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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_5870_Библиотеки_им_академика_М_И_Перельмана
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Battery
https://t.me/medicina_free
A rechargeable lithium
ion battery that provides
power for atomizer.
ANATOMY OF A VAPE PEN
Button
Used to control on/off
and other functions.
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Tank/Chamber
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Contains cannabis or cannabis
extract that will be vaporized.
Atomizer
A small heating element that
generates heat for vaporization.
Mouth Piece
Users inhale through this part.
103
EDIBLES
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ONSET: 1.5 to 2 hours
DURATION: 6 to 10 hours
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BIOAVAILABILITY: 5 to 20%
Edibles do not provide immediate relief but they do provide stronger, longer- lasting relief than inhaled
cannabis – 6 to 9 hours depending on the material and a patient’s own endocannabinoid system.
The reason? The process of passing through the gastrointestinal tract and then being metabolized
in the liver before ultimately being absorbed into the bloodstream changes Delta-9 THC into Delta-11
THC, an entirely different, longer lasting, and more powerful compound. This difference is significant.
Smoking results in 20% of Delta-9 THC metabolizing into Delta-11 THC, whereas ingestion results in
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100%.
Edibles come in a variety of forms: candies, gummy bears, chocolates, cookies, pills, and lozenges.
Some of these products are delicious, which makes dose control all the more challenging.
The primary challenge with edibles is dose titration. Too small a dose produces no relief and too
large a dose can produce extreme psychoactivity, which can result in paranoia and discomfort.
Since the onset time is so long it may take several attempts for a patient to find an optimal dose. This
is why the Medical Marijuana 411 mantra, especially with inexperienced patients, is...
or 4 to 20% 19 or 4 to 12%
20
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“
Start Low, Go Slow
”
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ADVANTAGES VERSUS DISADVANTAGES
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OF EDIBLES
• ADVANTAGES OF EDIBLES
Long duration and stronger effects
▪
Dosing may be easier for a patient to consume
▪
Eliminates risk associated with smoking
▪
Exact cannabinoid dosing can be achieved
• DISADVANTAGES OF EDIBLES
Onset of effects is delayed considerably by absorption through the
gastrointestinal tract
▪
Edible products may be made with sugar, which can present
complications with diabetic patents
▪
Patients may over consume due to the long onset time
▪
Serving size may need to be reduced based on patient’s tolerance
▪
High risk of accidental cannabis poisoning to children and pets
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▪ Manufacturing practices may put a patient with food allergies at risk
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KNOW YOUR EDIBLES
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Don’t be that person who eats an edible, declares that “nothing is happening,”
eats four more, and proceeds to have the worst experience ever.
Know yourself and know your edible servings!
Start With One
Just eat one serving of a low dose edible until you learn how you respond.
Wait, Wait, Wait
…and wait some more. Edibles can take up to two hours to work.
Start With One
Just eat one serving of a low dose edible until you learn how you respond.
Don’t Mix
Do not mix edibles with alcohol or other substances.
Lock It Up
Store edibles in a child proof container and/or original packaging.
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NEW TO EDIBLES?
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or significant medical needs.
This is a single serving
for experienced users only.
“Professional” level users
Start here.
1 to 5 mg
5 to 10 mg
10 to 15 mg
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ORAL MUCOSAL: TINCTURES, SPRAYS, SUBLINGUAL DROPS
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ONSET: 1 to 15 minutes if held in mouth; 1.5 hours if swallowed
DURATION: 2 to 8 HOURS
BIOAVAILABILITY: 1 to 12%24 OR 11 to 13%
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Oral mucosal tinctures and extracts are easy to use and reflect the full chemical spectrum of the
plant. Even better, they come in various ratios of CBD:THC, which makes dosing for experienced
and inexperienced users easy to monitor and adjust. GW Pharmaceuticals has proven the efficacy
of this delivery method with its sublingual prescription medication, Sativex,
®26
which has passed
regulatory hurdles and been approved for use in 12 countries to date.
The best method of taking an oral mucosal tincture or extract is to drop or spray some under
the tongue or between the gums and cheek where a huge number of blood vessels reside,
and keep it there for a few minutes before swallowing. Avoid drinking or eating anything for
ten minutes following administration. If the tincture is alcohol based, the alcohol could irritate
or burn sensitive gums.27 To lessen irritation, dilute the tincture in water and swish around the
mouth for oral mucosal application. Another option is to dilute the tincture in a liquid oil or
medium fat yogurt drink to increase lipophilic absorption.
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ADVANTAGES VERSUS DISADVANTAGES
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OF ORAL MUCOSAL
• ADVANTAGESOF ORAL MUCOSAL
Tinctures easy to use and titrate
Various ratios of CBD:THC content are available
Minor cannabinoids and terpenes are included in some formulations
Tinctures can be added to food or beverages
Long shelf-life and flexibility
Discreet and portable
• DISADVANTAGES OF ORAL MUCOSAL
Inconsistencies in labeling on non-FDA approved formulations
Delayed onset if swallowed by the patient
Patients with allergies to carrier oils should use caution
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TOPICALS
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ONSET: Immediate
DURATION: 30 minutes to 3 hours
BIOAVAILABILITY: Not applicable
Topicals are available in creams, salves, roll-ons, and patches. Topicals in general will not result in a
high typically associated with THC. Topicals are non psychoactive unless they contain unusually high
amounts of cannabinoids. This is due to CBD crossing the skin barrier more efficiently than THC.
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Penetration of the skin barrier can be enhanced by alcohol or lipid media, which is used in longer
duration transdermal patches. Conditions topicals treat include joint/muscle pain, eczema/psoriasis,
acne, and certain forms of skin cancer or precancerous lesions on the skin.
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ADVANTAGES VERSUS DISADVANTAGES
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OF TOPICALS
• ADVANTAGES OF TOPICALS
Avoids first-pass metabolism by the liver
Localized pain management
Reduces inflammation and arthritis
Non psychoactive even when containing THC
• DISADVANTAGES OF TOPICALS
Possibility of local irritation
Low skin penetration of cannabinoids
Patients with allergies to carrier ingredients should use caution
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