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See Law Enforcement Assistance 490–491 purchase pletal 100mg online, 722 Kiu (Ancient beer) purchase 50 mg pletal visa, 164–165 Administration Stimulants Drug Law of 1951 generic pletal 50mg on-line, 119 Kleber, Herbert D. See Contingent tolerance alcoholism theories, 355, 399, 1124 Kola nut, 210, 281–282, 282 Learning factors in substance abuse, memorial fund, 671–672 Kolb, Lawrence, 1276–1278 234–239 Rutgers Center of Alcohol Studies, Koller, Carl, 268, 549, 875 alcohol and, 710–711 1012–1013 Kool cigarettes, 1094 amphetamines and, 112–113, 712 Jellinek Memorial Fund, 671–672 Koop, C. Everett, 48 animal research on Jesus, wine and, 79 Korea, 119, 145 conditioning and, 996–1002 Jewish Alcoholics, Chemically Dependent Korean-Americans and alcohol, 254 schedules of reinforcement and, Persons and Significant Others Korsakoff’s syndrome. See Alcohol opioids and, 296 nicotine and, 786–787 Lissner, Arlene, 1138 Lymphatic disorders. See Leukocytes psychological treatment and, 1256 for aggression, 227 Lysergic acid diethylamide, 689–695, 1024 community-reinforcement approach, with alcohol, 59 aggression and, 53 1258–1259 for alcoholism, 1156, 1251 carcinogenicity of, 220 skill training, 1258 for bipolar disorder, 136 chemical structure of, 589, 690 state dependent, 708–710, 1001 Lithonate. See Lithium as club drug, 264 treatment methods and, 1192 Little Cigar Act of 1973, 50, 1092 vs. See Decriminalization opioid-related, 806 Anonymous Legislation on substance abuse. See laws alcohol and, 309, 310, 859–861 Methadone Anonymous Lehder, Carlos, 285 drug interactions and, 437 MacAndrew scale, 739–740 Lemoine, Paul, 533 hepatitis Band, 313 MacDonald, Donald Ian, 837, 1280, 1285 Length of treatment. See Mothers Against Drunk Driving Leo Burnett advertising agency, 1094–1095 distilled spirits industry and, 409, 410 Mafia. See Chlorambucil Lobeline, 1089 Magnetic resonance imaging, 624 Leukocytes Locus coeruleus The Mahabharata, 560 alcohol and, 299–301 opioids and, 262 Mahareshi Mohesh Yogi, 378 allergic responses and, 104, 105 polydrug detoxification and, 1196 Maier, H. See L-alpha- 1243–1244 Major tranquilizers, withdrawal from, 1353 acetylmethadol Longitudinal studies. See L-alpha- on adolescents, 35 Malaysia and betel nut use, 183 acetylmethadol on risk factors, 1317 Malcolm X, 791 Levorphanol, 832 Looking Backward, 1119 Malnutrition and alcohol, 337–339 Lewin, Louis, 157 Lophophra williamsii. See Peyote Malt, 165–166 Lewis, Dio, 1361 Lorazepam, 173 Managed care Lexington, Kentucky, Public Health Service abuse liability of, 177 outpatient vs. Public Health for anxiety, 178 treatment policy and, 1129–1130 Service Hospitals metabolism of, 172 Manatt, Marsha. See Chlordiazepoxide for nausea, 705 Mandatory sentencing, 697–700 Licensed Beverage Information Council, 409 rebound anxiety from, 180 Anslinger, Harry J. See Monoamine oxidase inhibitors generic cigarettes, 1097 Louisiana, boot-camp programs in, Mapp v. Ohio (1961), 511 tobacco antitrust litigation and, 1094 1031–1032 Marathon House, 1135 Lightner, Candy, 744, 744 Lowery, Christine T. See National Brain structures Lucky Strike cigarettes, 1094 Commission on Marihuana and mesocorticolimbic dopaminergic system, ‘‘Lucy in the Sky with Diamonds,’’ 378 Drug Abuse 195 Ludes. See Methaqualone Marihuana Tax Act of 1937, 131–132, 349 reinforcement and, 194–195, 196 Ludlow, Fitz Hugh, 593 Marijuana, 702–707, 703. See Phenobarbital Cannabis sativa structure of, 688 Lung disorders Marijuana Anonymous, 1187 Lime. See Calcium hydroxide cannabis-related, 705 Marijuana Check-Up, 1187 Lincoln Hospital (New York), 1223 injection route of administration and, 344 The Marijuana Problem in the City of New Lindesmith Center. See Isocarboxazid state dependent learning and, 708–710 Methadone Anonymous, 1178 Marriage. See also Families stimulants and, 293 Methadone maintenance programs, alcohol-related aggression and, 525–529 Men 716–722, 718 alcoholism treatment and, 1148 antisocial personality disorder and, 138 British treatment system and, 201–204, Martinez, Bob, 1281, 1286, 1297–1298 Canadian substance abuse, 218 598 Martinez, Julio, 1138 elderly, and alcohol, 57 for cocaine polydrug addiction, Marvin Burt Associates, 730–731 family violence and, 521–522 1170–1171 Maryland homelessness and, 613–615 for heroin addiction, 804, 1182, 1183, Oxford House, 1136–1137 hypogonadism and, 320–321 1253–1254 Mass spectrometry, 457 vulnerability in, 1319–1322, 1323 Netherlands treatment and, 769–770 Massachusetts Mendocino State Hospital (California), 1122 for opioid addiction, 436–437, 811, Hospital for Dipsomaniacs and Inebriates, Menstrual cycle, 296, 297 818–819, 969, 1219–1220 1120–1121 Mental disorders, 325–331. See Michigan Alcohol Screening Test alcohol pharmacotherapy and, 1155–1156 chemical structure of, 722 Matching. See Patient cannabis and, 704–705 as club drug, 264 Mate´, 210 child abuse and, 249–250 crime and, 368 Maternal drug use. See Methanol chemical structure of, 590, 707 Meperidine, 713–714 Methyl-beta-carboline-3-carboxylate, 174 as designer drug, 384 chemical structure of, 713 1-methyl, 4-phenyl, 1, 2, 3, 6- as stimulant-hallucinogen, 589–590 convulsions from, 806 tetrahydropyridine. See Peyote Methylxanthines Medellin drug cartel, 284, 285–286, Mescaline, 714–715, 876 caffeine, 209–210, 214–215 658–660 chemical structure of, 590, 690, 714 theobromine, 1085 Media and prevention movements, 839–840, as hallucinogen, 586–587, 690–691, Metoclopramide, 705 906 1023–1024 Metronidazole, 59, 411, 1252 Median effective dose. See Psilocybin Medicaid, 484, 1115–1116 194–195, 195 Mexico Medical complications, 314–325, 881. See Health care Metcalf-Volker Narcotic Addict Commitment as drug source, 725–728, 727, 1054 professionals Act of 1962 (New York), 782 amphetamines, 117 Medicare, 484, 1116 Methadone, 715–716 cannabis, 373, 655–657, 664 Medications benzodiazepines with, 177 cocaine, 666 over-the-counter (See Over-the-counter chemical structure of, 715 opium, 655–657, 660–661, 663–664, drugs) development of, 1181 665–666 for substance abuse (See endocrine disorders and, 296 Operation Intercept and, 794–796 Pharmacotherapy) history of treatment and, 1125 terrorism in, 1081–1082 Megavitamins. See Leukocytes accidents Microsomal ethanol-oxidizing system, 306, Monopolies, tobacco, 1094–1095 Moulton, Connie, 288, 836–837 860–861 Monroe, Marilyn, 435 Moulton, Otto, 288, 836–837 Microtubules (Neurons), 773–774, 776 Mood and drugs. See Magnetic resonance imaging Middle East Moonshine, 741 Multi-Health Systems (Canada), 148 cannabis use in, 221, 377, 592 The Moonstone, 709 Multi-Opium Poppy Sensing, 727 coffee cultivation in, 874–875 Moral views Multidisciplinary treatment. See Multimodal crop control in, 372 on decriminalization, 879–880, 885–886 treatment opium and, 143, 665–666, 813–814, dependence syndrome and, 403–405, 591 Multidoctoring, 54, 56, 747 821, 876 drug policies and, 883 Multimodal treatment Military-style prisons. See Boot-camp prisons needle exchange programs and, 764, 767 for alcoholism, 1143, 1148 Military (U. See also Prohibition and, 936, 1077–1078, 1080 behavioral approaches, 1226 names of specific wars, e. See Polydrug abuse Mill, John Stuart, 883 742 Multiple family group therapy, 1240 Miller Brewing Corp. See Hallucinogens allergic response to, 105 Muscarine A Mind That Found Itself, 1120 as analgesic, 827–828, 828, 832 acetylcholine and, 183, 710 Minimal intervention. See Deaths Mitchell, John, 794 Mothers Against Drunk Driving, 7, 744, N Mitral neurons, 775 744–746 Mixed agonist-antagonists. See Agonist- drinking age laws and, 905–906 N-acetyltransferase, 448 antagonists (Mixed) establishment of, 469–470 N-methyl, d-aspartic acid. See Controlled drinking for cocaine addiction, 1166 Nalbuphine, 63 Moderate Drinking: The New Option for for heroin addiction, 1176 Nalepka, Joyce, 837 Problem Drinkers, 96 for marijuana addiction, 1186–1187 Nalmefene, 1143 Moderation Management, 96 in operant conditioning, 1217 Nalorex. See for health professional addiction, 632 Drug Abuse, 288, 758–759 High School Senior Survey for opioid addiction, 712, 969–970, 1182, on availability, 683 National Highway Safety Bureau. See Narcotic Addict Rehabilitation National Commission on Mental Hygiene, Act of 1966 drinking age laws and, 735 393–394 drunk driving and, 469 Naranon, 1241 National Commission on Sports and Narcan. See National Council Prevention Network, 838 Narcolepsy on Alcoholism and Drug amphetamines for, 110–111, 385 National Household Survey on Drug Abuse, Dependence 422–423, 496, 498, 760–763, methylphenidate for, 725 National Committee for the Prevention of Narcoterrorism. See Terrorism and drugs 1355–1356 Child Abuse, 247 alcohol, 497–498 Narcotherapy, 108, 109 National Committee on Alcoholism.

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Pregnancy registries can help women and their doctors learn more about how diabetes medicines afect women during pregnancy buy 50 mg pletal overnight delivery. Check to see if there is a registry for your diabetes medicine or other medicines at: www generic pletal 100 mg on line. Work with your doctor cheap pletal 50 mg free shipping, nurse, or diabetes educator to plan how you will manage your diabetes. Work with your health care team to keep your feet, eyes, heart, and teeth healthy. The former are proverbs used for medical purposes even though they may have no medical content. The perception of a proverb as medical in content is flexible, varying from collection to collection. In thematic proverb collections the items are usually taken out of the context but their very inclusion is in itself a context-specifying factor. A new definition of applied folklore is proposed, stressing the role of non-folklorists. The wish to use prov- erbs for concrete purposes inheres in the material itself as much as the wish to reveal its universal formulas. He informed his readers that he was publishing it after becoming disillusioned with the topic, which initially had been designed for his doctoral dissertation (Krikmann 2001: 11). This confession encourages me to open this article, which is intended for publication in this journal’s issue hon- ouring Prof. My interest in medical proverbs began in my early student years, when my father, a physi- cian, suggested this topic to me as a joint venture. For two years we searched for medical proverbs in various collections, discussing the criteria for the no- tion “medical” and for the classification of our material. Concurrently with our joint collecting activities I completed my seminar paper and even published a short paper, which I do not include in my list of publications. At that point I began to harbour misgivings as to the scientific value of the topic, and I took the opportunity to discuss them with two venerable literary scholars, Miron Petrovskii and Vadim Skuratovskii. Their verdict was unanimous: although the collection was interesting and the seminar work showed a student’s ability in research, the topic itself had no philological value. Both the collection and Folklore 46Folklore 46Folklore 46Folklore 46Folklore 46 http://www. Although presented to me very politely and amiably, this conclusion caused me a profound psychological trauma. For six months I could write nothing at all, and then I switched abruptly from folklore to literary studies. My emigra- tion in 1991 caused me to return to the path of folklore studies, but one angle of it, namely medical proverbs, remained previously sealed for me and thus my father must be again mentioned. He carried our collection in his immi- grant luggage; he even brought along my old seminar paper. For thirty years he tried to persuade me to publish our collection, occasionally encountering “explosions” from myself. He refused to publish it under his own name, al- though I ardently suggested that he do so and while I said “never”, he still waited patiently. Then, suddenly, the situation changed when two years ago, in one of our numerous fervent debates on medical proverbs it struck me that my father was growing old. This understanding changed the whole perspective of the issue so I was not about to deprive him of one of the few pleasures remain- ing to him. The fear that he might not see this work published, and I would blame myself for it, was bitterer than the memory of my failure so long ago. And so I agreed to publish the book of medical proverbs, with the proviso that he typed it out himself on the computer and as my father was still not really computer literate the task was enormous. But he accomplished it, and even added many Jewish proverbs himself and so the upshot is that our book has been published. And my paper on medical proverbs can be viewed as one of the confirmations of the wise folk sayings – “Never say never”. But the difference should be defined as not all the proverbs used by medical practitioners are medical in content; and medical content does not automati- cally imply the use of these items in medicine. Medical proverbs and proverbial sayings uttered by people constitute pithy observations, opinions and advices across a whole array of human existence, covering life, death, illnesses, and relations of doctors and patients. Elmquist introduced the notions of indirect and direct references to physiologi- cal matters in proverbs and proverbial sayings, limiting his research to the latter group (Elmquist 1934: 75). In principle, I accept this dichotomy, although Elmquist’s examples of indirect references to physiological matters are, I be- 112 www. I see no physiological significance in such prov- erbs as “A new broom sweeps clean” or “Coming events cast their shadows before” (Elmquist 1934: 75). To my mind, the narrow cluster of medical prov- erbs includes those about illness, pain, doctors, patients, folk healers, healthy and unhealthy habits, medication, and diagnostic and prognostic proverbs, while a broad cluster also encompasses proverbs and sayings about life and death, general ideas about age and so on. To the best of my knowledge, the collections of medical proverbs are not limited to the narrow group, which is as it should be. The borders between health and illness, age and illness, and even life and death, are permeable and cannot be sealed. It has been noted that the prov- erbs’ reflection of the “actual healing art is poor” (Garrison, 1928: 984; Anony- mous 1914: 875) and that they “are not particularly enlightening from the scientific point of view” (Mieder 1993: 153). For all that medical proverbs were and remain in demand, as they are perceived as a true reflection of people’s worldview and a source of good counsel (Zakharov & Zhungietu 1975: 5–6). Latin medical proverbs are known from late Antiquity while collections of medical proverbs exist since the Middle Ages (Mieder 1993: 152–153). Medical proverbs might equally be included in general collections as separate chapters (Dal’ 1957). Past and present collections of such proverbs have been compiled by medical doctors and/or by specialists in humanities (folklorists, linguists, etc. Vladimir Dal’, who was both a physician and a great linguist) or in a single team of a physi- cian or a biologist and a folklorist (Fialkov & Fialkova 2009; Zakharov & Zhungietu 1975). In other cases, the work can be accomplished by physicians and psychologists themselves (Dudnikov 1969; Kadymov 1971; Zhitnikova & Polivanova 2001) or by a folklorist with no medical education (Sysoev 2007). The intended readership of such publications varies between the general pub- lic and medical personnel. With the former, the aim of publication is usually to disseminate medical information in a popular form easy to remember (Kadymov 1971; Sysoev 2007; Zakharov & Zhungietu 1975); with the latter, it is to pro- vide doctors and psychologists (both at the clinic and in their teaching activi- ties) with lively material to facilitate their communication with patients or with an audience (Dunaevskii 1965; Zhitnikova & Polivanova 2001). Which- ever audience is targeted does not influence the type of the material, although it becomes more important in the case of analyses (Zhitnikov & Polivanova 2001).

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The author is also indebted to Jackson’s article for other colorful examples of amphetamine’s history generic 50mg pletal amex. Plessinger discount pletal 100 mg mastercard, “Prenatal Exposure to Amphetamines: Risks and Adverse Outcomes in Pregnancy purchase pletal 50 mg online,” Obstetrics and Gynecology Clinics of North America 25 (1998): 119–38. Apovian, “The Use of Pharmacologic Agents in the Treatment of the Obese Patient,” Journal of the American Osteopathic Association, pt. Hinkle, “The Effect of Expectation on Response to Phen- metrazine,” Psychosomatic Medicine 26 (1964): 369–73. Hollister, “Phenmetrazine: An Obsolete Problem Drug,” Clin- ical Pharmacology and Therapeutics 32 (1982): 672. Population–Based Sample of Male Twins,” Archives of General Psychiatry 57 (2000): 261–69. Coutinho, “Transtornos mentais como fatores de risco para o desenvolvimento de abuso/dependeˆncia de cocaı´na: Estudo caso-controle” (Mental disorders as risk factors for the development of cocaine abuse/dependence: Case- control study), Revista de Saude Publica 33 (1999): 477–86 (abstract in English). Wisner, “Methamphetamine Use in Trauma Patients: A Population-Based Study,” Journal of the American College of Surgeons 189 (1999): 442–49. Chen, “Extent of Smoking and Nicotine Dependence in the United States: 1991–1993,” Nicotine and Tobacco Research 2 (2000): 263–74. Cheng, “Substance Use Disorders among Ad- olescents in Taiwan: Prevalence, Sociodemographic Correlates and Psychiatric Comor- bidity,” Psychological Medicine 29 (1999): 1387–96. College Students’ Use of Tobacco Products: Results of a National Survey,” Journal of the American Medical Association 284 (2000): 699–705. Mahowald, “Long-Term, Nightly Benzodiazepine Treat- ment of Injurious Parasomnias and Other Disorders of Disrupted Nocturnal Sleep in 170 Adults,” American Journal of Medicine 100 (1996): 333–37. Ciraulo, “Abuse Potential of Benzodiazepines,” Bulletin of the New York Academy of Medicine 61 (1985): 728–41. Nel, “Die Afhanklikheidspotensiaal van die Bensodiasepiene: Toepassing van die Resultate van die Behandeling van die Alkoholonttrekkingsind- room” (The addiction potential of benzodiazepines. Application of the results of treat- ment of alcohol withdrawal syndrome), South African Medical Journal 59 (1981): 115–16 (abstract in English). Nel, “Pharmacological Requirements of Patients during Alcohol Withdrawal,” South African Medical Journal 59 (1981): 114. Hansen, “Benzodiazepines Enhance the Consumption and Palatability of Alcohol in the Rat,” Psychopharmacology 137 (1998): 215–22. Lundberg, “The Effect of Benzodiazepines on the Fetus and the Newborn,” Neuropediatrics 23 (1992): 18–23. Lundberg, “Neurodevelopment in Late Infancy after Prenatal Exposure to Benzodiazepines—A Prospective Study,” Neuropediatrics 23 (1992): 60–67. Laegreid, “Clinical Observations in Children after Prenatal Benzodiazepine Exposure,” Developmental Pharmacology and Therapeutics 15 (1990): 186–88. Viggedal, “Mental Development in Late Infancy after Prenatal Exposure to Benzodi- azepines—A Prospective Study,” Journal of Child Psychology and Psychiatry, and Allied Disciplines 34 (1993): 295–305. Silberstein, “Headaches and Women: Treatment of the Pregnant and Lactating Migraineur,” Headache 33 (1993): 536. McElhatton, “The Effects of Benzodiazepine Use during Pregnancy and Lac- tation,” Reproductive Toxicology 8 (1994): 461–75. Czeizel, “Lack of Evidence of Teratogenicity of Benzodiazepine Drugs in Hun- gary,” Reproductive Toxicology 1 (1987–1988): 183–88. McElhatton, “The Effects of Benzodiazepine Use during Pregnancy and Lactation,” Reproductive Toxicology 8 (1994): 461–75; U. Bergman, “Pharmacoepi- demiological Perspectives on the Suspected Teratogenic Effects of Benzodiazepines,” Bratislavske Lekarske Listy 92 (1991): 560–63 (abstract in English). Jick, “Addiction Rare in Patients Treated with Narcotics,” New England Journal of Medicine 302 (1980): 123. Heath, “Anabolic-Steroid Use, Strength Training, and Multiple Drug Use among Adolescents in the United States,” Pediatrics 96 (1995, pt. Massengale, “Glue-Sniffing in Children: Deliberate Inha- lation of Vaporized Plastic Cements,” Journal of the American Medical Association 181 (1962): 300–304. Patterson, “Acute and Chronic Effects of the Voluntary Inhalation of Certain Commercial Volatile Solvents by Juveniles,” Journal of Drug Issues 4 (1974): 167. A lphabetical Listings of rugs All substances listed here have been declared a public concern by government officials, medical caregivers, or news media. If a listing mentions another drug’s name in bold type, that drug has an entry of its own in this section of the book. For example, most anabolic steroids pro- mote development of male characteristics when used by females. If an indi- vidual anabolic steroid is known to have that effect, that information is given in the individual listing. Such a style might make some entries seem repetitive if someone is looking up one anabolic steroid after another, but this approach improves the odds of important information being communicated. A cross- reference style that expects readers to flip back and forth among pages to “see this” or “see that” in order to avoid repetition might work for scientists, but for readers of this book, ease of usage is more important. Although many drugs of abuse are described in this section, many others exist that are not included here. The choice of which to include and which to leave out was based on several factors. Another factor was whether a drug is abused even though it is not a controlled substance. Still another factor was whether enough data exist in the scientific literature to provide solid information. With some drugs described here, scientific infor- mation is scanty concerning particular aspects of a given drug, such as poten- tial for causing cancer; that lack is specifically noted where relevant in drug descriptions. Listings are arranged in the fol- lowing manner: Pronunciation: The proper way to pronounce a substance’s name is given here. Formal Names: Entries in this section are a partial list of brand names and ge- neric names.

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The critical times for the development of var- ious organs and structures of the human embryo are given in Fig cheap 100mg pletal. Fetal development Important changes occur during the embryonic development that can also be damaged outside the period of the embryo order 100mg pletal otc. Traditionally quality pletal 50mg, things that happened to a fetus were not considered a teratogenic effect, but some authorities have begun lumping fetal effects into this category. Changes in cellular structures such as the brain cell arrangements during neu- ronal migration occur during the fetal period. However, the predominant fetal event is hyperplastic growth (increase in cell number) with organs and other tissues becoming larger through cellular proliferation, and only secondarily through hypertrophy. An impor- tant example is the thyroid, which appears early in the fetal period, as does fetal endocrine function. Most of the potential adverse effects during fetal development are maldevelop- ment due to interrupted cell migration and growth retardation (Jones, 1988). If blood flow to an organ or structure is interrupted or obstructed, structures that were normally formed during embryogenesis may be malformed during the fetal period (e. The embryo and fetus are exposed to drugs through the placenta which can: (1) metabolize certain drugs before they reach the conceptus; (2) allow 99 percent of drugs to cross by simple diffusion; (3) not transport large molecules (i. Poor potential for transfer back to the maternal circulation occurs for some drugs (e. Recent findings from in vitro fertilization studies suggest that the majority of these 10 Introduction to drugs in pregnancy spontaneous abortuses are chromosomally abnormal. The risk of spontaneous abortion is 15–20 percent among fetuses surviving 59–126 days of gestation. The risk of sponta- neous abortion/fetal death decreases to 1–2 percent by 18–20 weeks (127–140 days). Up to 28 weeks (196 days) postconception the risk for spontaneous abortion is approxi- mately 2 percent. Congenital anomalies The frequency of congenital anomalies detected at birth is approximately 3. This figure is thought to underrepresent the true frequency of anomalies by as much as twofold because 100 percent detection of anomalies is not usually reached until about 5 years of age. The frequency of congenital anomalies is sev- eralfold higher among stillbirths and miscarriages than live births, and is especially high among early (i. Fetal effects Fetal effects are of four primary types: (1) damage to structures or organs that are formed normally during embryogenesis; (2) damage to systems undergoing histogenesis during the fetal period; (3) growth retardation; or (4) fetal death or stillbirth. Fetal effects may be caused by a teratogen, but may also be caused by agents that have no apparent potential to produce abnormal embryonic development. Organs, structures, or functions formed normally during embryogenesis can be damaged by some environmental exposures during the fetal period. Fetal growth retardation is the most frequently observed effect of agents given during pregnancy and outside the period of embryogenesis. Sometimes it is difficult to distin- guish between the effects of the agents from those of the disease entity being treated. Propranolol, for example, is associated with fetal growth retardation, but the maternal disease for which the drug is given (hypertension) is also associated with fetal growth retardation in the absence of antihypertensive therapy. Risks of fetal death, stillbirth, and other adverse effects are increased with exposure to some agents during pregnancy (Table 1. Neonatal and postnatal effects Prenatal exposure to some drugs is associated with adverse neonatal effects, such as diffi- culty in adaptation to life outside the womb. Drugs associated with adverse neonatal are not usually associated with teratogenic effects. Transient metabolic abnormalities, with- drawal, and hypoglycemia are well-documented neonatal effects of certain medications and nonmedical drugs. Developmental delay is frequently asso- ciated with the action of teratogens, but is also observed in association with the fetal effects of drugs that are apparently not teratogenic. Maternal enzymes, particularly cholinesterases (Pritchard, 1955), have lowered activity. Maternal blood volume increases dramatically during pregnancy, by perhaps 40–50 percent, to support the requirements of the developing fetus (Cunningham et al. Distribution of drugs in this increased blood volume may lower serum concentrations. Absorption of drugs occurs with about the same kinetics as in the nonpregnant adult; however, renal clear- ance is increased and enzyme activity is downregulated. Decreased enzyme activity lev- els are exacerbated somewhat by the increased blood volume, decreasing the overall effective serum concentration of a given dose. In turn, increased renal output may effect an increased clearance index for most drugs. Drugs that are tightly bound to the serum proteins have little opportunity to cross the placenta or enter breast milk. Consequently, increased demands are placed on cardiovascular, hepatic, and renal systems. In addition, the gravid uterus is vulnerable to a variety of effects not present in the nonpregnant state, such as hemorrhage, rupture, or preterm contraction. Increased demands imposed on these physiological systems by pregnancy may, under normal conditions, be dealt with in an uncomplicated manner. However, con- ditions of disease or other stress weaken these key systems and they may be unable to function normally. For example, cocaine abuse during pregnancy actually targets these key systems that are already stressed from the gravid state of the woman. Hence, it would be expected that cocaine use during pregnancy would place cardio- vascular, renal, and hepatic systems at greater risk than those of the nonpregnant Pharmacokinetics in pregnancy 13 adult. Indeed, these expectations are borne out in the observations of cocaine use during pregnancy. Only two investigations examined for this review made explicit quantitative recommendations for dose or schedule during pregnancy (Caritis et al.