseptsii - sense of heat, ease or gravity, change of a position of a body in space, perception of a body scheme and orientation in own body. Distresses of intellection.
Somatoneurologic exhibitings.Are expressed basically as a vegetative symptomatology.
the Set of symptoms of the changed reactivity- a morbid condition which includes:
the Set of symptoms of mental dependence- pathological a state which includes:
STAGES OF DEVELOPMENT OF THE NARCOMANIA.I the STAGE.Physiological action of a narcotic in this stage is not changed. The narcomaniac sleeps a little, dream superficial, but the sense nedosypanija is not present. Appetite is suppressed. The quantity of urine decreases, there is a delay of a chair for some days. There is a gradual habituation to a narcotic. Doses start to grow to reach former effect. Absence of a narcotic affects state of health of the patient only in 1-2 day, basically in the form of alienations: sense of intensity, mental discomfort, tendency to introduction of a narcotic. Thus, I the stage is characterized by a set of symptoms of the changed reactivity to a narcotic (regular reception, petering of an itch, body height of tolerance in 3-5 times) and a set of symptoms of mental dependence. Duration I of a stage is various: at a morphinism - 2-3 months, at use of opium - 3-4 months, Codeinum - till 6 months, at an opiophagy - about several years. At this stage patients, as a rule, mask the narkotizatsiju. II STAGE.the Set of symptoms of the changed reactivity completely is generated. The set of symptoms of mental dependence also reaches height of the development. Narkotizatsija it is regular, the individual rhythm of introduction is formed. Tolerance to a narcotic grows, being enlarged in 100-300 times in comparison with therapeutic doses. At a rest in narkotizatsii tolerance is reduced. Patients frequently act on treatment to reduce a dose of a consumed narcotic. Amnesias are not marked. Character of intoxication varies. The physiological effect of a narcotic peters. The chair and a diuresis is normalized, at colds there is a tussis, protivokashlevyj the effect of opiates is absent. Dream is recovered. However narrowing a pupil is stable kept. The behaviour of the narcomaniac varies. If in I stages of illness the narcomaniac was vigorous and mobile up to an injection, but is flaccid and delayed after it, that, since II stage of disease it becomes flaccid both powerless up to an injection and brisk after it. There are attributes of physical dependence. The set of symptoms of physical dependence is expressed by a compulsive appetence, ability to physical comfort in an intoxication and an abstinent set of symptoms. The compulsive appetence arises in an intoxication absent. Thebaic intoxication is not accompanied by loss of the quantitative control. The abstinent set of symptoms is shaped gradually. Formation of an abstinent set of symptoms borrows a short span (1-2 months. Regular consumption of a narcotic). Flow of an abstinent set of symptoms can be presented as a parabola which top part borrows an interspace till 10 days. Patients cannot, is, the mass of a body is reduced on 10-12 kg, do not sleep at night. Gravity of an abstinence is directly proportional to prescription of disease and size of a dose. The involution of abstinence signs descends liticheski. If an abstinent set of symptoms did not treat, the residual phenomena can be kept till 1,5-2 months. To them concern:
Duration of an abstinent set of symptoms and its residual phenomena assumes treatment 4 months sick not less. Duration of II stage of an opiomania since time of appearance of a set of symptoms of physical dependence compounds 5-10 years. III STAGE.In this stage consequences of a chronic intoxication are expressed not only narkomanichesky a set of symptoms, but also. Attributes of mental dependence in conditions continuous narkotizatsii are suppressed by attributes of dependence physical. The metabasis, the changed reactivity included in a set of symptoms is observed. The form of consumption remains regular, tolerance drops (approximately on 1/3 former doses) and sharply the form of an intoxication varies. In III stage action of a narcotic on the narcomaniac exclusively stimulating (tonic). The narcomaniac needs a dose amounting 1/8-1/10 constant doses (a sufficient dose) to reach a state of comfort, an attribute of physical dependence. Outside of an intoxication of the patient characterizes absence of vigour down to disability to move. Having accepted a sufficient dose, the patient is not delayed and weakened, and is mobile and able-bodied. The regimen of reception of a narcotic compounds 3-4-5 receptions in day. An intoxication Morphinum.
the Abstinent set of symptoms at a morphinism.
1-n a phase. 1. Attributes of mental dependence: an appetence to a narcotic, a state of a dissatisfaction, intensity. 2. Somato-vegetative reactions: a yawning, slezotechenie, a rhinitis with chihaniem, " an ancerine skin ". Appetite peters. Infringement zasypanija is observed. Arises in 8-12 hours after last reception of a narcotic. 2-n a phase. The sense of a fever, smenjajushcheesja sense of fever, attacks of a sweating and delicacy, " an ancerine skin " is constant. In muscles of a back, then legs, a neck and arms there is a sensation of inconvenience. Muscles of a body naprjazheny. There is a pain in intergnathic joints and masseters. Signs of the first phase show. Often chihanie (up to 50-100 times). Intensive zevanie. Slezotechenie. Are most expressed in 30-36 hours after last reception of a narcotic. 3-n a phase. There are muscular pains. Muscles of a back, extremities, less often necks reduces, pulls, twists. The part of patients has cramps of peripheric muscles (ikronozhnyh, stopnyh, etc.). The need to move is high. In the beginning of locomotion of a pain weaken, then strengthen. Patients cannot find to themselves a place, lozhatsja, rise, again lozhatsja, turn in bed. Joint pains are absent. Patients naprjazheny, are dissatisfied - are spiteful, depressive, with experiences of hopelessness and hopelessness. An appetence to a narcotic compulsive. Attributes first two phases strengthen. The state educes by the end of the second day of deprivation of a narcotic. 4-n a phase. Appearance of a new sign of the dyspeptic phenomena differs from the third phase. There are abdominal pains - an intestine. In some hours - a vomiting and diarrhea. Diarrhea till 10-15 once a day, is accompanied tenezmami. Appears for the third day of deprivation of a narcotic and lasts till 5-10 days. NOSOTROPIC MECHANISMS OF DEVELOPMENT OF THE NARCOMANIA.I.P.Anohonoj's researches and its employees have shown, that predilection to abuse by the psychotropic materials including narcotics, in many respects it is defined by the genetical constitution and is handed down. Authors consider, that the main part in formation of dependence are changes of the dofamin nejromediatsii in lymbic departments of a brain. The narcomania of any kind inevitably affects emotional - affective sphere of vital activity of the person. Originating and a becoming of a narcomania at the earliest stages of its development is connected to influence of a narcotic on emotional - positive centers of a brain. In turn, the emotional alterations caused by influence of narcotic material, shape jerk of the purpose on I.P.Pavlovu, consisting in search of the next emotional - positive reinforcement of behaviour of the individual. With each new reinforcement the functional system rendered in a brain more and more is stabilized, resulting in development of a steady morbid condition. The mechanism of habituation and predilection for narcotics is based that narcotics, modulating functions of a positive reinforcement, promote building of functional system of the behaviour directed to one purpose - to tendency again to repeat ejforizirujushchy effect. Infringements mediatornogo an exchange.Existence of opiate receptors in a brain, presence in the supporting regions of a brain opiatopodobnyh substances, such as enkefalins and endorfinses which cooperate with opiate receptors has been shown. Result of this interaction is appearance of sense of pleasure and euphoria. Exogenous opiates variate concentrations of b-endorfinses, an enkefalin and other opiate peptides in a brain. At the normal physiological state described by a state of " opiate sufficiency " the balance between synthesis, liberation, linkage with a receptor and anatropic seizure of a neuromediator which result is the sense of intrinsic comfort is marked. At a state of the opiate deficiency invoking an appetence to the use of exogenous opioids (for example, Morphinum), synthesis of enkefalins and other neuromediators, first of all monoamines decreases. Hence, in a synaptic gap the diminished quantity of a neuromediator and a part postsinapticheskih receptors is liberated remains not occupied. It results in originating sense of an appetence to Morphinum, irritability, depression, pavor and a dysphoria. In this case the natural relative disadvantage of endogenic opioids is compensated from an exogenous agonist and thus in a dose, in hundreds or thousand times of natural production of these neuropeptids exceeding volume. In result potent ejforizirujushchee action of a narcotic sharply shifts balance of an emotional state aside positive emotions. The person well remembers the sensations, but also the system of a homeostasis reacts bracing of a trace of memory to the given state. Replicating influence of a narcotic shapes the steady morbid condition of dependence closing a chain of nosotropic mechanisms of a narcomania. However by virtue of insufficient production or the reinforced destruction of endogenic opioids by the conforming fermental systems the number of the blocked (connected) opiate receptors can sharply decrease. In result there is an exaltation of ensemble of the neurones included in autopodium - region of a brain. The emotional balance is displaced, and negative emotions start to prevail. Originating during this moment of the external factor bearing the negative information for an organism, can repeatedly strengthen a negative emotion. At the long use of a narcotic deficiency not only opiate peptides, but also other neuromediators can develop. As the mechanism of indemnification of this phenomenon the reinforced synthesis KA (catecholamins) and depressing of activity of enzymes of their metabolism, first of all MAO and Dofaminum - betagidroksilazy (DBG), supervising metamorphosis of Dofaminum into Noradrenalinum acts. There is a formation accelerated krugooborota KA. At the arrest of reception of a narcotic the reinforced liberation KA from depot does not descend, but there is their accelerated synthesis. Owing to change of activity of enzymes in biofluids and tissues collects YES, that causes development of the basic clinical attributes of an abstinent set of symptoms: high uneasiness, intensity, exaltation, rise of a blood pressure, an acceleration of sphygmus, development of psychotic states, etc. The big number of people become narcomaniacs and topers just because in the season of the long depression caused by the intrinsic (biological) and choronomic (social) causes, they tried to stop this state reception of a dose of a narcotic. To this it is possible to add, that as a result of long influence of narcotic materials on frames of a central nervous system it will be reorganized sinaptoarhitektonika nervous networks, in many departments of nervous system on a background of damage and petering sinapticheskih formations are organized new mezhnejronalnye communications, not characteristic for an able-bodied brain not damaged by an intoxication. Originating new sinapticheskih formations and consequently, and building new nejronalnyh chains and communications, a distortion mediatornogo the mechanism result in formation of pathological functional systems. The special value has this phenomenon for the maximum vegetative centers of the central nervous systems regulating and coordinating activity of an internals and systems of an organism. Apparently, sources plural vegetosomaticheskih changes, characteristic for clinic of the diversified narcomanias here lay. These changes are a basis of formation of physical dependence on the psychotropic materials, including from Morphinum. the Steady morbid condition of a brain (a role of a long-term memory). The nature and pathes of influence on a state of narcotic dependence can be well explained from positions of the theory about a steady morbid condition which important element is representation about a template of the long-term memory causing stability of this state. As specifies N.P.Bekhterev, stability of a steady morbid condition as well as a steady state of health, it is connected to formation of the conforming template in a long-term memory. The engram of an able-bodied brain is characterized first of all by a plasticity of elements amounting her, convertibility of disintegration reverberatsionnoj chains that provides dynamism of its procreation during the moment determined by installation, motivations, an emotional state. Incorporation of procreation of the given engram is initiated by usual stimulant and provided specific to a short-term memory functional organizatsmej rigid and nonrigid parts of systems of maintenance of cerebral functions. The similar functional organization extremely labilna, is kept and at a stage of a long-term memory and quickly breaks up on a measure of extraction from memory of the fixed information. The engram of a morbid condition of a brain always is consequence of formation not inherent to an able-bodied brain nejroglialnyh complexes with a circumscribed plasticity. Her stability developed reverberatsionnoj distinguishes chains which functioning is rigidly fixed by virtue of constant incorporation of system of its procreation. Process zabyvanija thus is broken, as causes a constance of realization of determinant properties of the given engram. According to this excrete two types of a morbid condition of a brain. For the first type typically, that the system of procreation is in a regimen of periodic spontaneous incorporation, and for the second - that she works in a regimen of constant activity. The sequence of events during formation of a morbid condition of a brain can be presented in the following kind: the inducer of a morbid condition is the pathogenic factor, at originating pathological reaction descend kompensatornye rearrangements in work of a brain at structurally functional and biochemical levels, on from a basis and the engram of a morbid condition (a template of a long-term memory) with that region of a brain which infringement of function is the leading cause of disease is shaped further. The real approach to correction of a morbid condition is downstroke of an excitability of one and rising of activity of others nejroglialnyh the complexes included in determinant frame of an engram of a morbid condition, with the subsequent fastening the achieved results. AGE FEATURES OF FLOW OF THE MORPHINISM.Downstroke of the inferior age border narkotizatsii till 12-15 years compounds the main feature modern narkotizatsii, is especial in the big cities. Teenage age.
Advanced age.
CONSEQUENCES OF THE MORPHINISM.Mental infringements. An aphrenia (functional): downstroke of drives, oligotimija, anergija, disability to intellectual efforts. The alarm and depression are substituted by dysphorias. Acute psychosises are characteristic: intoksikatsionnyj (at height of intoxication) and educing in the season of an abstinence. Narkomanicheskim to acute psychosises all features of exogenous psychosises are peculiar, namely:
The amnesia after an output correlates with depth of a stupefaction. Inconsistency of memoirs reflects former razorvannost consciousnesses. The features inherent in an intoxication by neurotropic materials: at the subacute beginning emotional distresses (disforichnyj a debut are obligatory at deliriums, a paranoid, less often - at a hallucinosis), at an output - a stage of extraordinary deep dream. Somatic infringements. An attrition, the expressed trophic distresses. At long flow of illness: paleness, loss of a turgor of a skin, shine an eye, nails, a hair, flaking of nails, abaissement of a hair, pohudanie. Narcomaniacs look is much more senior than the present age. The yellowish shade of a skin is characteristic for abuse by opiates. Using opium is faster than others lose dens: dens are crumbled, drop out without a previous inflammation, without a pain. Traces of injections. Multilevel infringements nejroreguljatsii and a host defense (cellular and humoral immunodefence). Distresses of a gastrointestinal path prevail. Delicacy of a myocardium with the raised predisposition to an infarct is characteristic. Toxic action on nervous system shows both in central, and in its peripheric parts. Signs of the central parentage are symmetric, that specifies on diffuse, instead of a local lesion. The lesion of subcortical units, subthalamic formations, a reticular formation and a cerebellum are obligatory. At abaissement of functions educe parezy and paralyses, mainly in distalnyh departments, is more often the inferior extremities. If there comes a remission of disease she educes as a psychoorganic set of symptoms more often. The psychoorganic set of symptoms is the state of mental delicacy caused by an organic lesion of a brain (owing to traumas, intoxications, infection contaminations, vascular and other diseases). In the most mild form the psychoorganic set of symptoms represents an asthenic state with the delicacy raised by an emaciation, an emotional lability, instability of attention, downstroke of work capacity. In more serious cases psychopatholike changes of the person, mainly as irritability, vzryvchatosti, predilections to dysphorias are observed. Somatic illnesses, mental traumas sharply worsen a state of patients. Hystericses are possible. At serious forms of a psychoorganic set of symptoms on the first place the downstroke reaching a degree of an aphrenia (dementia) acts intellectually - mnesticheskoe. Along with downstroke of memory the circle of interests is narrowed, the criticism is lost. The mood can be careless - complacent (euphoria) with rastormozheniem appetences or indifferent - apathetic with loss of drives and aspontannostju. Morphinum and an abstinence neonatal.The central nervous system approaches to a birth in degradirovannom a state. The child who has born from the narcomaniac right after birthes appears in a vice of an abstinent set of symptoms. In the Criminal code of the Russian Federation there is article 230 which provides the responsibility for declination to the use of narcotics obviously minors. Abstientnyj the set of symptoms shows cramps, attacks, a fever, a vomiting, diarrhea, a hiccup, chihaniem, hysterical we cry, zalozhennostju a nose, strong edemas, dermatoses. This state can proceed from several days about several months. The neomortality from an abstinent set of symptoms compounds 3-15 %. Morphinum and pregnancy.The sharp arrest of the use of a narcotic results in development of an abstinent set of symptoms at the pregnant woman which acute flow can result in a misbirth, to premature births, a pelvic presentation, a casting-off of a placenta, a dyspnea of a fetus. During labors there can come subitaneous mors neonatal. At narkomanok early and serotinal toxicoses of pregnancy much more hardly proceed, serious lesions of a central nervous system educe. Frequency of serious postnatal complications, such as endokarditov, thrombophlebites, endocrine infringements, infitsirovanija operational wounds is high. Body height of a fetus is slowed down, its motor performance considerably raises, frequency of its cardiac reductions is enlarged, there come deflections in activity of a brain. Children of mothers - narcomaniacs badly sleep, are irritable, at them various skills slowly educe, speech is late, cognitive activity is weakened, frequently there is a strabismus, downstroke of a threshold of visual and acoustical perception. At such children problems in mutual relations with associates, endocrine infringements are frequent. Morphinum and endocrine infringements.Introduction of Morphinum invokes appreciable downstroke of sexual function. A point of the appendix of opiates in system a hypothalamus - a pituitary body - sexual Ferri lactases are the biochemical systems responsible for synthesis or liberation of rilizing-factors, sexual Ferri lactases regulating activity and reacting on a gipotalamo-pituitary level. Appreciable falling of concentration of luteinizing Hormonum in a blood comes at introduction of Morphinum in an insignificant dosage, even not capable to cause any appreciable anesthetizing effect. Under influence of Morphinum there is a raised abjection of a growth hormone and Prolactinum. Apparently, this phenomenon is connected to stimulating influence of opiates on the rilizing-factor of a growth hormone and inhibition of a somatostatin by them. Morphinum and its derivatives are capable to invoke antidiuretic effect due to appreciable outlier in a blood of Vasopressinum. Apparently, in this case the question is direct influence of opiates on the opiate receptors supraopticheskogo nucleus of a hypothalamus and neurosecretory cells of a mediate lobe of a pituitary body. Morphinum influences synthesis AKTG and TTG. Even unitary introduction of opiates results in appreciable dropping concentration of these Hormonums in a blood. TREATMENT OF THE MORPHINISM.The cupping of signs of an acute intoxication is carried out simply enough, but because of duration of the basic treatment and complexity of elimination of a state compulsive, and is especial, an obessive appetence very much few morphine addicts reach complete convalescence and conduct a mode of life of the able-bodied person. MetaDon.MetaDon a hydrochloride - synthetic it is long a reacting agonist of opiates - is the most wide-spread and effective pharmacological agent for treatment of the opiate dependence. It is used for initial therapy at the following indications: short detoxification or long support of patients with the opiate dependence. MetaDon substitutes short-range narcotics (Morphinum), stabilizes a state of the patient within several days with the minimal exhibitings a withdrawal and more infrequent episodes of euphoria and oppression. Subsequently carry out a gradual cancellation of metaDon within several days. The purpose of treatment is achievement by the patient of a state of freedom from narcotic dependence. MetaDon is safe and effective, as:
Contraindication to application of metaDon is dependence on a "soft drug " (Meperidinum (Demerolum), Codeinum) as gravity of dependence in this case can increase. Clonidinum.Clonidinum - the antagonist? 2-adrenoreceptors. It softens physiological signs of a withdrawal, influences psychologic exhibitings (for example, on bent for to Morphinum) a little. Does not invoke euphoria, predilection. Apply its course of 10-14 days. The combination of Clonidinum with naltreksonom reacts more quickly. Naloxonum.Synonyms: Naloxone hydrochloride, Narcan, Narcanti. On chemical frame it is close to Nalorfinum. Is the opiate antagonist deprived morfinopodobnoj of activity. It reacts for phylum of a competitive antagonism, quenching linkage of agonists or superseding them from the opiate receptors. The greatest affinity has Naloxonum to m-and to h-receptors. In the big doses the preparation can give the small agonistic effect which is not having, however, practical value. Introduce Naloxonum intramuscularly or intravenously, at intake it is ineffective, as it is quickly metabolized in a liver. At parenteral introduction reacts quickly (through 1 - 3 mines), but it is rather short (from 0,5 up to 3 - 4 ÷) in dependence on a dose and a method of application. Apply Naloxonum mainly at an acute intoxication narcotic analgethics. It is effective also at an alcoholic coma and various kinds of a shock that is connected, apparently, to an activation at a shock and some forms of a stress endogenic opiodnoj systems, and also with ability of Naloxonum to decrease a hypotension. The brevity of action of Naloxonum limits an opportunity of its application for therapy of narcomanias. Introduction of Naloxonum suffering a narcomania invokes a characteristic attack of an abstinence, than sometimes use for revealing disease. Naltrekson.Synonyms: Antaxone, Nalorex, Naltrexone hydrochloride, Trexan. Chemically differs from Naloxonum presence in a molecula instead of allilnoj bunches of a cyclic radical. Farmakologicheski is the antagonist of the opiate receptors. In comparison with Naloxonum differs the greater activity; it is effective at intake. Action at intake comes through 1 - 2 ch and proceeds up to 24 - 48 ch. In connection with duration of action it can be applied to therapy of predilection for opiates. Appoint inside usually in a dose of 50 mg day. The form of release: tablets on 0,05 g (50 mg). "NALTREKSON"
There are interesting applications of endorfinses given about an opportunity as medical products and about their advantages in comparison with narcotic analgetikami such as Morphinum. Endorfinses stop a pain with the same efficacyy, as Morphinum. As endorfinses are the natural materials effected by a organism, do not invoke habituation. Hence, probably, in the future to replace Morphinum with endorfinses. Use of endorfinses can be useful and for treatment of a morphinism. With process of the chronic use of Morphinum the narcotic constantly exists in an organism, and endorfinses are exposed to disintegration. After the arrest of reception of Morphinum the organism remains without endorfinses and without Morphinum therefore the abstinent set of symptoms educes. Development of new endorfinses needs 7-10 days. " I know: it is an admixture of a devil with my blood. And niknet Vlas on a porch, and I hate it, and the decline, restlessly rumbling, burns out to me a viscera. And so some times successively, within evening while I shall not understand, that I am venenate. Heart starts to knock so, that I feel it in arms, in temples... And then it fails in a chasm, and there are seconds when I think that more the doctor of Poles will not return to life... " (M.A.Bulgakov of " the Note of the juvenile doctor ") About, cheloveche! An axiom:
THE LIST OF THE LITERATURE:
P.S. The resulted verses are taken from page of the Internet, from a heading " Narkomanskie verses ". Their authorship is not specified in the text of the abstract, as such information in www. was not given. To discuss a material at a forum of a site Keywords: narcotics, morphini, dependence, predilection, habituation, Morphinum, narcotics, a morphinism, alkoloid, opium Main | Abstracts, compositions, lectures | Psychiatry | Links
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