pharmacology

Take-Home Essays for Exam No. 2: Drugs and Behavior

Answer the following questions in well-constructed, comprehensive, and TYPED essays. You may use your

textbook, Internet, and library resources in formulating your answer. You may submit your answers either

via e-mail or as a paper copy. Each question can be answered in 1.5 to 2 pages. Each is worth 10 points.

Your essays are due at the time of our exam, but can be submitted without penalty via email up to the

Saturday following the exam.

1. Should alcoholics be eligible for liver transplantation? In order to answer this question, please first describe the

current UNOS policy on this issue, and then identify three arguments in favor of allowing alcoholics to receive

liver transplants, and three arguments against such a policy. Then, provide your well-reasoned policy statement.

Consider the broader implications of your policy in terms of medical standards and care.

2. Attached are two newspaper articles. One was written by Senator (later Vice President, now President) Joseph

Biden (D: Del) concerning ecstasy (Philadelphia Inquirer, February 22, 2002). What was your initial reaction?

What was your position after thinking about this essay? How effective are the arguments Senator Biden makes

concerning this drug?

The other article was from the Inquirer (December 7, 2005) concerning fatal overdoses of cold medications

in infants. Use the comparison with the Biden article to discuss issues of safety and legality in drug (both legal and

illegal) use. Why is the link between safety and legality? What factors affect this link? Is safety the predominant

issue when determining whether a substance should be legal or not?

Biden Article

OP-ED: Designer Drug Is Dangerous, and Ignorance Makes It Worse

This op-ed appeared in the PHILADELPHIA INQUIRER on February 22, 2002.

DESIGNER DRUG IS DANGEROUS, AND IGNORANCE MAKES IT WORSE

By Joseph R. Biden Jr.

Pushers have reached new heights - or new lows - in the case of "ecstasy," a misnamed little pill whose use is

reaching epidemic proportions among America's youth.

Ecstasy dealers and manufacturers go to great lengths to package and market their drug so it seems harmless and

appealing to young people. They emblazon the pills with popular logos or write words like peace and love on

them.

But no amount of public relations spin can mask a lethal reality: Ecstasy is a dangerous drug with potentially fatal

consequences.

All across the country, thousands of teenagers are treated for overdoses and ecstasy-related health problems in

emergency rooms each year. And recent statistics from the Partnership for a Drug Free America show that teen use

of ecstasy has increased 71 percent since 1999. Unless we mount a major education campaign in schools and on

campuses nationwide, we may not be able to counter the widespread misconception that ecstasy is "no big deal."

Too many people continue to believe the drug is harmless, fashionable and hip.

Try telling the parents of Brandy French, 16, who died last May after overdosing on a single ecstasy pill that the

drug is "harmless." French tried ecstasy for the first time at a concert with a group of friends, and 24 hours later

was pronounced dead at Allegheny General Hospital in Pittsburgh. The coroner ruled the cause of death was an

overdose of ecstasy, which had caused irreversible brain damage.

Try telling the doctors who battled for 36 hours to save the life of 19-year-old Lorna Spinks, a student who died

after taking ecstasy at a nightclub with friends, that there is anything "fashionable" about the drug. The paramedic

who helped rush her to the hospital told investigators she had a look of "sheer fright" on her face: "Her eyes were

wide open with her tongue sticking out."

Try telling Preston Chambers, whose younger sister Brittney died six days after taking a single pill of ecstasy at

her 16th birthday party, that there is anything hip about the drug. Chambers told doctors his sister drank three

gallons of water in 45 minutes after ingesting a single tablet, which released an antidiuretic hormone preventing

Brittney from excreting fluids. The excessive water diluted her blood, led to brain swelling and the coma from

which she never recovered.

What too many of our children don't yet realize is that ecstasy - an illegal and highly unpredictable drug - often is

produced in unsanitary conditions in makeshift labs with no quality control. In the interest of making a profit,

producers often cut corners and add substances to their pills to make them more potent or cost-effective. And

research shows that the chemicals found in ecstasy affect the brain in profound ways by depleting it of serotonin,

leading to hallucinations, paranoia and amnesia.

We've made some progress in helping Americans better understand the dangers of drug use, but it's a continuing

process that requires a national commitment to educating every generation. We need to spread the message so that

today's kids know the risks of taking ecstasy, and what it can do to their bodies, their brains, their futures.

Adults, too, need an education: about what ecstasy looks like, how someone high on ecstasy behaves, and what to

do upon discovering someone they know is using it.

We need to hear, loudly and forcefully, from the many doctors, coroners and parents who have learned the hard

lesson that ecstasy is extremely dangerous, unpredictable, and even lethal.

We must dispel the myth that ecstasy is safe - our children's lives may depend on it.

Cold Medication Article

Parents cautioned on giving infants cold medications (Philadelphia Inquirer: Dec 7, 2005)

By Dawn Fallik

Inquirer Staff Writer

Philadelphia health officials are warning parents of infants to be careful with over-the-counter cold medications

after 13 infants died with unusually high levels of the drugs in their systems.

The deaths all occurred in children under the age of 12 months, between 1999 and 2005. Cold medication was

found in all the infants, and in 10 of the cases, the drugs either directly caused or contributed to the death, officials

said.

Some of infants were given adult medication and others received overdoses of the infant drugs. In some cases "the

levels found would have been toxic for adults," said Susan Robbins, medical director of pediatric services for the

Philadelphia Department of Public Health.

The drug pseudoephedrine, found in Sudafed and PediaCare Infants' Oral Decongestant Drops, among others, was

found in all 13 cases, officials said.

In general, children under a year old should not be given cold medicine, said Wayne Snodgrass, a pediatrician and

chair of the American Academy of Pediatrics' Committee on Drugs.

"Parents need to decide if the child really needs any medication," he said. "Sometimes a child might be on more

than one medication and there might be the same ingredient in each of the products," and the combination can

cause problems.

In Philadelphia, the health department policy is to review all infant deaths within 96 hours, said department

spokesman Jeff Moran. The findings about the cold medications grew from those investigations.

Even in low doses, the medicine can cause rapid heartbeats and an increase in blood pressure as well as tremors,

said Robbins.

A similar series of deaths recently occurred in Montgomery County, Ohio. Authorities documented 10 cases over

an eight-month period in which cough or cold medicine contributed to - or caused - the deaths of the infants.

A study was published in the October issue of the Journal of Analytical Toxicology by Laureen Marinetti, chief

toxicologist of the Montgomery County Coroner's office in Ohio.

"Caregivers may be under the mistaken notion that OTC [over-the-counter] cold medications formulated for

children are also safe for use in infants," Marinetti wrote. "These cases demonstrate that not only is the

administration of some OTC cold medications not safe, but use of OTC cold medications in infants can result in

toxicity that can lead to death."

Two of the Ohio deaths turned out to be the result of child abuse, according to the study. So far, none of the cases

here has been connected with child abuse, Moran said.

Robbins, the health department pediatrician, said that parents should read all labels very carefully, and if a

medication warns parents to contact their physician for infant use, they should do just that.

Babies with coughs or pain or who are having trouble breathing should be brought into a doctor's office, she said.

Snodgrass said he had seen problems with infant formulas when they were given by the teaspoonful - and not by

the drop - to a toddler. But, he said, mostly a cold is something babies will get over naturally, just like adults.