Transcript Placebo Effect

Non-drug Factors Affecting
Pharmacologic Effects Of
Drugs
Group I Members:
Andaya, Erwin B
Brar, Rita
Caangay, Ephraim
Chen,Chun-Huang(Alex)
Chen,Chun-Yu(Kim)
Chen,I-Chung(Afra)
Chen.I-Ling(Claire)
Chitcaj,Pumchandh
Chou,Hsin-Yi (Chou)
De Los Reyes, Ellen Marie
De Los Santos, Marinelle
De Mesa, Andrea
Duh, Yidow
Huang, Lin-Yi (Tracy)
Purpose :
• Basically, there are three types of
drug. And each of them will let
human produce different effects
The Stimulant Effect:
• Substance that causes an increase in
activity in various parts of the nervous
system or directly increases muscle
activity
The Depressant Effect:
• One of various substances that diminish
functional activity, usually by depressing
the nervous system. And it have various
modes of action and effects. Some are
primarily used medically to relieve
emotion stress, anxiety, and tension;
others induce sleep, and still others are
used to relieve pain
The Placebo Effect:
• Inert substance given instead of a potent
drug. Placebo medications are sometimes
prescribed when a drug is not really
needed or when one would not be
appropriate because they make patients
feel well taken care of. But A traditional
placebo's lack of side effects. “placebo
effect” is an apparent improvement in
health due not to any treatment but only to
the patient's belief that he or she will
improve
Methodology:
• Each subject will be given one or two capsules of
the same color from marked containers. The
identity of the drug is coded and will be revealed to
the members of the class only at the end of the
conference, unless adverse reactions by any
participants require immediate intervention.
Students who are not subjects will be divided as
observers, recorders and reporters.
Control observations before taking the drug should
be done. Observations should be repeated every
15 minutes or as necessary.
Methodology:
• Changes in observation are noted. All
observations should be appropriately
recorded.
Subjects should stay apart from each other,
do not communicate nor compare reactions.
Observers should refrain from asking leading
questions; e.g. ”Do you feel sleepy?” Avoid
giving preconceived ideas. Do not inject fear
or apprehension to the subject.
Methodology:
• The subject will be observed for the following:
• Psychological ( self-rating assessment )
• Physiological observations ( objective
assessment )
• Other reactions
Methodology:
• Rate the degree of reactions of the subject before and after
intake of the drug according to the following scale:
0 - absent
+ - present
• If the reaction is present, take note of the intensity according
to the following:
Presence of:
<3 effects- mild to moderately intense
>4 effects – significantly intense
• For the physiological parameters, compute for the %
increase or reduction:
<10% reduction/increase – mild to moderate
>10% reduction/increase – significant
Parameters used:
EFFECT
A. Physiological
•
Cheerful
•
Talkative
•
Alert
•
Tense
•
Jittery
•
Irritable
•
Easy-going
•
Drowsy
•
Sulggish
•
Tired
•
Relaxed
•
Calm
•
Sleep
•
Weakness
CONTROL
15 MINS
AFTER
30
MIN
45 MIN >1HOUR
REMARKS
Parameters used:
EFFECT
B..Physiological
•
Pulse
•
Resp.rate
•
Bld
Pressure
•
Pupil Size
CONTROL
15 MINS
AFTER
30
MIN
45 MIN
>1HOUR
REMARKS
Parameters used:
EFFECT
C. Other Effect
•
Tremors
•
Sweating
•
Flushing
•
Headache
•
Dizziness
•
Difficulty in
concentration
•
Abdominal
Discomfort
CONTROL 15 MINS
AFTER
30
MIN
45 MIN >1HOUR
REMARKS
What is a Placebo
• It is an inert material with exactly the same
physical appearance , odor, consistency as
the active form
Types of Placebo
• Pure/Insert Placebo are those that are
devoid from any action, be it pharmacologic
al, surgical etc.
– contain starch, flour, sugar
• Impure/Active placebo are those that actually
have actions that may not be specific to the
disease
– contain starch and vitamin C
Placebo Effect
• It is the psychological effect of any
medication or procedure given with the
therapeutic intent, which is independent of,
or minimally related to the specific effects of
the procedure and which operates through a
psychological mechanism
Placebo theories
1. Psychological theory
2. “Nature taking its course”
3. Process of Treatment
Psychological Theory
• The belief that the placebo effect is caused
by just believing that the given substance or
procedure will work.
• The power of suggestion, beliefs, and hopes
about the treatment may have a significant
biochemical effect
Nature Taking Its Course Theory
• The placebo effect is due to an illness or
injury just taking its course.
Process of Treatment Theory
• By giving the placebo it displays the process
of treatment that involves showing attention,
care, affection etc to the patient or subject.
• This process is encouraging and hopeful and
this may trigger the physical reaction in the
body to promote healing.
Advantages of Placebo
• The Placebo effect can supplement
pharmacological effects
• In trials, can represent the difference
between success and failure
Disadvantage of the Placebo
• Because the physician is deceiving the
patient, there may be an adverse effect on
the physician-patient relationship
• If the deception is discovered, then the
patient will feel betrayed by the physician
and the confidence will be impaired.
DEPRESSANTS
• Any substance that diminishes functional
activity.
• Usually depressing the Central Nervous
System
• 2 major categories of depressant drugs used
as medicines are: Barbiturates and
Benzodiazepines - referred to as sleeping
pills, tranquilizers, sedatives or anxiolytic or
hypnotic drugs.
Barbiturates
Actions include:
• CNS depression
• Respiratory depression
• Enzyme induction
• Anesthetic
• Anticonvulsant.
Consequences include:
• Induction of drug
tolerance
• Physical dependence
(addiction)
• Severe Withdrawal
symptoms
• Can cause coma in
toxic dose
Doses and Effect
• Small amount – produce calmness and relax
muscles
• Moderate – cause drowsiness, confusion,
inability to concentrate, loss of coordination,
tremors and slurred speech.
• Large doses – produce depressed pulse
rate, dilated pupils, and shallow breathing.
Such doses may easily cause
unconsciousness and death.
Barbiturates Pharmacodynamics
• Work by enhancing the action of a brain
neurotransmitter that is in charge of inhibiting
parts of the brain.
• Facilitate the activity of one of the main
inhibiting neurotransmitters (GABA).
• Leads to inhibition of polysynaptic
transmissions in the CNS
• Commonly abused include amobarbital
(Amytal), pentobarbital (Nembutal), and
secobarbital (Seconal).
Benzodiazepines
Actions include:
• Reduction of anxiety
• Sedative and
hypnotic agent
• Anticonvulsant
• Muscle relaxant
Consequence include:
• Drowsiness, confusion
• Dizziness
• Weight gain
• Memory loss
Benzodiazepines Pharmacodynamics
• Activates all 3 specific gamma amino butyric
acid-benzodiazepine (GABA-BZ) binding
sites of GABA receptors
• Opens chloride channels and reduces the
rate of neuronal and muscle firing.
STIMULANTS
• Any agent temporarily increasing functional
activity.
• Stimulants may be classified according to the
organ upon which they act, as follows:
cardiac, bronchial, gastric, cerebral,
intestinal, nervous, motor, vasomotor,
respiratory, and secretory.
• Commonly used stimulants include caffeine,
low doses of ethanol, methamphetamines,
and cocaine.
Cocaine
• Used as a local anesthesia
• Self administered by chewing, intranasal
snorting, smoking, and IV.
Cocaine
Actions include:
• Produce intense
euphoria
• Powerful stimulation of
cortex and brainstem
• Increased sympathetic
“fight/flight response”
Consequences include:
• Hypertension
• Tachycardia
• Paranoia
• Depression
• Seizures
• Overdosage is fatal
• Addictive
Caffeine
• stimulates the central nervous system and of
gastric acid and pepsin secretion, elevation of free
fatty acids in plasma, diuresis, basal metabolic rate
increase, total sleep time decrease, and possible
blood glucose level increase.
• Caffeine is considered an ergogenic aid in athletics
because it tends to enhance endurance and
improves reaction time.
• Adverse effects include drug dependence and
withdrawal in some habitual users.
Physiologic Effects
• CNS – usual doses of 50-200 mg. causes a
decrease in fatigue and mental alertness.
• CVS – positive inotropic and chronotropic
effects on the heart.
• Renal system – mild diuretic action that
increases urinary output of sodium, chloride
and potassium
• GI system – stimulates secretion of gastric
acid and digestive enzymes
Clinical uses
• Relaxation of the smooth muscle of the
bronchioles
• Theophylline, widely used in asthma therapy
previously.
• For vasomotor headache
• Facilitates falling asleep in elderly people
and hypertensive patients
Adverse Effects
• Sensitive to low dose – sleeplessness,
tachycardia, diarrhea
• Moderate dose – Insomnia, anxiety, agitation
• High dose – emesis, convulsions,
restlessness, decreased attention span,
tremors
• Lethal dose – cardiac arrhythmias
Pharmacodynamics
• Inhibition of phosphodiesterase, thereby increasing
intracellular cyclic adenosine monophosphate
(cAMP)
• Directs effects on intracellular calcium
concentration
• Indirect effects on intracellular calcium
concentration via cell membrane hyperpolarization
• Uncoupling of intracellular calcium increasing with
muscle contractile elements
• Antagonism of adenosine receptors
The Results
Psychological Stats of DRUG A
Time
0
15
Depressant
Effects
III
IIII
II
Stimulant
Effects
III
II
30
IIII
I
45
II
I
60
IIII
II
0
Vital Stats of Subject A
Vital Stats of Subject A
20.000%
% Change from Control
10.000%
0.000%
-10.000%
1
2
3
4
5
-20.000%
-30.000%
-40.000%
-50.000%
-60.000%
-70.000%
Time (15 min increments)
Pulse Rate
Resp Rate
Pupil Size
BP - Systolic
BP - Diastolic
Psychological Stats of DRUG B
Time
Stimulant
Effects
I
Other
Effects
0
Depressant
Effects
III
15
III
III
Dizziness &
Diuresis
30
II
IIII
Tremors
45
IIII
IIII
60
IIII
IIII
Flushing & Cold
Extremities
Vital Stats of Subject B
Vital Stats of Subject B
40.000%
% Change from Control
30.000%
20.000%
10.000%
0.000%
1
2
3
4
5
-10.000%
-20.000%
Time (15 min increments)
Pulse Rate
Resp Rate
Pupil Size
BP - Systolic
BP - Diastolic
Psychological Stats of DRUG C
Time
0
Depressant
Effects
IIII
Stimulant
Effects
III
15
IIII
IIII
30
IIII
IIII
45
IIII
IIII
60
IIII I
IIII
Vital Stats of Subject C
Vital Stats of Subject C
50.000%
% Change from Control
40.000%
30.000%
20.000%
10.000%
0.000%
1
2
3
4
5
-10.000%
-20.000%
-30.000%
Time (15 min increments)
Pulse Rate
Resp Rate
Pupil Size
BP - Systolic
* Blood Pressure reading was not taken at time 15 min
BP - Diastolic
Psychological Stats of DRUG D
Time
Stimulant Effects
0
Depressant
Effects
IIII
15
IIII
III
30
IIII
III
45
IIII
III
60
IIII
III
III
* Control data (physical), may have be skewed due to the possibility that the
patient was excited to be the volunteer and that we did not have lecture : )
Vital Stats of Subject D
Vital Stats of Subject D
20.000%
% Change from Control
10.000%
0.000%
1
2
3
4
5
-10.000%
-20.000%
-30.000%
-40.000%
-50.000%
Time (15 min increments)
Pulse Rate
Resp Rate
Pupil Size
BP - Systolic
BP - Diastolic
Conclusions
Stats of Subject A
Vital Stats of Subject A
20.000%
% Change from Control
10.000%
0.000%
-10.000%
1
2
3
4
5
-20.000%
-30.000%
-40.000%
-50.000%
-60.000%
-70.000%
Time (15 min increments)
Pulse Rate
Resp Rate
Pupil Size
BP - Systolic
Depressant Effects
Stimulant Effects
21
7
BP - Diastolic
DRUG A
Experimental Conclusion
The drug is probably a :
Depressant
Stats of Subject B
Vital Stats of Subject B
40.000%
% Change from Control
30.000%
20.000%
10.000%
0.000%
1
2
3
4
5
-10.000%
-20.000%
Time (15 min increments)
Pulse Rate
Resp Rate
Pupil Size
Depressant Effects
Stimulant Effects
16
18
BP - Systolic
BP - Diastolic
DRUG B
Experimental Conclusion
The drug is probably a :
Stimulant
Stats of Subject C
* Blood Pressure reading was not taken at time 15 min
Vital Stats of Subject C
50.000%
% Change from Control
40.000%
30.000%
20.000%
10.000%
0.000%
1
2
3
4
5
-10.000%
-20.000%
-30.000%
Time (15 min increments)
Pulse Rate
Resp Rate
Pupil Size
Depressant Effects
Stimulant Effects
24
23
BP - Systolic
BP - Diastolic
DRUG C
Experimental Conclusion
The drug is probably a :
Depressant
Stats of Subject D
Vital Stats of Subject D
20.000%
% Change from Control
10.000%
0.000%
1
2
3
4
5
-10.000%
-20.000%
-30.000%
-40.000%
-50.000%
Time (15 min increments)
Pulse Rate
Resp Rate
Pupil Size
Depressant Effects
Stimulant Effects
24
15
BP - Systolic
BP - Diastolic
DRUG D
Experimental Conclusion
The drug is probably a :
Depressant
Summary of Results and Conclusion
•
•
•
•
Drug A – Depressant
Drug B – Stimulant
Drug C – Depressant
Drug D – Depressant
Back with the
Suggestions &
Recommendations
post game show
But first, a word from our
sponsors. . . . .
Medical Supplies: Le Medique
• Conveniently located, just behind the school
• On hand stock of commonly needed items
• Special orders welcomed
Quick Snacks: Waffle Dog
• Conveniently
located
• Same hours
as school
• Prices start
at only P14
Liquid Refreshments
• Detox
• Clean up
• Chill Out
Suggestions and
Recommendations
(How we can improve
the experiment.)
S&R–
Consistency in the subject, data
collection, statistical tools, &
environment setting
• Have the control time equal the experimental time
(includes readings for the hour)
• Have same person collect measurements
• Guidelines need to be established prior to taking
initial measurements
• Clearer guidelines for psychological factors
• Strict application & adherence to the scientific
method