How does an overdose of pills occur?

How does an overdose of pills occur?

What are side effects for overdose of sleeping pills & how to manage it? - Dr. Sanjay Gupta

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answers (2)

Answer 1
September, 2021

As always, I will not be brief and will start with a preface, sorry: ^)

Overdose is an overdose. For most drugs, the following are installed:

  • higher single doses (above which it is dangerous to take a single dose),
  • higher daily doses (above which it is dangerous to take in total per day);

- for most other substances (and some drugs as well):

  • maximum permissible concentrations (above which it is dangerous to enter the body from a particular object or environment),
  • toxic doses (at which the first signs of poisoning occur),
  • half-lethal doses (at which half of the subjects die).

- these data are taken not from the air - they are established empirically as a result of a number of tragic circumstances or in the course of an experiment on animals.

Dose as a maximum concentration of a substance that enters the body and is in it, there is not in a vacuum - it has a physiological basis:

  • On the one hand, substances are distributed throughout the body, along sensitive tissues and organs (the affinity of a substance for tissue depends on its physicochemical characteristics; in short - like to like: fat-soluble will accumulate in the organs rich in fat, and so on);
  • On the other hand, substances are processed in and out of the body .

- both are carried out at a certain speed to a certain extent, and those interested can read deeper about the kinetics of the zero and first orders (explaining this in my own words here, I will deviate too much from topic).

The processing of substances is carried out to a greater extent by the liver (liver cells, hepatocytes) and often by those tissues into which the substances penetrate. Recycling has two purposes:

  1. to reduce the toxicity of the substance ,
  2. to speed up its removal.

The essence of processing is in changing the chemical structure of a substance - depriving it of certain radicals or supplementing it with them. As a result of processing, the physicochemical properties of the substance change, its distribution throughout the body changes, and it goes into the kidneys or intestines, from where it is removed in an understandable way. In most cases, everything ends well if the products of metabolism are not even more toxic substances, as in the case of methanol and its product that damages the optic nerve - formic acid.

Processing both in the liver and in other cells is are chemical reactions as mentioned above. Chemical reactions also represent the effects of substances on cells. In any chemical reaction, as you know (from the school course, who even bothered to study it) substances turn one to the other is most often reversible, but due to constant circulation throughout the body, it is rather irreversible. In order to transform a foreign substance, one must use a substance from the body itself. Thus, the substances of the body's defense systems are wasted on the reactions of neutralizing substances coming from outside, and this pool is not infinite.

Dose is determined precisely by the number of molecules of the substance and the time of their stay in the body has enough pool of the very substances involved in neutralization (those interested can read about the P450 family of cytochromes). For ethanol we have specific processing systems (thanks evolution!), But for methanol we do not, and only a little they are suitable for processing alcohol isomers. We have absolutely nothing for metal poisons. And so on.

If neutralization is ineffective, all xenobiotics (foreign substances) begin to enter the metabolic pathways of the body, disrupting the natural course of things, forming even more toxic metabolites and entering into undesirable reactions with cell molecules, leading to violation of their functions. It is precisely those organs in which the substance accumulates and / or is converted to a greater extent (see above) are affected - therefore psychotropic substances mainly affect the brain, metal poisons of muscle and bone tissue, and any substances - the liver.

Answer 2
September, 2021

The principle laid down by Paracelsus is sola dosis facit venenum.

When the highest single dose or the highest daily dose is exceeded, the "medicine" begins to bear a toxic effect, exerts an unnecessary effect on the body.

The bottom line is that drugs cannot affect only certain systems, they affect others, and more often either neutrally or negatively (see the list of side effects)

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