Medical term:

M

nitrofurantoin

Apo-Nitrofurantoin, Furadantin, Novo-Furantoin

nitrofurantoin macrocrystals

Macrobid, Macrodantin

Pharmacologic class: 5-nitrofuran derivative

Therapeutic class: Anti-infective, urinary tract anti-infective

Pregnancy risk category B

Action

Inhibits bacterial enzymes required for normal cell activity at low concentrations; inhibits normal cell-wall synthesis at high concentrations

Availability

Capsules: 25 mg, 50 mg, 100 mg (macrocrystals)

Capsules (extended-release): 100 mg (macrocrystals)

Oral suspension: 25 mg/5 ml

Tablets: 50 mg, 100 mg (macrocrystals)

Indications and dosages

➣ Active urinary tract infections (UTIs)

Adults: 50 to 100 mg P.O. q.i.d. or 100 mg q 12 hours (extended-release), continued for 1 week, or for 3 days after urine becomes sterile

Children older than 1 month: 5 to 7 mg/kg/day P.O. in four divided doses, continued for 1 week, or for 3 days after urine becomes sterile

➣ Chronic suppression of UTIs

Adults: 50 to 100 mg P.O. at bedtime

Children: 1 mg/kg/day P.O. in one or two divided doses

Contraindications

• Hypersensitivity to drug or parabens (oral suspension)

• Oliguria, anuria, or significant renal impairment

• Pregnancy near term (38 to 42 weeks' gestation), imminent labor onset, labor and delivery

• Infants younger than 1 month

Precautions

Use cautiously in:

• diabetes mellitus, renal impairment

• blacks and patients of Mediterranean or near-Eastern descent (because of possible G6PD deficiency)

• elderly or debilitated patients

• pregnant (to week 32) or breastfeeding patients.

Administration

• As appropriate, obtain specimens for repeat urine culture and sensitivity tests before therapy.

• To avoid GI upset and increase drug bioavailability, give with food or milk.

Adverse reactions

CNS: dizziness, drowsiness, headache, asthenia, peripheral neuropathy, vertigo

CV: chest pain

EENT: nystagmus

GI: nausea, vomiting, diarrhea, abdominal pain, anorexia, parotitis, pancreatitis

Hematologic: eosinophilia, agranulocytosis, thrombocytopenia, leukopenia, granulocytopenia, G6PD deficiency anemia, hemolytic anemia, megaloblastic anemia

Hepatic: hepatitis, hepatic necrosis

Musculoskeletal: arthralgia, myalgia

Respiratory: asthma attacks, pulmonary hypersensitivity reactions including diffuse interstitial pneumonias (with prolonged therapy)

Skin: rash, exfoliative dermatitis, alopecia, pruritus, urticaria, angioedema, photosensitivity, Stevens-Johnson syndrome

Other: drug fever, chills, superinfection (limited to urinary tract), hypersensitivity reactions including anaphylaxis, lupus-like syndrome

Interactions

Drug-drug. Anticholinergics: increased nitrofurantoin absorption and bioavailability

Drugs that can cause pulmonary toxicity: increased risk of pneumonitis

Hepatotoxic drugs: increased risk of hepatotoxicity

Magnesium salts: decreased nitrofurantoin absorption

Neurotoxic drugs: increased risk of neu-rotoxicity

Uricosurics (such as probenecid): decreased renal clearance and increased blood level of nitrofurantoin

Drug-diagnostic tests. Alanine aminotransferase, alkaline phosphatase, aspartate aminotransferase, bilirubin, blood urea nitrogen, creatinine: increased levels Granulocytes, platelets, hemoglobin: decreased levels

Urine glucose tests using Benedict's reagent or Fehling's solution: false-positive results

Drug-food. Any food: increased drug bioavailability

Patient monitoring

• Monitor patient's response to therapy. Assess urine culture and sensitivity tests.

Watch for and immediately report peripheral neuropathy.

Assess respiratory status. Watch for signs and symptoms of serious pulmonary hypersensitivity reaction.

Monitor CBC and liver function tests closely. Stay alert for evidence of hematologic and hepatic disorders.

• Evaluate patient for rash.

Patient teaching

• Instruct patient to take with food or milk at regular intervals around the clock.

• Advise patient to complete entire course of therapy.

• Tell patient not to take magnesium-containing drugs (such as antacids) during therapy.

• Caution patient not to drive or perform other hazardous activities until he knows how drug affects vision, concentration, and alertness.

Tell patient to immediately report fever, chills, cough, chest pain, difficulty breathing, rash, bleeding or easy bruising, dark urine, yellowing of skin or eyes, numbness or tingling of fingers or toes, or intolerable GI distress.

• Advise female patient to avoid taking drug during pregnancy, especially near term.

• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, and foods mentioned above.

nitrofurantoin

(nye-troe-fyoor-an-toyn) ,

Furadantin

(trade name),

Furantoin

(trade name),

Macrobid

(trade name),

Macrodantin

(trade name)

Classification

Therapeutic: anti infectives

Pregnancy Category: B

Indications

Prevention and treatment of urinary tract infections caused by susceptible organisms; not effective in systemic bacterial infections.

Action

Interferes with bacterial enzymes.

Therapeutic effects

Bactericidal or bacteriostatic action against susceptible organisms.

Many gram-negative and some gram-positive organisms, specifically:

Citrobacter,

Corynebacterium,

Enterobacter,

Escherichia coli,

Klebsiella,

Neisseria,

Salmonella,

Shigella,

Staphylococcus aureus,

Staphylococcus epidermidis,

Enterococcus.

Pharmacokinetics

Absorption: Readily absorbed after oral administration. Absorption is slower but more complete with macrocrystals (Macrodantin).

Distribution: Crosses placenta; enters breast milk.

Protein Binding: 40%.

Metabolism and Excretion: Partially metabolized by the liver; 30–50% excreted unchanged by the kidneys.

Half-life: 20 min (↑ in renal impairment).

Time/action profile (urine levels)

ROUTE	ONSET	PEAK	DURATION
PO	unknown	30 min	6–12 hr

Contraindications/Precautions

Contraindicated in: Hypersensitivity;Hypersensitivity to parabens (suspension);Oliguria, anuria, or significant renal impairment (CCr <60 mL/min);History of cholestatic jaundice or hepatic impairment with previous use of nitrofurantoin;Pregnancy near term and infants <1 mo (↑ risk of hemolytic anemia).

Use Cautiously in: genetic implication Glucose–6–phosphate dehydrogenase (G6PD) deficiency (↑ risk of hemolytic anemia, especially in Blacks and Mediterranean and Near-Eastern ethnic groups);Patients with diabetes or debilitated patients (neuropathy may be more common); Obstetric / Safety not established but has been used safely in pregnant women. Lactation: May cause hemolysis in infants with G6PD deficiency who are breast fed; Geriatric: Appears on Beers list; ↑ risk for renal, hepatic, and pulmonary reactions.

Adverse Reactions/Side Effects

Central nervous system

dizziness
drowsiness
headache

Ear, Eye, Nose, Throat

nystagmus

Respiratory

pneumonitis (life-threatening)
pulmonary fibrosis (life-threatening)

Cardiovascular

chest pain

Gastrointestinal

hepatotoxicity (life-threatening)
pseudomembranous colitis (life-threatening)
anorexia (most frequent)
nausea (most frequent)
vomiting (most frequent)
abdominal pain
diarrhea

Genitourinary

rust/brown discoloration of urine

Dermatologic

photosensitivity

Hematologic

blood dyscrasias
hemolytic anemia

Neurologic

peripheral neuropathy

Miscellaneous

hypersensitivity reactions (most frequent)

Interactions

Drug-Drug interaction

Probenecid prevents high urinary concentrations; may ↓ effectiveness.Antacids may ↓ absorption.↑ risk of neurotoxicity with neurotoxic drugs.↑ risk of hepatotoxicity with hepatotoxic drugs.↑ risk of pneumonitis with drugs having pulmonary toxicity.

Route/Dosage

Oral (Adults) Treatment of active infection—50–100 mg q 6–8 hr or 100 mg q 12 hr as extended-release product. Chronic suppression—50–100 mg single evening dose.

Oral (Children >1 mo) Treatment of active infection—5–7 mg/kg/day divided q 6 hr; maximum dose: 400 mg/day. Chronic suppression—1–2 mg/kg/day as a single dose at bedtime; maximum dose: 100 mg/day (unlabeled).

Availability (generic available)

Oral suspension: 25 mg/5 mL Cost: Generic — $608.68 / 230 mL

Capsules: 25 mg, 50 mg, 100 mg Cost: Generic — 50 mg $199.00 / 100, 100 mg $338.00 / 100

Extended-release capsules: 100 mg Cost: Generic — $320.92 / 100

Nursing implications

Nursing assessment

Assess for signs and symptoms of urinary tract infection (frequency, urgency, pain, and burning on urination; fever; cloudy or foul-smelling urine) before and periodically during therapy.
Obtain specimens for culture and sensitivity before and during drug administration.
Monitor intake and output ratios. Report significant discrepancies in totals.
Monitor bowel function. Diarrhea, abdominal cramping, fever, and bloody stools should be reported to health care professional promptly as a sign of pseudomembranous colitis. May begin up to several weeks following cessation of therapy.
Assess for signs and symptoms of pulmonary reactions periodically during therapy. Acute reactions (fever, chills, cough, chest pain, dyspnea, pulmonary infiltration with consolidation or pleural effusion on x-ray, eosinophilia) usually occur within first week of treatment and resolve when therapy is discontinued. Chronic reactions (malaise, dyspnea on exertion, cough, altered pulmonary function) may indicate pneumonitis or pulmonary fibrosis and are more common in patients taking nitrofurantoin for 6 mo or longer.
Lab Test Considerations: Monitor CBC routinely with patients on prolonged therapy.
- Monitor liver function tests periodically during therapy. May cause ↑ serum glucose, bilirubin, alkaline phosphatase, BUN, and creatinine. If hepatotoxicity occurs, discontinue therapy.
- Monitor renal function periodically during therapy.

Potential Nursing Diagnoses

Risk for infection (Indications)

Implementation

Oral: Administer with food or milk to minimize GI irritation, to delay and increase absorption, to increase peak concentration, and to prolong duration of therapeutic concentration in the urine.
- Do not crush tablets or open capsules.
- Administer liquid preparations with calibrated measuring device. Shake well before administration. Oral suspension may be mixed with water, milk, fruit juices, or infant formula. Rinse mouth with water after administration of oral suspension to avoid staining teeth.

Patient/Family Teaching

Instruct patient to take medication around the clock, as directed. Take missed doses as soon as remembered and space next dose 2–4 hr apart. Do not skip or double up on missed doses.
May cause dizziness or drowsiness. Caution patient to avoid driving or other activities requiring alertness until response to medication is known.
Inform patient that medication may cause a rust-yellow to brown discoloration of urine, which is not significant.
Advise patient to notify health care professional if fever, chills, cough, chest pain, dyspnea, skin rash, numbness or tingling of the fingers or toes, or intolerable GI upset occurs. Signs of superinfection (milky, foul-smelling urine; perineal irritation; dysuria) should also be reported.
Instruct patient to notify health care professional if fever and diarrhea develop, especially if stool contains blood, pus, or mucus. Advise patient not to treat diarrhea without consulting health care professional.
Instruct patient to consult health care professional if no improvement is seen within a few days after initiation of therapy.

Evaluation/Desired Outcomes

Resolution of the signs and symptoms of infection. Therapy should be continued for a minimum of 7 days and for at least 3 days after the urine has become sterile.
Decrease in the frequency of infections in chronic suppressive therapy.

Macrobid

A brand name for NITROFURANTOIN.

Collins Dictionary of Medicine © Robert M. Youngson 2004, 2005

Marijuana

Definition

Marijuana (marihuana) Cannabis sativa L., also known as Indian hemp, is a member of the Cannabaceae or hemp family, thought to have originated in the mountainous districts of India, north of the Himalayan mountains.

Description

The herb was referred to as "hempe" in A.D. 1000 and listed in a dictionary under that English name. Supporters of the notorious Pancho Villa first used the name marijuana in 1895 in Sonora, Mexico. They called the mood-altering herb they smoked marijuana. The term hashish, is derived from the name for the Saracen soldiers, called hashashins, who ingested the highly potent cannabis resin before being sent out to assassinate enemies.

Two related species of cannabis are C. ruderalis, and C. indica, a variety known as Indian hemp. Indian hemp grows to a height of about 4 ft (1.2 m) and the seed coats have a marbled appearance.

The species C. sativa L. has many variations, depending on the soil, temperature, and light conditions, and the origin of the parent seed. These factors also affect the relative amounts of THC (tetra-hydrocannabinol) and cannabidiol, the chemicals present in varying amounts in cannabis that determine if the plant is primarily a fiber type or an intoxicant. Generally the species grown at higher elevations and in hotter climates exudes more of the resin and is more medicinally potent.

Marijuana is a somewhat weedy plant and may grow as high as 18 ft (5.4 m). The hairy leaves are arranged opposite one another on the erect and branching stem. Leaves are palmate and compound, deeply divided into five to seven narrow, toothed and pointed leaflets. Male and female flowers are small and greenish in color and grow on separate plants. Male flowers grow in the leaf axils in elongated clusters. The female flowers grow in spike-like clusters. The resinous blossoms have five sepals and five petals. The male and female blossoms can be distinguished at maturity. The male plant matures first, shedding its pollen and dying after flowering. Female plants die after dropping the mature seeds. Marijuana produces an abundance of quickly germinating seeds. This hardy annual is wind pollinated and has escaped from cultivation to grow wild along roadsides, trails, stream banks, and in wayside places throughout the world. The plant matures within three to five months after the seed has been sown.

History

Marijuana has been cultivated for thousands of years. Cannabis was first described for its therapeutic use in the first known Chinese pharmacopoeia, the Pen Ts'ao. (A pharmacopoeia is a book containing a list of medicinal drugs, and their descriptions of preparation and use.) Cannabis was called a "superior" herb by the Emperor Shen-Nung (2737-2697 B.C.), who is believed to have authored the work. Cannabis was recommended as a treatment for numerous common ailments. Around that same period in Egypt, cannabis was used as a treatment for sore eyes. The herb was used in India in cultural and religious ceremonies, and recorded in Sanskrit scriptural texts around 1,400 B.C. Cannabis was considered a holy herb and was characterized as the "soother of grief," "the sky flyer," and "the poor man's heaven." Centuries later, around 700 B.C., the Assyrian people used the herb they called Qunnabu, for incense. The ancient Greeks used cannabis as a remedy to treat inflammation, earache, and edema (swelling of a body part due to collection of fluids). Shortly after 500 B.C. the historian and geographer Herodotus recorded that the peoples known as Scythians used cannabis to produce fine linens. They called the herb kannabis and inhaled the "intoxicating vapor" that resulted when it was burned. By the year 100 B.C. the Chinese were using cannabis to make paper.

Cannabis use and cultivation migrated with the movement of various traders and travelers, and knowledge of the herb's value spread throughout the Middle East, Eastern Europe, and Africa. Around 100, Dioscorides, a surgeon in the Roman Legions under the Emperor Nero, named the herb Cannabis sativa and recorded numerous medicinal uses. In the second century, the Chinese physician Hoa-Tho, used cannabis in surgical procedures, relying on its analgesic properties. In ancient India, around 600, Sanskrit writers recorded a recipe for "pills of gaiety," a combination of hemp and sugar. By 1150, Moslems were using cannabis fiber in Europe's first paper production. This use of cannabis as a durable and renewable source of paper fiber continued for the next 750 years.

By the 1300s, government and religious authorities, concerned about the psychoactive effects on citizens consuming the herb, were placing harsh restrictions on its use. The Emir Soudon Sheikhouni of Joneima outlawed cannabis use among the poor. He destroyed the crops and ordered that offenders' teeth be pulled out. In 1484, Pope Innocent VIII outlawed the use of hashish, a concentrated form of cannabis. Cannabis cultivation continued, however, because of its economic value. A little more than a century later, the English Queen Elizabeth I issued a decree commanding that landowners holding sixty acres or more must grow hemp or pay a fine. Commerce in hemp, which was primarily valued for the strength and versatility of its fibers, was profitable and thriving. Hemp ropes and sails were crossing the sea to North America with the explorers. By 1621, the British were growing cannabis in Virginia where cultivation of hemp was mandatory. In 1776, the Declaration of Independence was drafted on hemp paper. Both President George Washington and President Thomas Jefferson were advocates of hemp as a valuable cash crop. Jefferson urged farmers to grow the crop in lieu of tobacco. By the 1850s, hemp had become the third largest agricultural crop grown in North America. The U. S. Census of that year recorded 8,327 hemp plantations, each with 2,000 or more acres in cultivation. But the invention of the cotton gin was already bringing many changes, and cotton was becoming a prime and profitable textile fiber. More change came with the introduction of the sulfite and chlorine processes used to turn trees into paper. Restrictions on the personal use of cannabis as a mood-altering, psychoactive herb, were soon to come.

Controversy

The 1856 edition of the Encyclopedia Britannica, in its lengthy entry on hemp, noted that the herb "produces inebriation and delirium of decidedly hilarious character, inducing violent laughter, jumping and dancing." This inebriating effect of marijuana use has fueled the controversy and led to restrictions that have surrounded marijuana use throughout history in many cultures and regions of the world. Cannabis use has been criminalized in some parts of the United States since 1915. Utah was the first state to criminalize it, then California and Texas. By 1923, Louisiana, Nevada, Oregon, and Washington had legal restrictions on the herb. New York prohibited cannabis use in 1927. Despite the restrictions, cannabis use was woven into the cultural and social fabric in some communities, and widespread use persisted, particularly among the Mexican, Asian, and African American populations.

In 1937, the federal government passed the Marihuana Tax Act, prohibiting the cultivation and farming of marijuana. This bill was introduced to Congress by then Secretary of the Treasury Andrew Mellon, who was also a banker for the DuPont Corporation. That same year, the DuPont Chemical Company filed a patent for nylon, plastics, and a new bleaching process for paper. The 1937 Marijuana Transfer Tax Bill prohibited industrial and medical use of marijuana and classified the flowering tops as narcotic, and restrictions on the cultivation and use of cannabis continued. Marijuana was categorized as an illegal narcotic, in the company of LSD and heroin, cocaine, and morphine. Illegal use continued. The FBI publication, Uniform Crime Reports for The United States, 1966 reported that 641,642 Americans were arrested for marijuana offenses that year, with as many as 85% of these arrests for simple possession, rather than cultivation or commerce.

In a reversal of the state-by-state progression of criminalizing marijuana that led to the 1937 Marijuana Transfer Tax Bill, there is a movement underway, state by state, to endorse the legalized use of medical marijuana. By 1992, 35 states in the U. S. had endorsed referenda for medical marijuana. A growing body of scientific research and many thousands of years of folk use support the importance of medical marijuana in treatment of a variety of illnesses, and the economic value of hemp in the textile, paper, and cordage industries has a long history.

The controversy and misinformation persists around this relatively safe and non-toxic herb. The World Health Organization, in a 1998 study, stated that the risks from cannabis use were unlikely to seriously compare to the public health risks of the legal drugs, alcohol and tobacco. And despite thousands of years of human consumption, not one death has been directly attributed to cannabis use. According to Lester Grinspoon, MD, and James B. Bakalar, JD, in a 1995 Journal of the American Medical Association article, "Marihuana is also far less addictive and far less subject to abuse than many drugs now used as muscle relaxants, hypnotics, and analgesics. The chief legitimate concern is the effect of smoking on the lungs. Cannabis smoke carries even more tars and other particulate matter than tobacco smoke. But the amount smoked is much less, especially in medical use, and once marihuana is an openly recognized medicine, solutions may be found."

Purpose

The whole cannabis plant, including buds, leaves, seeds, and root, have all been utilized throughout the long history of this controversial herb. Despite persistent legal restrictions and severe criminal penalties for illicit use, marijuana continues to be widely used in the United States, and throughout the world, both for its mood-altering properties and its proven medicinal applications. The conflicting opinions on the safety and effectiveness of cannabis in a climate of prohibition make any discussion of its beneficial uses politically charged. Marijuana has analgesic, antiemetic, anti-inflammatory, sedative, anticonvulsive, and laxative actions. Clinical studies have demonstrated its effectiveness in relieving nausea and vomiting following chemotherapy treatments for cancer. The herb has also been shown to reduce intra-ocular pressure in the eye by as much as 45%, a beneficial action in the treatment for glaucoma. Cannabis has proven anticonvulsive action, and may be helpful in treating epilepsy. Other research has documented an in-vitro tumor inhibiting effect of THC. Marijuana also increases appetite and reduces nausea and has been used with AIDS patients to counter weight loss and "wasting" that may result from the disease. Several chemical constituents of cannabis displayed antimicrobial action and antibacterial effects in research studies. The components CBC and d-9-tetrahydrocannabinol have been shown to destroy and inhibit the growth of streptococci and staphylococci bacteria.

Cannabis contains chemical compounds known as cannabinoids. Different cannabinoids seem to exert different effects on the body after ingestion. Scientific research indicates that these substances have potential therapeutic value for pain relief, control of nausea and vomiting, and appetite stimulation. The primary active agent identified to date is 9-tetrahydro-cannabinol, known as THC. This chemical may constitute as much as 12% of the active chemicals in the herb, and is said to be responsible for as much as 70-100% of the euphoric action, or "high," experienced when ingesting the herb. The predominance of this mental lightness or "euphoria" depends on the balance of other active ingredients and the freshness of the herb. THC degrades into a component known as cannabinol, or CBN. This relatively inactive chemical predominates in marijuana that has been stored too long prior to use. Another chemical component, cannabidiol, known as CBD, has a sedative and mildly analgesic effect, and contributes to a somatic heaviness sometimes experienced by marijuana users.

Before prohibition, cannabis was recommended for treatment of gonorrhea, angina pectoris (constricting pain in the chest due to insufficient blood to the heart), and choking fits. It was also used for insomnia, neuralgia, rheumatism, gastrointestinal disorders, cholera, tetanus, epilepsy, strychnine poisoning, bronchitis, whooping cough, and asthma. Other phytotherapeutic (plant-based therapeutic) uses include treatment of ulcers, cancer, emphysema, migraine, Lou Gehrig's disease, HIV infection, and multiple sclerosis.

The United States federal government policy prohibits physicians from prescribing marijuana, even for seriously ill patients because of possible adverse effects, and the disputed belief that cannabis is dangerously addictive. U. S. Attorney General Janet Reno warned that physicians in any state who prescribed marijuana could lose the privilege of writing prescriptions, be excluded from Medicare and Medicaid reimbursement, and even be prosecuted for a federal crime, according to a 1997 editorial in the New England Journal of Medicine.

Preparations

Cannabis extracts, prepared for medicinal application, are prohibited in the United States. Marijuana is ingested by smoking, which quickly delivers the active ingredients to the blood system. The dried herb can also be prepared for eating in cookies or other baked goods. The essential oil consists of beta caryophyllenes, humules, caryophyllene oxide, alpha-pinenes, betapinenes, limonene, myrcene, and betaocimene. The oil expressed from the seeds is used for massage and in making salves used to relieve muscle strain.

Precautions

Marijauna is considered a Class I narcotic and its use has been restricted by federal law since 1937. Penalties include fines and imprisonment. The National Commission on Marihuana and Drug Abuse concluded in 1972 that "A careful search of the literature and testimony of the nation's health officials has not revealed a single human fatality in the United States proven to have resulted solely from ingestion of marihuana."

Research has shown that cannabis acts to increase heart frequency by as much as 40 beats per minute. A study reported by The American Heart Association in February 2000, concluded that smoking marijuana can precipitate a heart attack in persons with preexisting heart conditions. One hour after smoking marijuana, the likelihood of having a heart attack is four and one-half times greater than if the person had not smoked, according to the research.

An additional health concern is the effect that marijuana smoking has on the lungs. Cannabis smoke carries more tars and other particulate matter than tobacco smoke.

Although marijuana is less likely than some other drugs to lead to dependence, heavy users may suffer a withdrawal syndrome characterized by anxiety, irritability, chills, and muscle cramps if they stop usage abruptly.

More seriously, marijuana has been linked to the onset or worsening of certain psychiatric conditions, including panic disorder, schizophrenia, and depersonalization disorder. Persons diagnosed with or at risk for these conditions should not use marijuana.

Side effects

The PDR For Herbal Medicine reports, "No health hazards or side effects are known in conjunction with the proper administration of designated therapeutic dosages." Smoking the herb, however, "… leads almost at once to euphoric states (pronounced gaiety, laughing fits)," according to the PDR, while "long term usage leads to a clear increase in tolerance for most of the pharmacological effects." The ability to safely operate automobiles and machinery can be impaired for up to eight hours after ingesting the herb. Chronic abuse results in "laryngitis, bronchitis, apathy, psychic decline and disturbances of genital functions," according to the PDR.

Some people may be hypersensitive to marijuana. They may be allergic or hypersensitive to the plant. Chronic sinus fungal infections have been linked to chronic marijuana smoking.

Key terms

Antiemetic — A drug or herbal preparation given to relieve nausea and vomiting. Marijuana has antiemetic properties.

Cannabinoids — The chemical compounds that are the active principles in marijuana.

Euphoria — An intense feeling of elation or well-being. Many marijuana users experience temporary euphoria.

A team of German researchers reported in early 2004 that marijuana appears to speed up the progression of cancer. If this finding is replicated by other researchers, it would limit the usefulness of marijuana in treating pain and depression in cancer patients.

Interactions

Marijauna use may mask the perceived effects of alcohol and cocaine when the drugs are consumed together. Marijuana is said to exert a synergistic effect with other medicinal agents. When used with nitrous oxide it may enhance the effect.

Resources

Books

Beers, Mark H., MD, and Robert Berkow, MD, editors. "Cannabis (Marijuana) Dependence." Section 15, Chapter 195. In The Merck Manual of Diagnosis and Therapy. Whitehouse Station, NJ: Merck Research Laboratories, 2004.

Periodicals

Amtmann, D., P. Weydt, K. L. Johnson, et al. "Survey of Cannabis Use in Patients with Amyotrophic Lateral Sclerosis." American Journal of Hospice and Palliative Care 21 (March-April 2004): 95-104.

Arsenault, L., M. Cannon, J. Witton, and R. M. Murray. "Causal Association between Cannabis and Psychosis: Examination of the Evidence." British Journal of Psychiatry 184 (February 2004): 110-117.

Dannon, P. N., K. Lowengrub, R. Amiaz, et al. "Comorbid Cannabis Use and Panic Disorder: Short Term and Long Term Follow-Up Study." Human Psychopharmacology 19 (March 2004): 97-101.

Haney, M., C. L. Hart, S. K. Vosburg, et al. "Marijuana Withdrawal in Humans: Effects of Oral THC or Divalproex." Neuropsychopharmacology 29 (January 2004): 158-170.

Hart, S., O. O. Fischer, and A. Ullrich. "Cannabinoids Induce Cancer Cell Proliferation Via Tumor Necrosis Factor Alpha-Converting Enzyme (TACE/ADAM17)-Mediated Transactivation of the Epidermal Growth Factor Receptor." Cancer Research 64 (March 15, 2004): 1943-1950.

Simeon, D. "Depersonalisation Disorder: A Contemporary Overview." CNS Drugs 18 (2004): 343-354.

Other

Campaign to Legalise Cannabis International Association. Cannabis Campaigner's Guide, Up-to-Date Chronology of Cannabis Hemp. 〈http://www.paston.co.uk/users/webbooks/chronol.html〉.

Center for Cardiovascular Education, Inc. Smoking Marijuana Increases Heart Attack Risk. Heart Information Network. June 14, 2000. 〈http://www.heartinfo.org/news2000/marijuana061400.htm〉.

Deerman, Dixie, RN. The Best Herb You're Not Using That Could Add Years to Your Life! North Carolina: Community of Compassion, 2000.

Goddard, Ian Williams. Proven: Cannabis Is Safe Medicine. 〈http://sers.erols.com/igoddard/hempsafe.htm〉.

Lewin, Louis. Phantastica, Hallucinating Substances, Indian Hemp: Cannabis Indica. 〈http://users.lycaeum.org/∼sputnik/Ludlow/Texts/phantastica.html〉.

Taima in Japan. Drug War Facts: Marijuana. http://taima.org/drugfacts/mj.htm.

marijuana

[mar″ĭ-wahn´ah]

a preparation of the leaves and flowering tops of Cannabis sativa, the hemp plant, which contains a number of pharmacologically active principles (cannabinoids). hashish, also derived from the hemp plant, is obtained from the clear resin secreted by the flowering tops of the plant and is four to eight times as potent as marijuana. Both drugs are used for their euphoric properties and are considerably more potent when smoked and inhaled than when simply eaten.

tetrahydrocannabinol (THC), the most active ingredient of marijuana, can, with heavy smoking, narrow the bronchi and bronchioles and produce inflammation of the mucous membranes. In addition, marijuana smoke contains many of the same chemicals and “tars” as tobacco smoke and, therefore, increases the risk of lung cancer. There is some evidence that marijuana increases the risk for miscarriage and birth defects. Even though these dangers have not been completely documented, it is recommended that both men and women who plan to have children should avoid marijuana as they would any other unnecessary drug.

One beneficial effect of THC is the lowering of intraocular pressure, which can be helpful in the control of glaucoma. However, because it causes tachycardia and increased work for the heart, it cannot be used in most elderly persons, the age group in which glaucoma is most prevalent. Another use of THC is for relief of extreme nausea and vomiting in patients undergoing cancer chemotherapy, although not every patient responds favorably to THC.

marijuana

also

marihuana

(măr′ə-wä′nə)

1. The cannabis plant.

2. The dried flower clusters and leaves of this plant, smoked or ingested to induce euphoria or to treat the symptoms of certain medical conditions. Use of marijuana is illegal under federal law, but certain jurisdictions permit regulated use for medical or recreational purposes.

Dried leaves of Cannabis that are often smoked for euphoric effect, which also has minimal therapeutic currency
Herbal medicine MJ is listed in ancient pharmacopeias of China, and used for pain, insomnia, nervous complaints
Mainstream medicine MJ has been evaluated as an appetite stimulant and as a way to control nausea due to chemotherapy, and as beneficial for asthma, glaucoma and seizures; see below, Therapeutics
Substance abuse A substance derived from the hemp plant Cannabis sativa, the leaves of which are smoked, producing a hallucinogenic effect due to the neurochemical delta9-tetrahydrocannabinol (THC), which has a cognate THC receptor in the brain
Effects
Immune system THC blocks monocyte maturation
Nervous system Impaired motor skills, defective eye tracking and perception; THC receptors are most abundant in the hippocampus, where memory is consolidated—explaining MJ’s detrimental effect on memory—and least abundant in the brainstem, explaining why death by overdose is unknown with chronic marijuana abuse
Pregnancy Heavy use is associated with residual neuropsychological effects, as evidenced by increased perseverations on card-sorting, and decreased learning of lists
Respiratory tract MJ is inhaled or ‘toked’ in a fashion that differs from that of tobacco; in order to maximize THC absorption and elicit the desired ‘high’, the subject prolongs inhalation, markedly increasing carbon monoxide and tar. Thus it may be more detrimental than tobacco smoke
Therapeutics MJ is an analgesic, but unusable as such, due to the inseparable hallucinogenic effect; it is of use for
(1) Control of nausea and vomiting in terminal cancer. Two antiemetic cannabinoids are commercially available, nabilone—Cesamet, a synthetic derivative of MJ—and dronabinol—Marinol, the principle psychoactive substance in MJ; both are 2nd-line therapies, given their psychotomimetic effects and side effects—drowsiness, dizziness, vertigo, loss of ability to concentrate and mood swings.
(2) Control of intraocular pressure in open-angle glaucoma, administered orally, in topical drops or smoked; MJ may evoke anxiety or panic attacks
Route Inhaled, oral
Pharmacologic effects Hallucinations, euphoria, relaxed inhibitions, increased appetite, disorientation, increased pulse rate, reddening of conjunctiva
Toxicology THC and metabolites are detectable in urine 1 hr after smoking, later if used as a garnee—i.e., 'pot in a pan'

marijuana

Cannabis sativa, C indica MJ Herbal medicine MJ is listed in ancient pharmacopeias of China, and used for pain, insomnia, nervous complaints Mainstream medicine MJ has been evaluated as an appetite stimulant, and to control asthma, glaucoma, seizures, and nausea due to chemotherapy. See Herbal medicine, THC Substance abuse A substance derived from the hemp plant Cannabis sativa, the leaves of which are smoked, producing a hallucinogenic effect due to the neurochemical Δ9-tetrahydrocannabinol–THC, which has a cognate THC receptor in the brain Immune system THC blocks monocyte maturation Nervous system Impaired motor skills, defective eye tracking and perception; THC receptors are most abundant in the hippocampus, where memory is consolidated, explaining MJ's detrimental effect on memory and least abundant in the brainstem, explaining why death by overdose is unknown with chronic marijuana abuse; heavy use is associated with residual neuropsychological effects, as evidenced by ↑ perseverations on card-sorting, and ↓ learning of lists Respiratory tract MJ is inhaled or 'toked' in a fashion that differs from that of tobacco; in order to maximize THC absorption and elicit the desired 'high. ', the subject prolongs inhalation, markedly ↑ carbon monoxide and tar, and thus is possibly more detrimental than tobacco smoke Therapeutic uses MJ is an analgesic, but unusable as such, due to the inseparable hallucinogenic effect; it is of use for

1. Control of N&V in terminal CA–2 antiemetic cannabinoids are commercially available, nabilone–Cesamet, a synthetic derivative of MJ and dronabinol–Marinol the principle psychoactive substance in MJ; both are 2^nd-line therapies, given their psychotomimetic effects and side effects–drowsiness, dizziness, vertigo, loss of ability to concentrate and mood swings and.

2. Control of intraocular pressure in open-angle glaucoma, administered orally, in topical drops or smoked; MJ may evoke anxiety or panic attacks Route Inhaled, oral Pharmacologic effects Hallucinations, euphoria, relaxed inhibitions, ↑ appetite, disorientation, ↑ pulse rate, reddening of conjunctiva Toxicology THC and metabolites are detectable in urine 1 hr post-pot puffery, later if used as a garnee–ie, pot in pan. See Amotivational syndrome, Joint, Medical marijuana, Substance abuse, THC receptor, Toke.

mar·i·jua·na

, marihuana (mar'i-hwahn'ă)

Popular name for the dried flowering leaves of Cannabis sativa, which are smoked as cigarettes, "joints," or "blunts." In the U.S., marijuana includes any part of, or any extracts from, the female plant. Alternative spellings are mariguana, marihuana.
See also: cannabis

[fr. Sp. Maria Juana, Mary Jane]

marijuana

, marihuana (mar?i-wan'a) [Mexican Sp. marihuana, mariguana]

The dried flowering tops of Cannabis sativa, the hemp plant. Marijuana has many colloquial and street names, e.g., dope, ganja, Mary Jane, pot, and weed. See: Cannabis sativa; tetrahydrocannabinol

Its active ingredient, delta-9-tetrahydrocannabinol (THC), may produce euphoria, alterations in mood and judgment, and changes in sensory perception, cognition, and coordination. Driving and machine-operating skills may be impaired. Users of marijuana have impaired short-term memory; memory deficits are transient, however, and return to normal within about a week of abstinence. Depending on the dose of the drug and the underlying psychological conditions of the user, marijuana may cause transient episodes of confusion, anxiety, or delirium. Its use may exacerbate mental illness, esp. schizophrenia. Long-term, relatively heavy use may be associated with behavioral disorders and a kind of ennui called the amotivational syndrome, but it is not known whether use of the drug is a cause or a result of this condition. Transient symptoms occur on withdrawal, indicating that the drug can lead to physical dependence. There has been considerable interest in the effects of marijuana on pregnancy and fetal growth, but substance abusers often abuse more than a single substance, making it difficult to evaluate the effects of individual substances on the outcome of pregnancy or fetal development.

There is no definitive evidence that prolonged heavy smoking of marijuana leads to impaired pulmonary function. The possibility that chronic marijuana use is associated with an increased risk of developing head and neck cancer exists, but it has not been proven.

Delta-9-tetrahydrocannabinol, also known as dronabinol, is approved for use in treating nausea and vomiting associated with cancer chemotherapy in patients who have failed to respond adequately to conventional antiemetic treatment, and treatment of anorexia associated with weight loss in patients with acquired immunodeficiency syndrome. Marijuana has also been approved for other medical uses in some states, although such use violates federal Drug Enforcement Administration standards.

CAUTION!

Dronabinol is a controlled substance. Prescriptions are limited to the amount necessary for a single cycle of chemotherapy.

MEDICAL MARIJUANA CARD

medical marijuana

Legally sanctioned use of marijuana for people with a variety of conditions, including chronic pain, glaucoma, or nausea and vomiting caused by chemotherapy.

See: illustration

marijuana

See CANNABIS.

marijuana

cannabis.

Patient discussion about marijuana

Q. what are the requirements of getting medicinal marijuana? i'd like to know the requirements of getting prescribed medicinal marijuana. i have heard alot about health benefits of moderate use of marijuana or should i refer to it as cannabis.

A. marijuana has been proven to help in these diseases,but the problem is getting a drs order for it.IT is easyer to get it under the table than legally.

Q. My 37 year old son is depressed. He uses marijuana and alcohol daily - how can I help him? He refuses to obtain professional help (says the drugs they give you are harmful). Says his drinking is due to his genes, and there is little he can do about it. Has run up 70k in credit card debt. Does not want to quit smoking weed, and drinking booze.

A. DOUG66,my friend cbellh47 said it all-he is to sick to know what is happening around him-I know this is hard to do,but you have to let him hit rock bottom,and hope that he makes it back-giving him money or helping him with his bills is only making the disease worst.at this point he needs to go in-patiant rehab,to detox. You have your own health to worry about,this is very stressful.ALCOHOL effects everyone in the family,there is no easy way out of this,and its all up to him-mrfoot56

Q. One of my friends is an addict to Alcohol. Which one is worse? Marijuana or alcohol One of my friends is an addict to Alcohol. He later stopped and started using Marijuana. Which one is worse? Marijuana or alcohol

A. I agree with corey,alcohol is more dangerous-because people think that because it is legal,its alright,also the media makes it seem that you will have a lot of fun when you drink,which is not always the case.people die from all kinds of drugs ever the ones DRs order,because every ones system is different. ALL DRUGS ARE BAD (BUT)in the united states the government makes a lot of mmony in taxes on each bottle/or can,so we will never get alcohol on the same list as other drugs--I have said this before but people have to be more responsible with what they put in there body,how much they put in there bodys.If you are going to use a drug,I suggest marijuana/cocaine because people who use marijuana get hungry and go to sleep---people that use cocaine take it less than alcohol,meth is a killer no matter how much you take,so i say met is in the no#2 spot. but it is always smarter to not use drugs at all.mrfoot56---peace

More discussions about marijuana

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