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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_5536_Библиотеки_им_академика_М_И_Перельмана.pdf
Cannabis and Amphetamines
throughout the body, cells receive oxygen and nutrients. Carbon dioxide and other
wastes are removed from the body as well. The word cardiovascular stems from
the Greek word kardia which means “heart” and the Latin word vasculum which
means “small vessel.”
In this complex system, the heart acts as a pump, forcing the blood to move through
the body and relaxing so that more blood can enter its chambers. The majority of
the blood is comprised of plasma, a watery fluid filled with protein. Less than half
of the blood is made up of platelets and red and white blood cells. The platelets
help blood to clot if a person suffers a cut or hemorrhages.
It’s important to maintain a healthy cardiovascular system since the blood and blood
vessels are crucial to good health. The cardiovascular system is the workhorse of
the body, continuously moving to push blood to the cells. If this important system
ceases its work, the body dies.
The heart contracts more than 100,000 times daily as it pushes blood through
the blood vessels. As it contracts, it forces blood into the bloodstream. The blood
transports nutrients from the digestive system and oxygen from the lungs to the
body’s cells. Then the blood carries waste products that are removed by the kidneys
and carbon dioxide that is expelled by the lungs.
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The heart is a muscle about the size of a fist and is divided into four chambers.
These chambers are the right atrium, the left atrium, the right ventricle, and the
left ventricle. During the circulatory process, blood enters the heart’s right atrium.
As the heart contracts, blood moves through a valve from the right atrium into the
right ventricle. The blood then flows through another heart valve into the lungs.
This is where the blood picks up oxygen. At this point, the blood flows to the
heart’s left atrium and through a valve into the left ventricle, from where it then
flows through a valve into the aorta. Upon leaving the aorta, the blood travels to
the remainder of the body, carrying much needed nutrients and oxygen to the body’s
cells.When problems arise within the cardiovascular system, a person suffers from
a cardiovascular disease. More than 60 kinds of cardiovascular diseases can cause
serious health problems. Common diseases include stroke or heart disease. Some
280
conditions such as congenital heart disease are present when a person is born;
other cardiovascular diseases develop gradually as a person grows into adulthood.
Acute cardiovascular signs may also be present, either related to:
■ panic (e.g. hypertension, tachycardia); or
■ an exacerbation of angina pectoris
Illustrated Handbook of Drugs & Alcohol Related Health Issues
Cardiovascular Exercise
Cardiovascular exercise is a form of exercise which is designed to work the
cardiovascular system, improving lung and heart health along with improving
the condition of the musculoskeletal system. It is a highly recommended form of
exercise for people at a wide range of fitness levels, although people should always
consult with a doctor before embarking on a new exercise program. A wide variety
of activities can be part of a cardio exercise routine, keeping the routine varied
and interesting.
The primary goal of cardiovascular exercise is to get the heart rate up and keep it
up for a sustained period. Jogging, cycling, and aerobics classes are some common
examples of cardiovascular exercise. Ideally, the exercise should be sustained for
at least 40 minutes, between three and four days a week. These recommendations
can vary, depending on an individual’s condition, with some people benefiting from
more exercise, while others should exercise less for safety.
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Cannabis and Amphetamines
Target heart rates for cardio vary, and are established by monitoring the regular
heart rate and using a variety of formulas to arrive at an ideal heart rate. A doctor
or fitness instructor may be able to recommend a specific formula, depending on
the goal of the exercise, the age of the participant, and the type of exercise. As
a general rule, the heart rate should never exceed a rate of 226 minus the age of
the exerciser per minute. This means that a 26 year old should have a maximum
heart rate which is below 200 during cardiovascular exercise.
Regular cardiovascular exercise promotes healthier lungs, hearts, and muscles.
Routine exercise promotes the delivery of oxygen to the muscles, helps the body
regulate the presence of many compounds, and contributes to weight loss; the
body literally burns fat for energy in periods of prolonged cardiovascular exercise.
In the process, the muscles get stronger and more toned, and an exerciser usually
develops an overall improvement in physical condition.
This type of exercise is also known simply as “cardio” or “aerobic exercise,” and
it may be mixed with other forms of exercise such as weight training for muscle
fitness, and stretching disciplines like yoga and pilates to improve flexibility and
muscle tone. Some people design their own exercise regimens, working out a routine
that is workable and sustainable for them, while others prefer to consult with a
personal trainer, fitness instructor, or doctor to develop a safe and effective routine.
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What is Cardiovascular Training?
Cardiovascular training, or aerobic training, is a type of exercise designed to
increase muscular endurance by improving the performance of the heart and lungs
to distribute oxygen to the muscles. Cardiovascular training can also help one
achieve and maintain a healthy weight by burning calories. Exercises of this type
use large muscle groups, and involve raising the heart rate to a target rate for at
least 30 minutes.
Cardiovascular training is an important component of a health regimen. Ideally, it
should be performed at least three times a week, for a minimum of 30 minutes
each time. Some popular cardiovascular training exercises are power walking,
running, swimming, biking aerobic dance, and step. Using more than one type of
cardiovascular exercise, a practice called cross-training, can be even more effective
than using just one.
If cardiovascular training is used to burn fat, the target heart rate is typically 60%
to 70% of the maximum heart rate. Beginners can start at a lower target heart rate,
around 50% of the maximum. When using a target heart rate of 50% to 70% of
the maximum heart rate, about 85% of the calories burned will come from fat. If
your goals instead are to maximize the performance of your cardiovascular and
respiratory system, thereby building your endurance, maintain a heart rate of 70%
to 80% of your maximum heart rate. Performing cardiovascular training at this level
can increase the size and strength of one’s heart. To determine your ideal heart rate
for cardiovascular training, first determine your resting heart rate. This is best done
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in the morning, when the body is as close as possible to a resting state. Find your
pulse on the throat, or the inside of the wrist, by pressing lightly with the index
and middle finger. Do not use the thumb, as the thumb also has a pulse. Using a
watch with a second hand, count the number of heart beats in ten seconds, then
multiply by six. For maximum accuracy, repeat this process for three consecutive
mornings and average the result for the resting heart rate.
Illustrated Handbook of Drugs & Alcohol Related Health Issues
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To find your maximum heart rate, subtract your age from 220. Next, subtract the
resting heart rate from the maximum heart rate to determine your heart rate reserve.
Depending upon your goals, determine the range of your target heart rate. Multiply
the heart rate reserve by the maximum and minimum levels of your target heart
rate -- say 60% and 70% then add your resting heart rate to each number to find
the maximum and minimum beats per minute of your target heart range.
Since it is important to maintain a certain heart rate for cardiovascular training,
neither falling short nor exceeding it, it is important to monitor one’s heart rate
during exercise. Many cardio machines allow the user to constantly measure his or
her heart rate, and there are also wristbands that serve this purpose. Alternatively,
one can use a clock with a second hand or a stopwatch and take ones pulse at
regular intervals to determine whether one is in the target heart rate zone while
exercising.
Detection by Urine Analysis
Psychotropic effects of cannabis are maximal at 20 minutes and last for 2–4 hours;
cannabinoid levels can, however, be detected in urine up to 28 days after use.
Urinary cannabinoid levels are therefore not an appropriate measure of recent
cannabis use, intoxication or impairment.
Cannabis and Amphetamines
283
Psychosocial Interventions
Psychosocial interventions for cannabis use disorder are still in their infancy. Most
interventions used for cannabis dependence have been adapted from alcohol
interventions.
Even one session of cognitive behavioral therapy can produce clinically significant
reductions in the frequency and amount of cannabis use and related problems
among severely dependent users. The cognitive behavioral therapy produces more
favorable outcomes than brief motivational interventions, especially with more
severely dependent users.
Psychosocial interventions and support services describe a wide variety of services,
supports and strategies that aim to change behaviour and support people who are
affected by alcohol and drug use. These are services which are provided within
community settings.
These types of services provide a range of psychosocial (non-medical) interventions
for people with alcohol and drug issues including assessment, counseling, case
management, coordination of care, group work, information, community education
and professional consultation to other service providers.
The Alcohol and Drug Service also provides a range of specialist targeted services
in the following areas:
■ Support for Youth
■ Outreach Services
■ Relapse Prevention
■ Management of Complex Needs
■ Brief and Early Intervention
■ Smoking Cessation
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Illustrated Handbook of Drugs & Alcohol Related Health Issues
Support for Youth
The Alcohol and Drug Service employs specialist youth workers who work with
young people affected by alcohol and drug use. These specialists also work closely
with a range of youth services provided by community sector organisations.
Outreach Services
Outreach services are useful in providing services to clients who would otherwise
be unable to access specialist alcohol, tobacco and other drug services in a timely
and equitable manner.
Services are designed to provide: counseling; assistance with accessing other services;
access to skilled and professional help; assistance with the development of strategies
to reduce harm; and access to specialist advice and information. Services can be
provided to individuals or in group settings.
Relapse Prevention
Relapse prevention is a collection of techniques that increase the client’s ability
to control cravings and urges, and enhance coping skills for handling high-risk
situations where lapse or relapse is a possibility. By combining the learning of
specific skills with lifestyle changes, these interventions assist clients to manage
lapses and prevent relapses.
Management of Complex Needs
A large proportion of clients who access alcohol, tobacco and other drug services
are presenting with increasingly complex and multiple needs. In some cases, these
clients also present with difficult (and at times high risk) behaviour. The needs of the
client group can be complicated by the presence of coexisting mental health issues.
Brief and Early Intervention
Early intervention involves intervention at an early stage of a person’s alcohol and
drug use to prevent the development of serious drug problems later on.
Early intervention focuses on service users who are engaged in patterns or contexts of
drug use that have the potential to harm. Early intervention involves identifying drug
use and assessing harm and intervening with service users who are consuming drugs
in a potentially harmful way before problems become entrenched or dependence
develops.
Smoking Cessation
Reducing smoking initiation and reducing the exposure to second-hand smoke,
through tobacco control strategies, along with increasing the rate at which people
Cannabis and Amphetamines
quit smoking are key objectives of tobacco control activities. Interventions such as
price increases, mass media campaigns and sale restrictions are effective in both
preventing uptake and promoting quit attempts. Advice and support provided by
health professionals is also an essential component of increasing the rate at which
people quit smoking.
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Pharmacological and psychosocial interventions for cannabis use
disorders
Cannabis remains the most widely used illicit substance in most developed countries.
The most recent United Nations Office on Drug and Crime (UNODC) estimates
between 140 and 190 million users worldwide. The addictive potential of cannabis
has been established through rigorous clinical and neurobiological research, and
the need for primary and secondary interventions to address cannabis-related
problems among youth and adults has become clear over the past 15 years. Thus,
the debate over the addictive potential of cannabis has become obsolete. Treatment
admissions for primary cannabis problems in the United States more than doubled
between 1993 to 2003 and similar increases have been reported in Australia and
the European Union. In response to this increase in demand, treatment research
programs in multiple countries and continents: e.g., Australia, Brazil, Canada,
France, Germany, Mexico, Spain, and the United States, have been established to
investigate effective ways to assist those with cannabis use disorders. The extent of
cannabis misuse and its associated consequences clearly indicates a public health
problem that requires systematic efforts focused on prevention and intervention.
The problems and consequences reported by those enrolled in treatment for cannabis
use disorders parallel what is observed among those in treatment for other addictive
drugs, although problems associated with abuse of cannabis tend to be less severe
than problems associated with abuse of drugs like cocaine and heroin. Treatment
seeking cannabis users endorse the full range of abuse and dependence diagnostic
criteria, including experiencing a withdrawal syndrome and failed attempts to quit
or cut down. School or employment problems, relationship and family problems,
guilt related to cannabis use, financial difficulties, low energy, low self-esteem,
dissatisfaction with productivity level, sleep and memory problems, and low life
satisfaction are commonly reported.
The provide a summary and update of the scientific literature on psychosocial
and pharmacological interventions focused on cannabis use and disorders. The
psychosocial literature base has spanned approximately 20 years, but produced
relatively few controlled treatment outcome studies. The pharmacotherapy literature
spans less than 10 years and comprises primarily laboratory studies evaluating the
potential of various medications, and only a few clinical trials. A general overview
will alert the reader to the extant literature; more detailed analyses can be found
in a number of recently published reviews. Comments and discussion will focus
on the strengths and limitations of the current knowledge, needs for the future, and
potential areas of future investigation.
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Illustrated Handbook of Drugs & Alcohol Related Health Issues
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Tolerance, Dependence and Withdrawal
A dependence syndrome associated with cannabis use has been well described.
While severe dependence clearly exists, the cannabis dependence syndrome is
generally less pronounced than dependence associated with drugs such as opioids
and alcohol. However, the evidence is conflicting and concerns are emerging that
dependence on cannabis in some younger people may develop rapidly and be
more severe than previously believed. The most common symptoms of cannabis
dependence are difficulties controlling use and withdrawal
The most common symptoms of cannabis withdrawal reportedly include:
■ anxiety, restlessness and irritability
■ anorexia
■ disturbed sleep and increases in vivid dreams
■ gastrointestinal disturbances
■ night sweats
■ tremor
The symptoms are usually relatively mild and last a week or two. They do not
require more than short-term symptomatic management.
Cannabis and Amphetamines
287
Management and Intervention
Health professionals can significantly improve the outcome for patients presenting
with cannabis use disorders by:
■ Providing information on the harms associated with heavy long term
cannabis use
■ Providing advice on reducing or ceasing use
■ Adopting brief motivational and cognitive
■ Behavioral techniques to manage withdrawal and craving
Some people at the severe end of the dependence spectrum or with comorbid
disorders may be helped by referral to specialized addiction and/or psychiatric
services.
AMPHETAMINES
Amphetamines are the second most commonly used illicit drug in Australia after
cannabis. There is evidence of increasing use and purity, and of serious harms
associated with regular use. Health workers can expect to see increasing numbers
of amphetamine users. Although there are few specific interventions or treatment
options for those experiencing problems related to their use of amphetamines,
engaging individuals in harm reduction measures and responding to their specific
needs can substantially reduce harms.
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Illustrated Handbook of Drugs & Alcohol Related Health Issues
Pharmacology
Amphetamine is a closely related family of drugs with psychostimulant properties.
This group of drugs includes:
amphetamines used for recreational purposes, produced in illegal or ‘clandestine’
laboratories e.g. amphetamine sulphate/amphetamine and methamphetamine/
methylamphetamine
pharmaceutical quality amphetamines available on prescription for the treatment
of obesity, narcolepsy, and Attention Deficit Hyperactivity Disorder (ADHD)/(ADD).
These drugs include:
■ phentermine (Duramine)
■ diethylpropion (Tenuate)
■ dexamphetamine
■ methylphenidate
Amphetamines (including methamphetamine) are synthetic substances structurally
related to naturally occurring adrenaline and ephedrine. Amphetamines activate the
central nervous system (CNS) and sympathetic nervous system (SNS), increasing
synaptic concentrations of excitatory neurotransmitters and inhibiting their reuptake.
The monoamines affected by amphetamines are:
■ dopamine
■ noradrenaline
■ serotonin
Through stimulating neurotransmitter release, and preventing their reuptake,
amphetamine use results in:
CNS effects: euphoria; increased wellbeing, confidence and physical activity; improved
cognitive and physical performance; suppression of appetite and need for sleep
SNS effects: increased blood pressure, tachycardia or reflex bradycardia, increased
temperature
Distribution
Amphetamines are concentrated in the brain, lungs and kidneys. Metabolism Between
30–40% of amphetamines are metabolized by the liver, with the remaining 60–70%
excreted by the kidneys. The half-life of amphetamine and methamphetamine are
12–36 hours and 8–17 hours respectively. Although amphetamines can be more
rapidly eliminated if the urine is artificially acidified, the practice of acidifying urine
is believed to increase risk of renal failure from rhabdomyolysis. Some amphetamine
users deliberately exploit this fact by alkalinizing their urine to prolong the effects.