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If there is significant conjunctival or corneal damage cheap 4mg montelukast fast delivery, the patient should be seen urgently by an ophthalmologist buy montelukast 4 mg amex. Inhalation of irritant gases may cause swelling and upper airway obstruction cheap 5 mg montelukast with visa, bronchospasm and delayed pneumonitis. Signs are those of excess parasympathetic activation: salivation, sweating, lacrimation, slow pulse, small pupils, convulsions, muscle weakness/twitching, then paralysis and loss of bladder control, pulmonary oedema, and respiratory depression. Treatment  Remove poison by irrigating eye or washing skin (if in eye or on skin). Repeat every 10- 15 minutes until no chest signs of secretions, and pulse and respiratory rate returns to normal. For conscious and no vomiting give C: Methionine (<6 years: 1 gram every 4 hours - 4 doses; 6 years and above: 2. If charcoal is not available and a severely toxic dose has been given, then perform gastric lavage or induce vomiting as above  If available check the blood gases, pH, bicarbonates and serum electrolyte. In severe poisoning there may be gastrointestinal haemorrhage, hypotension, drowsiness, convulsions and metabolic acidosis. Symptoms: Most bites and stings result in pain, swelling, redness, and itching to the affected area. Treatment and Management Treatment depends on the type of reaction  Clean the area with soap and water to remove contaminated particles left behind by some insects  Refrain from scratching because this may cause the skin to break down and results to an infection  Treat itching at the site of the bite with antihistamine  Give appropriate analgesics  Where there is an anaphylactic reaction treat according to guideline. Diagnosis of Scorpion poisoning (envenoming) Signs of envenoming can develop within minutes and are due to autonomic nervous system activation. Hospital care Antivenom o If signs of severe envenoming give scorpion antivenom, if available (as above for snake antivenom infusion). Clinical condition depends on the type of snake bite and amount of poison (venom) injected. Hence envenomation (poisoning) will be neurotoxic in cobra and mambas and sea snakes and haemotoxic in vipers and boomslang. Snake bite should be considered in any severe pain or swelling of a limb or in any unexplained illness presenting with bleeding or abnormal neurological signs. Contact with snakes, scorpions and other insects result in two types of injuries: those due to direct effect of venom on victim and those due to indirect effect of poison e. Diagnosis of snake poisoning (envenoming)  General signs include shock, vomiting and headache. These include: o Shock o Local swelling that may gradually extend up the bitten limb o Bleeding: external from gums, wounds or sores; internal especially intracranial o Signs of neurotoxicity: respiratory arrest or paralysis, ptosis, bulbar palsy (difficulty swallowing and talking), limb weakness o Signs of muscle breakdown: muscle pains and black urine  Check haemoglobin (where possible, blood clotting should be assessed). Treatment First aid  Reasure the patient;  Splint the limb to reduce movement and absorption of venom. If the bite was likely to have come from a snake with neurotoxic venom, apply a firm bandage to the affected limb from fingers or toes to proximal of site of bite;  Clean the site with clean water to remove any poison and remove any fangs;  If any of the above signs, transport to hospital which has antivenom as soon as possible. Treatment Hospital care Treatment of shock/respiratory arrest  Treat shock, if present. Other treatment  Surgical opinion Seek surgical opinion if there is severe swelling in a limb, it is pulseless or painful or there is local necrosis. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted and dashed lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specifc companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. In no event shall the World Health Organization be liable for damages arising from its use. A combination of an artemisinin derivative with a longer-acting antimalarial that has a different mode of action. The life cycle of the malaria parasite in the host, from merozoite invasion of red blood cells to schizont rupture (merozoite  ring stage  trophozoite  schizont  merozoites). The level of asexual parasitaemia determined by microscopy can be expressed in several ways: the percentage of infected red blood cells, the number of infected red cells per unit volume of blood, the number of parasites seen in one feld on high power microscopy examination of a thick blood flm, or the number of parasites seen per 200–1000 white blood cells on high-power examination of a thick blood flm. A combination of two or more classes of antimalarial drug with unrelated mechanisms of action. The ability of a parasite strain to survive and/or to multiply despite the administration and absorption of a drug given in doses equal to or higher than those usually recommended, provided the exposure is adequate. Resistance to antimalarial agents arises because of the selection of parasites with genetic changes (mutations or gene amplifcations) that confer reduced susceptibility. The sexual stages of malaria parasites that infect anopheline mosquitoes when taken up during a blood meal. A combination in which two antimalarial drugs are formulated together in the same tablet, capsule, powder, suspension or granule. A high density of parasites in the blood, which increases the risk of deterioration to severe malaria (although the risk varies in different endemic areas according to the level of transmission) and of subsequent treatment failure. In this document, the term is used to refer to a parasite density > 4% (~ 200 000/ µL). A dark-brown granular material formed by malaria parasites as a by-product of haemoglobin digestion. It may also be phagocytosed by monocytes, macrophages and polymorphonuclear neutrophils. Parasite released into the host bloodstream when a hepatic or erythrocytic schizont bursts. Antimalarial treatment with a single medicine: either a single active compound or a synergistic combination of two compounds with related mechanisms of action. A genus of protozoan vertebrate blood parasites that includes the causal agents of malaria. After inoculation into a human by a female anopheline mosquito, sporozoites invade hepatocytes in the host liver and multiply there for 5–12 days, forming hepatic schizonts. These then burst, liberating merozoites into the bloodstream, where they subsequently invade red blood cells. This term refers to both cure of blood-stage infection and prevention of relapses by killing hypnozoites (in P. An antigen-based stick, cassette or card test for malaria in which a coloured line indicates the presence of plasmodial antigens. Recurrence of asexual parasitaemia following antimalarial treatment comprising the same genotype(s) that caused the original illness. This results from incomplete clearance of asexual parasitaemia because of inadequate or ineffective treatment. It must be distinguished from re-infection (usually determined by molecular genotyping in endemic areas). Recurrence of asexual parasitaemia after treatment, due to recrudescence, relapse (in P. After an interval of weeks or months, the hepatic schizonts burst and liberate merozoites into the bloodstream. Young, usually ring-shaped, intra-erythrocytic malaria parasites, before malaria pigment is evident by microscopy. Mature malaria parasite in host liver cells (hepatic schizont) or red blood cells (erythrocytic schizont) that is undergoing nuclear division by a process called schizogony. Resistance to antimalarial agents emerges and spreads because of the survival advantage of resistant parasites in the presence of the drug. The selection pressure refects the intensity and magnitude of selection: the greater the proportion of parasites in a given population exposed to concentrations of an antimalarial agent that allow proliferation of resistant but not sensitive parasites, the greater is the selection pressure. Acute falciparum malaria with signs of severity and/or evidence of vital organ dysfunction. Motile malaria parasite that is infective to humans, inoculated by a feeding female anopheline mosquito, that invades hepatocytes. This is the frequency with which people living in an area are bitten by anopheline mosquitoes carrying human malaria sporozoites. It is often expressed as the annual entomological inoculation rate, which is the average number of inoculations with malaria parasites received by one person in 1 year. The stage of development of malaria parasites growing within host red blood cells from the ring stage to just before nuclear division.

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So if you do not use medicines But many drugs have another liability: they as they are supposed to be used generic montelukast 5 mg on-line, they can directly affect the mind generic montelukast 5mg without prescription. As a result cheap montelukast 4mg without prescription, the person’s actions may be odd, irrational, inappropriate and even destructive. And each time, the emotional And as he has more failures and life gets plunge is lower and lower. Eventually, drugs harder, he wants more drugs to help him will completely destroy all the creativity a deal with the problem. By the time I revolved around one thing: my realized I was addicted, snorting OxyContin was part plan for getting the money I of my daily routine. And amphetamine— it was the every time I tried to kick it, the physical craving only thing in my life. They are included here to provide you with the truth about what these drugs are and what they do. Page 30 11 Marijuana arijuana is usually rolled up in a cigarette to a National Household Survey on Drug Mcalled a joint or a nail. It can also be Abuse, kids who frequently use marijuana brewed as a tea or mixed with food, or are almost four times more likely to act smoked through a water pipe called a bong. They are five * times more likely to steal than those who Cannabis is number three of the top do not use the drug. Growing techniques and selective use of seeds have produced Street Names: a more powerful drug. As a result, there • eed • Smoke • Ganja has been a sharp increase in the number of marijuana-related emergency room visits • Blunt • Mary Jane • Super by young pot smokers. When the effects start to wear off, the person may turn to • Reefer • Chronic • Nederweed * cannabis: any of the different drugs that come from 12 Indian hemp, including marijuana and hashish. Marijuana Long‑term use can cause itself does not lead the person to the other psychotic symptoms. It can drugs: people take drugs to get rid of also damage the lungs and the unwanted situations or feelings. The drug heart, worsen the symptoms of (marijuana) masks the problem for a time bronchitis and cause coughing (while the user is high). It may reduce fades, the problem, unwanted condition the body’s ability to fight or situation returns more intensely than lung infections and illness. In fact, in the first hour of smoking marijuana, a user’s risk of a heart attack could increase fivefold. School performance is reduced through impaired memory and lessened ability to solve problems. Mixing alcohol with medications or Alcohol street drugs is extremely dangerous and can be fatal. Alcohol influences your brain Street Names: and leads to a loss of coordination, slowed • Booze reflexes, distorted vision, memory lapses and • Sauce blackouts. Teenage bodies are still growing • Brews and alcohol has a greater impact on young • Brewskis people’s physical and mental well-being than • Hooch on older people. Heavy drinking usually results in a “hangover,” headache, nausea, anxiety, weakness, shakiness and sometimes vomiting. Drinking effects of alcohol and a resulting ability to large amounts can lead to a coma and even drink more. Mixing alcohol with medications or physical condition that can include liver street drugs is extremely dangerous and damage and increases the risk of heart can be fatal. A pregnant woman may give and leads to a loss of coordination, slowed birth to a baby with defects that affect reflexes, distorted vision, memory lapses and the baby’s heart, brain and other major blackouts. A person can become dependent and alcohol has a greater impact on young on alcohol. If someone suddenly stops people’s physical and mental well-being than drinking, withdrawal symptoms may set in. They range from jumpiness, sleeplessness, sweating and poor appetite to convulsions Short‑term Effects: and sometimes death. Alcohol abuse Feeling of warmth, flushed skin, impaired can also lead to violence judgment, lack of coordination, slurred and conflicts in speech, memory and comprehension one’s personal loss. A class of synthetic drugs • K2 known as“designer drugs” include synthetic • Smiles marijuana (“Spice” or “K2”), synthetic • Spice stimulants (“Bath Salts”) and “N-bomb”. Because the chemicals used constantly change, users have no way of knowing the content and effects. Headaches, nausea, confusion, paralysis, persistent vomiting, diarrhea, heavy sweating, and severe anxiety and high fever, kidney malfunction, heart depression, breakdown of attack, bleeding in the brain. Makers may add Street Names: anything they choose to the drug, such as • E • Hug • Lover’s caffeine, amphetamine* and even cocaine. The pills • Adam are of different colors and are sometimes marked with cartoon-like images. The stimulative effects of drugs such as Ecstasy enable the user to dance for long periods, and when combined with the hot, crowded conditions found at raves, can lead to extreme dehydration and heart or kidney failure. I had Short‑term Effects: • Impaired Judgment • Drug craving to have my mouth full of pieces • False sense • Muscle tension of glass to realize what was of affection • Involuntary happening to me. The terms used to describe ingestion include chewing, snorting, mainlining (injecting into a large vein) and Street Names: smoking. Long‑term Effects: In addition to those effects already mentioned, cocaine can cause irritability, mood disturbances, restlessness, paranoia and auditory (hearing) Short‑term Effects: hallucinations. Tolerance to the drug Cocaine causes a short‑lived intense develops so that more is needed to high that is immediately followed by the produce the same “high. People who use it often don’t severe depression, which becomes deeper eat or sleep properly. This can get greatly increased heart rate, muscle so severe that a person will do almost spasms and convulsions. The drug can anything to get the drug— even commit make people feel paranoid, angry, hostile murder. In higher doses has a Methamphetamine greater “rush,” followed by increased rystal meth and meth are inhaled, smoked agitation and sometimes violence. It is a highly powerful Street Names: and addictive man-made stimulant that • Speed • Tweak • Tina causes aggression and violent or psychotic • Meth • Go‑fast • Quartz behavior. Many users report getting hooked • Crystal • Ice (addicted) from the first time they use it. Can and cardiovascular (involving the heart and cause decreased hunger and bring blood vessels) collapse or death. Users may greater “rush,” followed by increased suffer brain damage, including memory agitation and sometimes violence. Other impairment and an increasing inability effects can include insomnia, confusion, to grasp abstract thoughts. I had a great band and played great music and had great members who weren’t only band members but best friends. When substances • hippets or fumes are inhaled through the nose or • Laughing Gas mouth, they can cause permanent physical • Rush and mental damage. They starve the body of oxygen and force the heart to beat irregularly and more rapidly. People who use inhalants can lose their sense of smell, suffer nausea and nosebleeds and may develop liver, lung and kidney problems. Much of the damage is caused to the brain tissue when the toxic fumes are sniffed straight into the sinus. Long‑term Effects: Can lead to muscle wasting and reduced muscle tone and strength. Heroin enters the brain rapidly but makes people think and react slowly, impairing their decision-making ability. Heroin • Brown is one of the three drugs most frequently Sugar involved in drug abuse deaths. The “trip” itself usually begins to clear up after about 12 hours, but some users manifest long‑lasting psychoses. Effects can include slowed breathing, ill Tell You Aa more serious problem than most nausea and unconsciousness. Painkillers, tranquilizers, antidepressants, sleeping pills and Depressants: These drugs, which slow down your brain and nervous system functions, include Xanax, Zyprexa, stimulants may appear “safe” due to being Amytal, Seconal, Valium and many others.

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In order to cut this particular Gordian knot discount montelukast 5mg fast delivery, parties may wish to consider withdrawing from the treaties montelukast 5mg without a prescription. Withdrawal from the treaties The administrative blocking possibilities within the convention review procedures mean that the prohibitionist block can effectively ensure no undesirable revisions are made purchase montelukast 5mg on-line. The only option then available to an individual state wishing to operate outside of the conventions would be to withdraw from the relevant treaty. The possibilities of denunciation Articles within all the treaties allow any Party to opt out by depositing a denunciation with the Secretary-General in writing, and including reference to the legal grounds for the move. With regard to the 1961 and 1971 Conventions, if the Secretary-General receives this instrument on or before the frst of July, the denunciation comes into effect for that Party at the beginning of the following year. Denunciation of the 1988 Convention comes into effect for the denouncing Party one year after the receipt of the notifcation by the Secretary-General. As of March 2008 it would, however, require 143 individual state denun- ciations to reduce the number of ratifcations of the 1961 Convention to below 40, thus triggering its termination (in accordance with Article 41). There is no shortage of criminals competing to claw out a share of a market in which hundred fold increases in price from production to retail are not uncommon. Public health, which is clearly the first principle of drug control… was displaced into the background. The 1988 Convention in fact has no termination clause and would thus, in accordance with Article 55 of the Vienna Convention on the Law of Treaties, somewhat bizarrely remain in force even if there was only one remaining signatory. It should also be clearly acknowledged that, beyond the possibilities of what is technically allowed, the political consequences for any indi- vidual state that opted out of the prohibitionist regime in this way could potentially be severe. The Netherlands for example has taken criticism for years because of its coffee shop cannabis system, but even they have not opted out of the treaties, instead choosing to operate at the fringes of what is allow- able in their letter and spirit. Far more likely is that a group of like- minded revision oriented states would collectively mount a challenge to 134 the system. The ‘denouncers’ may fnd safety in numbers and quite legitimately walk away from the treaties. Bewley-Taylor also suggests that even the threat of such action could be enough to precipitate substantial reform, allowing the system to be revised in such a way as to facilitate far more fexibility along the spectrum of policy options than the existing barriers created by the absolutist prohibitionist structures currently permit. The prohibi- tionist states could give way to partial reforms, if they were placed in 132 Quoted in Bewley-Taylor, 2003. Bewley-Taylor, ‘Emerging policy contradictions between the United Nations drug control system and the core values of the United Nations’, International Journal of Drug Policy, 2005, 182 Vol. Bewley-Taylor notes that: Such a scenario is possible since it is generally agreed that denuncia- tion of any treaty can lead to its demise. This would likely be the case with regard to any of the drug control treaties due to the nature of the issue and the convention’s reliance on widespread transnational adher- ence. Using denunciation as a trigger for treaty revision would differ from the procedures to modify the conventions discussed above since a group of like minded states would not simply be playing the numbers game in an effort to gain majority decisions in both the Council or the Commission. The Beckley Foundation’s Global Cannabis commission report iden- 135 tifies an additional possibility, arguably more attractive from a political perspective, of denunciation followed by re-accession with a reservation. The commission highlights the technical problems with this course of action but does note that both the Netherlands and Switzerland made reservations against the application of some of the provisions on criminalisation (in Article 3) when they ratified the 1988 Convention. Only the 1988 Convention clearly requires parties to establish as criminal offences under law the possession, purchase or cultivation of 135 Beckley Foundation, ‘Global Cannabis Commission’, 2008, page 155 (note: the discussion is limited to cannabis rather than the more substantive debate around all options for all currently illegal drugs). As has already been alluded to, if the constitutional courts in a signa- tory nation determined and ruled prohibition of a single drug, group of, or even all drugs, was contrary to their constitutional principles then the party would effectively be no longer bound by the limitations of the Conventions with respect to those drugs. An active debate already exists with regard to the possibilities of challenging drug prohibition on the grounds of human rights violations, that might allow some way to exploit this constitutional principles ‘loophole’. Once again, pursuing this course of action would incur the wrath of the prohibitionist block and their strategic/ideological allies in drug control thinking, and not be without political consequences. But similarly a group of reform oriented nations acting together could fnd strength in numbers to withstand any ensuing pressure. Such a defection would, as Bewley-Taylor describes it, ‘severely weaken the treaty system and possibly act as a trigger for regime change’. One would be if a new treaty were drafted and adopted on the same subject, superseding the previous treaties and those bound by them. A second would be if, for example, something such as the right of indigenous people to sovereignty over natural resources were to become recognised as jus cogens (i. Both of these possibilities are constrained by the political impediments outlined above. Disregarding the treaties Parties could simply ignore all or part of the treaties. If multiple states 184 4 5 6 Making a regulated system happen Regulated drug markets in practice Appendices engaged in such a strategy, the treaties would ‘I say drug use cannot be eventually ‘wither on the vine’, falling into disuse criminalised. I’m talking about criminalising trafficking but not without any specifc termination or reform. From a scientific perspective, individual country disregarding the treaties, I cannot understand the repressive or applying them only partially, could in this policy perspective. Such a move however, like all the other possible reforms discussed here, raises serious issues that go beyond the realm of drug control—particularly if taken unilaterally. The possibility of nations unilaterally ignoring drug control treaty commitments could threaten, or be perceived to threaten, the stability of the entire treaty system. As determined by the Vienna Convention on the Law of Treaties 1969, article 62, all treaties can naturally cease to be binding when a fundamental change of circumstances has occurred since the time of signing. This could be argued with regard to the fundamental change in the nature and scope of the international drug phenomenon that has taken place since 1961, meaning this doctrine of rebus sic stantibus could potentially be applied to the drug treaties. But, yet again, the selective application of such a principle would potentially call into question the wider validity of the many and varied conventions. All of these actions can be seen as not only undermining the trea- ties themselves, but additionally threatening the wider treaty system. By Bewley-Taylor’s analysis: In facilitating this unprecedented move the administration of George W. Under the 1969 Convention, a country that has signed a treaty cannot act to defeat the purpose of that treaty, even if it does not intend to ratify it. Thus, having set this precedent on the basis of national interest, Washington will surely fnd itself in an awkward position vis-à-vis its opposition to any defection from the drug control treaties on similar grounds. This group of countries is already, through the widespread adoption of pragmatic harm reduction and tolerance policies, increasingly moving away from both the spirit and letter of certain crucial prohibitive aspects of the conventions as they stand. If these trends continue, as seems inevitable, a crisis point will be reached where the tensions between treaty commitments and actual policy imple- mentation will mean a more substantial recasting of the conventions would be required for the overall system of drug controls to be preserved, including the valued and unquestioned benefits of the system for controlling licit pharmaceuticals. Insofar as nicotine- tion’) demonstrated; key elements of the addiction, alcoholism, and the abuse of solvents and inhalants may represent consensus behind the international drug greater threats to health than the abuse control system as it stands are already of some substances presently under beginning to crumble. At the same time they now acknowledge the primacy of public health in drug policy, the centrality of the harm reduction approach and the fact that there is a spirit of reform in the air. Key steps towards reform will include: * Moves must be made to establish meaningful international data collection. These include questions concerning the impact of drug control on human rights, confict, crime, corruption, development and security—as well as the more familiar public health measures. It will support a more effective critique of current successes and failings, which will help inform and guide more serious discussion of alternative approaches. This would echo the trend in drug policy generally away from a criminal justice focus to a more public health focus (including the location of the drug brief in domestic government, for example Spain, moving from Home Affairs to Health). Novak, ‘The United Nations and Drug Policy, Towards a human rights based approach’ (in: ‘The diversity of international law: Essays in honour of Kalliopi K Koufa’), 2009. It would move beyond the polarised legalisation/ prohibition debates of the past, instead talking about shared principles and aims, exploring options and potential outcomes, critiquing the failings of the drugs war and explaining in clear practical terms how phased moves towards regulation could bring benefits to individual countries and to the wider global community. Bewley-Taylor, ‘Emerging policy contradictions between the United Nations drug control system and the core values of the United Nations’, International Journal of Drug Policy, 2005, Vol. Novak, ‘The United Nations and Drug Policy: Towards a human rights based approach’ (in: ‘The diversity of international law: Essays in honour of Kalliopi K Koufa’, pages 449–477), 2009 191 1 2 3 Introduction Five models for regulating drug supply The practical detail of regulation 4 5 6 Making a regulated system happen Regulated drug markets in practice Appendices Appendix 2 Current legal production frameworks for opium, coca, cannabis and pharmaceuticals The regulated production of psychoactive drugs requires less attention than supply issues. There are already a large range of models in place for regulated production of plant and or pharmaceutical based drugs, from which lessons can be learned. In many cases, given that the same drugs are being considered, production for non-medical use will merely require expansion of existing frameworks.

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