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Strategy No. 6: Herbs for Lowering High Blood Pressure

CBD – CBD 60 Hemp mg ml/900 Wisely Potency High Oil

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22.05.2018

Content:

  • CBD – CBD 60 Hemp mg ml/900 Wisely Potency High Oil
  • Healthcare Professional Question Database
  • ABDOMINAL AORTIC ANEURYSM (AAA)
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    CBD – CBD 60 Hemp mg ml/900 Wisely Potency High Oil

    Lexi interaction checker 4. Micromedex- tramadol and bupropion 6. Pencillin allergy Medication History: Prevacid, bismuth subsalicylate, tetracycline, metronidazole Pepto Bismol bismuth subsalicylate - 2 tabs QID for 14 days Pradaxa BID- second month filled today was on warfarin for prevention of clots and then got a clot Response: No major drug interaction between Pepto Bismol and dabigatran.

    Each of these agents possess the potential to cause bleeding. Their combined use would seem to increase that potential. Recommended monitoring for increased signs of bleeding. Increase monitoring diligence for signs and symptoms of bleeding if these agents are used concomitantly.

    Pepto Bismol, PPI, metronidazole and tetracycline. Lexidrug interaction checker 2. Stockleys drug interaction checker 3. Rxfiles h pylori testing and eradication 5. Acid suppressing medications have a limited role in the treatment of infants with regurgitation. They are not valuable in treating children less than one year of age with uncomplicated GER "happy spitters". When pharmacotherapy is chosen as a treatment, or for a limited trial, a PPI is generally preferred over histamine type 2 receptor antagonists H2RA.

    Post marketing reports of severe skin reactions associated with Accutane, like Stevens-Johnson syndrome, toxic epidermal necrolysis, and erthema have been reported.

    A Roche global safety database as of reported 66 incidences of severe skin reactions in adults and children worldwide, however there are approximately 16 million medication users. To manage the photosensitivity you can trial a decreased dose of Accutane or apply hydrocortisone cream to a small area to see if it helps reduce the redness and itchiness.

    Potential consequences of abrupt discontinuation or large dose reduction of an antipsychotic include discontinuation syndrome flu-like , psychosis, and movement disorders.

    Clinical Handbook of Psychotropic Drugs, 20th Ed, pg There are some interactions with grapefruit juice and calcium channel blockers however none were recognized with amlodipine.

    Stockleys drug interaction checker 2. Food and Drug interactions book. Topical steroids may be used in treating mild-moderate contact dermatitis. If skin irritation occurs with fentanyl patches, steroidal sprays have been used; wait 1 minute after spraying before applying the new patch.

    However they can be used as a last resort. Alprazolam Cyclobenzaprine Ranitidine Response: No interactions identified 2. Lexi-drug interaction checker 2. Stockleys drug interaction checker. In disorders with excess absorption via diet or intestinal disorder it may be more important to reduce oxalate content in diet.

    An association of oxalates and vulval pain was found involving a woman with vulvodynia. She presented with high levels of oxalate in her urine. Her symptoms resolved and oxalate levels declined after starting a low-oxalate diet and calcium citrate to remove oxalate from the body.

    In the US, a low oxalate diet is widely used for treatment of vulvodynia. Up to date- prevention of recurrent calcium stones in adults 2. Uptodate — primary hyperoxaluria 3. Vulval pain society- http: Shortage is estmated to be resolved April 6th. Referred to Amantadine shortages document. Schedule II means a pharmacist needs to be involved in discussion with the patient. The fact your patient is tolerating amitriptyline is reassuring. Ann Allergy Asthma Immunol.

    Proton pump inhibitors PPIs may decrease serum mycophenolate acid levels, depending on the product used. Stockleys Drug Interactions 2. Lexicomp Drug Interaction Checker 3. Intestinal parasite - dientamoeba fragilis, blastocytis hominis Medication History: Tried Vermox and Combantrin Response: Bugs and Drugs app 2. There is no equivalent dose of opioids and marijuana.

    Tapering of high dose opioid can be considered before starting marijuana as there may potentially be additional CNS depression with the combination. Butrans Patch for Weekly Application for converting opioids to Butrans patches which may be of some assistance. Health Canada drug product database- buprenorphine 2. Pharmacists Letter- Medicinal Marijuana 5. Serum salicylate levels are reduced by steroids; however the main concern is following steroid withdrawal in those taking moderate to high doses of ASA.

    Stockleys Drug interactions 2. There is no difference in terms of bioavailability or onset of action between the two products. Lexidrugs - Ondansetron 3. Canadian Pharmacist's Letter ; 20 Treatment of eosinophilic esophagitis EoE consists of: As the esophagus may be inflamed, PPIs will confer protection to potential acid exposure. In a randomized study patients received esomeprazole 40 mg for 8 weeks along with swallowed fluticasone; treated patients experienced significant improvement in symptoms of dysphagia regardless of GERD status.

    Most patients receive swallowed fluticasone which is administered using an MDI without a spacer. The medication is sprayed into the mouth and swallowed; the patient should not eat or drink for 30 minutes after administration. Adults should use mcg twice daily. If treatment is not beneficial, the dose may need to be increased or the patient can be switched to oral viscous budesonide budesonide nebules mixed with sucralose [4].

    Budesonide can also be administered using a nebulizer and having the patient swallow the accumulated liquid. Patients generally continue with treatment for 8 weeks and if relapse is an issue afterwards a maintenance dose or dietary changes may be considered. It may reduce the burden of allergy and risk of anaphylaxis however there is the possibility that the immunotherapy may trigger the EoE as seen in mice. Further research is needed to determine safety and efficacy.

    Esophageal dilation will relieve dysphagia but not improve the underlying inflammation. Treatment of Eosinophilic Esophagitis 2. Emerging Therapeutic Options for Eosinophilic Esophagitis. Management of benign esophageal strictures 4.

    Oral viscous budesonide is effective in children with eosinophilic esophagitis in a randomized, placebo-controlled trial. Carbamazepine is an enzyme inducer that may increase estrogen metabolism, thereby reducing its effectiveness; however, this is not relevant for locally applied estrogen used for menopausal vaginits.

    Stockleys Drug Interaction Checker 2. Lexicomp Drug Interaction Checker: Not available Medication History: Diversion colitis is characterized by inflammation of the defunctionalized, bypassed colon following surgery. Most patients with diversion colitis are asymptomatic, but in a small proportion of patients, symptoms can significantly impact quality of life.

    Bacterial metabolism results in SCFA synthesis. SCFA are absorbed by the lumen which then supplies fuel to mucosal cells, modulates fluids and electrolytes, enhances colonic motility and mucosal blood flow, and production of inflammatory cytokines.

    The enemas must be compounded and consist of sodium acetate 60 mmol , sodium propionate 30 mmol , and sodium n-butyrate 40 mmol with additional sodium chloride 22 mmol. This yields a similar osmolality to plasma and pH is adjusted to 7.

    The enema is instilled twice daily for 6 weeks at a dose of 60 mls. Frequency may be reduced if improvement occurs. In one randomized crossover trial of 10 patients with IBD and colectomy, SCFA enema use for 3 weeks was not shown to improve inflammation compared to placebo.

    However these patients had severe inflammation which may have been due to IBD. Uptodate- Diversion Colitis 2. Pathophysiology, clinical presentation and management of diversion colitis: A review of current literature. International Journal of Surgery. There is minimal data for melatonin supplementation during breastfeeding and effects are relatively unknown.

    Briggs in Pregnancy and Lactation 2. The common guidelines for statin therapy, such as that of the American College of Cardiology do not mention how to manage low LDL, but some articles have explored targeting lower LDLs to assess if there is a greater benefit with more aggressive treatment.

    This patient would have been put on a statin following the heart attack, as this would be considered clinical atherosclerotic cardiovascular disease. A systematic review of RCTs of statin therapy found no association between being treated with statins and cognitive decline; the LDL numbers of the study were not disclosed but it did include participants on higher intensity statin therapy.

    Do Statins Impair Cognition? Journal of General Internal Medicine. Journal of the American College of Cardiology. Kastelein, MDc, John B. The American Journal of Cardiology. Can LDL cholesterol be too low? Possible risks of extremely low levels.

    Journal of Internal Medicine. How quickly after ingestion does antidote therapy need to be instituted ie: They found that delaying the antidote more than 6 hours increased rates of death OR prolonged renal insufficiency and associated morbidity significantly composite end-point, odds ratio of 3.

    They do not conclude that giving the antidote within 6 hours is optimal it could be within hours, for example , but delaying more than 6 hours definitely leads to more harm. Is oral alcohol a good option? This is not definitive, however: This World Health Organization suggests fomepizole is likely more cost-effective depending on regional costs of acquisition and staffing 6.

    Oral ethanol dosing protocols suggested for both pediatric and adult: O Another protocol 1 basically the same, slightly lower dose: The loading dose is 0. For both modalities, blood ethanol levels must be monitored hourly and adjusted accordingly, and both require patient monitoring in an ICU setting.

    Treatment of ethylene glycol poisonings 2. UpToDate, treatment of ethylene glycol poisoning 3. Epub Dec Reddy's - inventory Response: UpToDate - Teratogenicity, pregnancy complications, and postnatal risks of antipsychotics, benzodiazepines, lithium, and electroconvulsive therapy.

    Accessed on-line 08Sep 3. There is no indication to titrate statin doses. RxTx - Post-myocardial Infarction 4. Treatments for molluscum in immunocompetent children with the most evidence include: It is applied with the blunt end of cotton swab to lesion only in the office.

    Application is painless and does not cause bleeding. The area can be washed with soap and water within hours. The agent causes small blisters at the lesion site. If lesions persist, treatment can be repeated in weeks.

    This solution can be applied at home once or twice daily 3—4 days per week for up to 4—6 weeks. Pain, burning, erosions, pruritus and bleeding may occur. In the methods it described 4: Treatment was to be discontinued if inflammation occurred. UTD - Molluscum contagiosum 3. Pediatr Dermatol May-Jun;23 3: Common and Flat Warts.

    As per Canadian Immunization Guidelines, Canadians 50 years of age and older with no known history of varicella infection are still eligible for herpes zoster vaccination. Patients should not obtain lab confirmation - there are no known safety concerns of herpes zoster vaccine in healthy patients susceptible to varicella virus.

    Only if lab confirmation of varicella virus has been obtained in the past for other reasons would one vaccinate with two doses of univalent varicella vaccine. There are liquid sodium phosphate solutions marketed for laxative use and contain 4.

    Dieticians of Canada phosphorus content of foods available. UpToDate - Evaluation and treatment of hypophosphatemia 2. Phone communication with , Novartis Customer Service, , Mar 31, Platelets usually highest was 5. I found but one case report of hydroxyurea HU -associated hyperkalemia in a patient with polycythemia vera. While the authors describe normalization of potassium levels with discontinuation of the HU, they do not provide any information about how the condition was subsequently managed.

    There have been three cases reported via MedEffect 3 ; however, all of these seem to be tumour lysis syndrome as other metabolic abnormalities hyperuricemia, hyperphosphatemia, hypocalcemia were present, which is typical of tumour lysis syndrome. No reason to believe any of the other drugs would be a causative factor, whether by interaction or adverse effect profile was found.

    There is a decent amount of information regarding pseudohyperkalemia in patients with myeloproliferative disorders. Because it is possible furosemide was affecting potassium simultaneously, if simultaneous plasma and serum samples can be ordered, pseudohyperkalemia can easily be ruled in or out.

    Should this be a true hyperkalemia,low dose Kayexalate sodium polystyrene sulfonate — SPS is reasonable to try. They followed these patients for a mean 14 months; baseline potassium was 6. Some did experience nausea but this subsided with continued use. It is best to use the sorbitol-free product 19 , which is powder. Hyperkalaemia associated with hydroxyurea in a patient with polycythaemia vera. Eur J Clin Pharmacol.

    MedEffect Adverse Drug reaction database 4. UTD - Tumor lysis syndrome: Definition, pathogenesis, clinical manifestations, etiology and risk factors 5. UTD - Prognosis and treatment of essential thrombocythemia 6.

    Renal complications in oncohematologic patients. J Invest Med ; 57 8: UTD - Treatment and prevention of hyperkalemia in adults Clinical utility of patiromer, sodium zirconium cyclosilicate, and sodium polystyrene sulfonate for the treatment of hyperkalemia: Pseudohyperkalemia in patients with increased cellular components of blood. Am J Med Sci. When is a high potassium not a high potassium? J R Soc Med. Pseudohyperkalemia occurring in a patient with chronic renal failure and polycythemia vera without severe leukocytosis or thrombocytosis.

    The tip of the iceberg. Am J Case Rep. Epub Jun Secondary prevention of hyperkalemia with sodium polystyrene sulfonate in cardiac and kidney patients on renin-angiotensin-aldosterone system inhibition therapy.

    Epub Nov 6. That said, if she has some 0. Geri RxFiles, pg 2. The threshold dose of prednisone considered sufficient to interfere with immune response such that Zostavax should not be given or prednisone started after Zostavax is 20 mg once daily.

    The only information available is from an abstract in which ampicillin rectal suppository was compared to amoxicillin suspension administered rectally. There was less perianal irritation in the amoxicillin group 5. J Int Med Res. Clinical evaluation of rectally administered ampicillin in acute otitis media.

    There is no need to discontinue breastfeeding if using topical fluorouracil on small areas. Hale - Medications and Mothers' Milk. No drug interactions between evolocumab and adalimumab were identified. However, given the total amount of endogenous IgG of 50— g, the usual dose of most mAbs of The possibility of additive immunosupppression was considered; however while adalimumab does cause immunosuppression, 4 the target of evolocumab, PCSK9, is not involved in the immune system and there is no indication evolocumab affects the immune system.

    ECPS - Humira 5. Epub Jul Pharmacokinetics interactions of monoclonal antibodies. The Risperdal Consta Kit should be stored under refrigeration, however, if there is no refrigeration available, it can be stored at room temperature References: Risperdal Consta Drug Product Monograph.

    The hairline, neck, temples, and forehead may be infested in infants and geriatric patients. In these populations, permethrin should also be applied to the scalp and face, sparing the eyes and mouth.

    UpToDate, treatment of scabies. Rare cases of hypertrichosis have been associated with topically applied minoxidil. The laboratory investigation excluded hyperandrogenism and thyroid dysfunction. Topical minoxidil should be used with caution in children.

    Hypertrichosis is a common side effect of topical minoxidil treatment in women. Although usually localized to the face, it may occasionally involve limbs and other body areas. Systemic absorption of the drug is typically minimal with topical therapy, with 1. However, hypotheses on the pathogenesis of the diffuse hypertrichosis reaction routinely include systemic absorption, as well as high sensitivity of the follicular apparatus to minoxidil.

    These effects included sinus tachycardia, sensation of palpitation and dizziness. The efficacy of topical minoxidil in alopecia areata has never been definitively proven. The possibility of systemic absorption contraindicates, in some reasearchers opinion, this treatment in young children, who can develop serious cutaneous or systemic side effects. Infantile generalized hypertrichosis caused by topical minoxidil.

    Minoxidil induced hypertrichosis in a 2 year-old child. Rabeprazole is enteric coated because it is unstable in acidic media and undergoes pH-dependent decomposition especially rapidly below pH ; therefore it should not be crushed. DPD - apo-rabeprazole monograph 2. There are no drug interactions or contraindications for getting zostavax after having the prolia injection. Unlike other live vaccines, because HZ vaccine is not used for eliciting a primary immune response, it is reasonable to consider HZ vaccine in people receiving low dose immunosuppressive therapy.

    Prolia is used with caution in patients with impaired immune systems or using concomitant immunosuppressive therapy; may be at increased risk for serious infections. Olopatadine comes in a nasal spray called Patanase 0. It is used for seasonal allergic rhinitis at 2 sprays in each nostril twice daily. Has patient tried taking iron with a meal to decrease GI side effects? IM generally not recommended as it is painful, stains the buttocks, and has variable absorption and case reports of sarcoma 1 IV Dexiron is the cheapest and most convenient form of IV Iron.

    Dexiron and Venofer not available for another couple of weeks. Dexiron and the other option Venofer are not available from the manufacturer for at least a few weeks. Escitalopram is predicted to increase the exposure to nortriptyline. The serotonin syndrome has, rarely, been seen in patients given SSRIs with tricyclics.

    Nortriptyline has been associated with QT prolongation or torsade de pointes mainly in overdose but an effect is not established, whereas escitalopram has some risk of prolonging the QT interval. Some consider that concurrent use might increase the risk. Since both citalopram and escitalopram are thought to be among the SSRIs least likely to alter the metabolism of other drugs, escitalopram is likely the best choice among the SSRI's to use with someone also taking nortriptyline.

    Monitor concurrent use for tricyclic toxicity dry mouth, sedation, confusion , and adjust the dose if necessary. Some suggest a small initial SSRI dose. Increasing age, female sex, cardiac disease, and some metabolic disturbances notably hypokalaemia predispose to QT prolongation: Escitalopram and citalopram are considered weak inhibitors of CYP2D6. The tablets are film-coated 1 and immediate release. Phone communication with AST medical information, question originally emailed to: Morphine IR can be crushed 2.

    ISMP do not crush 3. Manufactuer call to Purdue Pharma. For low-dose aspirin, there are not any specific recommendations for monitoring, beyond what a patient would already have done. Diabetics, also on diuretics , other NSAIDs -- these populations likely already have renal function testing done, so low dose ASA would not impact this. If a person has no risk factors for compromised renal function, then extra testing would not be necessary based on just being on ASA 81mg.

    Monograph for ASA 81mg 2. One resource that has fairly comprehensive list of metabolites is drugbank. Florinef is known to be stable up to 30 days at room temperature. Phone communication with Julia, Paladin Labs, 07 Apr Furosemide is available as an oral solution. Clearly it has a slower onset of effect minutes for diuresis compared to 5 minutes for IV.

    Ethacrynic acid is a loop diuretic available as injectable DIN It has a higher risk of ototoxicity than other loops and should be avoided in those with CrCl Unfortunately, the ethacrynic acid is the only other IV diuretic available in Canada. Ottawa Hospital Parenteral drug Manual 5. A placebo double-blind pilot study of dextromethorphan for problematic behaviors in children with autism.

    An update on its utility for neurological and neuropsychiatric disorders. Spiriva, salbutamol, statin, Lantus, metformin, amlodipine clarithromycin mg BID x 7 days, 10 days ago with prednisone not sure if hospitalized Response: If it is strongly felt the etiology is bacterial, amoxicillin-clavulanate is a better choice in this complicated patient. Herath SC, Poole P.

    Prophylactic antibiotic therapy for chronic obstructive pulmonary disease COPD. Cochrane Database of Systematic Reviews , Issue Surgeon wants to know what can use for breakthrough?

    Monograph - Plus - CIs - alkalosis, where disteneion may be due to partial or complete gastric obstruction. While it is not stated in monographs, it would seem the reason for the contraindication of antacids in patients with intestinal obstruction may be due to risk of bezoar formation, which has been reported in earlier literature. Possibly bezoar formation can be monitored during dilatations. Small bowel obstruction caused by a medication bezoar: Intestinal obstruction from medication bezoars.

    Small bowel obstruction from an antacid bezoar: The reason for enteric coated ASA is to reduce dyspepsia. When taken during a suspected MI, it is preferred to chew ASA for faster absorption; certainly chewables are easier to chew and taste better. The next best option in this case would be a regular tablet though enteric coated can be used if it's all that's available - it may be more difficult to chew.

    The risk of GI bleed is a systemic effect of ASA and is not reduced by use of enteric coated products. As stated above, enteric coated products serve to reduce dyspepsia, but not reduce GI bleeding. Canadian Pharmacist's Letter; November ; Vol: Lantus Insupen Needles 32G 4mm Response: The resounding consensus is needle length has no effect. I have outlined some strategies to manage and information that I gathered from these references. There is conflicting information about what angle to hold the pen, but there are several other suggestions.

    Strategies to reduce leakage - Leave pen in for 10 seconds to prevent leakage 1,2 - After removing needle, place finger on site for seconds 1 - Always remove the needle from the pen after injection ; leaving the needles attached can cause air to enter the cartridge and it will take longer to inject the insulin 1 or affect the dose 2 - Try injecting at degree angle rather than 90 1 o however, another says: Everything you wanted to know about injecting insulin.

    Post CVA several years lives at home. Had significant urinary retention post stroke and now continent on tamsulosin. Booked for cataract extraction and was told to be off it for a month. In the case of a patient established on tamsulosin therapy and requiring cataract surgery, mitigating factors lie largely with the surgeon.

    Switching to a less selective alpha-antagonist would seemingly be a good compromise of risk reduction and maintenance of control of lower urinary tract symptoms LUTS ; however, there is no evidence to support this strategy. Other drugs used for LUTS include other alpha-1 blockers, 5-alpha-reductase inhibitors, antimuscarinics in combination with alpha-1 blockers and tadalafil.

    The effects of tamsulosin on the iris have been reported to occur even several years after discontinuation,2, likely because some of the effects are irreversible. However, it needs to be mentioned the estimate of the hazard ratio of tamsulosin compared to other alpha blockers has been wide from study to study which could be because in most studies either the tamsulosin cohort was significantly larger than the others or the cohort in general was small.

    Unfortunately, the only research to address this is a small case series published in abstract only. I realize this leaves you in a difficult position. There is also a good chance his use of tamsulosin will complicate the surgery.

    The research to date suggests likely not on both of these last points, but it is too limited to make conclusions. Hopefully with this information you, your patient and the surgeon can reach a best-fit solution. Ferri's Clinical Advisor , Know the Risks, Avoid the Complications. Prospective masked comparison of intraoperative floppy iris syndrome severity with tamsulosin versus alfuzosin.

    Epub Dec 4. Expert Opin Drug Saf. Intraoperative floppy iris syndrome IFIS: How to avoide intraoperative floppy iris syndrome. Intraoperative floppy iris syndrome associated with tamsulosin. J Cataract Refract Surg ; Intraoperative floppy-iris syndrome associated with alpha1-adrenoreceptors: J Cataract Refract Surg. Jan Teper S, Dobrowolski D, et al. Complications of cataract surgery in patients with BPH treated with alpha 1A-blockers. Cent European J Urol.

    Can switching tamsulosin to alfuzosin prevent intra-operative floppy iris syndrome in patients with benign prostate hypertrophy? Product monograph from DPD. It is possible the nystatin was not used optimally. Nystatin should be used for days 1,3,6 until 2 days after the infection has cleared.

    If the mother does not have symptoms, there is no need to switch from the suspension. Dynamed - Oral candidiasis in infants 4. Canadian Pharmacist's Letter ; 32 SickKids drug handbook 6. Bugs and Drugs 7. BNF for children CHF, AF, aortic valve stenosis. EF and NYHF class not available Never smoked, lived healthy all his life, ran until his hip replacement and then biked well into his 70's. Because of the presence of AF in your patient, ivabradine is not an option. However, some other tweaks can be made before considering Entresto: Diltiazem worsens exercise tolerance 4,5,7 and therefore should be discontinued.

    The dose of ramipril is not optimal. Perhaps his dose has been limited by side effects such as hyperkalemia but this should be investigated. The dose of bisoprolol is not optimal. As such, concentrate on optimizing ramipril first. If after this his symptoms still persist, consider adding Entresto. The plasma B-type natriuretic peptide level will need to be investigated. Also the NHYA class will need to be confirmed.

    One note with Entresto is it caused more symptomatic hypotension than the comparator enalapril in the trials. Clinical Resource, New Drug: Euro-K 20 would be expected to act similarly as K-Dur as K-Dur is the brand reference 2 ; however, none of the potassium chloride products are interchangeable.

    The underlying premise of the article is that inhibiting synapse formation is harmful. In other words, synapses are being formed uncontrollably or at least aberrantly , causing disease. So, while the animal studies indicate pregabalin and gabapentin do inhibit synaptogenesis, in this sense they are controlling chaos as opposed to interfering with normal development.

    As such, I make no claims that gabapentinoids do not or cannot cause long-term negative effects on neuropsychiatric development. All drugs carry risks and these risks are amplified in the pediatric population due to their intense state of development of all facets as well as the dearth of medical studies conducted in them.

    It always comes down to risk vs. This study by no means proves gabapentinoids are harmful to the neurodevelopment of a child or adolescent. For this reason the usual tenets of drug use apply: Jasper's Basic Mechanisms of the Epilepsies [Internet].

    Adolescent intermittent alcohol exposure: Alcohol Clin Exp Res. Featuring triple-quartz rods in a ceramic chamber, this vape pen comes in a leak-proof base and is handmade in the USA. Charge through a micro-USB and receive an applicator tool and silicone container as a little lagniappe.

    The only hemp herbal wrap, sourced from European hemp, High Hemp Wraps provide a clean experience void of harmful ingredients commonly used in other wraps. Combining the steady burn of a tobacco wrap with the smooth taste of hemp rolling paper, these gems are certified organic, free of tobacco, and non-GMO. They not only offer the highest purity but have tested positive for low dosages of CBD.

    These wraps are truly one of a kind. This is the first Pax model capable of being a dual-use vaporizer, which means it accepts both herbals and concentrates.

    Pax 3 looks and feels much smaller and sleeker than the Pax 2 and comes in four colors: Inside the box is a card that urges you to download the app on your smartphone and register your device for a year warranty.

    This is our personal favorite feature, aside from the concentrate chamber. It is capable of working on smart watches, making it easy to change your temperature and set it up on the go. Pax 3 has also bumped up the battery, meaning it heats up quickly seconds and outlasts its predecessor. It uses lip-sensing technology and an internal accelerometer, so it will be idle if left on while not being used, a convenient feature for those looking to conserve their materials. The Pax 3 has four pre-set heating temperatures, but we encourage users to download the smartphone app to set the actual temperature in degrees.

    The app also unlocks four other heat settings: The cleaning set and magnetic charger remain unchanged from the Pax 2. Donuts is available at Mushroom New Orleans. This oil and wax-only pen will bubble your wax rather than burn it thanks to SloBurn technology and comes with a sturdy carrying case, USB charger, and dab tool. The Gravity is available at Mushroom New Orleans.

    The Gravity is a well-crafted wax pen vaporizer sporting a sleek design and advanced quartz crystal and coilless ceramic atomizers. This model has a temp-controlled battery that comes with a lifetime warranty and is available in Sandblasted Black, Satin Rubber Black, or Glossy Black finish.

    The Gravity comes with a USB charger, alcohol cleaning wipes, travel case, and dab tool. A noticeable upgrade from the first edition, the new Kiln RA Heating Attachment adds state-of-the-art rebuildable atomizers, making this new model user-friendly and easy to maintain. Its ceramic chamber is deeper and able to hold an impressive amount of product, which is a common request heard from vapers.

    The Kiln RA is versatile and comes with an advanced dual post system, which makes swapping out ceramic coils easier and faster. As you might have guessed by the name, this kit swaps out the menthol flavor for the more traditional tobacco.

    The Juno Menthol Kit comes with three disposable e-liquid pods in menthol, fruit, and dessert. This is a great product for first-time vapers. The Greedy Sub OHM is compatible with most box mods and batteries and comes with adjustable airflow and a special mouthpiece to prevent splash. This heavy-duty heating attachment is made of stainless steel and employs a stainless steel and quartz rod heating chamber. The Greedy can hold quite the amount of wax consistency products, producing one power-punch of a vapor and enjoyable flavor.

    Cloud Pens was very popular in the wake of the wax pen explosion that has happened in the past few years. This unit takes the cake for anything the company has done yet. The Paragon comes with two quartz coil, and there is also an herbal attachment available if you want to swap out. It has plenty of airflow options, 3-heat settings, and charges through a micro USB port.

    KandyPens is a popular, high-quality brand responsible for units like the Galaxy, Gravity, Donuts, and Ice Cream Man, all of which come in a variety of colors and an array of coils. Their newest unit is the MiNi, a more compact unit that comes with multiple coils. The battery is a sub-ohm style and the top reminds us of the Atmos-branded Kiln.

    It takes a micro USB charger and the battery has a lifetime warranty. This unit comes with a dabber tool and charging cable. This is a battery specifically for pre-filled standard-sized cartridges. A threaded magnetic adapter screws on to the end of the tank, connecting it to the heating element at the bottom of the tank port.

    The design allows for easy to cartridge swapping or refilling. We find that HoneyStick The BeeKeeper works much better than regular batteries, or pull and draw pens. It comes with an empty cartridge, adapter, and micro USB charger. Those who use cartridges regularly would benefit from this unit.

    The top piece is triple quartz coils wrapped in grade 2 titanium, put into a pure quartz chamber, which means it will heat quickly and evenly for a fantastic taste. The bottom is a basic tiny box battery with a single button and takes a micro USB charger. It runs on a 0. Pulsar offers a one-year warranty along with a small wax container, charger, and steel dabber. Instead of a traditional firing button, this unit uses a firing bar which we find to be more comfortable.

    The LED display shows voltage, wattage, amps, ohms, and battery life. The unit also allows for adjusting what material your coil is made of. The tank holds 3mL of juice at a time and has a top-fill latch, allowing it to slide off but stay connected. The Baby Beast coils are larger than normal so it can generally take more wattage running depending on the ohms, of course. The Alien kit is one of the best on the market right now for beginners, those wishing to upgrade, or even the advanced vaper.

    Measuring four inches in length, it is made of high-quality aluminum and contains a draw-activated mechanism, meaning there is no button to press. The larger size of the MY. Each Liquidpod contains 1. It is charged through a micro USB port located on the bottom of the stick. We find that the MY. We also recommend this unit to first-time e-cig users because of how easy they are! We enjoyed being able to see how much smoke we were getting those vape pens can surprise you!

    The coil atomizer is a single ceramic rod with a ceramic dish underneath. The inside of the atomizer is actually ceramic, allowing you to pack it pretty full and still get an even heat. The R Series Vape Pen comes with a tool, silicone jar, cleaning wipes, and an extra coil. The first PuffCo won many awards upon its release in , and the company does not disappoint with their latest edition.

    It comes with a charger and extra atomizer. The threading on the PuffCo Plus is pretty neat. Instead of a full thread, it has a quarter-turn release, eliminating endless unscrewing, similar to how Cali Crusher grinders are set up.

    Dabber is a fantastic company known for its innovative designs. Aurora is the perfect example, as one of the best new concentrate wax pens to come to the market. A notable difference in this pen is the thread-less magnetic connections, so you no longer have to screw on the coil, the mouthpiece, etc.

    The Aurora comes with 3 different coils: Each coil is wrapped in Titanium Grade 2, and each chamber is lined with titanium and quartz for maximum heat. This model has large chambers compared to most vape pens, similar to KandyPens, and produces maximum flavor.

    Comes with a basic charger and small slick. The iCare Mini is one of our favorite vapes, nearly convincing us to ditch our RX with a Herakles tank. The iCare Mini comes in five colors: With a portable magnetic charger as well as a standard USB charging port, this is a vape for someone on the go.

    The unit is smaller than any of our other box units and fits nicely in your hand. At around three inches tall and less than half an inch wide, it holds a little over 1ml of liquid and maxes out at 15 watts. To fill, pop off the lid and unscrew the metal piece inside. It pulls out so you can attach your small coil to the bottom. Fill your liquid only up to that max line, as the stick connected to the coil pushes the liquid down and overfilling will cause leakage.

    The iCare Mini provides a pleasant hit and can produce a good bit of vapor for only 15 watts. We highly recommend it to any vapor user, whether you are just starting out and want an easy-to-use compact unit, or are just tired of carrying around the larger variety.

    With all the e-juice you will be saving by using a low-wattage unit, the iCare Mini is a really affordable starter kit. The JUUL is a portable nicotine vaporizer, and with its ease of use, is perfect for beginners. The starter set comes with a compact battery unit, charger, and four flavored pods: This is a pull-and-draw model that can sense when you are taking a drag, so there is no button as found on other units. We found the flavors to be a little lackluster but packing a punch with nicotine.

    If you want something similar but with a higher-quality e-juice, we suggest another starter kit, the iCare Mini by Eleaf. Available in-store at Mushroom New Orleans. Pax 3 looks and feels much smaller and sleeker than the full kit comes in four matte finishes silver, black, teal, and rose gold and four glossy finishes black, gold, silver, rose gold. The full kit tacks on a concentrate insert, half pack of oven lids, a multi-tool, and three screens.

    This lightweight yet durable turntable is housed in a fashionable suitcase of leatherette material, and could very well replace your beloved ipod as your go-to music-sharing medium. Get a piece of beautifully-crafted mobility for yourself. The Keepsake also comes with ripping capabilities, allowing you to connect your computer to the unit and preserve your old recordings. This 3-speed model attracts minimalists and tech-lovers alike. It has a fully automatic return tone arm, built-in speakers and diamond stylus needle.

    Simple, sweet and highly recommended. Similar to the Director sans the recording functionality, the Lancaster boasts sophisticated old school grillwork yet still allows for plugging in a portable music player. Targeting your inner director, this Crosley record player provides you with all the options you crave to be the boss of your living room entertainment hub.

    Forget about simply hearing vinyl, this modern unit supports old and new. Preserve all your oldies by recording them onto CDs. Our staff can vouch for this superb grinder. With a 4-piece setup, amazing quality and durable materials, the grind is flawless. The Santa Cruz Shredder comes in many colors, regular or matte. It has quad side blades, which make it super easy to grind. We find that you can pack your materials all the way to the brim and it is still completely ground in twists.

    The inside is coated with a non-stick lining, which will eventually wear down ours started after 8 months of usage. The dish the herbals fall through varies in size of course, but proves sufficient.

    The holes in the screen are a bit too large for some folks but lets you collect an ample amount of pollen easily. There is even a secret slit between the screen and metal casing of the grinder that allows any pollen that is stuck in those corners to fall through to the bottom dish.

    Very similar to the Santa Cruz Shredder, the Cosmic Case is made with heavy materials and boasts a sleek design. It comes in tons of colors, but the most popular are rasta and silver. Like the Santa Cruz, the Cosmic has quad side blades, a non-stick coating on the inside, and the top part of the grinder has a strong magnet in case it gets knocked around a bit.

    The Cosmic possesses a finer screen; however, and you can still pack this thing to the brim and grind it easily. The Cali Crusher is a very different kind of grinder. Made from the highest-quality aluminum out there, the inside is also coated with a non-stick layer. The bottom half has standard grinder holes and more oddly-curved blades. The screen has a screw right in the middle of it which is handy for always keeping your grinder nice and clean, and also getting every last bit of pollen.

    The curved pollen dish is massive, perfect for scooping out of. Definitely worth checking out if you want something different and unique that still showcases craftsmanship. The casing of the unit is durable and can take a beating. The digital display allows you to heat the electronic nail to specific temperatures and can be programmed for preset temperatures.

    One new feature is the V outlet built into the back of the unit which can be used with other electronic accessories. Comes with a 2-year warranty. Available in painted aluminum enclosure. While the analog controller does not possess as high a degree of precision as featured in their digital units, the controller has been calibrated and labeled, allowing you to dial into a range that works best for your nail and essential oil.

    This is not a cheap Chinese-made electronic nail. It performs well and holds up to wear and tear. I highly recommend this unit for anyone on a budget looking for a quality electronic nail. The D-NAIL version 2 uses the same XLR heaters as their digital units, so compatibility is never an issue if you later decide to purchase a higher-tier model. The Analog Controller is covered by a 1-year warranty. Made out of Schott German Borosilicate, you can feel the difference just by holding it.

    All Sheldon Blacks are handblown in the United States and showcase extremely clean ground joints and curves. Each piece displays a unique artistic design on its chamber amid its signature cursive logo. Sheldon has set high standards in the commercialized glass industry with its sleek look, fair price, and incredible glass quality.

    They even have little top hat bowls! Based out of California, and with a remarkable selection of pipes and vaporizers, Medicali uses strictly Schott German Borosilicate glass. They blow everything by hand rather than mass produce and take pride in creating well-crafted pieces for new and experienced smokers. The brand makes it all, from basic beakers and a new upside down beaker and oil rigs to accessories like the revolving bowl and vaporizers for both herbal and wax.

    Each piece comes in a different color scheme, with a different version of the logo on the front and down stem where applicable. This company really is one of our favorites. Famous for their geyser perc down stem and screened bowl, HiSi is purely scientific glass and does not use any color. Their pipes are tested and re-tested, ensuring top-grade water filtration. With a limited but designer-level selection, the clean look and periodic table logo are recognizable signatures of the brand that takes smoking seriously.

    The Wismec Reuleaux RX is a great quality unit with a unique design. It tops out at watts and fits great in your hand. The unit is shaped almost hexagon-like and runs on a triple set of batteries.

    It has vents on the bottom to prevent overheating the batteries, and usually lasts around hours, depending on usage. Super cool box mod that features a touch screen rather than a basic LED, and tops out at watts. The Sigelei T operates on dual batteries and needs an external battery charger. The touchscreen works nicely, and takes up the entire side of the vape, allowing you to easily change the wattage, voltage, settings and temperature control.

    The battery door to get to the dual s is magnetic yet still easy to get off. The connection for tanks has innovative airflow channels, making this a quality unit with stellar design. The Sigelei T is more advanced so we recommend becoming more experienced before graduating to this unit.

    A relatively large box unit, the Sigelei Fuchai tops out at watts. It has temperature control and runs on two batteries. The shape is a literal box, and it comes in a few select colors. One great feature is the ability to switch from nickel to titanium coils, through temperature control. You need an external battery charger for this unit, so we recommend buying a few extras for emergencies. A well-made product for the serious vaper who wants large clouds. This is the strongest IPV mod to date, topping out at watts.

    It has a nice grip on the sides and still fits in your hand comfortably. Methadone may also cause QT prolongation but is an uncommon cause of Torsades Des Pointes, the potentially fatal arrhythmia that can result from QT prolongation. Suboxone can also cause hypotension, including orthostatic hypotension, and should be used with caution in patients with established cardiovascular disease e. However, I am unaware of any unique cardiovascular side effects associated with suboxone use.

    Does smoking have effects on the heart? Smoking is an extremely strong and independent risk factor for heart disease, stroke, and peripheral artery disease. Smoking increases the risk of these conditions in a dose dependent fashion, and no amount of smoking is safe. People who smoke less than five cigarettes per day are at increased risk for myocardial infarction relative to non-smokers.

    The incidence of myocardial infarction among men and women who have smoked at least twenty cigarettes per day for any period of time is three fold and six fold higher, respectively, than the incidence of myocardial infarction in never smokers. More generally, smoking increases the risk of coronary artery disease, heart attack, arterial aneurysms, aortic dissection, blood clots, carotid artery stenosis, upper and lower extremity ischemic claudication, and death.

    Smoking is associated with insulin resistance and oxidization of low-density lipoprotein LDL-c, or bad cholesterol.

    Oxidization of LDL-c makes it more proatherogenic. Smoking also activates the sympathetic nervous system which increases heart rate and blood pressure and leads to peripheral vasoconstriction. Moreover, smoking increases inflammation, which activates platelets and creates a prothrombotic milieu. Furthermore, smoking damages blood vessel walls, rendering them less elastic and promoting premature arterial stiffening; in addition, smoking promotes endothelial dysfunction, which impairs the ability of coronary arteries to vasodilate.

    The risks of cardiovascular, cerebrovascular, and peripheral artery disease and associated events decrease significantly and relatively rapidly with smoking cessation. What about cannabis addicts or chronic smokers and the cardiologist? While we know relatively less about the effects of marijuana on the cardiovascular system, there is significant and growing interest in understanding how marijuana use impacts heart and blood vessel function.

    We do know that smoking marijuana leads to an acute, four- to five-fold increase in the risk of myocardial infarction in young men. This risk persists for approximately 60 minutes following inhalation.

    Daily cannabis use is associated with a 1. There is some evidence that the mechanism underlying this increased risk is a higher likelihood of experiencing coronary artery vasospasm as opposed to accelerated atherogenesis. The physiologic effects of marijuana may surprise some people. Marijuana intoxication typically leads to a slowing of the reflexes, and the appearance of a relaxed state. However, marijuana use actually stimulates the sympathetic nervous system, which leads to tachycardia, the release of systemic catecholamines, and increased myocardial oxygen demand.

    At the same time, marijuana use increases supine systolic and diastolic blood pressure, and increases the likelihood of experiencing orthostatic hypotension. There is also some evidence that marijuana use activates platelets by modulating the endocannabinoid system. Longitudinal prospective studies of cannabis users have failed to reveal evidence that chronic cannabis use leads to significant alterations body mass index, blood pressure, total cholesterol, high density lipoprotein, triglycerides, or blood glucose levels.

    There is no consistent evidence that marijuana use increases cardiovascular mortality. We know relatively little about whether the mode of use i. Ketamine is being used off label for depression. What are the cardiovascular risks and concern when this is done?

    This is an extremely interesting question. Ketamine is a sympathomimetic. Ketamine does consistently produce tachycardia and this simple fact should lead us to be cautious about using it to treat depression in patients with obstructive coronary artery disease or congestive heart failure. The cardiovascular effects of Ketamine remain incompletely characterized, and the prospect of widespread use to treat chronic illnesses like depression heightens the need to more clearly elucidate how Ketamine effects the cardiovascular system.

    Withdrawal from opioids is associated with hypertension and tachycardia. Is this a concern? Yes—the hypertension and tachycardia which occur during opioid withdrawal can undoubtedly stress the cardiovascular system. Patients with a history of coronary artery disease particularly those with a history of angina , patients with congestive heart failure, and those with aortic aneurysms should be monitored closely during the withdrawal period for new or worsening cardiovascular symptoms. Are any drug withdrawal syndromes a concern to a cardiologist?

    In general, most withdrawal syndromes result in some degree of heightened sympathetic tone, which can produce hypertension and tachycardia.

    In patients with serious chronic cardiovascular illness, including coronary artery disease, congestive heart failure, valvular disease i. So, and this is a key point, it is the patient substrate which matters more than the specific withdrawal syndrome. Put another way, if the patient has significant cardiovascular comorbidities, any withdrawal syndrome may be dangerous. In general, I worry most about alcohol withdrawal for a few reasons. First, alcoholics regularly live with multiple comorbidities, including cardiovascular comorbidities like atrial fibrillation and heart failure which may be due to an alcoholic cardiomyopathy.

    I have seen alcohol withdrawal precipitate new or recurrent atrial fibrillation, and lead to acute heart failure decompensations in patients with underlying alcoholic cardiomyopathies. Second, alcohol withdrawal is by far the most mortal withdrawal syndrome; seizures due to withdrawal, or delirium tremens, carry a significant risk of mortality in patients without underlying cardiovascular illness, and may be even more dangerous in patients who are suffering from concomitant cardiovascular disease.

    Third, many alcoholics are poorly nourished, and have significant electrolyte disturbances, including hypokalemia which is a risk factor for ventricular arrhythmias. The wasting of magnesium that occurs in alcoholics is particularly concerning, because potassium repletion is ineffective in the absence of adequate serum magnesium levels.

    Thus, when checking basic electrolytes in an alcoholic e. Which patients should an addiction rehab send to a cardiologist for evaluation? This is a difficult question to answer with high specificity.

    In addition, anyone with a syncopal event without a prodrome i. Patients with chronic, stable cardiovascular comorbidities, including coronary artery disease with or without angina , congestive heart failure, peripheral artery disease with or without claudication , valvular disease i. However, a rehab should generally have a low threshold to engage a cardiologist in the management of any patient with complex, chronic cardiovascular disease.

    What are the CVD effects of alcohol use, abuse, and addiction? Alcohol users have a variety of CV effects including noticing that their heart skips a beat or so…is this related to alcohol abusers or alcoholics heart blocks? Modest alcohol consumption—two or fewer drinks per night for a man, and one drink per night for a woman— has been shown to be healthy, and may even reduce all-cause mortality and mortality due to cardiovascular disease. However, when consumed in greater quantities, alcohol is a cardiotoxin.

    People who abuse or are dependent on alcohol have a heightened risk of arrhythmias—including atrial fibrillation, atrial flutter, and ventricular arrhythmias due to electrolyte abnormalities or an alcoholic cardiomyopathy —and alcoholic cardiomyopathy. Importantly, alcoholic cardiomyopathy is usually not this fulminant. Many daily drinkers may suffer from very mild, and even subclinical, forms of this cardiomyopathy, and their LVEF may be normal.

    The electrolyte abnormalities commonly found in alcoholics—most notably hypomagnesemia and hypokalemia— further compound the risk for these arrhythmias. Alcoholic cardiomyopathy may at times reach a point of irreversibility, of course, but, broadly speaking, it has a very favorable prognosis if long term abstinence can be achieved.

    As the legalization of marijuana continues to spread among various states within the U. Since marijuana can be consumed through a variety of methods—e. With that in mind, a recent study from investigators at Portland State University found benzene and other potentially cancer-causing chemicals in the vapor produced by butane hash oil, a cannabis extract. Dabbing is already controversial. The practice consists of placing a small amount of cannabis extract a dab on a heated surface and inhaling the resulting vapor.

    The practice has raised concerns because it produces extremely elevated levels of cannabinoids—the active ingredients in marijuana. Strongin and his colleagues analyzed the chemical profile of terpenes—the fragrant oils in marijuana and other plants—by vaporizing them in much the same way as a user would vaporize hash oil.

    Methacrolein, benzene, and several other products of concern to human health were formed under the conditions that simulated real-world dabbing. The terpene degradation products observed are consistent with those reported in the atmospheric chemistry literature. Many of the terpenes that the researchers discovered in the vaporized hash oil are also used in e-cigarette liquids.

    Moreover, previous experiments by Dr. Strongin and his colleagues found similar toxic chemicals in e-cigarette vapor when the devices were used at high-temperature settings. The dabbing experiments in the current study produced benzene—a known carcinogen—at levels many times higher than the ambient air, the researchers noted. It also produced high levels of methacrolein, a chemical similar to acrolein, another carcinogen. Additionally, the heavy focus on terpenes as additives seen as of late in the cannabis industry is of great concern due to the oxidative liability of these compounds when heated.

    This research also has significant implications for flavored e-cigarette products due to the extensive use of terpenes as flavorings.

    Smoking cannabis or taking medication based on the drug can harm the brain and damage memory, research has found. Brain scans confirmed the finding, and showed cannabis can stop vital memory-controlling regions of the organ communicating with each other. Experts fear both recreational users and those who rely on it to combat their health conditions may be at risk of memory problems. The study comes after Government advisers yesterday declared doctors should be able to prescribe medicinal cannabis, which contains the potentially harmful cannabinoids.

    For years scientists have warned smoking cannabis can lead to mental health problems, such as schizophrenia. Studies have shown cannabis can also shrink memory-related structures in the brain, most notably the hippocampus.

    But there is little understanding of the potential negative side effects of cannabinoids, such as CBD. The new experiment, led by scientists at the universities of Lancaster and Lisbon, shines a light on the dangers. They studied the effects of cannabinoid drug WIN 55, in mice. It is similar to THC, the compound that causes a high in cannabis. Researchers discovered long-term exposure to the cannabinoid impaired the learning ability and memory of mice. Rodents who had been exposed to the drug could not even distinguish between a familiar and novel object.

    Brain scans backed up the initial finding — and showed the drug affected the healthy function of brain regions involved in learning and memory. It was discovered that the cannabinoid stopped the hippocampus and prefrontal cortex from communicating with each other. The findings were published in the Journal of Neurochemistry. The use of medicinal cannabis has been increasing worldwide over the past decade.

    It is currently not legal medicinally in the UK. Evidence published in respected journals shows the drug can help to combat epilepsy, multiple sclerosis and chronic pain.

    And in recent years, Spain, South Africa, Uruguay and several states in the US have even made cannabis legal for recreational use. Together, they are part of the cannabinoid group of compounds found in hashish, hash oil, and most strains of marijuana. THC interacts with CB1 receptors in the central nervous system and brain and creates the sensations of euphoria and anxiety. CBD does not fit these receptors well, and actually decreases the effects of THC, and is not psychoactive.

    CBD is thought to help reduce anxiety and inflammation. We provide a systematic review and meta-analysis on the efficacy, tolerability, and safety of cannabinoids in palliative medicine. Of the screened studies, nine studies with a total of participants were included. Overall, the nine studies were at moderate risk of bias. The quality of evidence comparing cannabinoids with placebo was rated according to Grading of Recommendations Assessment, Development, and Evaluation as low or very low because of indirectness, imprecision, and potential reporting bias.

    In cancer patients, there were no significant differences between cannabinoids and placebo for improving caloric intake standardized mean differences [SMD]: Regarding side effects in cancer patients, there were no differences between cannabinoids and placebo in symptoms of dizziness RD: Tolerability measured by the number of withdrawals because of adverse events did not differ significantly in cancer RD: Safety did not differ in cancer RD: In another study comparing megestrol to dronabinol in HIV patients, megestrol treatment led to higher weight gain without any differences in tolerability and safety.

    We found no convincing, unbiased, high quality evidence suggesting that cannabinoids are of value for anorexia or cachexia in cancer or HIV patients. I have Type 1 diabetes and have used marijuana for years to control my blood sugar. Marijuana, or cannabis, contains more than active chemical compounds. Known as cannabinoids, each behaves differently in the body. As the number of states that allow the use of cannabis for medical purposes continues to grow, so does the body of evidence that many of the compounds found within the plant have therapeutic potential.

    The challenge to investigate medical claims regarding cannabis is that it remains illegal at the federal level. Research is subject to numerous restrictions. Even so, various studies and clinical trials are moving forward. However, much of what we found is anecdotal evidence, which lacks scientific rigor. The study of cannabis and its potential effects on diabetes is in the early stages, which much of the work done in mice and on donated tissue samples.

    Until researchers are able to work extensively with human populations, the how and why of the effects of cannabis on the complex physiologic processes encompassed by diabetes will remain educated guesses.

    Some studies have found that cannabis can have a positive effect on insulin resistance. A study published in in a journal of the American Diabetes Association found that THCV, one of the cannabinoids that are not psychoactive, improved glycemic control in some individuals with Type 2 diabetes. Another study that same year drew a link between cannabidiol, a compound in cannabis, and a decrease in inflammation of the pancreas.

    The results of several other recent studies contradict a number of these pro-cannabis findings. So, basically, the jury is still out. Although cannabis shows promise in the area of diabetes, science has yet to catch up with the claims being made. In the research that has been done, the reason for the effects of cannabis is not yet fully understood.

    Interest in the subject is strong, though, and continues to grow. In , Colorado voters decriminalized marijuana for medical use; however, because marijuana use remained illegal under federal law, the number of users was low.

    In , President Obama instructed federal officials not to enforce marijuana laws that were in conflict with state laws, and the number of registered medical marijuana users in Colorado increased to 60, in compared with 2, in the prior 8 years. In , Colorado legalized recreational marijuana use. We expect that as other states liberalize marijuana laws, they will also experience an increase in marijuana-related ED visits.

    This article reviews several common marijuana-related ED cases that we have encountered in our practice. Total blue line and pediatric red line marijuana exposure calls received by the Rocky Mountain Poison and Drug Center from through How does this affect their immune status or ability to fight common infections?

    Smoking is a major risk factor for developing pneumonia. Those who smoke 20 or more cigarettes a day have three times the risk of developing pneumonia. Cigarette smoke damages the tracheal lining of the lungs, alters the consistency of the fluid that coats this lining, and destroys the cilia that move bacteria and other foreign substances out of the lung.

    When the fluid coating the tubes of the lung becomes thicker as a consequence of the inflammatory reaction to smoke, cilia can no longer transport this fluid, and the foreign particles, including bacteria, usually trapped by this fluid can no longer be transported out of the lungs.

    Damage to the cilia also interferes with this important protective mechanism. Alcohol and other sedating drugs interfere with the function of the epiglottis.

    This large flap of tissue covers the trachea to prevent saliva, food and liquids from entering the lungs. We have all accidently choked on water when our epiglottis malfunctions and water enters the lung. We quickly cough it out. When drugs lead to sedation our epiglottis is more likely to malfunction and food, saliva and bacteria from the mouth can more easily enter the lungs.

    Sedation also interferes with our cough reflex, and as a consequence, severe aspiration pneumonia can follow an overdose or an episode of heavy drinking. Malnutrition and the loss of these cells can depress the normal acute immune response to infection, and as a consequence, infections are often more severe and life threatening in alcoholics and patients who suffer drug abuse.

    The incidence of mononucleosis is not known to be higher. Influenza is more severe in addicts with depressed immune responses. Tuberculosis may have a higher incidence in addicts because their depressed immune function allows the organism to more readily spread in the lungs and throughout the body.

    What are some IDs associated with intravenous drug users? Another major risk for infection is the use of intravenous drugs. Too often the drugs being injected into the blood stream are contaminated with bacteria, particularly Staphylococcus aureus found on the skin and Pseudomonas found in tap water. These bacteria can infect the heart valves leading to endocarditis, a very serious and potentially fatal infection.

    Once bacteria enter the blood stream they can also lodge in small vessels of the bones, particularly the vertebral bodies or back bones resulting in bone infection or osteomyelitis. This infection is associated with chronic pain, fever and loss of energy. Osteomyelitis is very difficult to treat and requires six weeks of high dose intravenous antibiotics.

    Despite prolonged therapy, this infection often relapses resulting in years of pain and suffering. In addition to bacteria contaminating intravenous drug preparations, shared needles can transmit viruses — Hepatitis B, Hepatitis C, and HIV virus. Hepatitis B and Hepatitis C both can lead to severe liver inflammation that causes scaring of the liver called cirrhosis.

    Eventually the liver fails resulting in ascites filling of the abdominal cavity with fluid , dilatation and bleeding of the esophageal veins esophageal varices resulting in gastrointestinal bleeding, and difficulty detoxifying substances in the blood resulting in the loss of alertness and eventually coma called Hepatic encephalopathy.

    HIV is another dreaded and all too common complication of IV drug use. What would you evaluate all IV addicts for? They should also be screened for STDs. What vaccinations would you suggest for patients with substance use disorders? They should receive the influenza vaccine annually and the two pneumococcal vaccines.

    Also, if they are Hepatitis B antibody negative, they should receive the Hepatitis B vaccine. Can you explain Hepatitis C. Why do so many addicts and abusers have it? What can you do to prevent it? Hepatitis C is a virus that specifically infects the liver. This virus is transmitted by blood and blood products.

    Before the virus was recognized in the early s, it contaminated our blood supply. Risk factors associated with an increased risk of Hepatitis C include: Addicts who use intravenous drugs and share needles are at very high risk, because the virus is transmitted by needles contaminated with virally infected blood. Individuals infected with Hep C have very high numbers of viral particles in their blood, and when they share a needle with an uninfected person, that person is at high risk of inadvertently injecting those viral particles intotheir own blood stream and infecting their liver.

    The best way to prevent the spread of Hep C is to avoid IV drug use. Another alternative is to use a clean needle, and never share needles. The diagnosis can be readily made with a blood test that measures antibodies directed against the virus.

    This is a very sensitive and specific test and anyone who falls into the above risk groups should undergo testing because we now have excellent antiviral therapy for this infection. Treatment usually takes weeks of a single pill once per day. In more complicated cases, treatment may be continued for 24 weeks.

    Is there a new epidemic of STDs. Drug abuse is associated with increased sexual activity and the more sexual partners one has the greater the risk of STDs. The incidence of syphilis in the U. This is a particularly worrisome development because strains of gonorrhea are increasingly becoming drug resistant meaning that we are at risk of running out of antibiotic treatments for this infection in the future.

    Condoms prevent the spread of these diseases; and should always be used given the high risk of STDs among drug abusers. Public health workers try to identify contacts when a STD case is reported so that these contacts can be tested and treated to prevent the further spread of infection.

    All patients who have more than one sexual partner or who use illicit drugs should be screened for syphilis, gonorrhea, chlamydia, Hepatitis B and HIV, particularly sexually active women under 25, pregnant women, and men having sex with men. Gonorrhea and chlamydia are tested using vaginal and urethral opening of the penis swabs.

    These tests are all very sensitive and specific. Syphilis, gonorrhea and chlamydia are treated with antibiotics and can be cured. Hepatitis B, like Hepatitis C, can now be cured using antiviral agents, but at great expense. HIV requires lifelong treatment. Can you explain HIV? HIV stands for Human Immunodeficiency Virus and is caused by a retrovirus that is transmitted primarily through blood and through sexual contact as an STD.

    HIV is a lifelong infection that over time destroys immune cells and results in opportunistic infections infections by organisms that rarely infect people with normal immune systems including cryptococcal fungal meningitis, pneumocystis pneumonia, and toxoplasmosis brain infections. Anti-retroviral medications can lower the viral counts and reverse this immunodeficiency; however, these medications cannot completely eradicate the infection, and they must be taken for life. If anti-retroviral medications are discontinued, the infection reactivates.

    Can you explain what is HPV? Human papilloma virus HPV is a wart causing virus that is transmitted by close skin to skin contact and is most commonly transmitted by vaginal or anal sex.

    A high percentage of people become infected but our immune system often clears the virus; however, when the virus remains active it can cause genital warts that have a cauliflower like appearance.

    This virus can cause mouth and throat, penis, anal, vaginal and cervical cancer. The diagnosis of HPV is usually made based on examination. Cervical pap smears are recommended periodically for women to look for atypical precancerous cells.

    Treatment consists of removing the precancerous cells through surgical procedures. When cancer develops, chemotherapy and surgical resection are required.

    There is no medical treatment for HPV. However, a very effective vaccine is now available that can prevent HPV induced cancer.

    The vaccine is recommended for all children at age years and can be given up to age 21 for women and up to age 26 for men. This vaccine is strongly recommended for men who intend to have sex with men, transgenders, and adolescents who are immunocompromised, including patients with HIV. For many years, we treated cigarette-related cancers rather than identifying smokers and helping people stop smoking. Is that still happening today with alcohol and drugs?

    With no drug testing or limited in Pediatrics and Medicine, how can asking the patient if they use or inject drugs identify and help treat the primary disease or users? The newspapers and television news are now publicizing the worsening drug epidemic in our country. This epidemic has spread to people in every socioeconomic class. Given the many health risks of drug addiction, physicians and nurses have an obligation to ask questions about this potentially life-threatening behavior. Drug addiction is a disease, and to identify and treat this disease, medical caregivers are obligated to inquire about this important health issue.

    And those who suffer from drug addiction need not be ashamed. They should be open to help. The infectious disease risks of continuing addiction are real and potentially life threatening. Therapy for addiction is available and can be effective.

    Why wait until the damage has been done? It is no accident that in almost the same week both Australia and UK have decided that cannabis is to be recommended for a host of medical disorders mostly in advance of gold standard clinical trials.

    This is a direct product of the organized transnational global drug liberalization movement orchestrated from New York. I wish to most respectfully disagree with the points made by BMJ editor Dr. Statements from patients are uninterpretable without understanding the treatments tried, their withdrawal symptomatology and their personal preferences.

    Most importantly, as Dr Godlee states, cannabis is a mixture of cannabinoids. The tide cannot be both out and in at the same time. Medicines in western nations are universally pure substances. This comprises a fundamental difficulty.

    Studies have shown that the rate of use of cannabis by expecting mothers closely parallels that in the wider community. In fact given the long half-life of cannabis in tissues even were a maternal habitual smoker to stop when she discovered her pregnancy, her infant would continue to be exposed to her on-board cannabinoid load for several months afterwards during critical periods of organogenesis. Whilst much research has focussed on the effects of endocannabinoids in the adult brain relatively little research has looked at the impact of these same effects in the developing brain of the foetus and neonate.

    Whilst the brain stem is almost devoid of type 1 cannabinoid receptors CB1Rs they are in high concentration in many parts of the midbrain, limbic system, subcortical regions and cerebral and cerebellar cortices.

    Foetal CB1Rs have been shown to play key roles in virtually all aspects of brain development including neural stem cell function, determining the ratio of glial v neuronal differentiation, brain inflammation, axonal growth cone guidance, stem cell niche function and signalling, blood flow signalling, white matter and CNS tract formation, glial cell differentiation, myelination, dendrite formation, neural migration into the developing cortex, synapse formation and integration of newly formed neurons into the neural network.

    They are also found in high density on endoplasmic reticulum and mitochondria from which latter they indirectly control major issues including cognition, DNA maintenance and repair systems both by supplying energy and by metabolite shuttle and RNA signalling. Hence it is not surprising that gestational cannabis has been linked with a clear continuum of defects, including in protracted longitudinal studies from Pittsburgh, Ottawa and Netherlands impaired cortical and executive functioning; reduced spatial judgement; the need to recruit more brain to perform similar computational tasks; microcephaly; lifelong smaller heads and smaller brains; anencephaly in two CDC studies , and increased foetal death.

    This progression clearly reflects a spectrum of congenital neurological impairment which is quite consistent with the known distribution of CB1Rs mainly across the foetal and adult forebrain and midbrain and its derivatives.

    It is also consistent with a recent explosion of autism in Colorado, California, New Jersey and many other sites in USA and internationally in recent years. Moreover cannabis induced synpatopathy closely mimics that seen in autism, as do similar white matter disconnection endophenotypes. A similar scenario plays out in the cardiovasculature.

    This is consistent with recent Colorado experience where ventricular septal defect has risen from Both of these structures are derivatives of the endocardial cushions which are rich in CB1Rs. Exposure to other drugs does not explain this change as they were falling across this period.

    Similar findings play out in gastroschisis. There is an impressive concordance amongst the larger studies of the relationship of gastroschisis and congenital cannabis exposure where senior Canadian authors concluded that cannabis caused a three-fold rise in gastroschisis, consistent with a high density of CB1Rs on the umbilical vessels. And cannabis has also been implicated as an indirect chromosomal clastogen and indirect genotoxin through its effect to disrupt the mitotic spindle by microtubule inhibition, and likely DNA maintenance and repair by its effect on nuclear actin filaments.

    These considerations imply that if clinical trials continue to show efficacy for additional indications for cannabinoids, their genotoxic and teratogenic potential, from both mother and father, will need to be carefully balanced with their clinical utility. Only once before has a known teratogen been marketed globally: With its widespread uptake, rising concentrations, asymptotic genotoxic dose-response curves and actions through the paternal line cannabis could be much worse.

    The study, published in Biological Psychiatry, showed that exposure to psychosocial stress early in life altered the structure of immune cells and inflammatory signals in mice and led to increased drug-seeking behavior. Exposure to early psychosocial stress in mice, or a difficult childhood in humans, increased the immune response to cocaine in adulthood, revealing a shared mechanism in the role of immune response in the effects of early life stress on cocaine sensitivity in mice and humans.

    The findings help explain why as many as 50 percent of people who experience childhood maltreatment develop addiction problems. The results in mice and humans suggest that exposure to adversity during childhood triggers activation of the immune system, leading to permanent changes that sensitize the immune system and increase susceptibility to the effects of cocaine in adulthood.

    After inducing psychosocial stress in 2-week-old mice by exposing them to a threatening male, first author Luisa Lo Iacono, PhD, and colleagues examined brain immune cells, called microglia, in adulthood.

    Early social stress altered the structure of microglia in the ventral tegmental area, a brain region important for the reward system and drug-seeking, and increased the response of microglia to cocaine. In the peripheral immune system, early social stress increased the release of inflammatory molecules from white blood cells, which was further amplified by exposure to cocaine, compared with control mice.

    Mice who received an antibiotic to prevent activation of immune cells during social stress did not have cellular changes or drug-seeking behavior. The study also compared immune system function of 38 cocaine addicts and 20 healthy volunteers.

    Those who experienced childhood maltreatment had increased expression levels of genes important for immune system function. And the highest levels were found in cocaine addicts who had experienced a difficult childhood. The findings add to the growing collection of evidence from the research group for the negative effects of early life trauma on brain development.

    Abstract Core deficits in social functioning are associated with various neuropsychiatric and neurodevelopmental disorders, yet biomarker identification and the development of effective pharmacological interventions has been limited. Recent data suggest the intriguing possibility that endogenous cannabinoids, a class of lipid neuromodulators generally implicated in the regulation of neurotransmitter release, may contribute to species-typical social functioning.

    Systematic study of the endogenous cannabinoid signaling could, therefore, yield novel approaches to understand the neurobiological underpinnings of atypical social functioning. Data are evaluated in the context of Research Domain Criteria constructs for example, anxiety, chronic stress, reward learning, motivation, declarative and working memory, affiliation and attachment, and social communication to enable interrogation of endogenous cannabinoid signaling in social functioning across diagnostic categories.

    The empirical evidence reviewed strongly supports the role for dysregulated cannabinoid signaling in the pathophysiology of social functioning deficits observed in brain disorders, such as autism spectrum disorder, schizophrenia, major depressive disorder, posttraumatic stress disorder and bipolar disorder.

    Moreover, these findings indicate that the endogenous cannabinoid system holds exceptional promise as a biological marker of, and potential treatment target for, neuropsychiatric and neurodevelopmental disorders characterized by impairments in social functioning. Introduction Synaptic cell-adhesion molecules and their interactions with other molecular pathways affect both synapse formation and its function Varoqueaux et al. Neurexins are presynaptic cell-adhesion molecules that interact with neuroligins and other postsynaptic partners.

    Interestingly, despite studies linking neurexins to autism and other neuropsychiatric disorders Leone et al. The findings are particularly revealing in the field of recreational cannabis use. While studying the brains of a group of twenty occasional cannabis smokers, researchers from Harvard University found that as few as one or two uses a week can change the brain.

    Smoking marijuana was found to primarily affect the areas involved in decision making, emotions and motivations. Along the same lines, a group of French researchers found that marijuana use ups the risk of developing heart problems i. More research is needed to better understand the health risks associated with marijuana. Some media outlets have already corrected their original story. These inappropriate corrections overpowered the marijuana effect. SAM urges other media outlets to correct their headlines and stories.

    Smart Approaches to Marijuana SAM is a nonpartisan, non-profit alliance of physicians, policy makers, prevention workers, treatment and recovery professionals, scientists, and other concerned citizens opposed to marijuana legalization who want health and scientific evidence to guide marijuana policies. At the time of clinical admission, three quarters of drug users between 18 and 30 years of age had started taking drugs at age 17 or younger.

    A tenth of drug users had started at an even earlier age. While the dangers of frequent binge drinking have been widely studied, the potentially harmful effects of a single alcohol binge have not yet been explored in detail. According to a new study, even a single binge can be harmful. Excessive drinking can lead to the release of toxins in the blood that can cause fever, inflammation or tissue damage.

    Public health officials say the nerve pain medication gabapentin is being found in an increasing number of overdose deaths, according to CBS News.

    Gabapentin is a non-narcotic drug used to treat seizures and pain associated with shingles. Doctors have been prescribing it for a growing number of other conditions, as a way to offer pain relief without opioids.

    A study published last year found that for people who use heroin, the combination of opioids with gabapentin potentially increases the risk of overdose death. A growing number of drug overdose deaths are due to cocaine laced with fentanyl, NPR reports. Fentanyl is 50 to times more potent than heroin.

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