Drug Overdose - A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References

DRUG OVERDOSE A M EDICAL D ICTIONARY , B IBLIOGRAPHY , AND A NNOTATED R ESEARCH G UIDE TO I NTERNET R E FERENCES J AME...

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DRUG

OVERDOSE A M EDICAL D ICTIONARY , B IBLIOGRAPHY , AND A NNOTATED R ESEARCH G UIDE TO I NTERNET R E FERENCES

J AMES N. P ARKER , M.D. AND P HILIP M. P ARKER , P H .D., E DITORS

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ICON Health Publications ICON Group International, Inc. 4370 La Jolla Village Drive, 4th Floor San Diego, CA 92122 USA Copyright 2004 by ICON Group International, Inc. Copyright 2004 by ICON Group International, Inc. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission from the publisher. Printed in the United States of America. Last digit indicates print number: 10 9 8 7 6 4 5 3 2 1

Publisher, Health Care: Philip Parker, Ph.D. Editor(s): James Parker, M.D., Philip Parker, Ph.D. Publisher's note: The ideas, procedures, and suggestions contained in this book are not intended for the diagnosis or treatment of a health problem. As new medical or scientific information becomes available from academic and clinical research, recommended treatments and drug therapies may undergo changes. The authors, editors, and publisher have attempted to make the information in this book up to date and accurate in accord with accepted standards at the time of publication. The authors, editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of this book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation. The reader is advised to always check product information (package inserts) for changes and new information regarding dosage and contraindications before prescribing any drug or pharmacological product. Caution is especially urged when using new or infrequently ordered drugs, herbal remedies, vitamins and supplements, alternative therapies, complementary therapies and medicines, and integrative medical treatments. Cataloging-in-Publication Data Parker, James N., 1961Parker, Philip M., 1960Drug Overdose: A Medical Dictionary, Bibliography, and Annotated Research Guide to Internet References / James N. Parker and Philip M. Parker, editors p. cm. Includes bibliographical references, glossary, and index. ISBN: 0-497-00382-1 1. Drug Overdose-Popular works. I. Title.

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Disclaimer This publication is not intended to be used for the diagnosis or treatment of a health problem. It is sold with the understanding that the publisher, editors, and authors are not engaging in the rendering of medical, psychological, financial, legal, or other professional services. References to any entity, product, service, or source of information that may be contained in this publication should not be considered an endorsement, either direct or implied, by the publisher, editors, or authors. ICON Group International, Inc., the editors, and the authors are not responsible for the content of any Web pages or publications referenced in this publication.

Copyright Notice If a physician wishes to copy limited passages from this book for patient use, this right is automatically granted without written permission from ICON Group International, Inc. (ICON Group). However, all of ICON Group publications have copyrights. With exception to the above, copying our publications in whole or in part, for whatever reason, is a violation of copyright laws and can lead to penalties and fines. Should you want to copy tables, graphs, or other materials, please contact us to request permission (E-mail: [email protected]). ICON Group often grants permission for very limited reproduction of our publications for internal use, press releases, and academic research. Such reproduction requires confirmed permission from ICON Group International, Inc. The disclaimer above must accompany all reproductions, in whole or in part, of this book.

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Acknowledgements The collective knowledge generated from academic and applied research summarized in various references has been critical in the creation of this book which is best viewed as a comprehensive compilation and collection of information prepared by various official agencies which produce publications on drug overdose. Books in this series draw from various agencies and institutions associated with the United States Department of Health and Human Services, and in particular, the Office of the Secretary of Health and Human Services (OS), the Administration for Children and Families (ACF), the Administration on Aging (AOA), the Agency for Healthcare Research and Quality (AHRQ), the Agency for Toxic Substances and Disease Registry (ATSDR), the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), the Healthcare Financing Administration (HCFA), the Health Resources and Services Administration (HRSA), the Indian Health Service (IHS), the institutions of the National Institutes of Health (NIH), the Program Support Center (PSC), and the Substance Abuse and Mental Health Services Administration (SAMHSA). In addition to these sources, information gathered from the National Library of Medicine, the United States Patent Office, the European Union, and their related organizations has been invaluable in the creation of this book. Some of the work represented was financially supported by the Research and Development Committee at INSEAD. This support is gratefully acknowledged. Finally, special thanks are owed to Tiffany Freeman for her excellent editorial support.

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About the Editors James N. Parker, M.D. Dr. James N. Parker received his Bachelor of Science degree in Psychobiology from the University of California, Riverside and his M.D. from the University of California, San Diego. In addition to authoring numerous research publications, he has lectured at various academic institutions. Dr. Parker is the medical editor for health books by ICON Health Publications. Philip M. Parker, Ph.D. Philip M. Parker is the Eli Lilly Chair Professor of Innovation, Business and Society at INSEAD (Fontainebleau, France and Singapore). Dr. Parker has also been Professor at the University of California, San Diego and has taught courses at Harvard University, the Hong Kong University of Science and Technology, the Massachusetts Institute of Technology, Stanford University, and UCLA. Dr. Parker is the associate editor for ICON Health Publications.

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About ICON Health Publications To discover more about ICON Health Publications, simply check with your preferred online booksellers, including Barnes&Noble.com and Amazon.com which currently carry all of our titles. Or, feel free to contact us directly for bulk purchases or institutional discounts: ICON Group International, Inc. 4370 La Jolla Village Drive, Fourth Floor San Diego, CA 92122 USA Fax: 858-546-4341 Web site: www.icongrouponline.com/health

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Table of Contents FORWARD .......................................................................................................................................... 1 CHAPTER 1. STUDIES ON DRUG OVERDOSE...................................................................................... 3 Overview........................................................................................................................................ 3 The Combined Health Information Database................................................................................. 3 Federally Funded Research on Drug Overdose.............................................................................. 5 E-Journals: PubMed Central ......................................................................................................... 9 The National Library of Medicine: PubMed ................................................................................ 10 CHAPTER 2. NUTRITION AND DRUG OVERDOSE ............................................................................ 33 Overview...................................................................................................................................... 33 Finding Nutrition Studies on Drug Overdose ............................................................................ 33 Federal Resources on Nutrition ................................................................................................... 34 Additional Web Resources ........................................................................................................... 34 CHAPTER 3. ALTERNATIVE MEDICINE AND DRUG OVERDOSE...................................................... 37 Overview...................................................................................................................................... 37 National Center for Complementary and Alternative Medicine.................................................. 37 Additional Web Resources ........................................................................................................... 40 General References ....................................................................................................................... 41 CHAPTER 4. BOOKS ON DRUG OVERDOSE ...................................................................................... 43 Overview...................................................................................................................................... 43 Book Summaries: Federal Agencies.............................................................................................. 43 Chapters on Drug Overdose ........................................................................................................ 45 CHAPTER 5. PERIODICALS AND NEWS ON DRUG OVERDOSE ........................................................ 49 Overview...................................................................................................................................... 49 News Services and Press Releases................................................................................................ 49 Academic Periodicals covering Drug Overdose ........................................................................... 51 CHAPTER 6. RESEARCHING MEDICATIONS .................................................................................... 53 Overview...................................................................................................................................... 53 U.S. Pharmacopeia....................................................................................................................... 53 Commercial Databases ................................................................................................................. 54 Researching Orphan Drugs ......................................................................................................... 54 APPENDIX A. PHYSICIAN RESOURCES ............................................................................................ 59 Overview...................................................................................................................................... 59 NIH Guidelines............................................................................................................................ 59 NIH Databases............................................................................................................................. 61 Other Commercial Databases....................................................................................................... 63 APPENDIX B. PATIENT RESOURCES ................................................................................................. 65 Overview...................................................................................................................................... 65 Patient Guideline Sources............................................................................................................ 65 Finding Associations.................................................................................................................... 66 APPENDIX C. FINDING MEDICAL LIBRARIES .................................................................................. 69 Overview...................................................................................................................................... 69 Preparation................................................................................................................................... 69 Finding a Local Medical Library.................................................................................................. 69 Medical Libraries in the U.S. and Canada ................................................................................... 69 ONLINE GLOSSARIES.................................................................................................................. 75 Online Dictionary Directories ..................................................................................................... 75 DRUG OVERDOSE DICTIONARY............................................................................................. 77 INDEX .............................................................................................................................................. 107

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FORWARD In March 2001, the National Institutes of Health issued the following warning: "The number of Web sites offering health-related resources grows every day. Many sites provide valuable information, while others may have information that is unreliable or misleading."1 Furthermore, because of the rapid increase in Internet-based information, many hours can be wasted searching, selecting, and printing. Since only the smallest fraction of information dealing with drug overdose is indexed in search engines, such as www.google.com or others, a non-systematic approach to Internet research can be not only time consuming, but also incomplete. This book was created for medical professionals, students, and members of the general public who want to know as much as possible about drug overdose, using the most advanced research tools available and spending the least amount of time doing so. In addition to offering a structured and comprehensive bibliography, the pages that follow will tell you where and how to find reliable information covering virtually all topics related to drug overdose, from the essentials to the most advanced areas of research. Public, academic, government, and peer-reviewed research studies are emphasized. Various abstracts are reproduced to give you some of the latest official information available to date on drug overdose. Abundant guidance is given on how to obtain free-of-charge primary research results via the Internet. While this book focuses on the field of medicine, when some sources provide access to non-medical information relating to drug overdose, these are noted in the text. E-book and electronic versions of this book are fully interactive with each of the Internet sites mentioned (clicking on a hyperlink automatically opens your browser to the site indicated). If you are using the hard copy version of this book, you can access a cited Web site by typing the provided Web address directly into your Internet browser. You may find it useful to refer to synonyms or related terms when accessing these Internet databases. NOTE: At the time of publication, the Web addresses were functional. However, some links may fail due to URL address changes, which is a common occurrence on the Internet. For readers unfamiliar with the Internet, detailed instructions are offered on how to access electronic resources. For readers unfamiliar with medical terminology, a comprehensive glossary is provided. For readers without access to Internet resources, a directory of medical libraries, that have or can locate references cited here, is given. We hope these resources will prove useful to the widest possible audience seeking information on drug overdose. The Editors

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From the NIH, National Cancer Institute (NCI): http://www.cancer.gov/cancerinfo/ten-things-to-know.

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CHAPTER 1. STUDIES ON DRUG OVERDOSE Overview In this chapter, we will show you how to locate peer-reviewed references and studies on drug overdose.

The Combined Health Information Database The Combined Health Information Database summarizes studies across numerous federal agencies. To limit your investigation to research studies and drug overdose, you will need to use the advanced search options. First, go to http://chid.nih.gov/index.html. From there, select the “Detailed Search” option (or go directly to that page with the following hyperlink: http://chid.nih.gov/detail/detail.html). The trick in extracting studies is found in the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Journal Article.” At the top of the search form, select the number of records you would like to see (we recommend 100) and check the box to display “whole records.” We recommend that you type “drug overdose” (or synonyms) into the “For these words:” box. Consider using the option “anywhere in record” to make your search as broad as possible. If you want to limit the search to only a particular field, such as the title of the journal, then select this option in the “Search in these fields” drop box. The following is what you can expect from this type of search: •

Acute Renal Failure Due to Acetaminophen Ingestion: A Case Report and Review of the Literature Source: Journal of the American Society of Nephrology. 6(1): 48-53. July 1995. Contact: Available from Williams and Wilkins. 351 West Camden Street, Baltimore, MD 21201. (800) 638-0672 or (410) 528-4000. Summary: Acetaminophen is the most commonly reported drug overdose in the U.S. In this article, the authors present a case report of acute renal failure (ARF) due to acetaminophen ingestion and review the relevant literature. They note that, at therapeutic dosages, acetaminophen can be toxic to the kidneys in patients who are glutathione depleted (chronic alcohol injection, starvation, or fasting) or who take drugs that stimulate the P-450 microsomal oxidase enzymes (anticonvulsants). Acute renal

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failure due to acetaminophen manifests as acute tubular necrosis (ATN), either alone or in combination with hepatic necrosis. The azotemia of acetaminophen toxicity is typically reversible, although it may worsen over 7 to 10 days before the recovery of renal function occurs. The authors stress that recognition of acetaminophen nephropathy requires the following: a thorough drug history, including over-thecounter medications such as Tylenol or Nyquil; knowledge of the risk factors that lessen its margin of safety at therapeutic ingestions; and consideration of acetaminophen in the differential diagnosis of patients who present with combined hepatic dysfunction and ATN. 1 figure. 5 tables. 21 references. (AA-M). •

Medical Emergencies in the Dental Office Source: Journal of the CDA. Journal of the Colorado Dental Association. 72(4): 32-37. April 1994. Contact: Available from Colorado Dental Association. 3600 South Yosemite, Number 100, Denver, CO 80237. (800) 343-3010 or (303) 740-6900. Summary: Medical emergencies and their resulting complications can arise at any time in the dental office. This article outlines the recommended management of an emergency situation in the dental office. The authors focus on four categories of care: prevention, preparation, recognition, and treatment. Prevention begins with a complete medical history during the dental patient's first visit. The authors recommend a verbal review of the written history. Information obtained from the patient's medical history and physical exam can assist the practitioner in determining if further tests or consultations are required prior to dental treatment. Preparation consists of a welltrained and coordinated team working in an office with the proper emergency equipment. The authors list the recommended supplies for a basic emergency kit and for a more advanced kit (for properly trained practitioners). The practitioner and staff should be trained to recognize the different symptoms of a developing emergency situation. Correlation of symptoms and vital signs leads the practitioner to the correct diagnosis and subsequent treatment protocol. Treatment is dependent upon the diagnosis. The authors outline the general procedures for an emergency and the causes, symptoms and treatment for some common emergencies, including syncope (fainting), postural hypotension (also brief unconsciousness), hyperventilation syndrome, airway obstruction, bronchial asthma, diabetic or insulin shock, drug overdose or toxicity reaction, convulsions, adrenal insufficiency, urticaria or pruritis, angioneurotic edema, anaphylactic shock, respiratory arrest, stroke or cerebrovascular accident, angina pectoris, and myocardial infarction. 2 figures. 8 references.

•

What You Need to Know About Organ Donation Source: Patient Care. 32(7): 94, 97-98, 100. April 15, 1998. Contact: Available from Medical Economics. 5 Paragon Drive, Montvale, NJ 07645. (800) 432-4570. Fax (201) 573-4956. Summary: This article gives primary care physicians an update on organ donation, including current information on donor cards, mandated choice, presumed consent, brain death, and cadaver donor protocols. The author first encourages readers to have all their patients discuss organ donation with their family members, as this is the most important part of the process. The author then notes who organ donors usually are (most cadaveric donors were in good health but died suddenly from fatal neurologic injuries, primary central nervous system events, cerebrovascular accidents, subarachnoid hemorrhage, brain tumors or injuries, accidents, drug overdose, smoke

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inhalation, suicide, or cardiac arrest). Living donors can donate bone marrow, a kidney, and portions of the lungs, liver, and pancreas. Most living-donor solid organ and bone marrow transplants are performed on a relative of the donor. While many more people need transplants than there are organs available, efforts at increasing the donor pool have not yet equalized supply and demand. The mandated choice proposal currently being debated would require competent adults to decide whether they wish to donate organs when they die. People would have to register their choice in a database when they obtain a driver's license or file a tax return. The question of whether mandated choice and presumed consent violate personal freedom or the right to privacy is controversial. The guidelines issued by the National Kidney Foundation about communication between donor families and transplant recipients are also discussed. These guidelines are based on the belief that donor families and recipients have the right to choose whether they want to communicate with each other. Confidentiality is ensured for those who decline to communicate, and those who want contact are first provided with written information. Other topics covered include payment for organ donation, reasons people don't want to donate or sign a donor card, cadaveric donors, and hospital protocols for organ donation. 1 table. 3 references.

Federally Funded Research on Drug Overdose The U.S. Government supports a variety of research studies relating to drug overdose. These studies are tracked by the Office of Extramural Research at the National Institutes of Health.2 CRISP (Computerized Retrieval of Information on Scientific Projects) is a searchable database of federally funded biomedical research projects conducted at universities, hospitals, and other institutions. Search the CRISP Web site at http://crisp.cit.nih.gov/crisp/crisp_query.generate_screen. You will have the option to perform targeted searches by various criteria, including geography, date, and topics related to drug overdose. For most of the studies, the agencies reporting into CRISP provide summaries or abstracts. As opposed to clinical trial research using patients, many federally funded studies use animals or simulated models to explore drug overdose. The following is typical of the type of information found when searching the CRISP database for drug overdose: •

Project Title: CHANGES IN HOMICIDE AND DRUG OVERDOSE IN NEW YORK CITY Principal Investigator & Institution: Tardiff, Kenneth J.; Professor; Psychiatry; Weill Medical College of Cornell Univ New York, Ny 10021 Timing: Fiscal Year 2002; Project Start 30-SEP-1990; Project End 30-JUN-2007 Summary: (provided by applicant): We are applying for a continuation grant for the study of changes in homicide and accidental fatal drug overdoses. Continuing our long term collaboration with the New York City Medical Examiner, we will collect and analyze data from 2000 to 2006 on an estimated 30,000 fatal injuries, which added to our data base of 40,000 fatalities over 10 years, will allow us to analyze 70,000 fatalities over

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Healthcare projects are funded by the National Institutes of Health (NIH), Substance Abuse and Mental Health Services (SAMHSA), Health Resources and Services Administration (HRSA), Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDCP), Agency for Healthcare Research and Quality (AHRQ), and Office of Assistant Secretary of Health (OASH).

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a 17 year period from 1990-2006. Our data set is unique in that it contains information on types of fatal injuries, time and place of injury and death, characteristics and residence of the victim, and toxicology results for a wide range of illicit drugs and alcohol. This will enable us to extend our surveillance of homicide and overdose mortality in NYC and to test etiologic hypotheses regarding these two causes of death. Our aims are: 1) To determine the incidence, temporal trends, and correlates of homicide, accidental drug overdoses and other fatal accidents with a focus on identifying the emerging role of newer drugs such as ecstasy and oxycodone. 2) To determine neighborhood-level determinants of homicide (e.g., drug use, policing, concentrated disadvantages) and to assess how they are related to changes in the frequency of homicide over timw and place. 3) To determine the association between individual drug use, age of decedents, neighborhood factors (e.g., economic disadvantage, level of illicit drug use), and the risk of becoming a homicide case using fatal accidents as controls. 4) To determine neighborhood-level determinants of drug overdose and to assess how these are related to changes in fatal drug overdose over time and place. There have been significant changes in the use of illicit drugs, the frequency of homicide and of fatal drug overdoses in NYC over the past decade. Although there are many theories as to why these changes have occurred, few scientific studies have been able to address the key hypotheses regarding these changes. Some of the questions that can be addressed in this proposal include: Have arrests for "quality of life" crimes restored public order and lowered the frequency of homicide ad changed drug-dealing? Has individual use of certain illicit drugs increased the risk for homicide and fatal drug overdose? We intend our findings to be helpful to public health and law enforcement practice. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: IMMUNOTHERAPY FOR DRUG ABUSE Principal Investigator & Institution: Owens, S. Michael.; Professor & Director; Pharmacology and Toxicology; University of Arkansas Med Scis Ltl Rock Little Rock, Ar 72205 Timing: Fiscal Year 2002; Project Start 01-MAR-1992; Project End 30-JUN-2005 Summary: The long-term objective of this project is to develop short- and long-acting antibody-based medications for the treatment of drug abuse. Medications are badly needed since repeated use of these drugs can lead to toxicity, psychosis, violent behavior and addiction. These new medications could be used in an emergency room setting for rapidly reversing a drug overdose or in a treatment plan for a recovering addict. Although the long-term goal is to learn how to best use antibody-based "pharmacokinetic antagonists" for treating a wide range of drugs, the main focus of this project will be on phencyclidine (PCP). The experiments in this proposal are designed to systematically test the hypothesis that anti-PCP IgG monoclonal antibodies (MAb) and their antigen binding fragments (Fab) could be used to treat the medical problems associated with PCP abuse. The first studies will address the biopharmaceutical and clinical strategies for anti-PCP Fab treatment of PCP overdose in dogs. In the second studies, mouse MAb with a wide range of affinity constants (from about 1-300 nM) will be generated for use as potential long-acting antagonists of repeated PCP use. These antibody medications will then be used in rats to test our hypothesis that careful selection of antibody affinity can lead to an optimal balance between drug association with the antibody (to block drug effects), and drug dissociation from the antibody (to allow regeneration of antibody binding capacity). Combined pharmacokinetic and pharmacodynamic analysis of these experiments will allow us to design better clinical strategies for using antibody-based medications. In the final series of experiments, we

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will study the rates of partitioning into, and out of, the rodent brain without and with treatment with our antibody-based medications. These data will help to determine the ability of the MAb to redistribute the drug and the rate at which drugs of abuse enter and leave the brain. These integrated studies of pharmacokinetic, behavioral and central nervous system changes before and after antibody-based therapy will serve as a prototypic model that can be applied to treatment of drugs of abuse in humans. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: METALLOPROTEINASES IN VENTILATOR-INDUCED LUNG INJURY Principal Investigator & Institution: Foda, Hussein D.; Medicine; State University New York Stony Brook Stony Brook, Ny 11794 Timing: Fiscal Year 2002; Project Start 01-APR-2000; Project End 31-MAR-2004 Summary: Acute, diffuse lung injury often complicates sepsis, gastric acid aspiration, extensive trauma, drug overdose, and other conditions. Clinically, this condition is known as the Adult Respiratory Distress Syndrome (ARDS) that is characterized by catastrophic respiratory failure requiring mechanical ventilation (MV). Although mechanical ventilation is a main stay in managing patients with this condition, several MV-associated complications have been recognized. One of the most serious potential complications of MV is the newly recognized ventilator-induced acute lung injury (VILI). The NIH NHLBI ARDS clinical trials network has just reported that MV strategies employing low tidal volume ventilation reduced mortality in ARDS by 25 percent and lead to a decrease in lung injury and multisystem organ failure. The mechanism by which high volume ventilation causes increased mortality and lung injury is not well understood. In this proposal we will pursue very exciting preliminary results suggesting that matrix metalloproteinases (MMPs) especially gelatinases are responsible for ventilator-induced lung injury in animal lungs subjected to high tidal volume mechanical ventilation. We will also examine the mechanism by which MMPs are up regulated in this type of acute lung injury. Our hypothesis is that Ventilatorinduced lung injury is caused by the release and activation of MMPs especially gelatinases. This increase in MMPs is regulated by the cytokine Extracellular matrix metalloproteinase inducer (EMMPRIN) and is caused by the exposure of lung cells to mechanical stress. To prove this hypothesis we have set several specific aims: 1) To systematically examine the induction, release and activation of MMPs especially gelatinases in an experimental rat model of ventilator-induced lung injury (VILI); 2) To examine if MMP inhibitors can prevent ventilator-induced lung injury in rat lungs; 3) To characterize the role of EMMPRIN in VILI; 4) To investigate the influence of mechanical stress as a mechanism of the increased MMP production. This research has significant implications for the management of patients with acute, severe lung injury requiring mechanical ventilation. By better understanding the mechanisms that lead to ventilatorinduced lung injury, therapeutic strategies may be devised to improve the outcome in this highly fatal condition. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

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Project Title: METHYLPHENIDATE-ETHANOL INTERACTION IN ADHD AND COABUSE Principal Investigator & Institution: Patrick, Kennerly S.; Pharmaceutical Sciences; Medical University of South Carolina P O Box 250854 Charleston, Sc 29425 Timing: Fiscal Year 2002; Project Start 30-SEP-2002; Project End 31-AUG-2004

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Summary: (provided by applicant): Appropriate drug therapy for attention-deficit hyperactivity disorder (ADHD) requires special consideration of lifestyle and life span comorbidity. (1) dI-Methylphenidate (MPH) is a drug of choice for ADHD; (2) Substance/alcohol abuse and dependence is over-represented in adolescent and adult ADHD, especially in women; (3) A pilot study revealed a novel MPH-ethanol metabolic drug interaction, wherein ethanol combines with MPH to form ethylphenidate (ETPH); and (4) the ethanol also appeared to inhibit MPH metabolism (especially in the female subjects; women have been reported to exhibit reduced first-pass metabolism of ethanol). Given these considerations, the potential therapeutic and toxicological significance of the MPH-ethanol interaction is proposed for investigation. SPECIFIC AIM 1 is to test the hypothesis that the enantiomers of the metabolite ETPH contribute to the neuropharmacology of concomitant MPH-ethanol. Monoamine transporter inhibition and mouse behavioral screens will be used for this assessment. SPECIFIC AIM 2 will test the hypothesis that ETPH will be formed enantioselectively. Enantiospecific gas chromatography-mass spectrometry (GC-MS)-negative ion chemical ionization will be used to simultaneously quantitate d-MPH, I-MPH, d-ETPH and IETPH from serial plasma samples. Healthy human volunteers-eight men and eight women--will participate in these pharmacokinetic studies. SPECIFIC AIM 3 (a) will ask what extent the MPH-ethanol interaction increases MPH blood concentrations in men vs. women; (b) will test the prediction that ethanol will not only elevate total plasma MPH levels, but also reduce the plasma d-MPH/I-MPH ratio; and (c) will test the hypothesis that the order of administration of ethanol relative to MPH influences the extent of this drug interaction (in the same order-dependent manner that has been reported for the cocaine-ethanol interaction which forms cocaethylene and can inhibit cocaine metabolism). The findings will serve to broaden our understanding of the toxicological consequences of MPH-ethanol coabuse and contribute to the rational emergency management of this common concomitant drug overdose. Further, the results will be used to support recommendations for optimal drug individualization in the treatment of ADHD, e.g., dextroamphetamine vs. MPH; dI-MPH vs. d-MPH; immediate-release MPH vs. extended-release MPH; or adjustment of MPH. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: RELATIONSHIP BETWEEN THE INTERNET AND ILLICIT DRUG USE Principal Investigator & Institution: Boyer, Edward W.; Emergency Medicine; Univ of Massachusetts Med Sch Worcester Office of Research Funding Worcester, Ma 01655 Timing: Fiscal Year 2002; Project Start 30-SEP-2001; Project End 31-AUG-2004 Summary: (provided by the applicant): The Internet has been implicated in illicit drug overdose and death, and preliminary evidence suggests that the Internet may also encourage drug experimentation and increase drug abuse. Because the Internet is widely availability, is global in nature, and can disseminate information rapidly, it represents a significant source of drug information that is accessed by increasing numbers of people daily. The specific aims of this study are: 1) to determine the proportion of persons using the Internet to obtain information about the use of club drugs and other drugs; 2) to assess the association of knowledge, attitudes and behavior toward drugs with ways in which the Internet is used; 3) to determine the characteristics of persons whose self-reported drug-using behavior has been altered by information obtained from the Internet. We propose to conduct a cross sectional study of persons presenting to two emergency departments (one adult and one pediatric) using an interviewer-administered questionnaire. We will obtain information on demographic

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profile, drug use, and ways in which the Internet is used. After addressing the study hypotheses, we will conduct exploratory analyses to compare respondents who do and do not use the Internet to obtain information on illicit drugs. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen •

Project Title: THE NEIGHBORHOOD ENVIRONMENT AND DRUG USE IN NYC Principal Investigator & Institution: Galea, Sandro; Medical Epidemiologist; New York Academy of Medicine 1216 5Th Ave New York, Ny 10029 Timing: Fiscal Year 2004; Project Start 10-MAY-2004; Project End 30-APR-2008 Summary: (provided by applicant): Proposed is a study is to assess the relations between neighborhood characteristics (e.g., neighborhood disadvantage, collective efficacy, residential segregation) and drug use behavior among residents of New York City while controlling for relevant individual-level factors. A secondary purpose of this study is to determine the relation between key neighborhood characteristics and the medical consequences of drug use, particularly fatal drug overdose. Recent work has shown that neighborhood characteristics are associated with the likelihood of drug use, abuse, and dependence and that research focusing exclusively on individual patterns of drug use is insufficient to fully explain inter-individual drug use behavior. Here we propose a systematic collection of data to characterize neighborhoods in a large metropolitan area and to test key hypotheses that may explain inter-individual variability in drug use behavior and its consequences. Understanding how neighborhood factors affect drug use risk behavior can guide interventions that aim to mitigate drug use and its consequences, to create a social environment that better facilitates users to seek treatment, and to improve overall population health. In order to achieve the aims of this study we will use data from three sources: (i) We will collect data on individual drug use behavior (focusing on cigarette, alcohol, and marijuana use) through a random digit-dial phone survey of 5,000 New York City residents, geo-coding and mapping each respondent to their neighborhood of residence; (ii) we will compile a contextual database characterizing New York City neighborhoods using information collected in the survey and using archival data (collected from the New York City Department of Health and Mental Hygiene, Department of City Planning, Police Department, US Census and other sources); and (iii) we will combine this data with data from a NIDA funded study of drug overdose over time (DA 06534; principal investigator: Tardiff, a consultant on this project). We will test key hypotheses about the relations between neighborhood characteristics and drug use, abuse, and dependence using multi-level hierarchical models. We have recently completed several studies of New York City neighborhoods that serve as preliminary exploration of the key hypotheses of this study. This, coupled with our studies involving telephone interviews with 6,000+ New Yorkers is assurance that the aims of this study can be achieved. Website: http://crisp.cit.nih.gov/crisp/Crisp_Query.Generate_Screen

E-Journals: PubMed Central3 PubMed Central (PMC) is a digital archive of life sciences journal literature developed and managed by the National Center for Biotechnology Information (NCBI) at the U.S. National

3

Adapted from the National Library of Medicine: http://www.pubmedcentral.nih.gov/about/intro.html.

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Library of Medicine (NLM).4 Access to this growing archive of e-journals is free and unrestricted.5 To search, go to http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=Pmc, and type “drug overdose” (or synonyms) into the search box. This search gives you access to full-text articles. The following is a sample of items found for drug overdose in the PubMed Central database: •

Effects of a drug overdose in a television drama on knowledge of specific dangers of self poisoning: population based surveys. by O'Connor S, Deeks JJ, Hawton K, Simkin S, Keen A, Altman DG, Philo G, Bulstrode C.; 1999 Apr 10; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=27825

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Effects of a drug overdose in a television drama on presentations to hospital for self poisoning: time series and questionnaire study. by Hawton K, Simkin S, Deeks JJ, O'Connor S, Keen A, Altman DG, Philo G, Bulstrode C.; 1999 Apr 10; http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=27823

The National Library of Medicine: PubMed One of the quickest and most comprehensive ways to find academic studies in both English and other languages is to use PubMed, maintained by the National Library of Medicine.6 The advantage of PubMed over previously mentioned sources is that it covers a greater number of domestic and foreign references. It is also free to use. If the publisher has a Web site that offers full text of its journals, PubMed will provide links to that site, as well as to sites offering other related data. User registration, a subscription fee, or some other type of fee may be required to access the full text of articles in some journals. To generate your own bibliography of studies dealing with drug overdose, simply go to the PubMed Web site at http://www.ncbi.nlm.nih.gov/pubmed. Type “drug overdose” (or synonyms) into the search box, and click “Go.” The following is the type of output you can expect from PubMed for drug overdose (hyperlinks lead to article summaries): •

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A case of mixed transcortical aphasia following drug overdose. Author(s): Chenery HJ, Murdoch BE. Source: Br J Disord Commun. 1986 December; 21(3): 381-91. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2443153

With PubMed Central, NCBI is taking the lead in preservation and maintenance of open access to electronic literature, just as NLM has done for decades with printed biomedical literature. PubMed Central aims to become a world-class library of the digital age. 5 The value of PubMed Central, in addition to its role as an archive, lies in the availability of data from diverse sources stored in a common format in a single repository. Many journals already have online publishing operations, and there is a growing tendency to publish material online only, to the exclusion of print. 6 PubMed was developed by the National Center for Biotechnology Information (NCBI) at the National Library of Medicine (NLM) at the National Institutes of Health (NIH). The PubMed database was developed in conjunction with publishers of biomedical literature as a search tool for accessing literature citations and linking to full-text journal articles at Web sites of participating publishers. Publishers that participate in PubMed supply NLM with their citations electronically prior to or at the time of publication.

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A survey of non-barbiturate anticonvulsant drug overdose reported to the Poisons Information Service (UK). Author(s): Berry DJ, Wiseman HM, Volans GN. Source: Hum Toxicol. 1983 April; 2(2): 357-60. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6407979

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Accidental drug overdose. Action stat! Author(s): Dodd-Butera T, Baker JK. Source: Nursing. 1987 September; 17(9): 33. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3649638

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Activated charcoal in the treatment of drug overdose. An update. Author(s): Palatnick W, Tenenbein M. Source: Drug Safety : an International Journal of Medical Toxicology and Drug Experience. 1992 January-February; 7(1): 3-7. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1536696

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Acute dilatation of stomach as late complication of drug overdose. Author(s): How J, Strachan RW. Source: British Medical Journal. 1976 March 6; 1(6009): 563-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4191

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Acute drug overdose: one hospital's experience. Author(s): Soslow AR. Source: Annals of Emergency Medicine. 1981 January; 10(1): 18-21. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6109510

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Age- and sex-related differences in patterns of drug overdose and abuse. Author(s): Busto U, Kaplan HL, Sellers EM. Source: Soc Sci Med [e]. 1981 November; 15(4): 275-82. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7323849

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Alcohol use by patients admitted to hospital emergency rooms for treatment of drug overdose and misuse. Author(s): Kaplan HL, Sellers EM, Marshman JA, Giles HG, MacLeod SM, Kapur BM, Stapleton C, Sealey F, Busto U. Source: J Stud Alcohol. 1980 September; 41(9): 882-93. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7206719

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Anti hypertensive drug overdose. Author(s): Bara V. Source: Emergency Nurse : the Journal of the Rcn Accident and Emergency Nursing Association. 1999 July-August; 7(4): 13-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10595034

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Antiepileptic drug overdose. Author(s): McCrea S. Source: Emergency Nurse : the Journal of the Rcn Accident and Emergency Nursing Association. 2002 February; 9(9): 13-8. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11845727

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Antimalarial drug overdose: clinical features and management. Author(s): McCrea S. Source: Emergency Nurse : the Journal of the Rcn Accident and Emergency Nursing Association. 2001 April; 9(1): 20-5. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11935739

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Antipsychotic drug overdose. Author(s): Pickford M. Source: Emergency Nurse : the Journal of the Rcn Accident and Emergency Nursing Association. 2000 February; 7(9): 17-22. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10847011

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Application of GLC-AFID and GLC-MS procedures to analysis of plasma in suspected cases of psychotropic drug overdose. Author(s): Midha KK, Charette C, McGilveray IJ, Webb D, McLean MC. Source: Clin Toxicol. 1981 June; 18(6): 713-29. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7273677

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Argument against hemoperfusion in drug overdose. Author(s): Dumont C, Rangno R. Source: Jama : the Journal of the American Medical Association. 1979 October 12; 242(15): 1611. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=480575

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Attempted suicide by drug overdose and by poison-ingestion methods seen at the main general hospital in the Fiji islands: a comparative study. Author(s): Aghanwa HS. Source: General Hospital Psychiatry. 2001 September-October; 23(5): 266-71. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11600168

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Attempted suicide by drug overdose in a country town. Author(s): Bridges-Webb C. Source: The Medical Journal of Australia. 1973 October 20; 2(16): 782-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4757574

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Attempted suicide by drug overdose. Author(s): Weddige RL, Stenhilber RM. Source: Postgraduate Medicine. 1971 May; 49(5): 184-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5577353

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Audit of toxic screening in patients with drug overdose at Pretoria Academic Hospital. Author(s): Dhatt GS, Mostert K. Source: South African Medical Journal. Suid-Afrikaanse Tydskrif Vir Geneeskunde. 2002 October; 92(10): 793-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12432802

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Autonomic and behavioral responses in coma due to drug overdose. Author(s): Schuri U, von Cramon D. Source: Psychophysiology. 1980 May; 17(3): 253-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7384375

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Calcium channel blocking drug overdose: an Australian series. Author(s): Howarth DM, Dawson AH, Smith AJ, Buckley N, Whyte IM. Source: Human & Experimental Toxicology. 1994 March; 13(3): 161-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7909677

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Carbohydrate-deficient transferrin for identification of drug overdose patients at risk of an alcohol withdrawal syndrome. Author(s): Koppel C, Muller C, Wrobel N. Source: Journal of Toxicology. Clinical Toxicology. 1996; 34(3): 297-300. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8667467

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Cardiac drug overdose. Author(s): Drake CE. Source: American Family Physician. 1982 January; 25(1): 181-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7055025

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Cathartics for drug overdose. Author(s): Tenenbein M. Source: Annals of Emergency Medicine. 1987 July; 16(7): 832-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3592351

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Changes in arterial oxygen tension after gastric lavage for drug overdose. Author(s): Jorens PG, Joosens EJ, Nagler JM. Source: Human & Experimental Toxicology. 1991 May; 10(3): 221-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1678953

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Changes in cardiorespiratory function during gastric lavage for drug overdose. Author(s): Thompson AM, Robins JB, Prescott LF. Source: Hum Toxicol. 1987 May; 6(3): 215-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3596605

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Changing trends in drug overdose over a six-year period. Author(s): Strong JM. Source: Military Medicine. 1984 January; 149(1): 17-20. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6422327

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Chlormezanone plasma and blood levels in patients after single and repeated oral doses and after suicidal drug overdose. Author(s): Koppel C, Kristinsson J, Wagemann A, Tenczer J, Martens F. Source: Eur J Drug Metab Pharmacokinet. 1991 January-March; 16(1): 43-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1936060

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Chlorprothixene and chlorprothixene-sulfoxide in body fluids from a case of drug overdose. Author(s): Poklis A, Maginn D, Mackell MA. Source: Journal of Analytical Toxicology. 1983 January-February; 7(1): 29-32. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6834795

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Clinical management of cytotoxic drug overdose. Author(s): Thomas LL, Mertens MJ, von dem Borne AE, van Boxtel CJ, Veenhof CH, Veies EP. Source: Med Toxicol Adverse Drug Exp. 1988 July-August; 3(4): 253-63. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3054425

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Comparison of glutethimide concentration in the serum and cerebrospinal fluid of humans in drug overdose. Author(s): Gold M, Tassoni E, Etzl M. Source: Clinical Chemistry. 1973 October; 19(10): 1158-61. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4741955

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Concentration of glutethimide and associated compounds in huamn serum and cerebrospinal fluid after drug overdose. Author(s): Gold M, Tassoni E, Etzl M, Mathew G. Source: Clinical Chemistry. 1974 February; 20(2): 195-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4812995

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Deaths by unintentional illicit drug overdose in Italy, 1984-2000. Author(s): Preti A, Miotto P, De Coppi M. Source: Drug and Alcohol Dependence. 2002 May 1; 66(3): 275-82. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12062462

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Demographic characteristics of elderly drug overdose patients admitted to a hospital emergency department. Author(s): Schernitski P, Bootman JL, Byers J, Likes K, Hughes JH. Source: Journal of the American Geriatrics Society. 1980 December; 28(12): 544-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7430530

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Dermographism, erythema, and flare: clinical signs of drug overdose in the comatose patient. Author(s): Cotliar RW, Stringham LR, Leavell UW Jr. Source: Southern Medical Journal. 1973 November; 66(11): 1277-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4745611

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Diagnosis and management of the drug overdose patient. Author(s): Merigian KS, Blaho K. Source: American Journal of Therapeutics. 1997 February-March; 4(2-3): 99-113. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10423599

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Diagnostic and therapeutic utility of flumazenil in comatose patients with drug overdose. Author(s): Chern TL, Hu SC, Lee CH, Deng JF. Source: The American Journal of Emergency Medicine. 1993 March; 11(2): 122-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8476450

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Disseminated Herpesvirus hominis 2 infection following drug overdose. Author(s): Abraham AA, Manko MA. Source: Archives of Internal Medicine. 1977 September; 137(9): 1198-1200. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=901088

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Distribution of deaths by unintentional illicit drug overdose in Italy based on periodicity over time, 1984-2000. Author(s): Rocchi MB, Miotto P, Preti A. Source: Drug and Alcohol Dependence. 2003 October 24; 72(1): 23-31. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14563540

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Drug overdose and the elderly. Author(s): Carlson MJ. Source: Ohio Med. 1987 December; 83(12): 852-4. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3696667

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Drug overdose and the full moon. Author(s): Sharfman M. Source: Percept Mot Skills. 1980 February; 50(1): 124-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7367156

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Drug overdose as a consequence of misuse of a syringe pump. Author(s): Shenkman Z, Ornstein E, Adler D. Source: Anesthesia and Analgesia. 1995 September; 81(3): 652-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7653841

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Drug overdose during pregnancy: an overview from a metropolitan poison control center. Author(s): Rayburn W, Aronow R, DeLancey B, Hogan MJ. Source: Obstetrics and Gynecology. 1984 November; 64(5): 611-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6493653

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Drug overdose emergency room admissions. Author(s): Brandwin MA. Source: The American Journal of Drug and Alcohol Abuse. 1976; 3(4): 605-19. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1032766

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Drug overdose in children. Author(s): Tibballs J, McArdle EJ, Brown TC. Source: Aust Paediatr J. 1985 February; 21(1): 7-11. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3977796

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Drug overdose under study: critique of a hospital audit of adverse effects of drugs used nontherapeutically. Author(s): Buckingham WB, Fifer WR. Source: Qrb Qual Rev Bull. 1977 February; 3(2): 11-20, 27-8. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=403489

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Drug overdose. Author(s): Cooper K. Source: The American Journal of Nursing. 1989 September; 89(9): 1146-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2774017

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Drug overdose. Prevention, management and post mortem. Author(s): Stevenson NW. Source: Aust Fam Physician. 1989 October; 18(10): 1235-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2818311

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Drug overdose: changing concepts for modern drugs. Author(s): Smith JP. Source: Southern Medical Journal. 1986 October; 79(10): 1230-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3764518

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Drug overdose: new insights, innovative surveillance, and promising interventions. Author(s): Galea S, Coffin PO. Source: Journal of Urban Health : Bulletin of the New York Academy of Medicine. 2003 June; 80(2): 186-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12791794

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Drug overdose: salicylates. Author(s): Kuhn MM. Source: Critical Care Nurse. 1992 January; 12(1): 16, 25-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1310078

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Drug overdose--an increasing medical emergency. Author(s): Sannella JJ. Source: J Tenn Med Assoc. 1977 January; 70(1): 23. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=834041

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Drug overdose--the national picture. Author(s): Walsh M. Source: Nurs Times. 1982 July 7-13; 78(27): 1158-9. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6920719

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Drug-specific Fab therapy in drug overdose. Author(s): Hursting MJ, Raisys VA, Opheim KE. Source: Archives of Pathology & Laboratory Medicine. 1987 August; 111(8): 693-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3632280

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Early treatment of the unconscious patient suffering from drug overdose. Author(s): Matthew H. Source: The Medical Journal of Australia. 1969 April 5; 1(14): 752. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5771323

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Early treatment of the unconscious patient suffering from drug overdose. Author(s): Baker AB. Source: The Medical Journal of Australia. 1969 March 8; 1(10): 497-503. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4888072

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Effect of ethanol ingestion on outcome of drug overdose. Author(s): Rangno RE, Dumont CH, Sitar DS. Source: Critical Care Medicine. 1982 March; 10(3): 180-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6800703

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Effects of a drug overdose in a television drama on knowledge of specific dangers of self poisoning: population based surveys. Author(s): O'Connor S, Deeks JJ, Hawton K, Simkin S, Keen A, Altman DG, Philo G, Bulstrode C. Source: Bmj (Clinical Research Ed.). 1999 April 10; 318(7189): 978-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10195968

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Effects of a drug overdose in a television drama on presentations to hospital for self poisoning: time series and questionnaire study. Author(s): Hawton K, Simkin S, Deeks JJ, O'Connor S, Keen A, Altman DG, Philo G, Bulstrode C. Source: Bmj (Clinical Research Ed.). 1999 April 10; 318(7189): 972-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10195966

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Effects of drug overdose in television drama on presentations for self poisoning. A casual association cannot yet be inferred. Author(s): Pell J, Murdoch R. Source: Bmj (Clinical Research Ed.). 1999 October 23; 319(7217): 1131; Author Reply 1132. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10610145

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Effects of drug overdose in television drama on presentations for self poisoning. Antifreeze poisonings give more insight into copycat behaviour. Author(s): Veysey MJ, Kamanyire R, Volans GN. Source: Bmj (Clinical Research Ed.). 1999 October 23; 319(7217): 1131; Author Reply 1132. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10531114

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Effects of drug overdose in television drama on presentations for self poisoning. Study is impressive but raises methodological concerns. Author(s): Davies SJ, Atherton M, Williams T, Purkis J, Combe G, Brindley AJ, McCarthy G, Denny R. Source: Bmj (Clinical Research Ed.). 1999 October 23; 319(7217): 1131-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10610146

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Emergency management of drug overdose. Author(s): Weinman SA. Source: Critical Care Nurse. 1993 December; 13(6): 45-51. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8112096

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Emergency treatment of acute depressant drug overdose. Author(s): Sheppard CW, Gay GR, Smith DE. Source: Mo Med. 1972 February; 69(2): 109-11 Contd. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5058791

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Emergency treatment of drug overdose. Author(s): Erb HL. Source: Can Nurse. 1979 May; 75(5): 30-5. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=255096

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Emergency treatment of drug overdose. Author(s): Guarino GB, Vijay NK. Source: Rocky Mt Med J. 1975 October; 72(10): 446-8. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1209102

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Epidemiology of drug overdose in children. Author(s): Am J Emerg Med. 1994 May;12(3):392-5 Source: Drug Safety : an International Journal of Medical Toxicology and Drug Experience. 1993 October; 9(4): 291-308. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8179767

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Esophageal spasm in a case of drug overdose. Author(s): Laaban JP, Bodenan P, Marty M, Cosson JP, Rochemaure J. Source: The New England Journal of Medicine. 1984 November 29; 311(22): 1443. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6493308

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Evaluation of deaths from drug overdose. A clinicopathologic study. Author(s): Irey NS, Froede RC. Source: American Journal of Clinical Pathology. 1974 June; 61(6): 778-84. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4832116

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Evaluation of screendex--a multireagent system for detection of drug abuse and drug overdose. Author(s): Decker WJ, Lewis LR. Source: Clin Toxicol. 1973; 6(2): 201-9. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4146006

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Experimental and clinical studies on corneal grafts from donors dying of drug overdose: a review. Author(s): Basu PK. Source: Cornea. 1984-85; 3(4): 262-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6400575

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Fixed-bed charcoal hemoperfusion for the treatment of drug overdose. Author(s): Barbour BH, LaSette AM, Koffler A. Source: Kidney International. Supplement. 1976 December; (7): S333-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1070557

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Fixed-bed charcoal hemoperfusion. Treatment of drug overdose. Author(s): Koffler A, Bernstein M, LaSette A, Massry SG. Source: Archives of Internal Medicine. 1978 November; 138(11): 1691-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=718320

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Flumazenil in drug overdose: randomized, placebo-controlled study to assess cost effectiveness. Author(s): Barnett R, Grace M, Boothe P, Latozek K, Neal C, Legatt D, Finegan BA. Source: Critical Care Medicine. 1999 January; 27(1): 78-81. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9934897

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Frequency of drug overdose. Author(s): Walsh MH. Source: Nurs Times. 1981 January 29; 77(5): 202. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6906722

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Gangrenous ischaemic colitis following non-steroidal anti-inflammatory drug overdose. Author(s): Appu S, Thompson G. Source: Anz Journal of Surgery. 2001 November; 71(11): 694-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11736840

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Gluteal compartment syndrome following drug overdose. Author(s): Barnes MR, Harper WM, Tomson CR, Williams NM. Source: Injury. 1992; 23(4): 274-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1618574

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Guide to management of drug overdose. Author(s): Comstock EG. Source: Clin Toxicol. 1975; 8(4): 475-82. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1220898

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Hemodynamic responses to physostigmine in patients with a drug overdose. Author(s): Nilsson E, Meretoja OA, Neuvonen P. Source: Anesthesia and Analgesia. 1983 October; 62(10): 885-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6614520

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Hemoperfusion in drug overdose. Author(s): Freed CR, Gerber JG, Gal J, Rumack BH, Nies AS. Source: Jama : the Journal of the American Medical Association. 1979 April 13; 241(15): 1575. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=430707

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Hemoperfusion in drug overdose. Author(s): Gelfand MC. Source: Jama : the Journal of the American Medical Association. 1978 December 15; 240(25): 2761-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=713018

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Hemoperfusion: a new treatment for severe drug overdose. Author(s): Passer JA. Source: Nebr Med J. 1978 April; 63(4): 116-9. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=643117

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Hyperpyrexia following psychotropic drug overdose. Author(s): Peebles-Brown AE. Source: Anaesthesia. 1985 November; 40(11): 1097-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4073426

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Impaired metabolism of methylphenobarbital after a combined drug overdose: treatment by resin hemoperfusion. Author(s): Pond S, Jacob P 3rd, Humphreys M, Weiss R, Tong T. Source: Journal of Toxicology. Clinical Toxicology. 1982 April; 19(2): 187-96. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7109008

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Implications of discordance between clinical impression and toxicology analysis in drug overdose. Author(s): Brett AS. Source: Archives of Internal Medicine. 1988 February; 148(2): 437-41. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3341840

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Income distribution and risk of fatal drug overdose in New York City neighborhoods. Author(s): Galea S, Ahern J, Vlahov D, Coffin PO, Fuller C, Leon AC, Tardiff K. Source: Drug and Alcohol Dependence. 2003 May 21; 70(2): 139-48. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12732407

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Induced hypothermia for drug overdose. Author(s): Osterhoudt KC, Perrone J. Source: Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine. 2002 September; 9(9): 962. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12208689

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Intentional drug overdose: predictors of clinical course in the intensive care unit. Author(s): Heyman EN, LoCastro DE, Gouse LH, Morris DL, Lombardo BA, Montenegro HD, Takacs M. Source: Heart & Lung : the Journal of Critical Care. 1996 May-June; 25(3): 246-52. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8635925

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Late brain recovery processes after drug overdose. Author(s): Haider I, Oswald J. Source: Electroencephalography and Clinical Neurophysiology. 1970 September; 29(3): 326. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4195690

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Late brain recovery processes after drug overdose. Author(s): Haider I, Oswald I. Source: British Medical Journal. 1970 May 9; 1(5705): 318-22. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4317051

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Letter: Antidotes for drug overdose. Author(s): Mendelson G. Source: Anaesthesia and Intensive Care. 1975 August; 3(3): 268-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1166956

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Life-threatening drug overdose. Precipitants and prognosis. Author(s): Stern TA, Mulley AG, Thibault GE. Source: Jama : the Journal of the American Medical Association. 1984 April 20; 251(15): 1983-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6700101

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Management of cardiac drug overdose. Author(s): Volans GN, Holt DW, Ali C. Source: Resuscitation. 1984 March; 11(3-4): 207-16. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6144151

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Management of drug overdose in the adult. Author(s): Metz V, Hanenson IB. Source: Journal of Emergency Nursing: Jen : Official Publication of the Emergency Department Nurses Association. 1975 November-December; 1(6): 8-11. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=768580

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Management of drug overdose. Rapid whole-gut evacuation. Author(s): Boba A. Source: Imj Ill Med J. 1979 March; 155(3): 156-7. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=33937

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Management of the drug overdose patient. Part I. discussion of general principles. Author(s): Bianchine JR, Couri D. Source: Ohio State Med J. 1977 June; 73(6): 396-7. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=882234

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Management of the drug overdose patient. Part II. Specific antidotes. Author(s): Bianchine JR, Couri D. Source: Ohio State Med J. 1977 July; 73(7): 451-2. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=882237

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Measuring plasma paracetamol concentrations in all patients with drug overdose or altered consciousness: does it change outcome? Author(s): Dargan PI, Ladhani S, Jones AL. Source: Emergency Medicine Journal : Emj. 2001 May; 18(3): 178-82. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11354207

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Methodological issues in the surveillance of poisoning, illicit drug overdose, and heroin overdose deaths in new Mexico. Author(s): Landen MG, Castle S, Nolte KB, Gonzales M, Escobedo LG, Chatterjee BF, Johnson K, Sewell CM. Source: American Journal of Epidemiology. 2003 February 1; 157(3): 273-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12543628

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Multiple drug overdose in a kidney transplant patient. Author(s): Zylber-Katz E, Putterman C, Caraco Y. Source: Therapeutic Drug Monitoring. 1994 June; 16(3): 327-31. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8085287

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Muscle as an autopsy material for evaluation of fatal cases of drug overdose. Author(s): Christensen H, Steentoft A, Worm K. Source: J Forensic Sci Soc. 1985 May-June; 25(3): 191-206. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4045416

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Myonecrosis induced by drug overdose: pathogenesis, clinical aspects and radiological manifestations. Author(s): Vukanovic S, Hauser H, Curati WL. Source: European Journal of Radiology. 1983 November; 3(4): 314-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6653563

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Nursing care study - drug overdose: dealing with an unknown quantity. Author(s): Dodson AM. Source: Nurs Mirror. 1982 January 27; 154(4): 47-8. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6916346

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Obtundation in the elderly patient: presentation of a drug overdose. Author(s): Svenson J. Source: The American Journal of Emergency Medicine. 1987 November; 5(6): 524-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3663295

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Opiates, cocaine and alcohol combinations in accidental drug overdose deaths in New York City, 1990-98. Author(s): Coffin PO, Galea S, Ahern J, Leon AC, Vlahov D, Tardiff K. Source: Addiction (Abingdon, England). 2003 June; 98(6): 739-47. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12780362

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Overdose: a symptom or final diagnosis? Psychiatric considerations in audits of drug overdose. Author(s): Richman A. Source: Qrb Qual Rev Bull. 1977 February; 3(2): 25, 27. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=403491

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Patterns and economic effects of drug overdose mortality in Texas: 1980-1986. Author(s): Harlow KC, Swint JM. Source: Journal of Drug Education. 1989; 19(2): 165-82. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2788730

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Patterns of drug overdose. Author(s): Walsh MH. Source: Nurs Times. 1982 February 17-23; 78(7): 275-8. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6917217

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Pharmacist liability for suicide by drug overdose. Author(s): Brushwood DB. Source: Am J Hosp Pharm. 1983 March; 40(3): 439-43. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6846352

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Pharmacokinetic evaluation of hemodialysis in acute drug overdose. Author(s): Takki S, Gambertoglio JG, Honda DH, Tozer TN. Source: Journal of Pharmacokinetics and Biopharmaceutics. 1978 October; 6(5): 427-42. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=366103

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Pharmacokinetics of drug overdose. Author(s): Platt D. Source: Clin Lab Med. 1990 June; 10(2): 261-9. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2197050

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Pharmacokinetics of drug overdose. Author(s): Rosenberg J, Benowitz NL, Pond S. Source: Clinical Pharmacokinetics. 1981 May-June; 6(3): 161-92. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7016383

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Pharmacokinetics of haemoperfusion for drug overdose. Author(s): Pond S, Rosenberg J, Benowitz NL, Takki S. Source: Clinical Pharmacokinetics. 1979 September-October; 4(5): 329-54. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=389527

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Pharmacokinetics of phenobarbital during certain enhanced elimination modalities to evaluate their clinical efficacy in management of drug overdose. Author(s): Mohammed Ebid AH, Abdel-Rahman HM. Source: Therapeutic Drug Monitoring. 2001 June; 23(3): 209-16. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11360027

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Physostigmine dose for tricyclic drug overdose. Author(s): Brier RH. Source: Annals of Internal Medicine. 1978 October; 89(4): 579. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=697254

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Physostigmine in coma due to drug overdose. Author(s): Nattel S, Bayne L, Ruedy J. Source: Clinical Pharmacology and Therapeutics. 1979 January; 25(1): 96-102. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=363335

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Poisoning and drug overdose. Author(s): Vernon DD, Gleich MC. Source: Critical Care Clinics. 1997 July; 13(3): 647-67. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9246535

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Poisoning by drug overdose. Author(s): Achong MR. Source: Can Med Assoc J. 1977 September 3; 117(5): 424-9. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=902185

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Predicting the clinical course in intentional drug overdose. Author(s): Tunkel AR, D'Antonio J, Engel-Kominsky S, Browne B. Source: Archives of Internal Medicine. 1988 January; 148(1): 253. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3122680

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Predicting the clinical course in intentional drug overdose. Implications for use of the intensive care unit. Author(s): Brett AS, Rothschild N, Gray R, Perry M. Source: Archives of Internal Medicine. 1987 January; 147(1): 133-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3800515

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Predicting the need for hospital admission in patients with intentional drug overdose. Author(s): Meulendijks CF, van den Berg EJ, Fortuyn HD, Verkes RJ, van der Wilt GJ, Kramers C. Source: The Netherlands Journal of Medicine. 2003 May; 61(5): 164-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12916542

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Predictors of accidental fatal drug overdose among a cohort of injection drug users. Author(s): O'Driscoll PT, McGough J, Hagan H, Thiede H, Critchlow C, Alexander ER. Source: American Journal of Public Health. 2001 June; 91(6): 984-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11392946

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Psychiatric aspects of drug overdose in adults. Author(s): Burrows GD, Harari E. Source: Anaesthesia and Intensive Care. 1974 November; 2(4): 310-1. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4447245

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Psychopharmacological roulette: a follow-up study of patients hospitalized for drug overdose. Author(s): Mayo JA. Source: American Journal of Public Health. 1974 June; 64(6): 616-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4829077

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Quantitative serum toxic screening in the management of suspected drug overdose. Author(s): Mahoney JD, Gross PL, Stern TA, Browne BJ, Pollack MH, Reder V, Mulley AG. Source: The American Journal of Emergency Medicine. 1990 January; 8(1): 16-22. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2293827

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Reassuring a young girl after a drug overdose. Author(s): Adams S. Source: Nurs Times. 1986 September 17-23; 82(38): 44-7. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3640367

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Reliability of the toxic screen in drug overdose. Author(s): Ingelfinger JA, Isakson G, Shine D, Costello CE, Goldman P. Source: Clinical Pharmacology and Therapeutics. 1981 May; 29(5): 570-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7214786

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Rhabdomyolysis secondary to drug overdose and prolonged coma. Author(s): Chaikin HL. Source: Southern Medical Journal. 1980 August; 73(8): 990-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7403937

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Risk factors for drug overdose mortality. Author(s): Berg JE. Source: International Journal of Epidemiology. 1993 December; 22(6): 1204-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8144307

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Segmental analysis for cocaine and metabolites by HPLC in hair of suspected drug overdose cases. Author(s): Clauwaert KM, Van Bocxlaer JF, Lambert WE, De Leenheer AP. Source: Forensic Science International. 2000 June 5; 110(3): 157-66. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10842027

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Seizures associated with poisoning and drug overdose. Author(s): Olson KR, Kearney TE, Dyer JE, Benowitz NL, Blanc PD. Source: The American Journal of Emergency Medicine. 1994 May; 12(3): 392-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8179767

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Seizures associated with poisoning and drug overdose. Author(s): Olson KR, Kearney TE, Dyer JE, Benowitz NL, Blanc PD. Source: The American Journal of Emergency Medicine. 1993 November; 11(6): 565-8. Corrected and Republished In: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8192750

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Serum osmolality and its applicability to drug overdose. Author(s): Glasser L, Sternglanz PD, Combie J, Robinson A. Source: American Journal of Clinical Pathology. 1973 November; 60(5): 695-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4751712

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Severe acute drug overdose treated in ICU. Author(s): Bredgaard Sorensen M, Strom J, Sloth Madsen P, Reiz S. Source: Hum Toxicol. 1984 August; 3 Suppl: 49S-51S. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6480017

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Severe drug overdose: results of treatment. Author(s): Morgan EB. Source: Anaesthesia and Intensive Care. 1975 May; 3(2): 131-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1155756

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Six unusual cases of drug overdose. Author(s): James W, Gibbons J. Source: Anaesthesia and Intensive Care. 1976 February; 4(1): 63-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1251996

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Sleep and drug overdose. Author(s): Macgregor JM. Source: British Medical Journal. 1970 June 27; 2(712): 792-3. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5428758

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Spontaneous activity of autonomic functions in coma due to drug overdose. Author(s): Schuri U, von Cramon D. Source: Archives of Toxicology. 1979 July 11; 42(3): 199-205. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=475594

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Study of drug overdose patients in an emergency department. Author(s): Kresky B, Mangano L. Source: Qrb Qual Rev Bull. 1980 July; 6(7): 15-8. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6774300

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Subsequent deaths after attempted suicide by drug overdose in the western region of Adelaide, 1976. Author(s): Rosenman SJ. Source: The Medical Journal of Australia. 1983 November 12; 2(10): 496-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6633362

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Suicidal intent in non-fatal illicit drug overdose. Author(s): Neale J. Source: Addiction (Abingdon, England). 2000 January; 95(1): 85-93. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10723833

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Suicide attempt by drug overdose. Author(s): Bouknight RR. Source: American Family Physician. 1986 April; 33(4): 137-42. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3962830

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Suicide attempts with drug overdose. Outcomes of intensive vs conventional floor care. Author(s): Piper KW, Griner PF. Source: Archives of Internal Medicine. 1974 October; 134(4): 703-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4153489

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Surveillance of drug overdose deaths using medical examiner data. Author(s): Poulin C, Stein J, Butt J. Source: Chronic Diseases in Canada. 1998; 19(4): 177-82. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10029514

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Surveillance of poisoning and drug overdose through hospital discharge coding, poison control center reporting, and the Drug Abuse Warning Network. Author(s): Blanc PD, Jones MR, Olson KR. Source: The American Journal of Emergency Medicine. 1993 January; 11(1): 14-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8447863

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Suspected central nervous system toxicity from inadvertent nonsteroidal antiinflammatory drug overdose. Author(s): Bright TP, McNulty CJ. Source: Dicp. 1991 October; 25(10): 1066-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1803791

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The bodystuffer syndrome: a clandestine form of drug overdose. Author(s): Roberts JR, Price D, Goldfrank L, Hartnett L. Source: The American Journal of Emergency Medicine. 1986 January; 4(1): 24-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3947429

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The limited utility of electrocardiography variables used to predict arrhythmia in psychotropic drug overdose. Author(s): Buckley NA, Chevalier S, Leditschke IA, O'Connell DL, Leitch J, Pond SM. Source: Critical Care (London, England). 2003 October; 7(5): R101-7. Epub 2003 August 18. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12974977

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The reduction of coma time in lipophilic drug overdose using castor oil. Author(s): DIAMIND MJ, Brownstone YS, Erceg G, Kieraszewicz H, Keeri-Szanto M. Source: Can Anaesth Soc J. 1976 March; 23(2): 170-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3270

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The use of flumazenil (Anexate, Ro 15-1788) in the management of drug overdose. Author(s): Pollard BJ, Masters AP, Bunting P. Source: Anaesthesia. 1989 February; 44(2): 137-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2564746

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The use of protein therapy for drug overdose. Author(s): Griffin GD. Source: Drug Intell Clin Pharm. 1983 April; 17(4): 292. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=6839964

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Therapeutic drug monitoring in drug overdose. Author(s): Dawson AH, Whyte IM. Source: British Journal of Clinical Pharmacology. 2001; 52 Suppl 1: 97S-102S. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11564057

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Therapeutic drug monitoring in drug overdose. Author(s): Dawson AH, Whyte IM. Source: British Journal of Clinical Pharmacology. 1999 September; 48(3): 278-83. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10510137

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Toxicologic analysis in patients with drug overdose. Author(s): Brett A. Source: Archives of Internal Medicine. 1988 September; 148(9): 2077. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3415410

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Treatment of drug overdose. Author(s): Comstock EG. Source: Postgraduate Medicine. 1971 October; 50(4): 31-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=5129846

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Trends in deaths from drug overdose and poisoning in England and Wales 1993-1998. Author(s): Shah R, Uren Z, Baker A, Majeed A. Source: Journal of Public Health Medicine. 2001 September; 23(3): 242-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11585199

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Trends in drug overdose deaths in England and Wales 1993-98: methadone does not kill more people than heroin. Author(s): Hickman M, Madden P, Henry J, Baker A, Wallace C, Wakefield J, Stimson G, Elliott P. Source: Addiction (Abingdon, England). 2003 April; 98(4): 419-25. Erratum In: Addiction. 2003 September; 98(9): 1325-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12653812

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Trends in suicide from drug overdose in the elderly in England and Wales, 1993-1999. Author(s): Shah R, Uren Z, Baker A, Majeed A. Source: International Journal of Geriatric Psychiatry. 2002 May; 17(5): 416-21. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11994929

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•

Use of flumazenil in the treatment of drug overdose: a double-blind and open clinical study in 110 patients. Author(s): Weinbroum A, Rudick V, Sorkine P, Nevo Y, Halpern P, Geller E, Niv D. Source: Critical Care Medicine. 1996 February; 24(2): 199-206. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8605789

•

Using trade names: a risk factor for accidental drug overdose. Author(s): Schwab M, Oetzel C, Morike K, Jagle C, Gleiter CH, Eichelbaum M. Source: Archives of Internal Medicine. 2002 May 13; 162(9): 1065-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11996619

•

Value of rapid screening for acetaminophen in all patients with intentional drug overdose. Author(s): Ashbourne JF, Olson KR, Khayam-Bashi H. Source: Annals of Emergency Medicine. 1989 October; 18(10): 1035-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2802276

•

Whole bowel irrigation as a decontamination procedure after acute drug overdose. Author(s): Tenenbein M, Cohen S, Sitar DS. Source: Archives of Internal Medicine. 1987 May; 147(5): 905-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3579442

33

CHAPTER 2. NUTRITION AND DRUG OVERDOSE Overview In this chapter, we will show you how to find studies dedicated specifically to nutrition and drug overdose.

Finding Nutrition Studies on Drug Overdose The National Institutes of Health’s Office of Dietary Supplements (ODS) offers a searchable bibliographic database called the IBIDS (International Bibliographic Information on Dietary Supplements; National Institutes of Health, Building 31, Room 1B29, 31 Center Drive, MSC 2086, Bethesda, Maryland 20892-2086, Tel: 301-435-2920, Fax: 301-480-1845, E-mail: [email protected]). The IBIDS contains over 460,000 scientific citations and summaries about dietary supplements and nutrition as well as references to published international, scientific literature on dietary supplements such as vitamins, minerals, and botanicals.7 The IBIDS includes references and citations to both human and animal research studies. As a service of the ODS, access to the IBIDS database is available free of charge at the following Web address: http://ods.od.nih.gov/databases/ibids.html. After entering the search area, you have three choices: (1) IBIDS Consumer Database, (2) Full IBIDS Database, or (3) Peer Reviewed Citations Only. Now that you have selected a database, click on the “Advanced” tab. An advanced search allows you to retrieve up to 100 fully explained references in a comprehensive format. Type “drug overdose” (or synonyms) into the search box, and click “Go.” To narrow the search, you can also select the “Title” field.

7 Adapted from http://ods.od.nih.gov. IBIDS is produced by the Office of Dietary Supplements (ODS) at the National Institutes of Health to assist the public, healthcare providers, educators, and researchers in locating credible, scientific information on dietary supplements. IBIDS was developed and will be maintained through an interagency partnership with the Food and Nutrition Information Center of the National Agricultural Library, U.S. Department of Agriculture.

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The following information is typical of that found when using the “Full IBIDS Database” to search for “drug overdose” (or a synonym): •

A review of the management of oral drug overdose in the Accident and Emergency Department of the Royal Brisbane Hospital. Author(s): Accident and Emergency Department, Royal Brisbane Hospital, Australia. Source: Hodgkinson, D W Jellett, L B Ashby, R H Arch-Emerg-Med. 1991 March; 8(1): 816 0264-4924

Federal Resources on Nutrition In addition to the IBIDS, the United States Department of Health and Human Services (HHS) and the United States Department of Agriculture (USDA) provide many sources of information on general nutrition and health. Recommended resources include: •

healthfinder®, HHS’s gateway to health information, including diet and nutrition: http://www.healthfinder.gov/scripts/SearchContext.asp?topic=238&page=0

•

The United States Department of Agriculture’s Web site dedicated to nutrition information: www.nutrition.gov

•

The Food and Drug Administration’s Web site for federal food safety information: www.foodsafety.gov

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The National Action Plan on Overweight and Obesity sponsored by the United States Surgeon General: http://www.surgeongeneral.gov/topics/obesity/

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The Center for Food Safety and Applied Nutrition has an Internet site sponsored by the Food and Drug Administration and the Department of Health and Human Services: http://vm.cfsan.fda.gov/

•

Center for Nutrition Policy and Promotion sponsored by the United States Department of Agriculture: http://www.usda.gov/cnpp/

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Food and Nutrition Information Center, National Agricultural Library sponsored by the United States Department of Agriculture: http://www.nal.usda.gov/fnic/

•

Food and Nutrition Service sponsored by the United States Department of Agriculture: http://www.fns.usda.gov/fns/

Additional Web Resources A number of additional Web sites offer encyclopedic information covering food and nutrition. The following is a representative sample: •

AOL: http://search.aol.com/cat.adp?id=174&layer=&from=subcats

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Family Village: http://www.familyvillage.wisc.edu/med_nutrition.html

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Google: http://directory.google.com/Top/Health/Nutrition/

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Healthnotes: http://www.healthnotes.com/

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Open Directory Project: http://dmoz.org/Health/Nutrition/

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Yahoo.com: http://dir.yahoo.com/Health/Nutrition/

Nutrition

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WebMDHealth: http://my.webmd.com/nutrition

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WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,00.html

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CHAPTER

3.

ALTERNATIVE OVERDOSE

MEDICINE

AND

DRUG

Overview In this chapter, we will begin by introducing you to official information sources on complementary and alternative medicine (CAM) relating to drug overdose. At the conclusion of this chapter, we will provide additional sources.

National Center for Complementary and Alternative Medicine The National Center for Complementary and Alternative Medicine (NCCAM) of the National Institutes of Health (http://nccam.nih.gov/) has created a link to the National Library of Medicine’s databases to facilitate research for articles that specifically relate to drug overdose and complementary medicine. To search the database, go to the following Web site: http://www.nlm.nih.gov/nccam/camonpubmed.html. Select “CAM on PubMed.” Enter “drug overdose” (or synonyms) into the search box. Click “Go.” The following references provide information on particular aspects of complementary and alternative medicine that are related to drug overdose: •

“Take up thy bed and walk”: Aimee Semple McPherson and faith-healing. Author(s): Dickin J. Source: Can Bull Med Hist. 2000 November; 17(1-2): 137-53. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=14526802

•

“Vincristine overdosage in paediatric patients”. Author(s): Stones DK. Source: Medical and Pediatric Oncology. 1998 March; 30(3): 193. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9434832

•

A comparison of the efficacy of gastric lavage, ipecacuanha and activated charcoal in the emergency management of paracetamol overdose. Author(s): Underhill TJ, Greene MK, Dove AF.

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Source: Arch Emerg Med. 1990 September; 7(3): 148-54. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1983801 •

A review of the management of oral drug overdose in the Accident and Emergency Department of the Royal Brisbane Hospital. Author(s): Hodgkinson DW, Jellett LB, Ashby RH. Source: Arch Emerg Med. 1991 March; 8(1): 8-16. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1677244

•

A very long trip to gastric decontamination! Author(s): Robertson WO. Source: Vet Hum Toxicol. 2000 February; 42(1): 54. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10670089

•

A woman with tetraparesis and missed beats. Author(s): Mak W, Lau CP. Source: Hosp Med. 2000 June; 61(6): 438. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10962666

•

Abuse of over-the-counter dextromethorphan by teenagers. Author(s): Murray S, Brewerton T. Source: Southern Medical Journal. 1993 October; 86(10): 1151-3. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8211334

•

Acute fluoride toxicity from ingesting home-use dental products in children, birth to 6 years of age. Author(s): Shulman JD, Wells LM. Source: J Public Health Dent. 1997 Summer; 57(3): 150-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9383753

•

Acute iron poisoning. Author(s): Mehta M, Gharpure V, Raghavan K. Source: Indian J Pediatr. 1997 July-August; 64(4): 485-93. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=10771877

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Acute poisonings among adolescents and young adults with anorexia nervosa. Author(s): Woolf AD, Gren JM. Source: Am J Dis Child. 1990 July; 144(7): 785-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1972609

•

Acute renal failure following deferoxamine overdose. Author(s): Prasannan L, Flynn JT, Levine JE.

Alternative Medicine 39

Source: Pediatric Nephrology (Berlin, Germany). 2003 March; 18(3): 283-5. Epub 2003 February 07. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12644925 •

Acute renal failure occurring during intravenous desferrioxamine therapy: recovery after haemodialysis. Author(s): Cianciulli P, Sorrentino F, Forte L, Palombi M, Papa G, Meloni C, Taccone Gallucci M, Casciani CU. Source: Haematologica. 1992 November-December; 77(6): 514-5. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1289188

•

Acute salicylism due to accidental ingestion of a traditional medicine. Author(s): Malik AS, Zabidi MH, Noor AR. Source: Singapore Med J. 1994 April; 35(2): 215-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7939826

•

Acute thyroxine overdosage: two cases of parasuicide. Author(s): Matthews SJ. Source: Ulster Med J. 1993 October; 62(2): 170-3. Review. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=7905687

•

Adverse effects associated with herbal medicine. Author(s): Pinn G. Source: Aust Fam Physician. 2001 November; 30(11): 1070-5. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=11759460

•

Adverse pulmonary vascular effects of high dose tricyclic antidepressants: acute and chronic animal studies. Author(s): Liu X, Emery CJ, Laude E, Herget J, Gill G, Cope G, Barer GR. Source: The European Respiratory Journal : Official Journal of the European Society for Clinical Respiratory Physiology. 2002 August; 20(2): 344-52. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=12212966

•

An assessment of short-acting hypnotics. Author(s): Mendelson WB, Jain B. Source: Drug Safety : an International Journal of Medical Toxicology and Drug Experience. 1995 October; 13(4): 257-70. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8573298

•

An assessment of the delayed effects associated with valerian overdose. Author(s): Chan TY.

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Drug Overdose

Source: Int J Clin Pharmacol Ther. 1998 October; 36(10): 569. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=9799063 •

Drug overdose--a hidden hazard of obesity. Author(s): Cox J, Penn N, Masood M, Hancock AK, Parker D. Source: Journal of the Royal Society of Medicine. 1987 November; 80(11): 708-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=3694619

•

Drug overdose--reducing the load. Author(s): Jawary D, Cameron PA, Dziukas L, McNeil JJ. Source: The Medical Journal of Australia. 1992 March 2; 156(5): 343-6. Review. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=1350318

•

Efficacy of ipecac-induced emesis, orogastric lavage, and activated charcoal for acute drug overdose. Author(s): Tenenbein M, Cohen S, Sitar DS. Source: Annals of Emergency Medicine. 1987 August; 16(8): 838-41. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2887134

•

Management of drug overdoses in accident and emergency departments in the United Kingdom. Author(s): Greaves I, Goodacre S, Grout P. Source: Journal of Accident & Emergency Medicine. 1996 January; 13(1): 46-8. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=8821228

•

Treatment of sedative drug overdose. Author(s): Okun R. Source: Clin Toxicol. 1973; 6(1): 13-21. No Abstract Available. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=4145402

•

Use of emetic, adsorbent, and cathartic agents in acute drug overdose. Author(s): Joubert DW. Source: Journal of Emergency Nursing: Jen : Official Publication of the Emergency Department Nurses Association. 1987 January-February; 13(1): 49-51. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=A bstract&list_uids=2881022

Additional Web Resources A number of additional Web sites offer encyclopedic information covering CAM and related topics. The following is a representative sample: •

Alternative Medicine Foundation, Inc.: http://www.herbmed.org/

Alternative Medicine 41

•


•

Chinese Medicine: http://www.newcenturynutrition.com/

•

drkoop.com: http://www.drkoop.com/InteractiveMedicine/IndexC.html

•

Family Village: http://www.familyvillage.wisc.edu/med_altn.htm

•

Google: http://directory.google.com/Top/Health/Alternative/

•

Healthnotes: http://www.healthnotes.com/

•

MedWebPlus: http://medwebplus.com/subject/Alternative_and_Complementary_Medicine

•

Open Directory Project: http://dmoz.org/Health/Alternative/

•

HealthGate: http://www.tnp.com/

•

WebMDHealth: http://my.webmd.com/drugs_and_herbs

•

WholeHealthMD.com: http://www.wholehealthmd.com/reflib/0,1529,00.html

•

Yahoo.com: http://dir.yahoo.com/Health/Alternative_Medicine/

The following is a specific Web list relating to drug overdose; please note that any particular subject below may indicate either a therapeutic use, or a contraindication (potential danger), and does not reflect an official recommendation: •

General Overview Shock Source: Integrative Medicine Communications; www.drkoop.com

•

Herbs and Supplements Ipecac Source: Healthnotes, Inc.; www.healthnotes.com

General References A good place to find general background information on CAM is the National Library of Medicine. It has prepared within the MEDLINEplus system an information topic page dedicated to complementary and alternative medicine. To access this page, go to the MEDLINEplus site at http://www.nlm.nih.gov/medlineplus/alternativemedicine.html. This Web site provides a general overview of various topics and can lead to a number of general sources.

43

CHAPTER 4. BOOKS ON DRUG OVERDOSE Overview This chapter provides bibliographic book references relating to drug overdose. In addition to online booksellers such as www.amazon.com and www.bn.com, excellent sources for book titles on drug overdose include the Combined Health Information Database and the National Library of Medicine. Your local medical library also may have these titles available for loan.

Book Summaries: Federal Agencies The Combined Health Information Database collects various book abstracts from a variety of healthcare institutions and federal agencies. To access these summaries, go directly to the following hyperlink: http://chid.nih.gov/detail/detail.html. You will need to use the “Detailed Search” option. To find book summaries, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer. For the format option, select “Monograph/Book.” Now type “drug overdose” (or synonyms) into the “For these words:” box. You should check back periodically with this database which is updated every three months. The following is a typical result when searching for books on drug overdose: •

Dialysis Therapy Source: Philadelphia, PA: Hanley and Belfus, Inc. 2002. 561 p. Contact: Available from Hanley and Belfus, Inc. Medical Publishers, 210 South 13th Street, Philadelphia, PA 19107. (215) 546-7293 or (215) 546-4995. (800) 962-1892. Fax: (215) 790-9330. Website: www.hanleyandbelfus.com. PRICE: $59.95; plus shipping and handling. ISBN: 1560534265. Summary: It has recently been estimated that the end stage renal (kidney) disease (ESRD) population in the United States alone will approach 700,000 by the end of 2010. The trend for patients to be older and to have significant comorbidities (other diseases at the same time) such as diabetes and hypertension (high blood pressure) is continuing and unlikely to change. Children continue to be treated with extended dialysis, especially in-center hemodialysis, despite the increased use of living related donors and

44

Drug Overdose

being given priority for cadaver donor kidneys. So argue the editors of this textbook on dialysis therapy, which focuses on changes in the field of nephrology over the past decade. In the text, recognized experts in the field have written concise, focused chapters, emphasizing practical approaches to dialysis and management. Chapters are categorized into 33 sections: demographics, vascular access for hemodialysis, peritoneal access devices, the mechanical aspects of dialysis, dialyzers, kinetic modeling in hemodialysis, improving outcomes in dialysis patients, the hemodialysis procedure, complications during hemodialysis, reuse of hemodialyzers, alternative hemodialytic techniques, the clinical practice of peritoneal dialysis (PD), infectious complications of PD, noninfectious complications of PD, intraabdominal pressure related complications of PD, acid-base homeostasis, the nutritional management of dialysis patients, gastrointestinal disease, care of the HIV positive dialysis patient, anemia and Epoetin (erythropoietin) use, cardiovascular disease, metabolic abnormalities, the neurologic aspects of uremia (excessive waste products in the blood), uremic osteodystrophy (bone disease associated with kidney disease), dialysis amyloidosis, acquired cystic kidney disease, diabetes, drug therapy in uremia, rehabilitation and psychosocial issues, pediatric dialysis, surgery in end stage renal disease (ESRD) patients, the pregnant patient on dialysis, and the use of dialysis for drug overdose. Each chapter includes charts and diagrams; each section offers a selected reading list; and the text concludes with a subject index. •

Medical Emergencies in the Dental Office. 5th ed Source: St. Louis, MO: Mosby, Inc. 2000. 540 p. Contact: Available from Mosby, Inc. 11830 Westline Industrial Drive, St. Louis, MO 63146. (800) 426-4545. E-mail: [email protected]. Website: www.mosby.com. PRICE: $52.95 plus shipping and handling. ISBN: 1556644205. Summary: Maintaining a high level of skill in the prevention, recognition, and management of medical emergencies is important in the field of dentistry. This textbook covers the management of medical emergencies in the dental office. Thirty chapters are offered in eight sections: prevention, unconsciousness, respiratory distress, altered consciousness, seizures, drug related emergencies, chest pain, and cardiac arrest. Specific topics include medicolegal considerations, vasodepressor syncope (fainting), postural hypotension (low blood pressure and feeling faint upon getting up from a prone or semi prone position), acute adrenal insufficiency, differential diagnosis, airway obstruction, hyperventilation, asthma, heart failure, acute pulmonary edema (fluid in the lungs), diabetes mellitus, thyroid gland dysfunction, cerebrovascular accident (stroke), drug overdose reactions, allergy, angina pectoris, acute myocardial infarction, and cardiac arrest and cardiopulmonary resuscitation. The text concludes with a quick reference section to life threatening situations (offered in algorithm format) and a subject index. Each chapter includes black and white photographs and extensive references.

•

Introduction to Dialysis. 2nd ed Source: Naperville, IL: Churchill Livingstone. 1991. 394 p. Contact: Available from Churchill Livingstone. 5 S 250 Frontenac Road, Naperville, IL 60563-1711. (708) 416-3939 or (800) 553-5426. PRICE: $58. ISBN: 0443087202. Summary: This book is designed to acquaint health professionals with the principles of sound dialytic therapy. Six chapters, each written by experts in the field, cover dialyzers and delivery systems; access for dialysis; care of the patient on hemodialysis; care of the patient on peritoneal dialysis; care of the patient between dialyses; and drug overdose

Books

45

and pharmacologic considerations in dialysis. Also included is a discussion of the clinical indications, physiology, dosing kinetics, and complications of the recombinant drug erythropoietin. In addition, a special section discusses the technical features of water purification. One appendix presents a chart of drug dialysis reference data and a subject index concludes the volume.

Chapters on Drug Overdose In order to find chapters that specifically relate to drug overdose, an excellent source of abstracts is the Combined Health Information Database. You will need to limit your search to book chapters and drug overdose using the “Detailed Search” option. Go to the following hyperlink: http://chid.nih.gov/detail/detail.html. To find book chapters, use the drop boxes at the bottom of the search page where “You may refine your search by.” Select the dates and language you prefer, and the format option “Book Chapter.” Type “drug overdose” (or synonyms) into the “For these words:” box. The following is a typical result when searching for book chapters on drug overdose: •

Acute Renal Failure and Dialysis Source: in Gutch, C.F.; Stoner, M.H.; Corea, A.L. Review of Hemodialysis for Nurses and Dialysis Personnel. 6th ed. St. Louis, MO: Mosby. 1999. p. 173-191. Contact: Available from Harcourt Publishers. Foots Cray High Street, Sidcup, Kent DA14 5HP UK. 02083085700. Fax 02083085702. E-mail: [email protected]. Website: www.harcourt-international.com. PRICE: $37.95 plus shipping and handling. ISBN: 0815120990. Summary: Dialysis is often necessary for the treatment of acute kidney (renal) failure. The most common indications include uremia, hyperkalemia, acidosis, fluid overload, and drug overdose. This chapter on acute renal failure and dialysis is from a nursing text that poses questions and then answers those questions with the aim of giving a good understanding of the basic principles, basic diseases, and basic problems in the treatment of kidney patients by dialysis. The authors of the chapter define acute renal failure (ARF) as the rapid deterioration of kidney function and note that ARF is usually reversible if diagnosed and treated early. ARF is divided into three categories: prerenal, intrarenal, and postrenal. The most common indications for acute dialysis include uremia, pulmonary edema (fluid overload in the lungs), hyperkalemia (high amounts of potassium in the blood), acidosis, neurologic changes, and drug overdoses and poisonings. Treatment options for ARF include hemodialysis, isolated ultrafiltration, peritoneal dialysis, continuous renal replacement therapy (CRRT), and charcoal hemoperfusion. The chapter concludes with a brief section discussing the use of dialysis for patients undergoing rejection of a transplanted kidney. 4 figures.

•

Medical Emergencies Source: in Lockhart, P.B. Oral Medicine and Hospital Practice. Chicago, IL: Special Care Dentistry. 1997. p. 6.3-6.36. Contact: Available from Special Care Dentistry. 211 East Chicago Avenue, Chicago, IL 60611. (312) 440-2660. Fax (312) 440-2824. PRICE: $27.00 (member) or $30.00 (nonmember), plus shipping and handling; institutional prices and bulk orders available. ISBN: 0965719103.

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Drug Overdose

Summary: This chapter is from a manual designed to help dental residents, students, and practitioners engaged in the care of patients in the hospital setting. This chapter discusses medical emergencies. Topics include respiratory difficulty due to foreign body or asthma; cardiac and vascular emergencies, including angina pectoris, myocardial infarction, cardiac arrest, pulmonary edema, and cerebral vascular accident (stroke); allergic reactions; hemostasis, including patient evaluation and the treatment of hemorrhage; syncope, including vasovagal syncope, hypoglycemia, drug reactions, and postural hypotension; shock; adrenal cortical insufficiency; convulsive disorders; drug overdose and toxicity, including asymptomatic and symptomatic patients, narcotic overdose, benzodiazepine overdose, sedative or barbiturate overdose, and local anesthetic toxicity; and the diabetic emergencies of hypoglycemia shock and hyperglycemia coma. Most information is presented in outline format, for ease of access. 9 tables. •

Approach to the Patient with Drug or Alcohol Dependency Source: in Textbook of Gastroenterology. 4th ed. [2-volume set]. Hagerstown, MD: Lippincott Williams and Wilkins. 2003. p. 1107-1119. Contact: Available from Lippincott Williams and Wilkins. P.O. Box 1600, Hagerstown, MD 21741. (800) 638-6423. Fax: (301) 223-2400. Website: www.lww.com. PRICE: $289.00. ISBN: 781728614. Summary: This chapter on the approach to patients with drug or alcohol dependency is from a lengthy, two-volume textbook that integrates the various demands of science, technology, expanding information, good judgment, and common sense into the diagnosis and management of gastrointestinal patients. The authors of this chapter are concerned with the neurobiology and clinical presentations of traditional drugs of abuse, such as alcohol, sedative-hypnotics, narcotics, stimulants and hallucinogens, and cannabis, as well as tobacco, laxatives, diuretics, and anabolic steroids. Topics covered include drugs of abuse and brain reward systems, principles of treatment, individual drugs of abuse, bulimia and substance abuse, diagnosis of patients with suspected substance abuse, and management of acute drug overdose or toxicity. 1 figure. 8 tables. 162 references.

•

Drug Use in Renal Patients and the Extracorporeal Treatment of Poisonings Source: in Levine, D.Z. Care of the Renal Patient. Orlando, FL: W.B. Saunders Company. 1991. p. 130-138. Contact: Available from W.B. Saunders Company. 6277 Sea Harbor Drive, Orlando, FL 32887. (800) 782-4479. PRICE: $46.95 plus shipping and handling. ISBN: 0721630561. Summary: This chapter, from a comprehensive medical textbook about the care of the renal patient, discusses drug use in renal patients and the extracorporeal treatment of poisonings. The authors review basic pharmacologic principles and apply them to renal failure. Dosage recommendations appear in tabular form, with brief discussions centering on specific agents. The authors also discuss the role of hemodialysis and hemoperfusion in the treatment of drug overdose or poisoning. Three case examples are presented and discussed. 10 tables. 6 references.

•

Drug Monitoring Source: in Catto, G.R.D. New Clinical Applications-Nephrology: Drugs and the Kidney. Hingham, MA: Kluwer Academic Publishers. p. 113-151. 1990.

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47

Contact: Available from Kluwer Academic Publishers. P.O. Box 358, Accord Station, Hingham, MA 02018-0358. (617) 871-6600. PRICE: $54. ISBN: 0792389182. Summary: This review aims to cover aspects of drug monitoring with particular emphasis on the problems in patients with renal disease. Since an understanding of therapeutic drug monitoring requires a basic knowledge of drug disposition and pharmacokinetics, some important aspects of these topics are discussed first. Following consideration of therapeutic drug concentration monitoring, the final section of this review briefly discusses aspects of monitoring drugs by use of measurable pharmacodynamic end points. Topics include: the effect of renal disease on drug disposition and pharmacokinetics (absorption and bioavailability, distribution and protein binding, metabolism, excretion); the effect of renal disease on drug pharmacodynamics; and therapeutic drug monitoring (assay methods, individual drugs (digoxin, gentamicin, lithium, anticonvulsant drugs (phenytoin, carbamazepine, sodium valproate, other anticonvulsants), theophylline, cyclosporin), drug overdose, compliance with drug therapy, cost-effectiveness, pharmacodynamics). It is concluded that therapeutic drug monitoring has a limited, though important, role to play in the overall strategy for drug use in renal disease, and that, for a small number of drugs, such monitoring is essential to help minimize problems of both sub-therapeutic dosing and adverse effects. 33 references.

49

CHAPTER

5.

PERIODICALS OVERDOSE

AND

NEWS

ON

DRUG

Overview In this chapter, we suggest a number of news sources and present various periodicals that cover drug overdose.

News Services and Press Releases One of the simplest ways of tracking press releases on drug overdose is to search the news wires. In the following sample of sources, we will briefly describe how to access each service. These services only post recent news intended for public viewing. PR Newswire To access the PR Newswire archive, simply go to http://www.prnewswire.com/. Select your country. Type “drug overdose” (or synonyms) into the search box. You will automatically receive information on relevant news releases posted within the last 30 days. The search results are shown by order of relevance. Reuters Health The Reuters’ Medical News and Health eLine databases can be very useful in exploring news archives relating to drug overdose. While some of the listed articles are free to view, others are available for purchase for a nominal fee. To access this archive, go to http://www.reutershealth.com/en/index.html and search by “drug overdose” (or synonyms). The following was recently listed in this archive for drug overdose: •

Reduced lethality of drug overdose may explain suicide decline among young British women Source: Reuters Medical News Date: February 16, 1999

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Drug Overdose

The NIH Within MEDLINEplus, the NIH has made an agreement with the New York Times Syndicate, the AP News Service, and Reuters to deliver news that can be browsed by the public. Search news releases at http://www.nlm.nih.gov/medlineplus/alphanews_a.html. MEDLINEplus allows you to browse across an alphabetical index. Or you can search by date at the following Web page: http://www.nlm.nih.gov/medlineplus/newsbydate.html. Often, news items are indexed by MEDLINEplus within its search engine. Business Wire Business Wire is similar to PR Newswire. To access this archive, simply go to http://www.businesswire.com/. You can scan the news by industry category or company name. Market Wire Market Wire is more focused on technology than the other wires. To browse the latest press releases by topic, such as alternative medicine, biotechnology, fitness, healthcare, legal, nutrition, and pharmaceuticals, access Market Wire’s Medical/Health channel at http://www.marketwire.com/mw/release_index?channel=MedicalHealth. Or simply go to Market Wire’s home page at http://www.marketwire.com/mw/home, type “drug overdose” (or synonyms) into the search box, and click on “Search News.” As this service is technology oriented, you may wish to use it when searching for press releases covering diagnostic procedures or tests. Search Engines Medical news is also available in the news sections of commercial Internet search engines. See the health news page at Yahoo (http://dir.yahoo.com/Health/News_and_Media/), or you can use this Web site’s general news search page at http://news.yahoo.com/. Type in “drug overdose” (or synonyms). If you know the name of a company that is relevant to drug overdose, you can go to any stock trading Web site (such as http://www.etrade.com/) and search for the company name there. News items across various news sources are reported on indicated hyperlinks. Google offers a similar service at http://news.google.com/. BBC Covering news from a more European perspective, the British Broadcasting Corporation (BBC) allows the public free access to their news archive located at http://www.bbc.co.uk/. Search by “drug overdose” (or synonyms).

Periodicals and News

51

Academic Periodicals covering Drug Overdose Numerous periodicals are currently indexed within the National Library of Medicine’s PubMed database that are known to publish articles relating to drug overdose. In addition to these sources, you can search for articles covering drug overdose that have been published by any of the periodicals listed in previous chapters. To find the latest studies published, go to http://www.ncbi.nlm.nih.gov/pubmed, type the name of the periodical into the search box, and click “Go.” If you want complete details about the historical contents of a journal, you can also visit the following Web site: http://www.ncbi.nlm.nih.gov/entrez/jrbrowser.cgi. Here, type in the name of the journal or its abbreviation, and you will receive an index of published articles. At http://locatorplus.gov/, you can retrieve more indexing information on medical periodicals (e.g. the name of the publisher). Select the button “Search LOCATORplus.” Then type in the name of the journal and select the advanced search option “Journal Title Search.”

53

CHAPTER 6. RESEARCHING MEDICATIONS Overview While a number of hard copy or CD-ROM resources are available for researching medications, a more flexible method is to use Internet-based databases. Broadly speaking, there are two sources of information on approved medications: public sources and private sources. We will emphasize free-to-use public sources.

U.S. Pharmacopeia Because of historical investments by various organizations and the emergence of the Internet, it has become rather simple to learn about the medications recommended for drug overdose. One such source is the United States Pharmacopeia. In 1820, eleven physicians met in Washington, D.C. to establish the first compendium of standard drugs for the United States. They called this compendium the U.S. Pharmacopeia (USP). Today, the USP is a nonprofit organization consisting of 800 volunteer scientists, eleven elected officials, and 400 representatives of state associations and colleges of medicine and pharmacy. The USP is located in Rockville, Maryland, and its home page is located at http://www.usp.org/. The USP currently provides standards for over 3,700 medications. The resulting USP DI Advice for the Patient can be accessed through the National Library of Medicine of the National Institutes of Health. The database is partially derived from lists of federally approved medications in the Food and Drug Administration’s (FDA) Drug Approvals database, located at http://www.fda.gov/cder/da/da.htm. While the FDA database is rather large and difficult to navigate, the Phamacopeia is both user-friendly and free to use. It covers more than 9,000 prescription and over-the-counter medications. To access this database, simply type the following hyperlink into your Web browser: http://www.nlm.nih.gov/medlineplus/druginformation.html. To view examples of a given medication (brand names, category, description, preparation, proper use, precautions, side effects, etc.), simply follow the hyperlinks indicated within the United States Pharmacopeia (USP).

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Drug Overdose

Commercial Databases In addition to the medications listed in the USP above, a number of commercial sites are available by subscription to physicians and their institutions. Or, you may be able to access these sources from your local medical library.

Mosby’s Drug Consult Mosby’s Drug Consult database (also available on CD-ROM and book format) covers 45,000 drug products including generics and international brands. It provides prescribing information, drug interactions, and patient information. Subscription information is available at the following hyperlink: http://www.mosbysdrugconsult.com/.

PDRhealth The PDRhealth database is a free-to-use, drug information search engine that has been written for the public in layman’s terms. It contains FDA-approved drug information adapted from the Physicians’ Desk Reference (PDR) database. PDRhealth can be searched by brand name, generic name, or indication. It features multiple drug interactions reports. Search PDRhealth at http://www.pdrhealth.com/drug_info/index.html. Other Web Sites Drugs.com (www.drugs.com) reproduces the information in the Pharmacopeia as well as commercial information. You may also want to consider the Web site of the Medical Letter, Inc. (http://www.medletter.com/) which allows users to download articles on various drugs and therapeutics for a nominal fee.

Researching Orphan Drugs Although the list of orphan drugs is revised on a daily basis, you can quickly research orphan drugs that might be applicable to drug overdose by using the database managed by the National Organization for Rare Disorders, Inc. (NORD), at http://www.rarediseases.org/. Scroll down the page, and on the left toolbar, click on “Orphan Drug Designation Database.” On this page (http://www.rarediseases.org/search/noddsearch.html), type “drug overdose” (or synonyms) into the search box, and click “Submit Query.” When you receive your results, note that not all of the drugs may be relevant, as some may have been withdrawn from orphan status. Write down or print out the name of each drug and the relevant contact information. From there, visit the Pharmacopeia Web site and type the name of each orphan drug into the search box at http://www.nlm.nih.gov/medlineplus/druginformation.html. You may need to contact the sponsor or NORD for further information. NORD conducts “early access programs for investigational new drugs (IND) under the Food and Drug Administration’s (FDA’s) approval ‘Treatment INDs’ programs which allow for a limited number of individuals to receive investigational drugs before FDA marketing approval.” If the orphan product about which you are seeking information is approved for

Researching Medications

55

marketing, information on side effects can be found on the product’s label. If the product is not approved, you may need to contact the sponsor. The following is a list of orphan drugs currently listed in the NORD Orphan Drug Designation Database for drug overdose: •

Butyrylcholinesterase http://www.rarediseases.org/nord/search/nodd_full?code=687

If you have any questions about a medical treatment, the FDA may have an office near you. Look for their number in the blue pages of the phone book. You can also contact the FDA through its toll-free number, 1-888-INFO-FDA (1-888-463-6332), or on the World Wide Web at www.fda.gov.

57

APPENDICES

59

APPENDIX A. PHYSICIAN RESOURCES Overview In this chapter, we focus on databases and Internet-based guidelines and information resources created or written for a professional audience.

NIH Guidelines Commonly referred to as “clinical” or “professional” guidelines, the National Institutes of Health publish physician guidelines for the most common diseases. Publications are available at the following by relevant Institute8: •

Office of the Director (OD); guidelines consolidated across agencies available at http://www.nih.gov/health/consumer/conkey.htm

•

National Institute of General Medical Sciences (NIGMS); fact sheets available at http://www.nigms.nih.gov/news/facts/

•

National Library of Medicine (NLM); extensive encyclopedia (A.D.A.M., Inc.) with guidelines: http://www.nlm.nih.gov/medlineplus/healthtopics.html

•

National Cancer Institute (NCI); guidelines available at http://www.cancer.gov/cancerinfo/list.aspx?viewid=5f35036e-5497-4d86-8c2c714a9f7c8d25

•

National Eye Institute (NEI); guidelines available at http://www.nei.nih.gov/order/index.htm

•

National Heart, Lung, and Blood Institute (NHLBI); guidelines available at http://www.nhlbi.nih.gov/guidelines/index.htm

•

National Human Genome Research Institute (NHGRI); research available at http://www.genome.gov/page.cfm?pageID=10000375

•

National Institute on Aging (NIA); guidelines available at http://www.nia.nih.gov/health/

8

These publications are typically written by one or more of the various NIH Institutes.

60

Drug Overdose

•

National Institute on Alcohol Abuse and Alcoholism (NIAAA); guidelines available at http://www.niaaa.nih.gov/publications/publications.htm

•

National Institute of Allergy and Infectious Diseases (NIAID); guidelines available at http://www.niaid.nih.gov/publications/

•

National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS); fact sheets and guidelines available at http://www.niams.nih.gov/hi/index.htm

•

National Institute of Child Health and Human Development (NICHD); guidelines available at http://www.nichd.nih.gov/publications/pubskey.cfm

•

National Institute on Deafness and Other Communication Disorders (NIDCD); fact sheets and guidelines at http://www.nidcd.nih.gov/health/

•

National Institute of Dental and Craniofacial Research (NIDCR); guidelines available at http://www.nidr.nih.gov/health/

•

National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); guidelines available at http://www.niddk.nih.gov/health/health.htm

•

National Institute on Drug Abuse (NIDA); guidelines available at http://www.nida.nih.gov/DrugAbuse.html

•

National Institute of Environmental Health Sciences (NIEHS); environmental health information available at http://www.niehs.nih.gov/external/facts.htm

•

National Institute of Mental Health (NIMH); guidelines available at http://www.nimh.nih.gov/practitioners/index.cfm

•

National Institute of Neurological Disorders and Stroke (NINDS); neurological disorder information pages available at http://www.ninds.nih.gov/health_and_medical/disorder_index.htm

•

National Institute of Nursing Research (NINR); publications on selected illnesses at http://www.nih.gov/ninr/news-info/publications.html

•

National Institute of Biomedical Imaging and Bioengineering; general information at http://grants.nih.gov/grants/becon/becon_info.htm

•

Center for Information Technology (CIT); referrals to other agencies based on keyword searches available at http://kb.nih.gov/www_query_main.asp

•

National Center for Complementary and Alternative Medicine (NCCAM); health information available at http://nccam.nih.gov/health/

•

National Center for Research Resources (NCRR); various information directories available at http://www.ncrr.nih.gov/publications.asp

•

Office of Rare Diseases; various fact sheets available at http://rarediseases.info.nih.gov/html/resources/rep_pubs.html

•

Centers for Disease Control and Prevention; various fact sheets on infectious diseases available at http://www.cdc.gov/publications.htm

Physician Resources

61

NIH Databases In addition to the various Institutes of Health that publish professional guidelines, the NIH has designed a number of databases for professionals.9 Physician-oriented resources provide a wide variety of information related to the biomedical and health sciences, both past and present. The format of these resources varies. Searchable databases, bibliographic citations, full-text articles (when available), archival collections, and images are all available. The following are referenced by the National Library of Medicine:10 •

Bioethics: Access to published literature on the ethical, legal, and public policy issues surrounding healthcare and biomedical research. This information is provided in conjunction with the Kennedy Institute of Ethics located at Georgetown University, Washington, D.C.: http://www.nlm.nih.gov/databases/databases_bioethics.html

•

HIV/AIDS Resources: Describes various links and databases dedicated to HIV/AIDS research: http://www.nlm.nih.gov/pubs/factsheets/aidsinfs.html

•

NLM Online Exhibitions: Describes “Exhibitions in the History of Medicine”: http://www.nlm.nih.gov/exhibition/exhibition.html. Additional resources for historical scholarship in medicine: http://www.nlm.nih.gov/hmd/hmd.html

•

Biotechnology Information: Access to public databases. The National Center for Biotechnology Information conducts research in computational biology, develops software tools for analyzing genome data, and disseminates biomedical information for the better understanding of molecular processes affecting human health and disease: http://www.ncbi.nlm.nih.gov/

•

Population Information: The National Library of Medicine provides access to worldwide coverage of population, family planning, and related health issues, including family planning technology and programs, fertility, and population law and policy: http://www.nlm.nih.gov/databases/databases_population.html

•

Cancer Information: Access to cancer-oriented databases: http://www.nlm.nih.gov/databases/databases_cancer.html

•

Profiles in Science: Offering the archival collections of prominent twentieth-century biomedical scientists to the public through modern digital technology: http://www.profiles.nlm.nih.gov/

•

Chemical Information: Provides links to various chemical databases and references: http://sis.nlm.nih.gov/Chem/ChemMain.html

•

Clinical Alerts: Reports the release of findings from the NIH-funded clinical trials where such release could significantly affect morbidity and mortality: http://www.nlm.nih.gov/databases/alerts/clinical_alerts.html

•

Space Life Sciences: Provides links and information to space-based research (including NASA): http://www.nlm.nih.gov/databases/databases_space.html

•

MEDLINE: Bibliographic database covering the fields of medicine, nursing, dentistry, veterinary medicine, the healthcare system, and the pre-clinical sciences: http://www.nlm.nih.gov/databases/databases_medline.html

9

Remember, for the general public, the National Library of Medicine recommends the databases referenced in MEDLINEplus (http://medlineplus.gov/ or http://www.nlm.nih.gov/medlineplus/databases.html). 10 See http://www.nlm.nih.gov/databases/databases.html.

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Drug Overdose

•

Toxicology and Environmental Health Information (TOXNET): Databases covering toxicology and environmental health: http://sis.nlm.nih.gov/Tox/ToxMain.html

•

Visible Human Interface: Anatomically detailed, three-dimensional representations of normal male and female human bodies: http://www.nlm.nih.gov/research/visible/visible_human.html

The NLM Gateway11 The NLM (National Library of Medicine) Gateway is a Web-based system that lets users search simultaneously in multiple retrieval systems at the U.S. National Library of Medicine (NLM). It allows users of NLM services to initiate searches from one Web interface, providing one-stop searching for many of NLM’s information resources or databases.12 To use the NLM Gateway, simply go to the search site at http://gateway.nlm.nih.gov/gw/Cmd. Type “drug overdose” (or synonyms) into the search box and click “Search.” The results will be presented in a tabular form, indicating the number of references in each database category. Results Summary Category Journal Articles Books / Periodicals / Audio Visual Consumer Health Meeting Abstracts Other Collections Total

Items Found 4460 96 999 63 24 5642

HSTAT13 HSTAT is a free, Web-based resource that provides access to full-text documents used in healthcare decision-making.14 These documents include clinical practice guidelines, quickreference guides for clinicians, consumer health brochures, evidence reports and technology assessments from the Agency for Healthcare Research and Quality (AHRQ), as well as AHRQ’s Put Prevention Into Practice.15 Simply search by “drug overdose” (or synonyms) at the following Web site: http://text.nlm.nih.gov.

11

Adapted from NLM: http://gateway.nlm.nih.gov/gw/Cmd?Overview.x.

12

The NLM Gateway is currently being developed by the Lister Hill National Center for Biomedical Communications (LHNCBC) at the National Library of Medicine (NLM) of the National Institutes of Health (NIH). 13 Adapted from HSTAT: http://www.nlm.nih.gov/pubs/factsheets/hstat.html. 14 15

The HSTAT URL is http://hstat.nlm.nih.gov/.

Other important documents in HSTAT include: the National Institutes of Health (NIH) Consensus Conference Reports and Technology Assessment Reports; the HIV/AIDS Treatment Information Service (ATIS) resource documents; the Substance Abuse and Mental Health Services Administration's Center for Substance Abuse Treatment (SAMHSA/CSAT) Treatment Improvement Protocols (TIP) and Center for Substance Abuse Prevention (SAMHSA/CSAP) Prevention Enhancement Protocols System (PEPS); the Public Health Service (PHS) Preventive Services Task Force's Guide to Clinical Preventive Services; the independent, nonfederal Task Force on Community Services’ Guide to Community Preventive Services; and the Health Technology Advisory Committee (HTAC) of the Minnesota Health Care Commission (MHCC) health technology evaluations.

Physician Resources

63

Coffee Break: Tutorials for Biologists16 Coffee Break is a general healthcare site that takes a scientific view of the news and covers recent breakthroughs in biology that may one day assist physicians in developing treatments. Here you will find a collection of short reports on recent biological discoveries. Each report incorporates interactive tutorials that demonstrate how bioinformatics tools are used as a part of the research process. Currently, all Coffee Breaks are written by NCBI staff.17 Each report is about 400 words and is usually based on a discovery reported in one or more articles from recently published, peer-reviewed literature.18 This site has new articles every few weeks, so it can be considered an online magazine of sorts. It is intended for general background information. You can access the Coffee Break Web site at the following hyperlink: http://www.ncbi.nlm.nih.gov/Coffeebreak/.

Other Commercial Databases In addition to resources maintained by official agencies, other databases exist that are commercial ventures addressing medical professionals. Here are some examples that may interest you: •

CliniWeb International: Index and table of contents to selected clinical information on the Internet; see http://www.ohsu.edu/cliniweb/.

•

Medical World Search: Searches full text from thousands of selected medical sites on the Internet; see http://www.mwsearch.com/.

16 Adapted 17

from http://www.ncbi.nlm.nih.gov/Coffeebreak/Archive/FAQ.html.

The figure that accompanies each article is frequently supplied by an expert external to NCBI, in which case the source of the figure is cited. The result is an interactive tutorial that tells a biological story. 18 After a brief introduction that sets the work described into a broader context, the report focuses on how a molecular understanding can provide explanations of observed biology and lead to therapies for diseases. Each vignette is accompanied by a figure and hypertext links that lead to a series of pages that interactively show how NCBI tools and resources are used in the research process.

65

APPENDIX B. PATIENT RESOURCES Overview Official agencies, as well as federally funded institutions supported by national grants, frequently publish a variety of guidelines written with the patient in mind. These are typically called “Fact Sheets” or “Guidelines.” They can take the form of a brochure, information kit, pamphlet, or flyer. Often they are only a few pages in length. Since new guidelines on drug overdose can appear at any moment and be published by a number of sources, the best approach to finding guidelines is to systematically scan the Internet-based services that post them.

Patient Guideline Sources The remainder of this chapter directs you to sources which either publish or can help you find additional guidelines on topics related to drug overdose. Due to space limitations, these sources are listed in a concise manner. Do not hesitate to consult the following sources by either using the Internet hyperlink provided, or, in cases where the contact information is provided, contacting the publisher or author directly. The National Institutes of Health The NIH gateway to patients is located at http://health.nih.gov/. From this site, you can search across various sources and institutes, a number of which are summarized below. Topic Pages: MEDLINEplus The National Library of Medicine has created a vast and patient-oriented healthcare information portal called MEDLINEplus. Within this Internet-based system are “health topic pages” which list links to available materials relevant to drug overdose. To access this system, log on to http://www.nlm.nih.gov/medlineplus/healthtopics.html. From there you can either search using the alphabetical index or browse by broad topic areas. Recently, MEDLINEplus listed the following when searched for “drug overdose”:

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Drug Overdose

Drug and Medical Device Safety http://www.nlm.nih.gov/medlineplus/drugandmedicaldevicesafety.html Medicines http://www.nlm.nih.gov/medlineplus/medicines.html You may also choose to use the search utility provided by MEDLINEplus at the following Web address: http://www.nlm.nih.gov/medlineplus/. Simply type a keyword into the search box and click “Search.” This utility is similar to the NIH search utility, with the exception that it only includes materials that are linked within the MEDLINEplus system (mostly patient-oriented information). It also has the disadvantage of generating unstructured results. We recommend, therefore, that you use this method only if you have a very targeted search. The NIH Search Utility The NIH search utility allows you to search for documents on over 100 selected Web sites that comprise the NIH-WEB-SPACE. Each of these servers is “crawled” and indexed on an ongoing basis. Your search will produce a list of various documents, all of which will relate in some way to drug overdose. The drawbacks of this approach are that the information is not organized by theme and that the references are often a mix of information for professionals and patients. Nevertheless, a large number of the listed Web sites provide useful background information. We can only recommend this route, therefore, for relatively rare or specific disorders, or when using highly targeted searches. To use the NIH search utility, visit the following Web page: http://search.nih.gov/index.html. Additional Web Sources A number of Web sites are available to the public that often link to government sites. These can also point you in the direction of essential information. The following is a representative sample: •


•

Family Village: http://www.familyvillage.wisc.edu/specific.htm

•

Google: http://directory.google.com/Top/Health/Conditions_and_Diseases/

•

Med Help International: http://www.medhelp.org/HealthTopics/A.html

•

Open Directory Project: http://dmoz.org/Health/Conditions_and_Diseases/

•

Yahoo.com: http://dir.yahoo.com/Health/Diseases_and_Conditions/

•

WebMDHealth: http://my.webmd.com/health_topics

Finding Associations There are several Internet directories that provide lists of medical associations with information on or resources relating to drug overdose. By consulting all of associations listed in this chapter, you will have nearly exhausted all sources for patient associations concerned with drug overdose.

Patient Resources

67

The National Health Information Center (NHIC) The National Health Information Center (NHIC) offers a free referral service to help people find organizations that provide information about drug overdose. For more information, see the NHIC’s Web site at http://www.health.gov/NHIC/ or contact an information specialist by calling 1-800-336-4797. Directory of Health Organizations The Directory of Health Organizations, provided by the National Library of Medicine Specialized Information Services, is a comprehensive source of information on associations. The Directory of Health Organizations database can be accessed via the Internet at http://www.sis.nlm.nih.gov/Dir/DirMain.html. It is composed of two parts: DIRLINE and Health Hotlines. The DIRLINE database comprises some 10,000 records of organizations, research centers, and government institutes and associations that primarily focus on health and biomedicine. To access DIRLINE directly, go to the following Web site: http://dirline.nlm.nih.gov/. Simply type in “drug overdose” (or a synonym), and you will receive information on all relevant organizations listed in the database. Health Hotlines directs you to toll-free numbers to over 300 organizations. You can access this database directly at http://www.sis.nlm.nih.gov/hotlines/. On this page, you are given the option to search by keyword or by browsing the subject list. When you have received your search results, click on the name of the organization for its description and contact information. The Combined Health Information Database Another comprehensive source of information on healthcare associations is the Combined Health Information Database. Using the “Detailed Search” option, you will need to limit your search to “Organizations” and “drug overdose”. Type the following hyperlink into your Web browser: http://chid.nih.gov/detail/detail.html. To find associations, use the drop boxes at the bottom of the search page where “You may refine your search by.” For publication date, select “All Years.” Then, select your preferred language and the format option “Organization Resource Sheet.” Type “drug overdose” (or synonyms) into the “For these words:” box. You should check back periodically with this database since it is updated every three months. The National Organization for Rare Disorders, Inc. The National Organization for Rare Disorders, Inc. has prepared a Web site that provides, at no charge, lists of associations organized by health topic. You can access this database at the following Web site: http://www.rarediseases.org/search/orgsearch.html. Type “drug overdose” (or a synonym) into the search box, and click “Submit Query.”

69

APPENDIX C. FINDING MEDICAL LIBRARIES Overview In this Appendix, we show you how to quickly find a medical library in your area.

Preparation Your local public library and medical libraries have interlibrary loan programs with the National Library of Medicine (NLM), one of the largest medical collections in the world. According to the NLM, most of the literature in the general and historical collections of the National Library of Medicine is available on interlibrary loan to any library. If you would like to access NLM medical literature, then visit a library in your area that can request the publications for you.19

Finding a Local Medical Library The quickest method to locate medical libraries is to use the Internet-based directory published by the National Network of Libraries of Medicine (NN/LM). This network includes 4626 members and affiliates that provide many services to librarians, health professionals, and the public. To find a library in your area, simply visit http://nnlm.gov/members/adv.html or call 1-800-338-7657.

Medical Libraries in the U.S. and Canada In addition to the NN/LM, the National Library of Medicine (NLM) lists a number of libraries with reference facilities that are open to the public. The following is the NLM’s list and includes hyperlinks to each library’s Web site. These Web pages can provide information on hours of operation and other restrictions. The list below is a small sample of

19

Adapted from the NLM: http://www.nlm.nih.gov/psd/cas/interlibrary.html.

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Drug Overdose

libraries recommended by the National Library of Medicine (sorted alphabetically by name of the U.S. state or Canadian province where the library is located)20: •

Alabama: Health InfoNet of Jefferson County (Jefferson County Library Cooperative, Lister Hill Library of the Health Sciences), http://www.uab.edu/infonet/

•

Alabama: Richard M. Scrushy Library (American Sports Medicine Institute)

•

Arizona: Samaritan Regional Medical Center: The Learning Center (Samaritan Health System, Phoenix, Arizona), http://www.samaritan.edu/library/bannerlibs.htm

•

California: Kris Kelly Health Information Center (St. Joseph Health System, Humboldt), http://www.humboldt1.com/~kkhic/index.html

•

California: Community Health Library of Los Gatos, http://www.healthlib.org/orgresources.html

•

California: Consumer Health Program and Services (CHIPS) (County of Los Angeles Public Library, Los Angeles County Harbor-UCLA Medical Center Library) - Carson, CA, http://www.colapublib.org/services/chips.html

•

California: Gateway Health Library (Sutter Gould Medical Foundation)

•

California: Health Library (Stanford University Medical Center), http://wwwmed.stanford.edu/healthlibrary/

•

California: Patient Education Resource Center - Health Information and Resources (University of California, San Francisco), http://sfghdean.ucsf.edu/barnett/PERC/default.asp

•

California: Redwood Health Library (Petaluma Health Care District), http://www.phcd.org/rdwdlib.html

•

California: Los Gatos PlaneTree Health Library, http://planetreesanjose.org/

•

California: Sutter Resource Library (Sutter Hospitals Foundation, Sacramento), http://suttermedicalcenter.org/library/

•

California: Health Sciences Libraries (University of California, Davis), http://www.lib.ucdavis.edu/healthsci/

•

California: ValleyCare Health Library & Ryan Comer Cancer Resource Center (ValleyCare Health System, Pleasanton), http://gaelnet.stmarysca.edu/other.libs/gbal/east/vchl.html

•

California: Washington Community Health Resource Library (Fremont), http://www.healthlibrary.org/

•

Colorado: William V. Gervasini Memorial Library (Exempla Healthcare), http://www.saintjosephdenver.org/yourhealth/libraries/

•

Connecticut: Hartford Hospital Health Science Libraries (Hartford Hospital), http://www.harthosp.org/library/

•

Connecticut: Healthnet: Connecticut Consumer Health Information Center (University of Connecticut Health Center, Lyman Maynard Stowe Library), http://library.uchc.edu/departm/hnet/

20

Abstracted from http://www.nlm.nih.gov/medlineplus/libraries.html.

Finding Medical Libraries

71

•

Connecticut: Waterbury Hospital Health Center Library (Waterbury Hospital, Waterbury), http://www.waterburyhospital.com/library/consumer.shtml

•

Delaware: Consumer Health Library (Christiana Care Health System, Eugene du Pont Preventive Medicine & Rehabilitation Institute, Wilmington), http://www.christianacare.org/health_guide/health_guide_pmri_health_info.cfm

•

Delaware: Lewis B. Flinn Library (Delaware Academy of Medicine, Wilmington), http://www.delamed.org/chls.html

•

Georgia: Family Resource Library (Medical College of Georgia, Augusta), http://cmc.mcg.edu/kids_families/fam_resources/fam_res_lib/frl.htm

•

Georgia: Health Resource Center (Medical Center of Central Georgia, Macon), http://www.mccg.org/hrc/hrchome.asp

•

Hawaii: Hawaii Medical Library: Consumer Health Information Service (Hawaii Medical Library, Honolulu), http://hml.org/CHIS/

•

Idaho: DeArmond Consumer Health Library (Kootenai Medical Center, Coeur d’Alene), http://www.nicon.org/DeArmond/index.htm

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Illinois: Health Learning Center of Northwestern Memorial Hospital (Chicago), http://www.nmh.org/health_info/hlc.html

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Illinois: Medical Library (OSF Saint Francis Medical Center, Peoria), http://www.osfsaintfrancis.org/general/library/

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Kentucky: Medical Library - Services for Patients, Families, Students & the Public (Central Baptist Hospital, Lexington), http://www.centralbap.com/education/community/library.cfm

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Kentucky: University of Kentucky - Health Information Library (Chandler Medical Center, Lexington), http://www.mc.uky.edu/PatientEd/

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Louisiana: Alton Ochsner Medical Foundation Library (Alton Ochsner Medical Foundation, New Orleans), http://www.ochsner.org/library/

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Louisiana: Louisiana State University Health Sciences Center Medical LibraryShreveport, http://lib-sh.lsuhsc.edu/

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Maine: Franklin Memorial Hospital Medical Library (Franklin Memorial Hospital, Farmington), http://www.fchn.org/fmh/lib.htm

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Maine: Gerrish-True Health Sciences Library (Central Maine Medical Center, Lewiston), http://www.cmmc.org/library/library.html

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Maine: Hadley Parrot Health Science Library (Eastern Maine Healthcare, Bangor), http://www.emh.org/hll/hpl/guide.htm

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Maine: Maine Medical Center Library (Maine Medical Center, Portland), http://www.mmc.org/library/

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Maine: Parkview Hospital (Brunswick), http://www.parkviewhospital.org/

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Maine: Southern Maine Medical Center Health Sciences Library (Southern Maine Medical Center, Biddeford), http://www.smmc.org/services/service.php3?choice=10

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Maine: Stephens Memorial Hospital’s Health Information Library (Western Maine Health, Norway), http://www.wmhcc.org/Library/

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Manitoba, Canada: Consumer & Patient Health Information Service (University of Manitoba Libraries), http://www.umanitoba.ca/libraries/units/health/reference/chis.html

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Manitoba, Canada: J.W. Crane Memorial Library (Deer Lodge Centre, Winnipeg), http://www.deerlodge.mb.ca/crane_library/about.asp

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Maryland: Health Information Center at the Wheaton Regional Library (Montgomery County, Dept. of Public Libraries, Wheaton Regional Library), http://www.mont.lib.md.us/healthinfo/hic.asp

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Massachusetts: Baystate Medical Center Library (Baystate Health System), http://www.baystatehealth.com/1024/

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Massachusetts: Boston University Medical Center Alumni Medical Library (Boston University Medical Center), http://med-libwww.bu.edu/library/lib.html

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Massachusetts: Lowell General Hospital Health Sciences Library (Lowell General Hospital, Lowell), http://www.lowellgeneral.org/library/HomePageLinks/WWW.htm

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Massachusetts: Paul E. Woodard Health Sciences Library (New England Baptist Hospital, Boston), http://www.nebh.org/health_lib.asp

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Massachusetts: St. Luke’s Hospital Health Sciences Library (St. Luke’s Hospital, Southcoast Health System, New Bedford), http://www.southcoast.org/library/

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Massachusetts: Treadwell Library Consumer Health Reference Center (Massachusetts General Hospital), http://www.mgh.harvard.edu/library/chrcindex.html

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Massachusetts: UMass HealthNet (University of Massachusetts Medical School, Worchester), http://healthnet.umassmed.edu/

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Michigan: Botsford General Hospital Library - Consumer Health (Botsford General Hospital, Library & Internet Services), http://www.botsfordlibrary.org/consumer.htm

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Michigan: Helen DeRoy Medical Library (Providence Hospital and Medical Centers), http://www.providence-hospital.org/library/

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Michigan: Marquette General Hospital - Consumer Health Library (Marquette General Hospital, Health Information Center), http://www.mgh.org/center.html

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Michigan: Patient Education Resouce Center - University of Michigan Cancer Center (University of Michigan Comprehensive Cancer Center, Ann Arbor), http://www.cancer.med.umich.edu/learn/leares.htm

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Michigan: Sladen Library & Center for Health Information Resources - Consumer Health Information (Detroit), http://www.henryford.com/body.cfm?id=39330

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Montana: Center for Health Information (St. Patrick Hospital and Health Sciences Center, Missoula)

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National: Consumer Health Library Directory (Medical Library Association, Consumer and Patient Health Information Section), http://caphis.mlanet.org/directory/index.html

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National: National Network of Libraries of Medicine (National Library of Medicine) provides library services for health professionals in the United States who do not have access to a medical library, http://nnlm.gov/

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National: NN/LM List of Libraries Serving the Public (National Network of Libraries of Medicine), http://nnlm.gov/members/

Finding Medical Libraries

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Nevada: Health Science Library, West Charleston Library (Las Vegas-Clark County Library District, Las Vegas), http://www.lvccld.org/special_collections/medical/index.htm

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New Hampshire: Dartmouth Biomedical Libraries (Dartmouth College Library, Hanover), http://www.dartmouth.edu/~biomed/resources.htmld/conshealth.htmld/

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New Jersey: Consumer Health Library (Rahway Hospital, Rahway), http://www.rahwayhospital.com/library.htm

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New Jersey: Dr. Walter Phillips Health Sciences Library (Englewood Hospital and Medical Center, Englewood), http://www.englewoodhospital.com/links/index.htm

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New Jersey: Meland Foundation (Englewood Hospital and Medical Center, Englewood), http://www.geocities.com/ResearchTriangle/9360/

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New York: Choices in Health Information (New York Public Library) - NLM Consumer Pilot Project participant, http://www.nypl.org/branch/health/links.html

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New York: Health Information Center (Upstate Medical University, State University of New York, Syracuse), http://www.upstate.edu/library/hic/

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New York: Health Sciences Library (Long Island Jewish Medical Center, New Hyde Park), http://www.lij.edu/library/library.html

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New York: ViaHealth Medical Library (Rochester General Hospital), http://www.nyam.org/library/

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Ohio: Consumer Health Library (Akron General Medical Center, Medical & Consumer Health Library), http://www.akrongeneral.org/hwlibrary.htm

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Oklahoma: The Health Information Center at Saint Francis Hospital (Saint Francis Health System, Tulsa), http://www.sfh-tulsa.com/services/healthinfo.asp

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Oregon: Planetree Health Resource Center (Mid-Columbia Medical Center, The Dalles), http://www.mcmc.net/phrc/

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Pennsylvania: Community Health Information Library (Milton S. Hershey Medical Center, Hershey), http://www.hmc.psu.edu/commhealth/

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Pennsylvania: Community Health Resource Library (Geisinger Medical Center, Danville), http://www.geisinger.edu/education/commlib.shtml

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Pennsylvania: HealthInfo Library (Moses Taylor Hospital, Scranton), http://www.mth.org/healthwellness.html

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Pennsylvania: Hopwood Library (University of Pittsburgh, Health Sciences Library System, Pittsburgh), http://www.hsls.pitt.edu/guides/chi/hopwood/index_html

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Pennsylvania: Koop Community Health Information Center (College of Physicians of Philadelphia), http://www.collphyphil.org/kooppg1.shtml

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Pennsylvania: Learning Resources Center - Medical Library (Susquehanna Health System, Williamsport), http://www.shscares.org/services/lrc/index.asp

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Pennsylvania: Medical Library (UPMC Health System, Pittsburgh), http://www.upmc.edu/passavant/library.htm

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Quebec, Canada: Medical Library (Montreal General Hospital), http://www.mghlib.mcgill.ca/

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South Dakota: Rapid City Regional Hospital Medical Library (Rapid City Regional Hospital), http://www.rcrh.org/Services/Library/Default.asp

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Texas: Houston HealthWays (Houston Academy of Medicine-Texas Medical Center Library), http://hhw.library.tmc.edu/

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Washington: Community Health Library (Kittitas Valley Community Hospital), http://www.kvch.com/

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Washington: Southwest Washington Medical Center Library (Southwest Washington Medical Center, Vancouver), http://www.swmedicalcenter.com/body.cfm?id=72

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ONLINE GLOSSARIES The Internet provides access to a number of free-to-use medical dictionaries. The National Library of Medicine has compiled the following list of online dictionaries: •

ADAM Medical Encyclopedia (A.D.A.M., Inc.), comprehensive medical reference: http://www.nlm.nih.gov/medlineplus/encyclopedia.html

•

MedicineNet.com Medical Dictionary (MedicineNet, Inc.): http://www.medterms.com/Script/Main/hp.asp

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Merriam-Webster Medical Dictionary (Inteli-Health, Inc.): http://www.intelihealth.com/IH/

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Multilingual Glossary of Technical and Popular Medical Terms in Eight European Languages (European Commission) - Danish, Dutch, English, French, German, Italian, Portuguese, and Spanish: http://allserv.rug.ac.be/~rvdstich/eugloss/welcome.html

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On-line Medical Dictionary (CancerWEB): http://cancerweb.ncl.ac.uk/omd/

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Rare Diseases Terms (Office of Rare Diseases): http://ord.aspensys.com/asp/diseases/diseases.asp

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Technology Glossary (National Library of Medicine) - Health Care Technology: http://www.nlm.nih.gov/nichsr/ta101/ta10108.htm

Beyond these, MEDLINEplus contains a very patient-friendly encyclopedia covering every aspect of medicine (licensed from A.D.A.M., Inc.). The ADAM Medical Encyclopedia can be accessed at http://www.nlm.nih.gov/medlineplus/encyclopedia.html. ADAM is also available on commercial Web sites such as drkoop.com (http://www.drkoop.com/) and Web MD (http://my.webmd.com/adam/asset/adam_disease_articles/a_to_z/a).

Online Dictionary Directories The following are additional online directories compiled by the National Library of Medicine, including a number of specialized medical dictionaries: •

Medical Dictionaries: Medical & Biological (World Health Organization): http://www.who.int/hlt/virtuallibrary/English/diction.htm#Medical

•

MEL-Michigan Electronic Library List of Online Health and Medical Dictionaries (Michigan Electronic Library): http://mel.lib.mi.us/health/health-dictionaries.html

•

Patient Education: Glossaries (DMOZ Open Directory Project): http://dmoz.org/Health/Education/Patient_Education/Glossaries/

•

Web of Online Dictionaries (Bucknell University): http://www.yourdictionary.com/diction5.html#medicine

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DRUG OVERDOSE DICTIONARY The definitions below are derived from official public sources, including the National Institutes of Health [NIH] and the European Union [EU]. Abdominal: Having to do with the abdomen, which is the part of the body between the chest and the hips that contains the pancreas, stomach, intestines, liver, gallbladder, and other organs. [NIH] Acetaminophen: Analgesic antipyretic derivative of acetanilide. It has weak antiinflammatory properties and is used as a common analgesic, but may cause liver, blood cell, and kidney damage. [NIH] Acidosis: A pathologic condition resulting from accumulation of acid or depletion of the alkaline reserve (bicarbonate content) in the blood and body tissues, and characterized by an increase in hydrogen ion concentration. [EU] Acute renal: A condition in which the kidneys suddenly stop working. In most cases, kidneys can recover from almost complete loss of function. [NIH] Acute tubular: A severe form of acute renal failure that develops in people with severe illnesses like infections or with low blood pressure. Patients may need dialysis. Kidney function often improves if the underlying disease is successfully treated. [NIH] Adenosine: A nucleoside that is composed of adenine and d-ribose. Adenosine or adenosine derivatives play many important biological roles in addition to being components of DNA and RNA. Adenosine itself is a neurotransmitter. [NIH] Adjustment: The dynamic process wherein the thoughts, feelings, behavior, and biophysiological mechanisms of the individual continually change to adjust to the environment. [NIH] Adrenal Glands: Paired glands situated in the retroperitoneal tissues at the superior pole of each kidney. [NIH] Adrenal insufficiency: The reduced secretion of adrenal glands. [NIH] Adverse Effect: An unwanted side effect of treatment. [NIH] Affinity: 1. Inherent likeness or relationship. 2. A special attraction for a specific element, organ, or structure. 3. Chemical affinity; the force that binds atoms in molecules; the tendency of substances to combine by chemical reaction. 4. The strength of noncovalent chemical binding between two substances as measured by the dissociation constant of the complex. 5. In immunology, a thermodynamic expression of the strength of interaction between a single antigen-binding site and a single antigenic determinant (and thus of the stereochemical compatibility between them), most accurately applied to interactions among simple, uniform antigenic determinants such as haptens. Expressed as the association constant (K litres mole -1), which, owing to the heterogeneity of affinities in a population of antibody molecules of a given specificity, actually represents an average value (mean intrinsic association constant). 6. The reciprocal of the dissociation constant. [EU] Agarose: A polysaccharide complex, free of nitrogen and prepared from agar-agar which is produced by certain seaweeds (red algae). It dissolves in warm water to form a viscid solution. [NIH] Airway: A device for securing unobstructed passage of air into and out of the lungs during general anesthesia. [NIH]

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Airway Obstruction: Any hindrance to the passage of air into and out of the lungs. [NIH] Albumin: 1. Any protein that is soluble in water and moderately concentrated salt solutions and is coagulable by heat. 2. Serum albumin; the major plasma protein (approximately 60 per cent of the total), which is responsible for much of the plasma colloidal osmotic pressure and serves as a transport protein carrying large organic anions, such as fatty acids, bilirubin, and many drugs, and also carrying certain hormones, such as cortisol and thyroxine, when their specific binding globulins are saturated. Albumin is synthesized in the liver. Low serum levels occur in protein malnutrition, active inflammation and serious hepatic and renal disease. [EU] Algorithms: A procedure consisting of a sequence of algebraic formulas and/or logical steps to calculate or determine a given task. [NIH] Alkaline: Having the reactions of an alkali. [EU] Alkaloid: A member of a large group of chemicals that are made by plants and have nitrogen in them. Some alkaloids have been shown to work against cancer. [NIH] Alternative medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used instead of standard treatments. Alternative medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Alveoli: Tiny air sacs at the end of the bronchioles in the lungs. [NIH] Amenorrhea: Absence of menstruation. [NIH] Amphetamine: A powerful central nervous system stimulant and sympathomimetic. Amphetamine has multiple mechanisms of action including blocking uptake of adrenergics and dopamine, stimulation of release of monamines, and inhibiting monoamine oxidase. Amphetamine is also a drug of abuse and a psychotomimetic. The l- and the d,l-forms are included here. The l-form has less central nervous system activity but stronger cardiovascular effects. The d-form is dextroamphetamine. [NIH] Amyloidosis: A group of diseases in which protein is deposited in specific organs (localized amyloidosis) or throughout the body (systemic amyloidosis). Amyloidosis may be either primary (with no known cause) or secondary (caused by another disease, including some types of cancer). Generally, primary amyloidosis affects the nerves, skin, tongue, joints, heart, and liver; secondary amyloidosis often affects the spleen, kidneys, liver, and adrenal glands. [NIH] Anabolic: Relating to, characterized by, or promoting anabolism. [EU] Anabolic Steroids: Chemical derivatives of testosterone that are used for anabolic promotion of growth and repair of body tissues and the development of male sexual characteristics. [NIH] Anaesthesia: Loss of feeling or sensation. Although the term is used for loss of tactile sensibility, or of any of the other senses, it is applied especially to loss of the sensation of pain, as it is induced to permit performance of surgery or other painful procedures. [EU] Analgesic: An agent that alleviates pain without causing loss of consciousness. [EU] Analog: In chemistry, a substance that is similar, but not identical, to another. [NIH] Anaphylactic: Pertaining to anaphylaxis. [EU] Anaphylaxis: An acute hypersensitivity reaction due to exposure to a previously encountered antigen. The reaction may include rapidly progressing urticaria, respiratory distress, vascular collapse, systemic shock, and death. [NIH]

Dictionary 79

Anemia: A reduction in the number of circulating erythrocytes or in the quantity of hemoglobin. [NIH] Anesthesia: A state characterized by loss of feeling or sensation. This depression of nerve function is usually the result of pharmacologic action and is induced to allow performance of surgery or other painful procedures. [NIH] Anesthetics: Agents that are capable of inducing a total or partial loss of sensation, especially tactile sensation and pain. They may act to induce general anesthesia, in which an unconscious state is achieved, or may act locally to induce numbness or lack of sensation at a targeted site. [NIH] Angina: Chest pain that originates in the heart. [NIH] Angina Pectoris: The symptom of paroxysmal pain consequent to myocardial ischemia usually of distinctive character, location and radiation, and provoked by a transient stressful situation during which the oxygen requirements of the myocardium exceed the capacity of the coronary circulation to supply it. [NIH] Angioedema: A vascular reaction involving the deep dermis or subcutaneous or submucal tissues, representing localized edema caused by dilatation and increased permeability of the capillaries, and characterized by development of giant wheals. [EU] Angioneurotic: Denoting a neuropathy affecting the vascular system; see angioedema. [EU] Angioneurotic Edema: Recurring attacks of transient edema suddenly appearing in areas of the skin or mucous membranes and occasionally of the viscera, often associated with dermatographism, urticaria, erythema, and purpura. [NIH] Anorexia: Lack or loss of appetite for food. Appetite is psychologic, dependent on memory and associations. Anorexia can be brought about by unattractive food, surroundings, or company. [NIH] Anorexia Nervosa: The chief symptoms are inability to eat, weight loss, and amenorrhea. [NIH]

Antagonism: Interference with, or inhibition of, the growth of a living organism by another living organism, due either to creation of unfavorable conditions (e. g. exhaustion of food supplies) or to production of a specific antibiotic substance (e. g. penicillin). [NIH] Antibodies: Immunoglobulin molecules having a specific amino acid sequence by virtue of which they interact only with the antigen that induced their synthesis in cells of the lymphoid series (especially plasma cells), or with an antigen closely related to it. [NIH] Antibody: A type of protein made by certain white blood cells in response to a foreign substance (antigen). Each antibody can bind to only a specific antigen. The purpose of this binding is to help destroy the antigen. Antibodies can work in several ways, depending on the nature of the antigen. Some antibodies destroy antigens directly. Others make it easier for white blood cells to destroy the antigen. [NIH] Antibody Affinity: A measure of the binding strength between antibody and a simple hapten or antigen determinant. It depends on the closeness of stereochemical fit between antibody combining sites and antigen determinants, on the size of the area of contact between them, and on the distribution of charged and hydrophobic groups. It includes the concept of "avidity," which refers to the strength of the antigen-antibody bond after formation of reversible complexes. [NIH] Anticholinergic: An agent that blocks the parasympathetic nerves. Called also parasympatholytic. [EU] Anticonvulsant: An agent that prevents or relieves convulsions. [EU] Antidote: A remedy for counteracting a poison. [EU]

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Antigen: Any substance which is capable, under appropriate conditions, of inducing a specific immune response and of reacting with the products of that response, that is, with specific antibody or specifically sensitized T-lymphocytes, or both. Antigens may be soluble substances, such as toxins and foreign proteins, or particulate, such as bacteria and tissue cells; however, only the portion of the protein or polysaccharide molecule known as the antigenic determinant (q.v.) combines with antibody or a specific receptor on a lymphocyte. Abbreviated Ag. [EU] Anti-inflammatory: Having to do with reducing inflammation. [NIH] Antipyretic: An agent that relieves or reduces fever. Called also antifebrile, antithermic and febrifuge. [EU] Antitussive: An agent that relieves or prevents cough. [EU] Aphasia: A cognitive disorder marked by an impaired ability to comprehend or express language in its written or spoken form. This condition is caused by diseases which affect the language areas of the dominant hemisphere. Clinical features are used to classify the various subtypes of this condition. General categories include receptive, expressive, and mixed forms of aphasia. [NIH] Applicability: A list of the commodities to which the candidate method can be applied as presented or with minor modifications. [NIH] Aqueous: Having to do with water. [NIH] Arterial: Pertaining to an artery or to the arteries. [EU] Arteries: The vessels carrying blood away from the heart. [NIH] Artery: Vessel-carrying blood from the heart to various parts of the body. [NIH] Aspartate: A synthetic amino acid. [NIH] Aspiration: The act of inhaling. [NIH] Assay: Determination of the amount of a particular constituent of a mixture, or of the biological or pharmacological potency of a drug. [EU] Asymptomatic: Having no signs or symptoms of disease. [NIH] Autopsy: Postmortem examination of the body. [NIH] Avidity: The strength of the interaction of an antiserum with a multivalent antigen. [NIH] Azotemia: An excess of urea or other nitrogenous compounds in the blood. [EU] Bacteria: Unicellular prokaryotic microorganisms which generally possess rigid cell walls, multiply by cell division, and exhibit three principal forms: round or coccal, rodlike or bacillary, and spiral or spirochetal. [NIH] Bactericidal: Substance lethal to bacteria; substance capable of killing bacteria. [NIH] Barbiturate: A drug with sedative and hypnotic effects. Barbiturates have been used as sedatives and anesthetics, and they have been used to treat the convulsions associated with epilepsy. [NIH] Base: In chemistry, the nonacid part of a salt; a substance that combines with acids to form salts; a substance that dissociates to give hydroxide ions in aqueous solutions; a substance whose molecule or ion can combine with a proton (hydrogen ion); a substance capable of donating a pair of electrons (to an acid) for the formation of a coordinate covalent bond. [EU] Benzodiazepines: A two-ring heterocyclic compound consisting of a benzene ring fused to a diazepine ring. Permitted is any degree of hydrogenation, any substituents and any Hisomer. [NIH] Bile: An emulsifying agent produced in the liver and secreted into the duodenum. Its

Dictionary 81

composition includes bile acids and salts, cholesterol, and electrolytes. It aids digestion of fats in the duodenum. [NIH] Bioavailability: The degree to which a drug or other substance becomes available to the target tissue after administration. [EU] Biotechnology: Body of knowledge related to the use of organisms, cells or cell-derived constituents for the purpose of developing products which are technically, scientifically and clinically useful. Alteration of biologic function at the molecular level (i.e., genetic engineering) is a central focus; laboratory methods used include transfection and cloning technologies, sequence and structure analysis algorithms, computer databases, and gene and protein structure function analysis and prediction. [NIH] Bladder: The organ that stores urine. [NIH] Blood pressure: The pressure of blood against the walls of a blood vessel or heart chamber. Unless there is reference to another location, such as the pulmonary artery or one of the heart chambers, it refers to the pressure in the systemic arteries, as measured, for example, in the forearm. [NIH] Blood vessel: A tube in the body through which blood circulates. Blood vessels include a network of arteries, arterioles, capillaries, venules, and veins. [NIH] Blood-Brain Barrier: Specialized non-fenestrated tightly-joined endothelial cells (tight junctions) that form a transport barrier for certain substances between the cerebral capillaries and the brain tissue. [NIH] Body Fluids: Liquid components of living organisms. [NIH] Bone Marrow: The soft tissue filling the cavities of bones. Bone marrow exists in two types, yellow and red. Yellow marrow is found in the large cavities of large bones and consists mostly of fat cells and a few primitive blood cells. Red marrow is a hematopoietic tissue and is the site of production of erythrocytes and granular leukocytes. Bone marrow is made up of a framework of connective tissue containing branching fibers with the frame being filled with marrow cells. [NIH] Bowel: The long tube-shaped organ in the abdomen that completes the process of digestion. There is both a small and a large bowel. Also called the intestine. [NIH] Bronchi: The larger air passages of the lungs arising from the terminal bifurcation of the trachea. [NIH] Bronchial: Pertaining to one or more bronchi. [EU] Bulimia: Episodic binge eating. The episodes may be associated with the fear of not being able to stop eating, depressed mood, or self-deprecating thoughts (binge-eating disorder) and may frequently be terminated by self-induced vomiting (bulimia nervosa). [NIH] Cadaver: A dead body, usually a human body. [NIH] Calcium: A basic element found in nearly all organized tissues. It is a member of the alkaline earth family of metals with the atomic symbol Ca, atomic number 20, and atomic weight 40. Calcium is the most abundant mineral in the body and combines with phosphorus to form calcium phosphate in the bones and teeth. It is essential for the normal functioning of nerves and muscles and plays a role in blood coagulation (as factor IV) and in many enzymatic processes. [NIH] Cannabis: The hemp plant Cannabis sativa. Products prepared from the dried flowering tops of the plant include marijuana, hashish, bhang, and ganja. [NIH] Carbamazepine: An anticonvulsant used to control grand mal and psychomotor or focal seizures. Its mode of action is not fully understood, but some of its actions resemble those of

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phenytoin; although there is little chemical resemblance between the two compounds, their three-dimensional structure is similar. [NIH] Carbon Dioxide: A colorless, odorless gas that can be formed by the body and is necessary for the respiration cycle of plants and animals. [NIH] Cardiac: Having to do with the heart. [NIH] Cardiac arrest: A sudden stop of heart function. [NIH] Cardiopulmonary: Having to do with the heart and lungs. [NIH] Cardiopulmonary Resuscitation: The artificial substitution of heart and lung action as indicated for heart arrest resulting from electric shock, drowning, respiratory arrest, or other causes. The two major components of cardiopulmonary resuscitation are artificial ventilation and closed-chest cardiac massage. [NIH] Cardiopulmonary Resuscitation: The artificial substitution of heart and lung action as indicated for heart arrest resulting from electric shock, drowning, respiratory arrest, or other causes. The two major components of cardiopulmonary resuscitation are artificial ventilation and closed-chest cardiac massage. [NIH] Cardiorespiratory: Relating to the heart and lungs and their function. [EU] Cardiovascular: Having to do with the heart and blood vessels. [NIH] Cardiovascular disease: Any abnormal condition characterized by dysfunction of the heart and blood vessels. CVD includes atherosclerosis (especially coronary heart disease, which can lead to heart attacks), cerebrovascular disease (e.g., stroke), and hypertension (high blood pressure). [NIH] Case report: A detailed report of the diagnosis, treatment, and follow-up of an individual patient. Case reports also contain some demographic information about the patient (for example, age, gender, ethnic origin). [NIH] Case series: A group or series of case reports involving patients who were given similar treatment. Reports of case series usually contain detailed information about the individual patients. This includes demographic information (for example, age, gender, ethnic origin) and information on diagnosis, treatment, response to treatment, and follow-up after treatment. [NIH] Castor Oil: Oil obtained from seeds of Ricinus communis that is used as a cathartic and as a plasticizer. [NIH] Cell: The individual unit that makes up all of the tissues of the body. All living things are made up of one or more cells. [NIH] Cell Division: The fission of a cell. [NIH] Central Nervous System: The main information-processing organs of the nervous system, consisting of the brain, spinal cord, and meninges. [NIH] Centrifugation: A method of separating organelles or large molecules that relies upon differential sedimentation through a preformed density gradient under the influence of a gravitational field generated in a centrifuge. [NIH] Cerebral: Of or pertaining of the cerebrum or the brain. [EU] Cerebrospinal: Pertaining to the brain and spinal cord. [EU] Cerebrospinal fluid: CSF. The fluid flowing around the brain and spinal cord. Cerebrospinal fluid is produced in the ventricles in the brain. [NIH] Cerebrovascular: Pertaining to the blood vessels of the cerebrum, or brain. [EU] Cerebrum: The largest part of the brain. It is divided into two hemispheres, or halves, called

Dictionary 83

the cerebral hemispheres. The cerebrum controls muscle functions of the body and also controls speech, emotions, reading, writing, and learning. [NIH] Character: In current usage, approximately equivalent to personality. The sum of the relatively fixed personality traits and habitual modes of response of an individual. [NIH] Chemical Warfare: Tactical warfare using incendiary mixtures, smokes, or irritant, burning, or asphyxiating gases. [NIH] Chemical Warfare Agents: Chemicals that are used to cause the disturbance, disease, or death of humans during war. [NIH] Chemoreceptor: A receptor adapted for excitation by chemical substances, e.g., olfactory and gustatory receptors, or a sense organ, as the carotid body or the aortic (supracardial) bodies, which is sensitive to chemical changes in the blood stream, especially reduced oxygen content, and reflexly increases both respiration and blood pressure. [EU] Chest Pain: Pressure, burning, or numbness in the chest. [NIH] Chlorprothixene: A thioxanthine with effects similar to the phenothiazine antipsychotics. [NIH]

Chromosome: Part of a cell that contains genetic information. Except for sperm and eggs, all human cells contain 46 chromosomes. [NIH] Chronic: A disease or condition that persists or progresses over a long period of time. [NIH] Clinical study: A research study in which patients receive treatment in a clinic or other medical facility. Reports of clinical studies can contain results for single patients (case reports) or many patients (case series or clinical trials). [NIH] Clinical trial: A research study that tests how well new medical treatments or other interventions work in people. Each study is designed to test new methods of screening, prevention, diagnosis, or treatment of a disease. [NIH] Cloning: The production of a number of genetically identical individuals; in genetic engineering, a process for the efficient replication of a great number of identical DNA molecules. [NIH] Coagulation: 1. The process of clot formation. 2. In colloid chemistry, the solidification of a sol into a gelatinous mass; an alteration of a disperse phase or of a dissolved solid which causes the separation of the system into a liquid phase and an insoluble mass called the clot or curd. Coagulation is usually irreversible. 3. In surgery, the disruption of tissue by physical means to form an amorphous residuum, as in electrocoagulation and photocoagulation. [EU] Coca: Any of several South American shrubs of the Erythroxylon genus (and family) that yield cocaine; the leaves are chewed with alum for CNS stimulation. [NIH] Cocaethylene: Hard drug formed by cocaine and alcohol. [NIH] Cocaine: An alkaloid ester extracted from the leaves of plants including coca. It is a local anesthetic and vasoconstrictor and is clinically used for that purpose, particularly in the eye, ear, nose, and throat. It also has powerful central nervous system effects similar to the amphetamines and is a drug of abuse. Cocaine, like amphetamines, acts by multiple mechanisms on brain catecholaminergic neurons; the mechanism of its reinforcing effects is thought to involve inhibition of dopamine uptake. [NIH] Codeine: An opioid analgesic related to morphine but with less potent analgesic properties and mild sedative effects. It also acts centrally to suppress cough. [NIH] Colitis: Inflammation of the colon. [NIH] Collagen: A polypeptide substance comprising about one third of the total protein in

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mammalian organisms. It is the main constituent of skin, connective tissue, and the organic substance of bones and teeth. Different forms of collagen are produced in the body but all consist of three alpha-polypeptide chains arranged in a triple helix. Collagen is differentiated from other fibrous proteins, such as elastin, by the content of proline, hydroxyproline, and hydroxylysine; by the absence of tryptophan; and particularly by the high content of polar groups which are responsible for its swelling properties. [NIH] Colon: The long, coiled, tubelike organ that removes water from digested food. The remaining material, solid waste called stool, moves through the colon to the rectum and leaves the body through the anus. [NIH] Comatose: Pertaining to or affected with coma. [EU] Communis: Common tendon of the rectus group of muscles that surrounds the optic foramen and a portion of the superior orbital fissure, to the anterior margin of which it is attached at the spina recti lateralis. [NIH] Comorbidity: The presence of co-existing or additional diseases with reference to an initial diagnosis or with reference to the index condition that is the subject of study. Comorbidity may affect the ability of affected individuals to function and also their survival; it may be used as a prognostic indicator for length of hospital stay, cost factors, and outcome or survival. [NIH] Complement: A term originally used to refer to the heat-labile factor in serum that causes immune cytolysis, the lysis of antibody-coated cells, and now referring to the entire functionally related system comprising at least 20 distinct serum proteins that is the effector not only of immune cytolysis but also of other biologic functions. Complement activation occurs by two different sequences, the classic and alternative pathways. The proteins of the classic pathway are termed 'components of complement' and are designated by the symbols C1 through C9. C1 is a calcium-dependent complex of three distinct proteins C1q, C1r and C1s. The proteins of the alternative pathway (collectively referred to as the properdin system) and complement regulatory proteins are known by semisystematic or trivial names. Fragments resulting from proteolytic cleavage of complement proteins are designated with lower-case letter suffixes, e.g., C3a. Inactivated fragments may be designated with the suffix 'i', e.g. C3bi. Activated components or complexes with biological activity are designated by a bar over the symbol e.g. C1 or C4b,2a. The classic pathway is activated by the binding of C1 to classic pathway activators, primarily antigen-antibody complexes containing IgM, IgG1, IgG3; C1q binds to a single IgM molecule or two adjacent IgG molecules. The alternative pathway can be activated by IgA immune complexes and also by nonimmunologic materials including bacterial endotoxins, microbial polysaccharides, and cell walls. Activation of the classic pathway triggers an enzymatic cascade involving C1, C4, C2 and C3; activation of the alternative pathway triggers a cascade involving C3 and factors B, D and P. Both result in the cleavage of C5 and the formation of the membrane attack complex. Complement activation also results in the formation of many biologically active complement fragments that act as anaphylatoxins, opsonins, or chemotactic factors. [EU] Complementary and alternative medicine: CAM. Forms of treatment that are used in addition to (complementary) or instead of (alternative) standard treatments. These practices are not considered standard medical approaches. CAM includes dietary supplements, megadose vitamins, herbal preparations, special teas, massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Complementary medicine: Practices not generally recognized by the medical community as standard or conventional medical approaches and used to enhance or complement the standard treatments. Complementary medicine includes the taking of dietary supplements, megadose vitamins, and herbal preparations; the drinking of special teas; and practices such

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as massage therapy, magnet therapy, spiritual healing, and meditation. [NIH] Compliance: Distensibility measure of a chamber such as the lungs (lung compliance) or bladder. Compliance is expressed as a change in volume per unit change in pressure. [NIH] Computational Biology: A field of biology concerned with the development of techniques for the collection and manipulation of biological data, and the use of such data to make biological discoveries or predictions. This field encompasses all computational methods and theories applicable to molecular biology and areas of computer-based techniques for solving biological problems including manipulation of models and datasets. [NIH] Concomitant: Accompanying; accessory; joined with another. [EU] Confusion: A mental state characterized by bewilderment, emotional disturbance, lack of clear thinking, and perceptual disorientation. [NIH] Congestion: Excessive or abnormal accumulation of blood in a part. [EU] Conjugated: Acting or operating as if joined; simultaneous. [EU] Conjunctiva: The mucous membrane that lines the inner surface of the eyelids and the anterior part of the sclera. [NIH] Connective Tissue: Tissue that supports and binds other tissues. It consists of connective tissue cells embedded in a large amount of extracellular matrix. [NIH] Connective Tissue: Tissue that supports and binds other tissues. It consists of connective tissue cells embedded in a large amount of extracellular matrix. [NIH] Consciousness: Sense of awareness of self and of the environment. [NIH] Contraindications: Any factor or sign that it is unwise to pursue a certain kind of action or treatment, e. g. giving a general anesthetic to a person with pneumonia. [NIH] Controlled study: An experiment or clinical trial that includes a comparison (control) group. [NIH]

Convulsions: A general term referring to sudden and often violent motor activity of cerebral or brainstem origin. Convulsions may also occur in the absence of an electrical cerebral discharge (e.g., in response to hypotension). [NIH] Convulsive: Relating or referring to spasm; affected with spasm; characterized by a spasm or spasms. [NIH] Coronary: Encircling in the manner of a crown; a term applied to vessels; nerves, ligaments, etc. The term usually denotes the arteries that supply the heart muscle and, by extension, a pathologic involvement of them. [EU] Coronary Circulation: The circulation of blood through the coronary vessels of the heart. [NIH]

Coronary heart disease: A type of heart disease caused by narrowing of the coronary arteries that feed the heart, which needs a constant supply of oxygen and nutrients carried by the blood in the coronary arteries. When the coronary arteries become narrowed or clogged by fat and cholesterol deposits and cannot supply enough blood to the heart, CHD results. [NIH] Coronary Thrombosis: Presence of a thrombus in a coronary artery, often causing a myocardial infarction. [NIH] Cortex: The outer layer of an organ or other body structure, as distinguished from the internal substance. [EU] Cortical: Pertaining to or of the nature of a cortex or bark. [EU] Curative: Tending to overcome disease and promote recovery. [EU]

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Cyclic: Pertaining to or occurring in a cycle or cycles; the term is applied to chemical compounds that contain a ring of atoms in the nucleus. [EU] Cytokine: Small but highly potent protein that modulates the activity of many cell types, including T and B cells. [NIH] Cytotoxic: Cell-killing. [NIH] Decontamination: The removal of contaminating material, such as radioactive materials, biological materials, or chemical warfare agents, from a person or object. [NIH] Deferoxamine: Natural product isolated from Streptomyces pilosus. It forms iron complexes and is used as a chelating agent, particularly in the form of its mesylate. [NIH] Delusions: A false belief regarding the self or persons or objects outside the self that persists despite the facts, and is not considered tenable by one's associates. [NIH] Depressive Disorder: An affective disorder manifested by either a dysphoric mood or loss of interest or pleasure in usual activities. The mood disturbance is prominent and relatively persistent. [NIH] Dextroamphetamine: The d-form of amphetamine. It is a central nervous system stimulant and a sympathomimetic. It has also been used in the treatment of narcolepsy and of attention deficit disorders and hyperactivity in children. Dextroamphetamine has multiple mechanisms of action including blocking uptake of adrenergics and dopamine, stimulating release of monamines, and inhibiting monoamine oxidase. It is also a drug of abuse and a psychotomimetic. [NIH] Dextromethorphan: The d-isomer of the codeine analog of levorphanol. Dextromethorphan shows high affinity binding to several regions of the brain, including the medullary cough center. This compound is a NMDA receptor antagonist (receptors, N-methyl-D-aspartate) and acts as a non-competitive channel blocker. It is used widely as an antitussive agent, and is also used to study the involvement of glutamate receptors in neurotoxicity. [NIH] Diabetes Mellitus: A heterogeneous group of disorders that share glucose intolerance in common. [NIH] Diagnostic procedure: A method used to identify a disease. [NIH] Dialyzer: A part of the hemodialysis machine. (See hemodialysis under dialysis.) The dialyzer has two sections separated by a membrane. One section holds dialysate. The other holds the patient's blood. [NIH] Diastolic: Of or pertaining to the diastole. [EU] Diffusion: The tendency of a gas or solute to pass from a point of higher pressure or concentration to a point of lower pressure or concentration and to distribute itself throughout the available space; a major mechanism of biological transport. [NIH] Digestion: The process of breakdown of food for metabolism and use by the body. [NIH] Direct: 1. Straight; in a straight line. 2. Performed immediately and without the intervention of subsidiary means. [EU] Disinfectant: An agent that disinfects; applied particularly to agents used on inanimate objects. [EU] Disposition: A tendency either physical or mental toward certain diseases. [EU] Dissociation: 1. The act of separating or state of being separated. 2. The separation of a molecule into two or more fragments (atoms, molecules, ions, or free radicals) produced by the absorption of light or thermal energy or by solvation. 3. In psychology, a defense mechanism in which a group of mental processes are segregated from the rest of a person's mental activity in order to avoid emotional distress, as in the dissociative disorders (q.v.), or

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in which an idea or object is segregated from its emotional significance; in the first sense it is roughly equivalent to splitting, in the second, to isolation. 4. A defect of mental integration in which one or more groups of mental processes become separated off from normal consciousness and, thus separated, function as a unitary whole. [EU] Dissociative Disorders: Sudden temporary alterations in the normally integrative functions of consciousness. [NIH] Diuresis: Increased excretion of urine. [EU] Dopamine: An endogenous catecholamine and prominent neurotransmitter in several systems of the brain. In the synthesis of catecholamines from tyrosine, it is the immediate precursor to norepinephrine and epinephrine. Dopamine is a major transmitter in the extrapyramidal system of the brain, and important in regulating movement. A family of dopaminergic receptor subtypes mediate its action. Dopamine is used pharmacologically for its direct (beta adrenergic agonist) and indirect (adrenergic releasing) sympathomimetic effects including its actions as an inotropic agent and as a renal vasodilator. [NIH] Double-blind: Pertaining to a clinical trial or other experiment in which neither the subject nor the person administering treatment knows which treatment any particular subject is receiving. [EU] Drug Interactions: The action of a drug that may affect the activity, metabolism, or toxicity of another drug. [NIH] Drug Monitoring: The process of observing, recording, or detecting the effects of a chemical substance administered to an individual therapeutically or diagnostically. [NIH] Duodenum: The first part of the small intestine. [NIH] Edema: Excessive amount of watery fluid accumulated in the intercellular spaces, most commonly present in subcutaneous tissue. [NIH] Efficacy: The extent to which a specific intervention, procedure, regimen, or service produces a beneficial result under ideal conditions. Ideally, the determination of efficacy is based on the results of a randomized control trial. [NIH] Electric shock: A dangerous patho-physiological effect resulting from an electric current passing through the body of a human or animal. [NIH] Electrocardiography: Recording of the moment-to-moment electromotive forces of the heart as projected onto various sites on the body's surface, delineated as a scalar function of time. [NIH]

Electrolyte: A substance that dissociates into ions when fused or in solution, and thus becomes capable of conducting electricity; an ionic solute. [EU] Electrons: Stable elementary particles having the smallest known negative charge, present in all elements; also called negatrons. Positively charged electrons are called positrons. The numbers, energies and arrangement of electrons around atomic nuclei determine the chemical identities of elements. Beams of electrons are called cathode rays or beta rays, the latter being a high-energy biproduct of nuclear decay. [NIH] Embryo: The prenatal stage of mammalian development characterized by rapid morphological changes and the differentiation of basic structures. [NIH] Emesis: Vomiting; an act of vomiting. Also used as a word termination, as in haematemesis. [EU]

Emetic: An agent that causes vomiting. [EU] Emetine: The principal alkaloid of ipecac, from the ground roots of Uragoga (or Cephaelis) ipecacuanha or U. acuminata, of the Rubiaceae. It is used as an amebicide in many different preparations and may cause serious cardiac, hepatic, or renal damage and violent diarrhea

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and vomiting. Emetine inhibits protein syntheis in eucaryotic but not prokaryotic cells. [NIH] Endogenous: Produced inside an organism or cell. The opposite is external (exogenous) production. [NIH] Environmental Health: The science of controlling or modifying those conditions, influences, or forces surrounding man which relate to promoting, establishing, and maintaining health. [NIH]

Enzyme: A protein that speeds up chemical reactions in the body. [NIH] Epigastric: Having to do with the upper middle area of the abdomen. [NIH] Erythema: Redness of the skin produced by congestion of the capillaries. This condition may result from a variety of causes. [NIH] Erythrocytes: Red blood cells. Mature erythrocytes are non-nucleated, biconcave disks containing hemoglobin whose function is to transport oxygen. [NIH] Erythropoietin: Glycoprotein hormone, secreted chiefly by the kidney in the adult and the liver in the fetus, that acts on erythroid stem cells of the bone marrow to stimulate proliferation and differentiation. [NIH] Esophagus: The muscular tube through which food passes from the throat to the stomach. [NIH]

Ethanol: A clear, colorless liquid rapidly absorbed from the gastrointestinal tract and distributed throughout the body. It has bactericidal activity and is used often as a topical disinfectant. It is widely used as a solvent and preservative in pharmaceutical preparations as well as serving as the primary ingredient in alcoholic beverages. [NIH] Evacuation: An emptying, as of the bowels. [EU] Exocrine: Secreting outwardly, via a duct. [EU] Exogenous: Developed or originating outside the organism, as exogenous disease. [EU] Extracellular: Outside a cell or cells. [EU] Extracellular Matrix: A meshwork-like substance found within the extracellular space and in association with the basement membrane of the cell surface. It promotes cellular proliferation and provides a supporting structure to which cells or cell lysates in culture dishes adhere. [NIH] Extracellular Matrix Proteins: Macromolecular organic compounds that contain carbon, hydrogen, oxygen, nitrogen, and usually, sulfur. These macromolecules (proteins) form an intricate meshwork in which cells are embedded to construct tissues. Variations in the relative types of macromolecules and their organization determine the type of extracellular matrix, each adapted to the functional requirements of the tissue. The two main classes of macromolecules that form the extracellular matrix are: glycosaminoglycans, usually linked to proteins (proteoglycans), and fibrous proteins (e.g., collagen, elastin, fibronectins and laminin). [NIH] Extracorporeal: Situated or occurring outside the body. [EU] Family Planning: Programs or services designed to assist the family in controlling reproduction by either improving or diminishing fertility. [NIH] Fat: Total lipids including phospholipids. [NIH] Fatigue: The state of weariness following a period of exertion, mental or physical, characterized by a decreased capacity for work and reduced efficiency to respond to stimuli. [NIH]

Fetus: The developing offspring from 7 to 8 weeks after conception until birth. [NIH]

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Flatus: Gas passed through the rectum. [NIH] Flumazenil: A potent benzodiazepine receptor antagonist. Since it reverses the sedative and other actions of benzodiazepines, it has been suggested as an antidote to benzodiazepine overdoses. [NIH] Forearm: The part between the elbow and the wrist. [NIH] Free Radicals: Highly reactive molecules with an unsatisfied electron valence pair. Free radicals are produced in both normal and pathological processes. They are proven or suspected agents of tissue damage in a wide variety of circumstances including radiation, damage from environment chemicals, and aging. Natural and pharmacological prevention of free radical damage is being actively investigated. [NIH] Gas: Air that comes from normal breakdown of food. The gases are passed out of the body through the rectum (flatus) or the mouth (burp). [NIH] Gas exchange: Primary function of the lungs; transfer of oxygen from inhaled air into the blood and of carbon dioxide from the blood into the lungs. [NIH] Gastric: Having to do with the stomach. [NIH] Gastric Acid: Hydrochloric acid present in gastric juice. [NIH] Gastric Mucosa: Surface epithelium in the stomach that invaginates into the lamina propria, forming gastric pits. Tubular glands, characteristic of each region of the stomach (cardiac, gastric, and pyloric), empty into the gastric pits. The gastric mucosa is made up of several different kinds of cells. [NIH] Gastrointestinal: Refers to the stomach and intestines. [NIH] Gastrointestinal tract: The stomach and intestines. [NIH] Gelatinases: A class of enzymes that catalyzes the degradation of gelatin by acting on the peptide bonds. EC 3.4.24.-. [NIH] Gene: The functional and physical unit of heredity passed from parent to offspring. Genes are pieces of DNA, and most genes contain the information for making a specific protein. [NIH]

Gland: An organ that produces and releases one or more substances for use in the body. Some glands produce fluids that affect tissues or organs. Others produce hormones or participate in blood production. [NIH] Glomerular: Pertaining to or of the nature of a glomerulus, especially a renal glomerulus. [EU]

Glucose: D-Glucose. A primary source of energy for living organisms. It is naturally occurring and is found in fruits and other parts of plants in its free state. It is used therapeutically in fluid and nutrient replacement. [NIH] Glucose Intolerance: A pathological state in which the fasting plasma glucose level is less than 140 mg per deciliter and the 30-, 60-, or 90-minute plasma glucose concentration following a glucose tolerance test exceeds 200 mg per deciliter. This condition is seen frequently in diabetes mellitus but also occurs with other diseases. [NIH] Glutamate: Excitatory neurotransmitter of the brain. [NIH] Glutethimide: A hypnotic and sedative. Its use has been largely superseded by other drugs. [NIH]

Governing Board: The group in which legal authority is vested for the control of healthrelated institutions and organizations. [NIH] Haematemesis: The vomiting of blood. [EU]

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Haemodialysis: The removal of certain elements from the blood by virtue of the difference in the rates of their diffusion through a semipermeable membrane, e.g., by means of a haemodialyzer. [EU] Haemoperfusion: 1. The act of pouring over or through, especially the passage of blood through the vessels of a specific organ. 2. Blood poured over or through an organ or tissue. [EU]

Hallucinogen: A hallucination-producing drug, a category of drugs producing this effect. The user of a hallucinogenic drug is almost invariably aware that what he is seeing are hallucinations. [NIH] Haptens: Small antigenic determinants capable of eliciting an immune response only when coupled to a carrier. Haptens bind to antibodies but by themselves cannot elicit an antibody response. [NIH] Heart Arrest: Sudden and usually momentary cessation of the heart beat. This sudden cessation may, but not usually, lead to death, sudden, cardiac. [NIH] Heart attack: A seizure of weak or abnormal functioning of the heart. [NIH] Heart failure: Loss of pumping ability by the heart, often accompanied by fatigue, breathlessness, and excess fluid accumulation in body tissues. [NIH] Hemodiafiltration: The combination of hemodialysis and hemofiltration either simultaneously or sequentially. Convective transport (hemofiltration) may be better for removal of larger molecular weight substances and diffusive transport (hemodialysis) for smaller molecular weight solutes. [NIH] Hemodialysis: The use of a machine to clean wastes from the blood after the kidneys have failed. The blood travels through tubes to a dialyzer, which removes wastes and extra fluid. The cleaned blood then flows through another set of tubes back into the body. [NIH] Hemofiltration: Extracorporeal ultrafiltration technique without hemodialysis for treatment of fluid overload and electrolyte disturbances affecting renal, cardiac, or pulmonary function. [NIH] Hemoglobin: One of the fractions of glycosylated hemoglobin A1c. Glycosylated hemoglobin is formed when linkages of glucose and related monosaccharides bind to hemoglobin A and its concentration represents the average blood glucose level over the previous several weeks. HbA1c levels are used as a measure of long-term control of plasma glucose (normal, 4 to 6 percent). In controlled diabetes mellitus, the concentration of glycosylated hemoglobin A is within the normal range, but in uncontrolled cases the level may be 3 to 4 times the normal conentration. Generally, complications are substantially lower among patients with Hb levels of 7 percent or less than in patients with HbA1c levels of 9 percent or more. [NIH] Hemoperfusion: Removal of toxins or metabolites from the circulation by the passing of blood, within a suitable extracorporeal circuit, over semipermeable microcapsules containing adsorbents (e.g., activated charcoal) or enzymes, other enzyme preparations (e.g., gel-entrapped microsomes, membrane-free enzymes bound to artificial carriers), or other adsorbents (e.g., various resins, albumin-conjugated agarose). [NIH] Hemorrhage: Bleeding or escape of blood from a vessel. [NIH] Hemostasis: The process which spontaneously arrests the flow of blood from vessels carrying blood under pressure. It is accomplished by contraction of the vessels, adhesion and aggregation of formed blood elements, and the process of blood or plasma coagulation. [NIH]

Hepatic: Refers to the liver. [NIH]

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Heterogeneity: The property of one or more samples or populations which implies that they are not identical in respect of some or all of their parameters, e. g. heterogeneity of variance. [NIH]

Homeostasis: The processes whereby the internal environment of an organism tends to remain balanced and stable. [NIH] Homicide: The killing of one person by another. [NIH] Homologous: Corresponding in structure, position, origin, etc., as (a) the feathers of a bird and the scales of a fish, (b) antigen and its specific antibody, (c) allelic chromosomes. [EU] Hormonal: Pertaining to or of the nature of a hormone. [EU] Hormone: A substance in the body that regulates certain organs. Hormones such as gastrin help in breaking down food. Some hormones come from cells in the stomach and small intestine. [NIH] Hydrogen: The first chemical element in the periodic table. It has the atomic symbol H, atomic number 1, and atomic weight 1. It exists, under normal conditions, as a colorless, odorless, tasteless, diatomic gas. Hydrogen ions are protons. Besides the common H1 isotope, hydrogen exists as the stable isotope deuterium and the unstable, radioactive isotope tritium. [NIH] Hydrophobic: Not readily absorbing water, or being adversely affected by water, as a hydrophobic colloid. [EU] Hyperglycemia: Abnormally high blood sugar. [NIH] Hypertension: Persistently high arterial blood pressure. Currently accepted threshold levels are 140 mm Hg systolic and 90 mm Hg diastolic pressure. [NIH] Hyperventilation: A pulmonary ventilation rate faster than is metabolically necessary for the exchange of gases. It is the result of an increased frequency of breathing, an increased tidal volume, or a combination of both. It causes an excess intake of oxygen and the blowing off of carbon dioxide. [NIH] Hypnotic: A drug that acts to induce sleep. [EU] Hypoglycemia: Abnormally low blood sugar [NIH] Hypotension: Abnormally low blood pressure. [NIH] Hypothermia: Lower than normal body temperature, especially in warm-blooded animals; in man usually accidental or unintentional. [NIH] Illusions: The misinterpretation of a real external, sensory experience. [NIH] Immune response: The activity of the immune system against foreign substances (antigens). [NIH]

Immunology: The study of the body's immune system. [NIH] Impairment: In the context of health experience, an impairment is any loss or abnormality of psychological, physiological, or anatomical structure or function. [NIH] Induction: The act or process of inducing or causing to occur, especially the production of a specific morphogenetic effect in the developing embryo through the influence of evocators or organizers, or the production of anaesthesia or unconsciousness by use of appropriate agents. [EU] Infarction: A pathological process consisting of a sudden insufficient blood supply to an area, which results in necrosis of that area. It is usually caused by a thrombus, an embolus, or a vascular torsion. [NIH] Infection: 1. Invasion and multiplication of microorganisms in body tissues, which may be

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clinically unapparent or result in local cellular injury due to competitive metabolism, toxins, intracellular replication, or antigen-antibody response. The infection may remain localized, subclinical, and temporary if the body's defensive mechanisms are effective. A local infection may persist and spread by extension to become an acute, subacute, or chronic clinical infection or disease state. A local infection may also become systemic when the microorganisms gain access to the lymphatic or vascular system. 2. An infectious disease. [EU]

Inflammation: A pathological process characterized by injury or destruction of tissues caused by a variety of cytologic and chemical reactions. It is usually manifested by typical signs of pain, heat, redness, swelling, and loss of function. [NIH] Ingestion: Taking into the body by mouth [NIH] Inhalation: The drawing of air or other substances into the lungs. [EU] Insight: The capacity to understand one's own motives, to be aware of one's own psychodynamics, to appreciate the meaning of symbolic behavior. [NIH] Insulin: A protein hormone secreted by beta cells of the pancreas. Insulin plays a major role in the regulation of glucose metabolism, generally promoting the cellular utilization of glucose. It is also an important regulator of protein and lipid metabolism. Insulin is used as a drug to control insulin-dependent diabetes mellitus. [NIH] Insulin-dependent diabetes mellitus: A disease characterized by high levels of blood glucose resulting from defects in insulin secretion, insulin action, or both. Autoimmune, genetic, and environmental factors are involved in the development of type I diabetes. [NIH] Intensive Care: Advanced and highly specialized care provided to medical or surgical patients whose conditions are life-threatening and require comprehensive care and constant monitoring. It is usually administered in specially equipped units of a health care facility. [NIH]

Intermittent: Occurring at separated intervals; having periods of cessation of activity. [EU] Internal Medicine: A medical specialty concerned with the diagnosis and treatment of diseases of the internal organ systems of adults. [NIH] Interstitial: Pertaining to or situated between parts or in the interspaces of a tissue. [EU] Intestine: A long, tube-shaped organ in the abdomen that completes the process of digestion. There is both a large intestine and a small intestine. Also called the bowel. [NIH] Intoxication: Poisoning, the state of being poisoned. [EU] Intracellular: Inside a cell. [NIH] Intravenous: IV. Into a vein. [NIH] Intrinsic: Situated entirely within or pertaining exclusively to a part. [EU] Involuntary: Reaction occurring without intention or volition. [NIH] Ionization: 1. Any process by which a neutral atom gains or loses electrons, thus acquiring a net charge, as the dissociation of a substance in solution into ions or ion production by the passage of radioactive particles. 2. Iontophoresis. [EU] Ions: An atom or group of atoms that have a positive or negative electric charge due to a gain (negative charge) or loss (positive charge) of one or more electrons. Atoms with a positive charge are known as cations; those with a negative charge are anions. [NIH] Ipecac: A syrup made from the dried rhizomes of two different species, Cephaelis ipecacuanha and C. acuminata, belonging to the Rubiaciae family. They contain emetine, cephaeline, psychotrine and other isoquinolines. Ipecac syrup is used widely as an emetic acting both locally on the gastric mucosa and centrally on the chemoreceptor trigger zone.

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[NIH]

Irrigation: The washing of a body cavity or surface by flowing solution which is inserted and then removed. Any drug in the irrigation solution may be absorbed. [NIH] Kb: A measure of the length of DNA fragments, 1 Kb = 1000 base pairs. The largest DNA fragments are up to 50 kilobases long. [NIH] Ketamine: A cyclohexanone derivative used for induction of anesthesia. Its mechanism of action is not well understood, but ketamine can block NMDA receptors (receptors, NMethyl-D-Aspartate) and may interact with sigma receptors. [NIH] Kidney Disease: Any one of several chronic conditions that are caused by damage to the cells of the kidney. People who have had diabetes for a long time may have kidney damage. Also called nephropathy. [NIH] Kinetic: Pertaining to or producing motion. [EU] Levorphanol: A narcotic analgesic that may be habit-forming. It is nearly as effective orally as by injection. [NIH] Lipid: Fat. [NIH] Lipophilic: Having an affinity for fat; pertaining to or characterized by lipophilia. [EU] Lithium: An element in the alkali metals family. It has the atomic symbol Li, atomic number 3, and atomic weight 6.94. Salts of lithium are used in treating manic-depressive disorders. [NIH]

Liver: A large, glandular organ located in the upper abdomen. The liver cleanses the blood and aids in digestion by secreting bile. [NIH] Localized: Cancer which has not metastasized yet. [NIH] Lymphatic: The tissues and organs, including the bone marrow, spleen, thymus, and lymph nodes, that produce and store cells that fight infection and disease. [NIH] Lymphocytes: White blood cells formed in the body's lymphoid tissue. The nucleus is round or ovoid with coarse, irregularly clumped chromatin while the cytoplasm is typically pale blue with azurophilic (if any) granules. Most lymphocytes can be classified as either T or B (with subpopulations of each); those with characteristics of neither major class are called null cells. [NIH] Manic: Affected with mania. [EU] Manic-depressive psychosis: One of a group of psychotic reactions, fundamentally marked by severe mood swings and a tendency to remission and recurrence. [NIH] Matrix metalloproteinase: A member of a group of enzymes that can break down proteins, such as collagen, that are normally found in the spaces between cells in tissues (i.e., extracellular matrix proteins). Because these enzymes need zinc or calcium atoms to work properly, they are called metalloproteinases. Matrix metalloproteinases are involved in wound healing, angiogenesis, and tumor cell metastasis. [NIH] Mechanical ventilation: Use of a machine called a ventilator or respirator to improve the exchange of air between the lungs and the atmosphere. [NIH] MEDLINE: An online database of MEDLARS, the computerized bibliographic Medical Literature Analysis and Retrieval System of the National Library of Medicine. [NIH] Medullary: Pertaining to the marrow or to any medulla; resembling marrow. [EU] Membrane: A very thin layer of tissue that covers a surface. [NIH] Memory: Complex mental function having four distinct phases: (1) memorizing or learning, (2) retention, (3) recall, and (4) recognition. Clinically, it is usually subdivided into

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immediate, recent, and remote memory. [NIH] Meninges: The three membranes that cover and protect the brain and spinal cord. [NIH] Mental: Pertaining to the mind; psychic. 2. (L. mentum chin) pertaining to the chin. [EU] Mental Disorders: Psychiatric illness or diseases manifested by breakdowns in the adaptational process expressed primarily as abnormalities of thought, feeling, and behavior producing either distress or impairment of function. [NIH] Mental Health: The state wherein the person is well adjusted. [NIH] Mental Processes: Conceptual functions or thinking in all its forms. [NIH] Metabolite: Any substance produced by metabolism or by a metabolic process. [EU] Metastasis: The spread of cancer from one part of the body to another. Tumors formed from cells that have spread are called "secondary tumors" and contain cells that are like those in the original (primary) tumor. The plural is metastases. [NIH] Microbe: An organism which cannot be observed with the naked eye; e. g. unicellular animals, lower algae, lower fungi, bacteria. [NIH] Microsomal: Of or pertaining to microsomes : vesicular fragments of endoplasmic reticulum formed after disruption and centrifugation of cells. [EU] Mitochondrial Swelling: Increase in volume of mitochondria due to an influx of fluid; it occurs in hypotonic solutions due to osmotic pressure and in isotonic solutions as a result of altered permeability of the membranes of respiring mitochondria. [NIH] Modeling: A treatment procedure whereby the therapist presents the target behavior which the learner is to imitate and make part of his repertoire. [NIH] Modification: A change in an organism, or in a process in an organism, that is acquired from its own activity or environment. [NIH] Molecular: Of, pertaining to, or composed of molecules : a very small mass of matter. [EU] Molecular Structure: The location of the atoms, groups or ions relative to one another in a molecule, as well as the number, type and location of covalent bonds. [NIH] Molecule: A chemical made up of two or more atoms. The atoms in a molecule can be the same (an oxygen molecule has two oxygen atoms) or different (a water molecule has two hydrogen atoms and one oxygen atom). Biological molecules, such as proteins and DNA, can be made up of many thousands of atoms. [NIH] Monoamine: Enzyme that breaks down dopamine in the astrocytes and microglia. [NIH] Monoclonal: An antibody produced by culturing a single type of cell. It therefore consists of a single species of immunoglobulin molecules. [NIH] Monoclonal antibodies: Laboratory-produced substances that can locate and bind to cancer cells wherever they are in the body. Many monoclonal antibodies are used in cancer detection or therapy; each one recognizes a different protein on certain cancer cells. Monoclonal antibodies can be used alone, or they can be used to deliver drugs, toxins, or radioactive material directly to a tumor. [NIH] Morphine: The principal alkaloid in opium and the prototype opiate analgesic and narcotic. Morphine has widespread effects in the central nervous system and on smooth muscle. [NIH] Motor Activity: The physical activity of an organism as a behavioral phenomenon. [NIH] Muscle relaxant: An agent that specifically aids in reducing muscle tension, as those acting at the polysynaptic neurons of motor nerves (e.g. meprobamate) or at the myoneural junction (curare and related compounds). [EU] Muscle Spindles: Mechanoreceptors found between skeletal muscle fibers. Muscle spindles

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are arranged in parallel with muscle fibers and respond to the passive stretch of the muscle, but cease to discharge if the muscle contracts isotonically, thus signaling muscle length. The muscle spindles are the receptors responsible for the stretch or myotactic reflex. [NIH] Myocardial infarction: Gross necrosis of the myocardium as a result of interruption of the blood supply to the area; it is almost always caused by atherosclerosis of the coronary arteries, upon which coronary thrombosis is usually superimposed. [NIH] Myocardial Ischemia: A disorder of cardiac function caused by insufficient blood flow to the muscle tissue of the heart. The decreased blood flow may be due to narrowing of the coronary arteries (coronary arteriosclerosis), to obstruction by a thrombus (coronary thrombosis), or less commonly, to diffuse narrowing of arterioles and other small vessels within the heart. Severe interruption of the blood supply to the myocardial tissue may result in necrosis of cardiac muscle (myocardial infarction). [NIH] Myocardium: The muscle tissue of the heart composed of striated, involuntary muscle known as cardiac muscle. [NIH] Narcolepsy: A condition of unknown cause characterized by a periodic uncontrollable tendency to fall asleep. [NIH] Narcosis: A general and nonspecific reversible depression of neuronal excitability, produced by a number of physical and chemical aspects, usually resulting in stupor. [NIH] Narcotic: 1. Pertaining to or producing narcosis. 2. An agent that produces insensibility or stupor, applied especially to the opioids, i.e. to any natural or synthetic drug that has morphine-like actions. [EU] Nausea: An unpleasant sensation in the stomach usually accompanied by the urge to vomit. Common causes are early pregnancy, sea and motion sickness, emotional stress, intense pain, food poisoning, and various enteroviruses. [NIH] Necrosis: A pathological process caused by the progressive degradative action of enzymes that is generally associated with severe cellular trauma. It is characterized by mitochondrial swelling, nuclear flocculation, uncontrolled cell lysis, and ultimately cell death. [NIH] Nephrology: A subspecialty of internal medicine concerned with the anatomy, physiology, and pathology of the kidney. [NIH] Nephropathy: Disease of the kidneys. [EU] Nervous System: The entire nerve apparatus composed of the brain, spinal cord, nerves and ganglia. [NIH] Neural: 1. Pertaining to a nerve or to the nerves. 2. Situated in the region of the spinal axis, as the neutral arch. [EU] Neurologic: Having to do with nerves or the nervous system. [NIH] Neurons: The basic cellular units of nervous tissue. Each neuron consists of a body, an axon, and dendrites. Their purpose is to receive, conduct, and transmit impulses in the nervous system. [NIH] Neuropathy: A problem in any part of the nervous system except the brain and spinal cord. Neuropathies can be caused by infection, toxic substances, or disease. [NIH] Neuropharmacology: The branch of pharmacology dealing especially with the action of drugs upon various parts of the nervous system. [NIH] Neurotoxicity: The tendency of some treatments to cause damage to the nervous system. [NIH]

Nuclear: A test of the structure, blood flow, and function of the kidneys. The doctor injects a mildly radioactive solution into an arm vein and uses x-rays to monitor its progress through

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the kidneys. [NIH] Osmolality: The concentration of osmotically active particles in solution expressed in terms of osmoles of solute per kilogram of solvent. The osmolality is directly proportional to the colligative properties of solutions; osmotic pressure, boiling point elevation, freezing point depression, and vapour pressure lowering. [EU] Osmoles: The standard unit of osmotic pressure. [NIH] Osmotic: Pertaining to or of the nature of osmosis (= the passage of pure solvent from a solution of lesser to one of greater solute concentration when the two solutions are separated by a membrane which selectively prevents the passage of solute molecules, but is permeable to the solvent). [EU] Osteodystrophy: Defective bone formation. [EU] Overdosage: 1. The administration of an excessive dose. 2. The condition resulting from an excessive dose. [EU] Oxycodone: Semisynthetic derivative of codeine that acts as a narcotic analgesic more potent and addicting than codeine. [NIH] Paediatric: Of or relating to the care and medical treatment of children; belonging to or concerned with paediatrics. [EU] Palliative: 1. Affording relief, but not cure. 2. An alleviating medicine. [EU] Pancreas: A mixed exocrine and endocrine gland situated transversely across the posterior abdominal wall in the epigastric and hypochondriac regions. The endocrine portion is comprised of the Islets of Langerhans, while the exocrine portion is a compound acinar gland that secretes digestive enzymes. [NIH] Paroxysmal: Recurring in paroxysms (= spasms or seizures). [EU] Pathologic: 1. Indicative of or caused by a morbid condition. 2. Pertaining to pathology (= branch of medicine that treats the essential nature of the disease, especially the structural and functional changes in tissues and organs of the body caused by the disease). [EU] Peptide: Any compound consisting of two or more amino acids, the building blocks of proteins. Peptides are combined to make proteins. [NIH] Perception: The ability quickly and accurately to recognize similarities and differences among presented objects, whether these be pairs of words, pairs of number series, or multiple sets of these or other symbols such as geometric figures. [NIH] Periodicity: The tendency of a phenomenon to recur at regular intervals; in biological systems, the recurrence of certain activities (including hormonal, cellular, neural) may be annual, seasonal, monthly, daily, or more frequently (ultradian). [NIH] Peritoneal: Having to do with the peritoneum (the tissue that lines the abdominal wall and covers most of the organs in the abdomen). [NIH] Peritoneal Cavity: The space enclosed by the peritoneum. It is divided into two portions, the greater sac and the lesser sac or omental bursa, which lies behind the stomach. The two sacs are connected by the foramen of Winslow, or epiploic foramen. [NIH] Peritoneal Dialysis: Dialysis fluid being introduced into and removed from the peritoneal cavity as either a continuous or an intermittent procedure. [NIH] Peritoneum: Endothelial lining of the abdominal cavity, the parietal peritoneum covering the inside of the abdominal wall and the visceral peritoneum covering the bowel, the mesentery, and certain of the organs. The portion that covers the bowel becomes the serosal layer of the bowel wall. [NIH] Pharmacodynamic: Is concerned with the response of living tissues to chemical stimuli, that

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is, the action of drugs on the living organism in the absence of disease. [NIH] Pharmacokinetic: The mathematical analysis of the time courses of absorption, distribution, and elimination of drugs. [NIH] Pharmacologic: Pertaining to pharmacology or to the properties and reactions of drugs. [EU] Phencyclidine: A hallucinogen formerly used as a veterinary anesthetic, and briefly as a general anesthetic for humans. Phencyclidine is similar to ketamine in structure and in many of its effects. Like ketamine, it can produce a dissociative state. It exerts its pharmacological action through inhibition of NMDA receptors (receptors, N-methyl-Daspartate). As a drug of abuse, it is known as PCP and Angel Dust. [NIH] Phenobarbital: A barbituric acid derivative that acts as a nonselective central nervous system depressant. It promotes binding to inhibitory GABA subtype receptors, and modulates chloride currents through receptor channels. It also inhibits glutamate induced depolarizations. [NIH] Phenytoin: An anticonvulsant that is used in a wide variety of seizures. It is also an antiarrhythmic and a muscle relaxant. The mechanism of therapeutic action is not clear, although several cellular actions have been described including effects on ion channels, active transport, and general membrane stabilization. The mechanism of its muscle relaxant effect appears to involve a reduction in the sensitivity of muscle spindles to stretch. Phenytoin has been proposed for several other therapeutic uses, but its use has been limited by its many adverse effects and interactions with other drugs. [NIH] Physiology: The science that deals with the life processes and functions of organismus, their cells, tissues, and organs. [NIH] Physostigmine: A cholinesterase inhibitor that is rapidly absorbed through membranes. It can be applied topically to the conjunctiva. It also can cross the blood-brain barrier and is used when central nervous system effects are desired, as in the treatment of severe anticholinergic toxicity. [NIH] Pilot study: The initial study examining a new method or treatment. [NIH] Plants: Multicellular, eukaryotic life forms of the kingdom Plantae. They are characterized by a mainly photosynthetic mode of nutrition; essentially unlimited growth at localized regions of cell divisions (meristems); cellulose within cells providing rigidity; the absence of organs of locomotion; absense of nervous and sensory systems; and an alteration of haploid and diploid generations. [NIH] Plasma: The clear, yellowish, fluid part of the blood that carries the blood cells. The proteins that form blood clots are in plasma. [NIH] Pneumonia: Inflammation of the lungs. [NIH] Poisoning: A condition or physical state produced by the ingestion, injection or inhalation of, or exposure to a deleterious agent. [NIH] Polysaccharide: A type of carbohydrate. It contains sugar molecules that are linked together chemically. [NIH] Posterior: Situated in back of, or in the back part of, or affecting the back or dorsal surface of the body. In lower animals, it refers to the caudal end of the body. [EU] Postural: Pertaining to posture or position. [EU] Potassium: An element that is in the alkali group of metals. It has an atomic symbol K, atomic number 19, and atomic weight 39.10. It is the chief cation in the intracellular fluid of muscle and other cells. Potassium ion is a strong electrolyte and it plays a significant role in the regulation of fluid volume and maintenance of the water-electrolyte balance. [NIH]

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Practice Guidelines: Directions or principles presenting current or future rules of policy for the health care practitioner to assist him in patient care decisions regarding diagnosis, therapy, or related clinical circumstances. The guidelines may be developed by government agencies at any level, institutions, professional societies, governing boards, or by the convening of expert panels. The guidelines form a basis for the evaluation of all aspects of health care and delivery. [NIH] Presumed Consent: An institutional policy of granting authority to health personnel to perform procedures on patients or to remove organs from cadavers for transplantation unless an objection is registered by family members or by the patient prior to death. This also includes emergency care of minors without prior parental consent. [NIH] Progressive: Advancing; going forward; going from bad to worse; increasing in scope or severity. [EU] Prone: Having the front portion of the body downwards. [NIH] Prone Position: The posture of an individual lying face down. [NIH] Prostaglandin: Any of a group of components derived from unsaturated 20-carbon fatty acids, primarily arachidonic acid, via the cyclooxygenase pathway that are extremely potent mediators of a diverse group of physiologic processes. The abbreviation for prostaglandin is PG; specific compounds are designated by adding one of the letters A through I to indicate the type of substituents found on the hydrocarbon skeleton and a subscript (1, 2 or 3) to indicate the number of double bonds in the hydrocarbon skeleton e.g., PGE2. The predominant naturally occurring prostaglandins all have two double bonds and are synthesized from arachidonic acid (5,8,11,14-eicosatetraenoic acid) by the pathway shown in the illustration. The 1 series and 3 series are produced by the same pathway with fatty acids having one fewer double bond (8,11,14-eicosatrienoic acid or one more double bond (5,8,11,14,17-eicosapentaenoic acid) than arachidonic acid. The subscript a or ß indicates the configuration at C-9 (a denotes a substituent below the plane of the ring, ß, above the plane). The naturally occurring PGF's have the a configuration, e.g., PGF2a. All of the prostaglandins act by binding to specific cell-surface receptors causing an increase in the level of the intracellular second messenger cyclic AMP (and in some cases cyclic GMP also). The effect produced by the cyclic AMP increase depends on the specific cell type. In some cases there is also a positive feedback effect. Increased cyclic AMP increases prostaglandin synthesis leading to further increases in cyclic AMP. [EU] Protein Binding: The process in which substances, either endogenous or exogenous, bind to proteins, peptides, enzymes, protein precursors, or allied compounds. Specific proteinbinding measures are often used as assays in diagnostic assessments. [NIH] Protein S: The vitamin K-dependent cofactor of activated protein C. Together with protein C, it inhibits the action of factors VIIIa and Va. A deficiency in protein S can lead to recurrent venous and arterial thrombosis. [NIH] Proteins: Polymers of amino acids linked by peptide bonds. The specific sequence of amino acids determines the shape and function of the protein. [NIH] Protocol: The detailed plan for a clinical trial that states the trial's rationale, purpose, drug or vaccine dosages, length of study, routes of administration, who may participate, and other aspects of trial design. [NIH] Psychiatry: The medical science that deals with the origin, diagnosis, prevention, and treatment of mental disorders. [NIH] Psychic: Pertaining to the psyche or to the mind; mental. [EU] Psychoactive: Those drugs which alter sensation, mood, consciousness or other psychological or behavioral functions. [NIH]

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Psychology: The science dealing with the study of mental processes and behavior in man and animals. [NIH] Psychosis: A mental disorder characterized by gross impairment in reality testing as evidenced by delusions, hallucinations, markedly incoherent speech, or disorganized and agitated behaviour without apparent awareness on the part of the patient of the incomprehensibility of his behaviour; the term is also used in a more general sense to refer to mental disorders in which mental functioning is sufficiently impaired as to interfere grossly with the patient's capacity to meet the ordinary demands of life. Historically, the term has been applied to many conditions, e.g. manic-depressive psychosis, that were first described in psychotic patients, although many patients with the disorder are not judged psychotic. [EU] Psychotomimetic: Psychosis miming. [NIH] Psychotropic: Exerting an effect upon the mind; capable of modifying mental activity; usually applied to drugs that effect the mental state. [EU] Public Health: Branch of medicine concerned with the prevention and control of disease and disability, and the promotion of physical and mental health of the population on the international, national, state, or municipal level. [NIH] Public Policy: A course or method of action selected, usually by a government, from among alternatives to guide and determine present and future decisions. [NIH] Publishing: "The business or profession of the commercial production and issuance of literature" (Webster's 3d). It includes the publisher, publication processes, editing and editors. Production may be by conventional printing methods or by electronic publishing. [NIH]

Pulmonary: Relating to the lungs. [NIH] Pulmonary Artery: The short wide vessel arising from the conus arteriosus of the right ventricle and conveying unaerated blood to the lungs. [NIH] Pulmonary Edema: An accumulation of an excessive amount of watery fluid in the lungs, may be caused by acute exposure to dangerous concentrations of irritant gasses. [NIH] Pulmonary Ventilation: The total volume of gas per minute inspired or expired measured in liters per minute. [NIH] Purpura: Purplish or brownish red discoloration, easily visible through the epidermis, caused by hemorrhage into the tissues. [NIH] Quality of Life: A generic concept reflecting concern with the modification and enhancement of life attributes, e.g., physical, political, moral and social environment. [NIH] Radiation: Emission or propagation of electromagnetic energy (waves/rays), or the waves/rays themselves; a stream of electromagnetic particles (electrons, neutrons, protons, alpha particles) or a mixture of these. The most common source is the sun. [NIH] Radioactive: Giving off radiation. [NIH] Radiological: Pertaining to radiodiagnostic and radiotherapeutic procedures, and interventional radiology or other planning and guiding medical radiology. [NIH] Radiology: A specialty concerned with the use of x-ray and other forms of radiant energy in the diagnosis and treatment of disease. [NIH] Randomized: Describes an experiment or clinical trial in which animal or human subjects are assigned by chance to separate groups that compare different treatments. [NIH] Reality Testing: The individual's objective evaluation of the external world and the ability to differentiate adequately between it and the internal world; considered to be a primary ego

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function. [NIH] Receptor: A molecule inside or on the surface of a cell that binds to a specific substance and causes a specific physiologic effect in the cell. [NIH] Recombinant: A cell or an individual with a new combination of genes not found together in either parent; usually applied to linked genes. [EU] Rectum: The last 8 to 10 inches of the large intestine. [NIH] Recur: To occur again. Recurrence is the return of cancer, at the same site as the original (primary) tumor or in another location, after the tumor had disappeared. [NIH] Recurrence: The return of a sign, symptom, or disease after a remission. [NIH] Refer: To send or direct for treatment, aid, information, de decision. [NIH] Regeneration: The natural renewal of a structure, as of a lost tissue or part. [EU] Regimen: A treatment plan that specifies the dosage, the schedule, and the duration of treatment. [NIH] Renal failure: Progressive renal insufficiency and uremia, due to irreversible and progressive renal glomerular tubular or interstitial disease. [NIH] Renal Replacement Therapy: Procedures which temporarily or permanently remedy insufficient cleansing of body fluids by the kidneys. [NIH] Respirator: A mechanical device that helps a patient breathe; a mechanical ventilator. [NIH] Respiratory failure: Inability of the lungs to conduct gas exchange. [NIH] Respiratory Physiology: Functions and activities of the respiratory tract as a whole or of any of its parts. [NIH] Risk factor: A habit, trait, condition, or genetic alteration that increases a person's chance of developing a disease. [NIH] Salicylate: Non-steroidal anti-inflammatory drugs. [NIH] Salicylic: A tuberculosis drug. [NIH] Salicylic Acids: Derivatives and salts of salicylic acid. [NIH] Salicylism: A group of commonly occurring toxic effects of excessive dosage with salicylic acid or its salts, usually marked by tinnitus, nausea, and vomiting. [EU] Schizoid: Having qualities resembling those found in greater degree in schizophrenics; a person of schizoid personality. [NIH] Schizophrenia: A mental disorder characterized by a special type of disintegration of the personality. [NIH] Schizotypal Personality Disorder: A personality disorder in which there are oddities of thought (magical thinking, paranoid ideation, suspiciousness), perception (illusions, depersonalization), speech (digressive, vague, overelaborate), and behavior (inappropriate affect in social interactions, frequently social isolation) that are not severe enough to characterize schizophrenia. [NIH] Screening: Checking for disease when there are no symptoms. [NIH] Secretion: 1. The process of elaborating a specific product as a result of the activity of a gland; this activity may range from separating a specific substance of the blood to the elaboration of a new chemical substance. 2. Any substance produced by secretion. [EU] Sedative: 1. Allaying activity and excitement. 2. An agent that allays excitement. [EU] Segregation: The separation in meiotic cell division of homologous chromosome pairs and their contained allelomorphic gene pairs. [NIH]

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Seizures: Clinical or subclinical disturbances of cortical function due to a sudden, abnormal, excessive, and disorganized discharge of brain cells. Clinical manifestations include abnormal motor, sensory and psychic phenomena. Recurrent seizures are usually referred to as epilepsy or "seizure disorder." [NIH] Sepsis: The presence of bacteria in the bloodstream. [NIH] Serum: The clear liquid part of the blood that remains after blood cells and clotting proteins have been removed. [NIH] Shock: The general bodily disturbance following a severe injury; an emotional or moral upset occasioned by some disturbing or unexpected experience; disruption of the circulation, which can upset all body functions: sometimes referred to as circulatory shock. [NIH]

Side effect: A consequence other than the one(s) for which an agent or measure is used, as the adverse effects produced by a drug, especially on a tissue or organ system other than the one sought to be benefited by its administration. [EU] Skeletal: Having to do with the skeleton (boney part of the body). [NIH] Skull: The skeleton of the head including the bones of the face and the bones enclosing the brain. [NIH] Smooth muscle: Muscle that performs automatic tasks, such as constricting blood vessels. [NIH]

Social Environment: The aggregate of social and cultural institutions, forms, patterns, and processes that influence the life of an individual or community. [NIH] Sodium: An element that is a member of the alkali group of metals. It has the atomic symbol Na, atomic number 11, and atomic weight 23. With a valence of 1, it has a strong affinity for oxygen and other nonmetallic elements. Sodium provides the chief cation of the extracellular body fluids. Its salts are the most widely used in medicine. (From Dorland, 27th ed) Physiologically the sodium ion plays a major role in blood pressure regulation, maintenance of fluid volume, and electrolyte balance. [NIH] Soft tissue: Refers to muscle, fat, fibrous tissue, blood vessels, or other supporting tissue of the body. [NIH] Solvent: 1. Dissolving; effecting a solution. 2. A liquid that dissolves or that is capable of dissolving; the component of a solution that is present in greater amount. [EU] Spasm: An involuntary contraction of a muscle or group of muscles. Spasms may involve skeletal muscle or smooth muscle. [NIH] Specialist: In medicine, one who concentrates on 1 special branch of medical science. [NIH] Species: A taxonomic category subordinate to a genus (or subgenus) and superior to a subspecies or variety, composed of individuals possessing common characters distinguishing them from other categories of individuals of the same taxonomic level. In taxonomic nomenclature, species are designated by the genus name followed by a Latin or Latinized adjective or noun. [EU] Specificity: Degree of selectivity shown by an antibody with respect to the number and types of antigens with which the antibody combines, as well as with respect to the rates and the extents of these reactions. [NIH] Spinal cord: The main trunk or bundle of nerves running down the spine through holes in the spinal bone (the vertebrae) from the brain to the level of the lower back. [NIH] Spleen: An organ that is part of the lymphatic system. The spleen produces lymphocytes, filters the blood, stores blood cells, and destroys old blood cells. It is located on the left side of the abdomen near the stomach. [NIH]

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Stabilization: The creation of a stable state. [EU] Stem Cells: Relatively undifferentiated cells of the same lineage (family type) that retain the ability to divide and cycle throughout postnatal life to provide cells that can become specialized and take the place of those that die or are lost. [NIH] Stimulant: 1. Producing stimulation; especially producing stimulation by causing tension on muscle fibre through the nervous tissue. 2. An agent or remedy that produces stimulation. [EU]

Stomach: An organ of digestion situated in the left upper quadrant of the abdomen between the termination of the esophagus and the beginning of the duodenum. [NIH] Stress: Forcibly exerted influence; pressure. Any condition or situation that causes strain or tension. Stress may be either physical or psychologic, or both. [NIH] Stroke: Sudden loss of function of part of the brain because of loss of blood flow. Stroke may be caused by a clot (thrombosis) or rupture (hemorrhage) of a blood vessel to the brain. [NIH] Stupor: Partial or nearly complete unconsciousness, manifested by the subject's responding only to vigorous stimulation. Also, in psychiatry, a disorder marked by reduced responsiveness. [EU] Subacute: Somewhat acute; between acute and chronic. [EU] Subarachnoid: Situated or occurring between the arachnoid and the pia mater. [EU] Subclinical: Without clinical manifestations; said of the early stage(s) of an infection or other disease or abnormality before symptoms and signs become apparent or detectable by clinical examination or laboratory tests, or of a very mild form of an infection or other disease or abnormality. [EU] Substance P: An eleven-amino acid neurotransmitter that appears in both the central and peripheral nervous systems. It is involved in transmission of pain, causes rapid contractions of the gastrointestinal smooth muscle, and modulates inflammatory and immune responses. [NIH]

Sympathomimetic: 1. Mimicking the effects of impulses conveyed by adrenergic postganglionic fibres of the sympathetic nervous system. 2. An agent that produces effects similar to those of impulses conveyed by adrenergic postganglionic fibres of the sympathetic nervous system. Called also adrenergic. [EU] Symptomatic: Having to do with symptoms, which are signs of a condition or disease. [NIH] Syncope: A temporary suspension of consciousness due to generalized cerebral schemia, a faint or swoon. [EU] Systemic: Affecting the entire body. [NIH] Systolic: Indicating the maximum arterial pressure during contraction of the left ventricle of the heart. [EU] Temporal: One of the two irregular bones forming part of the lateral surfaces and base of the skull, and containing the organs of hearing. [NIH] Testosterone: A hormone that promotes the development and maintenance of male sex characteristics. [NIH] Theophylline: Alkaloid obtained from Thea sinensis (tea) and others. It stimulates the heart and central nervous system, dilates bronchi and blood vessels, and causes diuresis. The drug is used mainly in bronchial asthma and for myocardial stimulation. Among its more prominent cellular effects are inhibition of cyclic nucleotide phosphodiesterases and antagonism of adenosine receptors. [NIH] Therapeutics: The branch of medicine which is concerned with the treatment of diseases,

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palliative or curative. [NIH] Thermal: Pertaining to or characterized by heat. [EU] Threshold: For a specified sensory modality (e. g. light, sound, vibration), the lowest level (absolute threshold) or smallest difference (difference threshold, difference limen) or intensity of the stimulus discernible in prescribed conditions of stimulation. [NIH] Thrombosis: The formation or presence of a blood clot inside a blood vessel. [NIH] Thyroid: A gland located near the windpipe (trachea) that produces thyroid hormone, which helps regulate growth and metabolism. [NIH] Thyroid Gland: A highly vascular endocrine gland consisting of two lobes, one on either side of the trachea, joined by a narrow isthmus; it produces the thyroid hormones which are concerned in regulating the metabolic rate of the body. [NIH] Thyroid Hormones: Hormones secreted by the thyroid gland. [NIH] Thyroxine: An amino acid of the thyroid gland which exerts a stimulating effect on thyroid metabolism. [NIH] Tidal Volume: The volume of air inspired or expired during each normal, quiet respiratory cycle. Common abbreviations are TV or V with subscript T. [NIH] Tinnitus: Sounds that are perceived in the absence of any external noise source which may take the form of buzzing, ringing, clicking, pulsations, and other noises. Objective tinnitus refers to noises generated from within the ear or adjacent structures that can be heard by other individuals. The term subjective tinnitus is used when the sound is audible only to the affected individual. Tinnitus may occur as a manifestation of cochlear diseases; vestibulocochlear nerve diseases; intracranial hypertension; craniocerebral trauma; and other conditions. [NIH] Tissue: A group or layer of cells that are alike in type and work together to perform a specific function. [NIH] Topical: On the surface of the body. [NIH] Toxic: Having to do with poison or something harmful to the body. Toxic substances usually cause unwanted side effects. [NIH] Toxicity: The quality of being poisonous, especially the degree of virulence of a toxic microbe or of a poison. [EU] Toxicology: The science concerned with the detection, chemical composition, and pharmacologic action of toxic substances or poisons and the treatment and prevention of toxic manifestations. [NIH] Toxins: Specific, characterizable, poisonous chemicals, often proteins, with specific biological properties, including immunogenicity, produced by microbes, higher plants, or animals. [NIH] Trachea: The cartilaginous and membranous tube descending from the larynx and branching into the right and left main bronchi. [NIH] Transfection: The uptake of naked or purified DNA into cells, usually eukaryotic. It is analogous to bacterial transformation. [NIH] Transplantation: Transference of a tissue or organ, alive or dead, within an individual, between individuals of the same species, or between individuals of different species. [NIH] Trauma: Any injury, wound, or shock, must frequently physical or structural shock, producing a disturbance. [NIH] Tricyclic: Containing three fused rings or closed chains in the molecular structure. [EU]

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Drug Overdose

Trigger zone: Dolorogenic zone (= producing or causing pain). [EU] Ultrafiltration: The separation of particles from a suspension by passage through a filter with very fine pores. In ultrafiltration the separation is accomplished by convective transport; in dialysis separation relies instead upon differential diffusion. Ultrafiltration occurs naturally and is a laboratory procedure. Artificial ultrafiltration of the blood is referred to as hemofiltration or hemodiafiltration (if combined with hemodialysis). [NIH] Unconscious: Experience which was once conscious, but was subsequently rejected, as the "personal unconscious". [NIH] Urea: A compound (CO(NH2)2), formed in the liver from ammonia produced by the deamination of amino acids. It is the principal end product of protein catabolism and constitutes about one half of the total urinary solids. [NIH] Uremia: The illness associated with the buildup of urea in the blood because the kidneys are not working effectively. Symptoms include nausea, vomiting, loss of appetite, weakness, and mental confusion. [NIH] Urticaria: A vascular reaction of the skin characterized by erythema and wheal formation due to localized increase of vascular permeability. The causative mechanism may be allergy, infection, or stress. [NIH] Vaccine: A substance or group of substances meant to cause the immune system to respond to a tumor or to microorganisms, such as bacteria or viruses. [NIH] Valerian: Valeriana officinale, an ancient, sedative herb of the large family Valerianaceae. The roots were formerly used to treat hysterias and other neurotic states and are presently used to treat sleep disorders. [NIH] Vascular: Pertaining to blood vessels or indicative of a copious blood supply. [EU] Vein: Vessel-carrying blood from various parts of the body to the heart. [NIH] Ventilation: 1. In respiratory physiology, the process of exchange of air between the lungs and the ambient air. Pulmonary ventilation (usually measured in litres per minute) refers to the total exchange, whereas alveolar ventilation refers to the effective ventilation of the alveoli, in which gas exchange with the blood takes place. 2. In psychiatry, verbalization of one's emotional problems. [EU] Ventricles: Fluid-filled cavities in the heart or brain. [NIH] Vesicular: 1. Composed of or relating to small, saclike bodies. 2. Pertaining to or made up of vesicles on the skin. [EU] Veterinary Medicine: The medical science concerned with the prevention, diagnosis, and treatment of diseases in animals. [NIH] Virulence: The degree of pathogenicity within a group or species of microorganisms or viruses as indicated by case fatality rates and/or the ability of the organism to invade the tissues of the host. [NIH] Viscera: Any of the large interior organs in any one of the three great cavities of the body, especially in the abdomen. [NIH] White blood cell: A type of cell in the immune system that helps the body fight infection and disease. White blood cells include lymphocytes, granulocytes, macrophages, and others. [NIH]

Windpipe: A rigid tube, 10 cm long, extending from the cricoid cartilage to the upper border of the fifth thoracic vertebra. [NIH] Withdrawal: 1. A pathological retreat from interpersonal contact and social involvement, as may occur in schizophrenia, depression, or schizoid avoidant and schizotypal personality

Dictionary 105

disorders. 2. (DSM III-R) A substance-specific organic brain syndrome that follows the cessation of use or reduction in intake of a psychoactive substance that had been regularly used to induce a state of intoxication. [EU] Wound Healing: Restoration of integrity to traumatized tissue. [NIH]

107

INDEX A Abdominal, 77, 96 Acetaminophen, 3, 32, 77 Acidosis, 45, 77 Acute renal, 3, 38, 39, 45, 77 Acute tubular, 4, 77 Adenosine, 77, 102 Adjustment, 8, 77 Adrenal Glands, 77, 78 Adrenal insufficiency, 4, 44, 77 Adverse Effect, 16, 47, 77, 97, 101 Affinity, 6, 77, 86, 93, 101 Agarose, 77, 90 Airway, 4, 44, 77, 78 Airway Obstruction, 4, 44, 78 Albumin, 78, 90 Algorithms, 78, 81 Alkaline, 77, 78, 81 Alkaloid, 78, 83, 87, 94, 102 Alternative medicine, 50, 78 Alveoli, 78, 104 Amenorrhea, 78, 79 Amphetamine, 78, 86 Amyloidosis, 44, 78 Anabolic, 46, 78 Anabolic Steroids, 46, 78 Anaesthesia, 21, 22, 27, 28, 29, 30, 78, 91 Analgesic, 77, 78, 83, 93, 94, 96 Analog, 78, 86 Anaphylactic, 4, 78 Anaphylaxis, 78 Anemia, 44, 79 Anesthesia, 16, 21, 77, 79, 93 Anesthetics, 79, 80 Angina, 4, 44, 46, 79 Angina Pectoris, 4, 44, 46, 79 Angioedema, 79 Angioneurotic, 4, 79 Angioneurotic Edema, 4, 79 Anorexia, 38, 79 Anorexia Nervosa, 38, 79 Antagonism, 79, 102 Antibodies, 79, 90, 94 Antibody, 6, 77, 79, 80, 84, 90, 91, 92, 94, 101 Antibody Affinity, 6, 79 Anticholinergic, 79, 97 Anticonvulsant, 11, 47, 79, 81, 97

Antidote, 79, 89 Antigen, 6, 77, 78, 79, 80, 84, 91, 92 Anti-inflammatory, 20, 77, 80, 100 Antipyretic, 77, 80 Antitussive, 80, 86 Aphasia, 10, 80 Applicability, 28, 80 Aqueous, 80 Arterial, 14, 80, 91, 98, 102 Arteries, 80, 81, 85, 95 Artery, 80, 85 Aspartate, 80, 86, 93, 97 Aspiration, 7, 80 Assay, 47, 80 Asymptomatic, 46, 80 Autopsy, 24, 80 Avidity, 79, 80 Azotemia, 4, 80 B Bacteria, 80, 94, 101, 104 Bactericidal, 80, 88 Barbiturate, 11, 46, 80 Base, 5, 44, 80, 93, 102 Benzodiazepines, 80, 89 Bile, 80, 93 Bioavailability, 47, 81 Biotechnology, 9, 10, 50, 61, 81 Bladder, 81, 85 Blood pressure, 43, 44, 77, 81, 82, 83, 91, 101 Blood vessel, 81, 82, 101, 102, 103, 104 Blood-Brain Barrier, 81, 97 Body Fluids, 14, 81, 100, 101 Bone Marrow, 5, 81, 88, 93 Bowel, 32, 81, 92, 96 Bronchi, 81, 102, 103 Bronchial, 4, 81, 102 Bulimia, 46, 81 C Cadaver, 4, 44, 81 Calcium, 13, 81, 84, 93 Cannabis, 46, 81 Carbamazepine, 47, 81 Carbon Dioxide, 82, 89, 91 Cardiac, 5, 13, 23, 44, 46, 82, 87, 89, 90, 95 Cardiac arrest, 5, 44, 46, 82 Cardiopulmonary, 44, 82 Cardiopulmonary Resuscitation, 44, 82

108

Drug Overdose

Cardiorespiratory, 14, 82 Cardiovascular, 44, 78, 82 Cardiovascular disease, 44, 82 Case report, 3, 82, 83 Case series, 82, 83 Castor Oil, 30, 82 Cell, 77, 80, 81, 82, 83, 84, 86, 88, 92, 93, 94, 95, 97, 98, 100, 104 Cell Division, 80, 82, 97, 100 Central Nervous System, 4, 7, 30, 78, 82, 83, 86, 94, 97, 102 Centrifugation, 82, 94 Cerebral, 46, 81, 82, 83, 85, 102 Cerebrospinal, 14, 15, 82 Cerebrospinal fluid, 14, 15, 82 Cerebrovascular, 4, 44, 82 Cerebrum, 82 Character, 79, 83 Chemical Warfare, 83, 86 Chemical Warfare Agents, 83, 86 Chemoreceptor, 83, 92 Chest Pain, 44, 83 Chlorprothixene, 14, 83 Chromosome, 83, 100 Chronic, 3, 30, 39, 83, 92, 93, 102 Clinical study, 32, 83 Clinical trial, 5, 7, 61, 83, 85, 87, 98, 99 Cloning, 81, 83 Coagulation, 81, 83, 90 Coca, 83 Cocaethylene, 8, 83 Cocaine, 8, 24, 28, 83 Codeine, 83, 86, 96 Colitis, 20, 83 Collagen, 83, 88, 93 Colon, 83, 84 Comatose, 15, 84 Communis, 82, 84 Comorbidity, 8, 84 Complement, 84 Complementary and alternative medicine, 37, 41, 84 Complementary medicine, 37, 84 Compliance, 47, 85 Computational Biology, 61, 85 Concomitant, 8, 85 Confusion, 85, 104 Congestion, 85, 88 Conjugated, 85, 90 Conjunctiva, 85, 97 Connective Tissue, 81, 84, 85 Consciousness, 23, 44, 78, 85, 87, 98, 102

Contraindications, ii, 85 Controlled study, 20, 85 Convulsions, 4, 79, 80, 85 Convulsive, 46, 85 Coronary, 79, 82, 85, 95 Coronary Circulation, 79, 85 Coronary heart disease, 82, 85 Coronary Thrombosis, 85, 95 Cortex, 85 Cortical, 46, 85, 101 Curative, 85, 103 Cyclic, 86, 98, 102 Cytokine, 7, 86 Cytotoxic, 14, 86 D Decontamination, 32, 38, 86 Deferoxamine, 38, 86 Delusions, 86, 99 Depressive Disorder, 86, 93 Dextroamphetamine, 8, 78, 86 Dextromethorphan, 38, 86 Diabetes Mellitus, 44, 86, 89, 90 Diagnostic procedure, 50, 86 Dialyzer, 86, 90 Diastolic, 86, 91 Diffusion, 86, 90, 104 Digestion, 81, 86, 92, 93, 102 Direct, iii, 86, 87, 100 Disinfectant, 86, 88 Disposition, 47, 86 Dissociation, 6, 77, 86, 92 Dissociative Disorders, 86, 87 Diuresis, 87, 102 Dopamine, 78, 83, 86, 87, 94 Double-blind, 32, 87 Drug Interactions, 54, 87 Drug Monitoring, 24, 26, 31, 46, 47, 87 Duodenum, 80, 87, 102 E Edema, 79, 87 Efficacy, 9, 26, 37, 40, 87 Electric shock, 82, 87 Electrocardiography, 30, 87 Electrolyte, 87, 90, 97, 101 Electrons, 80, 87, 92, 99 Embryo, 87, 91 Emesis, 40, 87 Emetic, 40, 87, 92 Emetine, 87, 92 Endogenous, 87, 88, 98 Environmental Health, 60, 62, 88 Enzyme, 88, 90, 94

109

Epigastric, 88, 96 Erythema, 15, 79, 88, 104 Erythrocytes, 79, 81, 88 Erythropoietin, 44, 45, 88 Esophagus, 88, 102 Ethanol, 8, 18, 88 Evacuation, 23, 88 Exocrine, 88, 96 Exogenous, 88, 98 Extracellular, 7, 85, 88, 93, 101 Extracellular Matrix, 85, 88, 93 Extracellular Matrix Proteins, 88, 93 Extracorporeal, 46, 88, 90 F Family Planning, 61, 88 Fat, 81, 85, 88, 93, 101 Fatigue, 88, 90 Fetus, 88 Flatus, 89 Flumazenil, 15, 20, 30, 32, 89 Forearm, 81, 89 Free Radicals, 86, 89 G Gas, 8, 82, 86, 89, 91, 99, 100, 104 Gas exchange, 89, 100, 104 Gastric, 7, 14, 37, 38, 89, 92 Gastric Acid, 7, 89 Gastric Mucosa, 89, 92 Gastrointestinal, 44, 46, 88, 89, 102 Gastrointestinal tract, 88, 89 Gelatinases, 7, 89 Gene, 81, 89, 100 Gland, 89, 96, 100, 103 Glomerular, 89, 100 Glucose, 86, 89, 90, 92 Glucose Intolerance, 86, 89 Glutamate, 86, 89, 97 Glutethimide, 14, 15, 89 Governing Board, 89, 98 H Haematemesis, 87, 89 Haemodialysis, 39, 90 Haemoperfusion, 25, 90 Hallucinogen, 90, 97 Haptens, 77, 90 Heart Arrest, 82, 90 Heart attack, 82, 90 Heart failure, 44, 90 Hemodiafiltration, 90, 104 Hemodialysis, 25, 43, 44, 45, 46, 86, 90, 104 Hemofiltration, 90, 104 Hemoglobin, 79, 88, 90

Hemoperfusion, 12, 20, 21, 45, 46, 90 Hemorrhage, 4, 46, 90, 99, 102 Hemostasis, 46, 90 Hepatic, 4, 78, 87, 90 Heterogeneity, 77, 91 Homeostasis, 44, 91 Homicide, 5, 91 Homologous, 91, 100 Hormonal, 91, 96 Hormone, 88, 91, 92, 102, 103 Hydrogen, 77, 80, 88, 91, 94 Hydrophobic, 79, 91 Hyperglycemia, 46, 91 Hypertension, 43, 82, 91, 103 Hyperventilation, 4, 44, 91 Hypnotic, 80, 89, 91 Hypoglycemia, 46, 91 Hypotension, 4, 44, 46, 85, 91 Hypothermia, 22, 91 I Illusions, 91, 100 Immune response, 80, 90, 91, 102 Immunology, 77, 91 Impairment, 91, 94, 99 Induction, 7, 91, 93 Infarction, 91 Infection, 15, 91, 93, 95, 102, 104 Inflammation, 78, 80, 83, 92, 97 Ingestion, 3, 12, 18, 39, 92, 97 Inhalation, 5, 92, 97 Insight, 18, 92 Insulin, 4, 92 Insulin-dependent diabetes mellitus, 92 Intensive Care, 22, 26, 27, 28, 29, 92 Intermittent, 92, 96 Internal Medicine, 15, 20, 22, 26, 29, 31, 32, 92, 95 Interstitial, 92, 100 Intestine, 81, 87, 91, 92, 100 Intoxication, 92, 105 Intracellular, 92, 97, 98 Intravenous, 39, 92 Intrinsic, 77, 92 Involuntary, 92, 95, 101 Ionization, 8, 92 Ions, 80, 86, 87, 91, 92, 94 Ipecac, 40, 41, 87, 92 Irrigation, 32, 93 K Kb, 60, 93 Ketamine, 93, 97 Kidney Disease, 44, 60, 93

110

Drug Overdose

Kinetic, 44, 93 L Levorphanol, 86, 93 Lipid, 92, 93 Lipophilic, 30, 93 Lithium, 47, 93 Liver, 5, 77, 78, 80, 88, 90, 93, 104 Localized, 78, 79, 92, 93, 97, 104 Lymphatic, 92, 93, 101 Lymphocytes, 80, 93, 101, 104 M Manic, 93, 99 Manic-depressive psychosis, 93, 99 Matrix metalloproteinase, 7, 93 Mechanical ventilation, 7, 93 MEDLINE, 61, 93 Medullary, 86, 93 Membrane, 84, 85, 86, 88, 90, 93, 96, 97 Memory, 79, 93 Meninges, 82, 94 Mental, iv, 5, 9, 60, 62, 85, 86, 88, 93, 94, 98, 99, 100, 104 Mental Disorders, 94, 98, 99 Mental Health, iv, 5, 60, 62, 94, 99 Mental Processes, 86, 94, 99 Metabolite, 8, 94 Metastasis, 93, 94 Microbe, 94, 103 Microsomal, 3, 94 Mitochondrial Swelling, 94, 95 Modeling, 44, 94 Modification, 94, 99 Molecular, 61, 63, 81, 85, 90, 94, 103 Molecular Structure, 94, 103 Molecule, 80, 84, 86, 94, 100 Monoamine, 8, 78, 86, 94 Monoclonal, 6, 94 Monoclonal antibodies, 6, 94 Morphine, 83, 94, 95 Motor Activity, 85, 94 Muscle relaxant, 94, 97 Muscle Spindles, 94, 97 Myocardial infarction, 4, 44, 46, 85, 95 Myocardial Ischemia, 79, 95 Myocardium, 79, 95 N Narcolepsy, 86, 95 Narcosis, 95 Narcotic, 46, 93, 94, 95, 96 Nausea, 95, 100, 104 Necrosis, 4, 91, 95 Nephrology, 3, 39, 44, 46, 95

Nephropathy, 4, 93, 95 Nervous System, 78, 82, 95, 102 Neural, 95, 96 Neurologic, 4, 44, 45, 95 Neurons, 83, 94, 95 Neuropathy, 79, 95 Neuropharmacology, 8, 95 Neurotoxicity, 86, 95 Nuclear, 87, 95 O Osmolality, 28, 96 Osmoles, 96 Osmotic, 78, 94, 96 Osteodystrophy, 44, 96 Oxycodone, 6, 96 P Paediatric, 37, 96 Palliative, 96, 103 Pancreas, 5, 77, 92, 96 Paroxysmal, 79, 96 Pathologic, 77, 85, 96 Peptide, 89, 96, 98 Perception, 96, 100 Periodicity, 16, 96 Peritoneal, 44, 45, 96 Peritoneal Cavity, 96 Peritoneal Dialysis, 44, 45, 96 Peritoneum, 96 Pharmacodynamic, 6, 47, 96 Pharmacokinetic, 6, 8, 25, 97 Pharmacologic, 45, 46, 79, 97, 103 Phencyclidine, 6, 97 Phenobarbital, 26, 97 Phenytoin, 47, 82, 97 Physiology, 45, 95, 97 Physostigmine, 21, 26, 97 Pilot study, 8, 97 Plants, 78, 82, 83, 89, 97, 103 Plasma, 8, 12, 14, 23, 78, 79, 89, 90, 97 Pneumonia, 85, 97 Poisoning, 10, 18, 19, 24, 26, 28, 30, 31, 38, 46, 92, 95, 97 Polysaccharide, 77, 80, 97 Posterior, 96, 97 Postural, 4, 44, 46, 97 Potassium, 45, 97 Practice Guidelines, 62, 98 Presumed Consent, 4, 98 Progressive, 95, 98, 100 Prone, 44, 98 Prone Position, 44, 98 Prostaglandin, 98

111

Protein Binding, 47, 98 Protein S, 81, 88, 98 Proteins, 80, 84, 88, 93, 94, 96, 97, 98, 101, 103 Protocol, 4, 98 Psychiatry, 5, 12, 31, 98, 102, 104 Psychic, 94, 98, 101 Psychoactive, 98, 105 Psychology, 86, 99 Psychosis, 6, 99 Psychotomimetic, 78, 86, 99 Psychotropic, 12, 21, 30, 99 Public Health, 6, 27, 31, 38, 62, 99 Public Policy, 61, 99 Publishing, 10, 99 Pulmonary, 39, 44, 45, 46, 81, 90, 91, 99, 104 Pulmonary Artery, 81, 99 Pulmonary Edema, 44, 45, 46, 99 Pulmonary Ventilation, 91, 99 Purpura, 79, 99 Q Quality of Life, 6, 99 R Radiation, 79, 89, 99 Radioactive, 86, 91, 92, 94, 95, 99 Radiological, 24, 99 Radiology, 24, 99 Randomized, 20, 87, 99 Reality Testing, 99 Receptor, 80, 83, 86, 87, 89, 97, 100 Recombinant, 45, 100 Rectum, 84, 89, 100 Recur, 96, 100 Recurrence, 93, 96, 100 Refer, 1, 84, 99, 100 Regeneration, 6, 100 Regimen, 87, 100 Renal failure, 4, 45, 46, 100 Renal Replacement Therapy, 45, 100 Respirator, 93, 100 Respiratory failure, 7, 100 Respiratory Physiology, 39, 100, 104 Risk factor, 4, 28, 32, 100 S Salicylate, 100 Salicylic, 100 Salicylic Acids, 100 Salicylism, 39, 100 Schizoid, 100, 104 Schizophrenia, 100, 104 Schizotypal Personality Disorder, 100, 105

Screening, 13, 27, 32, 83, 100 Secretion, 77, 92, 100 Sedative, 40, 46, 80, 83, 89, 100, 104 Segregation, 9, 100 Seizures, 28, 44, 81, 96, 97, 101 Sepsis, 7, 101 Serum, 14, 15, 27, 28, 78, 84, 101 Shock, 4, 41, 46, 78, 101, 103 Side effect, 53, 55, 77, 101, 103 Skeletal, 94, 101 Skull, 101, 102 Smooth muscle, 94, 101, 102 Social Environment, 9, 99, 101 Sodium, 47, 101 Soft tissue, 81, 101 Solvent, 88, 96, 101 Spasm, 19, 85, 101 Specialist, 67, 101 Species, 92, 94, 101, 103, 104 Specificity, 77, 101 Spinal cord, 82, 94, 95, 101 Spleen, 78, 93, 101 Stabilization, 97, 102 Stem Cells, 88, 102 Stimulant, 78, 86, 102 Stomach, 11, 77, 88, 89, 91, 95, 96, 101, 102 Stress, 4, 7, 95, 102, 104 Stroke, 4, 44, 46, 60, 82, 102 Stupor, 95, 102 Subacute, 92, 102 Subarachnoid, 4, 102 Subclinical, 92, 101, 102 Substance P, 94, 100, 102 Sympathomimetic, 78, 86, 87, 102 Symptomatic, 46, 102 Syncope, 4, 44, 46, 102 Systemic, 78, 81, 92, 102 Systolic, 91, 102 T Temporal, 6, 102 Testosterone, 78, 102 Theophylline, 47, 102 Therapeutics, 15, 26, 27, 54, 102 Thermal, 86, 103 Threshold, 91, 103 Thrombosis, 98, 102, 103 Thyroid, 44, 103 Thyroid Gland, 44, 103 Thyroid Hormones, 103 Thyroxine, 39, 78, 103 Tidal Volume, 7, 91, 103 Tinnitus, 100, 103

112

Drug Overdose

Tissue, 80, 81, 83, 85, 87, 88, 89, 90, 92, 93, 95, 96, 100, 101, 102, 103, 105 Topical, 88, 103 Toxic, iv, 3, 13, 27, 95, 100, 103 Toxicity, 4, 6, 30, 38, 46, 87, 97, 103 Toxicology, 6, 11, 13, 14, 19, 21, 22, 29, 39, 62, 103 Toxins, 80, 90, 92, 94, 103 Trachea, 81, 103 Transfection, 81, 103 Transplantation, 98, 103 Trauma, 7, 95, 103 Tricyclic, 26, 39, 103 Trigger zone, 92, 104 U Ultrafiltration, 45, 90, 104 Unconscious, 18, 79, 104 Urea, 80, 104

Uremia, 44, 45, 100, 104 Urticaria, 4, 78, 79, 104 V Vaccine, 98, 104 Valerian, 39, 104 Vascular, 39, 44, 46, 78, 79, 91, 92, 103, 104 Vein, 92, 95, 104 Ventilation, 7, 82, 104 Ventricles, 82, 104 Vesicular, 94, 104 Veterinary Medicine, 61, 104 Virulence, 103, 104 Viscera, 79, 104 W White blood cell, 79, 93, 104 Windpipe, 103, 104 Withdrawal, 13, 104 Wound Healing, 93, 105

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