Drug addict

no problems, it's what I'm going to be doing for a career when I graduate

There are two main groups of (conventional) painkillers, non-steroidal anti-inflamatories (NSAIDs) and opiods. Paracetamol is in a class by itself. NSAIDs can be divided into traditional (e.g. ibuprofen, aspirin, diclofenac) and COX-2 inhibitors (e.g. rofecoxib [Vioxx], celecoxib [Celebrex]). Cyclooxygenase (COX) cleaves arachidonic acid to produce prostaglandins and thromboxanes which are mediators of inflamation. COX has several isoforms, COX-1 which is constitutive and plays a role in the protection of the gastric mucosa and platelet aggregation, and COX-2 which is inducible. Traditional NSAIDs inhibit both COX isoforms, the COX-1 inhibition causing the side effects such as gastric ulcers. COX-2 inhibitors have a far lower risk of serious upper GI events, but may increase risk of CV problems; Vioxx was recently withdrawn and a recent study using Celebrex to treat tumours showed a 2.5 fold increase in the risk of non-fatal heart attacks (http://www.nih.gov/news/pr/dec2004/od-17.htm). NSAIDs are not addictive. Opioid analgesics include morphine, diamorphine (heroin), codeine, oxycodone and tramadol (Zydol). Opioids act centrally on opioid receptors, of which there are several types - mu/delta, kappa and sigma. mu/delta receptors are responsible for most of the side effects of opioids - respiratory depression, constpation, euphoria, sedation and physical dependence. They are also involved in analgesia. Kappa receptors also play a role in analgesia and dependence (though less of a role than mu/delta), and cause dysphoria rather than euphoria. Tolerance to the effects of opioids develops rapidly and I have seen some scarily high doses of morphine. Opioid analgesics are addictive, though the potential for addiction depends on the exact drug used. Tramadol has less of the typical opioid side effects, notably less addiction potential. Though there are undoubtly problems with the opioid analgesics, they are the most effective analgesics available. If someone is terminally ill, dealing with their pain is the prime concern, addiction to opioids is not really a problem that matters in this group of patients. In the case of people in chronic pain, more care needs to be exercised with the use of opioids, which is why tramadol is used in preference to morphine. There is also often a psychological aspect with chronic pain.

It's all energy (ATP) dependent. Muscle fibres consist of actin and myosin. Hydrolysis of ATP to ADP + Pi causes a conformational change in the myosin protein which causes a shortening of the muscle. It's a bit tricky to explain in words, so I'll try and find some diagrams. I assume the principle is similar for other contractile proteins, but I'm sure someone will correct me if I'm wrong.

I just noticed this thread and wanted to add my views. In my view, PAS is acceptable when a patient has a terminal illness. In a law and ethics lecture I had recently it was mentioned that "doctors should not hasten death, but may take actions that coincidentally have this effect." Also consider that it is acceptable to withdraw treatment from a patient. What is the difference between this and taking action to hasten death? The Code of Ethics for pharmacists in the UK states '... pharmacists must act in the best interests of patients... and seek to provide the best possible health care... Pharmacists must respect patients' rights to participate in decisions about their care...' To me this is more flexible than the Hippocratic oath, however the problem remains that a Doctor needs to sign the prescription. Palliative care has improved, however there are some concerns, both from patients and doctors, over prescribing of opiod analgesics such as morphine because of the risk of dependency. This should not be an issue because the patient is terminally ill. I am somewhat fortunate in that I have both the knowledge and access to drugs to commit suicide in a painless way, which definately wouldn't involve paracetamol (acetaminophen). Most people do not have this knowledge and so are reliant on medical professionals, who are not (as the law stands at present in most places) in a position to help them. It is depressing when we treat pets better than we do humans. To me, the most depressing case would be suffering from a muscular dystrophy type disease (i.e. the case of Diane Pretty) where I was mentally competent and reached a decision that I wanted to end my life with dignity, but was physically unable to do so. *edit* This was published in the BMJ and may be of some interest: http://bmj.bmjjournals.com/cgi/content/full/329/7472/939-b?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=physician+assisted+suicide&andorexactfulltext=and&searchid=1103331470751_16656&stored_search=&FIRSTINDEX=0&sortspec=date&resourcetype=1

That's a very tough question to answer with a simple yes or no! I am anti-CP, pro-abortion and and pro-euthanasia and I believe these are not inconsistent positions to take. So, is life invaluable? It depends on a) your definition of life and b) the circumstances

Dopamine is involved in control of movement and Parkinson's disease is caused by loss of nigro-striatal dopaminergic neurones. This causes the main symptom of PD, lack of control over movement. Evidence supporting this is provided by the parkinsonian symptoms that may be produced by drugs which antagonise dopamine such as antipsychotics (e.g. chlorpromazine) or by amphetamines. There was also the case of the frozen addict (see this thread: http://www.scienceforums.net/forums/showthread.php?t=7787 or search for MPTP). Incidence increases with age, but the causes of Parkinson's disease are unknown. Factors that have been implicated are environmental insults (eg MPTP), genetic factors and ageing. Treatment is usually with levodopa, a precursor of dopamine, in combination with a peripheral decarboxylase inhibitor to reduced the dose of levodopa needed.

Hi everyone, I'm interested in finding out what people know about pharmacists' education, both undergraduate and postgraduate, and also what you think about pharmacists taking on new roles such as prescribing and medication reviews, and the increase in products being made available from pharmacies without prescription (such as simvastatin) I'd also be interested in your views on pharmacies selling products which have no evidence base, such as homeopathic products and copper bracelets. I can only add comments from a UK (possibly European) point of view. Cheers

I think I remember my stats teacher saying the average IQ was below 100 because of the negative skew caused by people who suffer brain damage for whatever reason. Could be wrong though, it was about five years ago.

So it's more bureaucratic for the pharmacy as there are lots of different insurance companies they have to deal with?

Assuming you have health insurance, when you get a prescription dispensed (which is covered by your insurance), do you pay the pharmacist? (and then claim the money back from the insurance company)

Agreed, though Kinnock did show some flashes of humour. Anway, now that he's no longer a shadow spokesperson they should bring back Boris. I think that the way the law stands at present, in allowing 'reasonable force' is fine. So therefore my answer would have to be the minimum required. It's an interesting and useful debate to have though, although we do not seem able to have it in the UK as the right-wing press and the Conservative party insist on using Tony Martin as a cause celebre.

I'll check in 'Herbal Medicines' (Barnes, Anderson & Phillipson) for you when I go to the library tomorrow.

Yep, its so communist that it was never dismantled by the Conservatives when they were in power for 18 years in the 80's and 90's (though maybe they tried to starve it to death). As for bureaucracy, I'm not sure. Yes there are a lot of managers in the NHS, but I'm sure there are plenty in America. From a patient perspective, surely it is less bureaucratic - you go and see a NHS doctor, who writes you a prescription which you take to a pharmacy to get dispensed for free (or a small charge). Seems pretty simple to me. As for pharmacists getting paid? I don't know exactly how the American system works. Does the patient pay the cost and then claim it back from their insurance, or does the patient get the drugs and then the pharmacist claim it back from the insurance company? I'd appreciate clarification on this. Thanks. The UK system is that at the end of the month the pharmacy sends all the prescriptions they've dispensed that month off to a government agency, who pay them three months down the line. Except its a bit more complex than that as what you get paid for a given month is an advance (based on previous figures), and the balance of payments from three months ago. And then there's a lovely book called the Drug Tarif which lists the price pharmacists get paid for drugs, except it's not that simple...

I would argue that it is one of the strongest arguements against capital punishment. If the state executes just one innocent person' date=' how can it then claim to be morally superior to a murderer, as by definition it is also one? Justice does not equal vengance or retribution. And if that pun is intended it's disgusting.

Here's my view: Capital punishment has no place in a civilised society. Ever. End of arguement. But somehow America manages to make it worse by executing people who were under the age of 18 when they killed. This puts America on a par with those beacons of civil liberties Saudi Arabi, Pakistan, Iran and China.

Pharmacology is interesting stuff and is central to my pharmacy degree. What I love about pharmacy, though, is the breadth of science we cover. By the time I graduate this summer after four years at uni, I will have learnt about genetics,cell biology, physiology, pharmacology, microbiology and antibiotics, medicinal chemistry (analytical chemistry, synthesis, pharmacogonosy) and pharmaceutics (how we can deliver drugs) in addition to all the legal and professional studies we have to do. I also get the chance to do an in depth project (contributes 1/3 of the mark for my final year), and though some people are doing questionnaire based projects or literature reviews, my project is investigating the role of protein kinase C in muscle protein degradation, such as occurs in cancer. I accept that my knowledge of, say, genetics will not be anywhere near the same as someone who has spent all three years of a BSc learning about it, however the breadth of my course presents lots of opportunities. There's also the security that having a professional degree will bring in that the only time I won't be working is when I don't want to work, unless I go and do something really stupid and get struck off, or if I go and do a PhD (does that count as work or not?)

That's why I prefer the UK healthcare system where any charges are nominal and access to healthcare is seen as a right and not a privelige. IMHO the American healthcare system is immoral and wrong. Don't get me wrong, I'm not claiming the NHS is perfect, nothing is, and I suspect that when I qualify as a pharmacist it would be easier to make money in the States than the UK, I just feel that the NHS offers a far more equitable system. I think your ire would be better directed toward the US healthcare system than Eli-Lilly. I'm sure you appreciate the fact that the price of medication is related to how much it costs to manufacture. Insulin is expensive to manufacture because it is made biosynthetically, with all the problems that entails. There are four manufacturers of insulin in the UK; Eli-Lilly, CP, Aventis Pharma and Novo Nordisk, although some insulins are only available from manufacturer e.g. only Aventis make Lantus (Insulin glargine). It would be interesting, though extremely problematic, to compare UK and US prices.

What about pharmacy? But then I am biased Bio/chem/phy should be fine for what you mention; though I found maths useful uni should teach you the maths you need for the course. The only maths that's been taught on my course has been calculus and some statistics (only normal distribution stuff, nothing too complex.) If anything I imagine there would be less maths in a medicine or dentistry course. that's my opinion anyway

It's pretty much the same in the UK. There has been a lot of progress in getting doctors to write prescriptions generically, though this can cause several problems. Firstly there are drugs which should be prescribed by brand name, modified release diltiazem or m/r lithium for example. There can also be difficulties for the pharmacist in figuring out which product to dispense - generically written insulin prescriptions are a damn nightmare. There is also a problem that may be somewhat unique to the UK, as most patients contribute through the tax system, where patients go to their doctor, get a generically written prescription and then ask for a certain brand as 'those tablets [the generic ones] don't work for me', not realising that the brand ones are often a lot more expensive than the generic ones. And then the doctor often won't change the prescription to the brand as it will affect their prescribing budget. Result - pharmacist has three options; try and convince the patient the brand and the generic are the same, dispense the brand and lose money, or refuse to dispense the brand and send the patient elsewhere, also losing money. On a side note, it irritates the hell out of me when people complain about having to pay prescription charges (£6.40 at the moment) [ a word of explanation: NHS prescriptions are free for certain groups of people - those under 16, over 60, people with certain diseases such as diabetes or hypothyroidism, those on benefits. People who don't qualify for free prescriptions pay a fixed charge for each item, regardless of the amount prescribed or the actual cost]. Yes, some drugs are cheap, many are not and some are exceedingly expensive!

In the US, do you have to show that a drug is better than those already on the market? I think they have to in Austraila, but in the UK it's not a requirement; MHRA/CSM only require you to show the drug's safety and efficacy, so you end up with lots of "me too" drugs which don't offer much of a step forward.