International Justice And The International Criminal Court Between Essay

International Justice And The International Criminal Court Between Sovereignty And The Rule Of Law - Essay Example He has addressed in International Law at Columbia University, in addition to at King's College London, since then he holds a Ph.D. He discovers resolutions to most important exceptional troubles of international law (universal jurisdiction, bureaucrat immunities, the association of the ICC to national courts, the function of the United States). This book assess the quick current expansion of international illegal law, and discovers explanations to chief harms of bureaucrat invulnerability, worldwide jurisdiction, the International Criminal Court, and the attitude of the United States, looking for to elucidate how impartiality can be done most excellent n a classification of sovereign States. At the same time as neither the ending of the Cold War nor the 'refusal of sovereignty' in themselves make dependable justice more probable, the ICC might give confidence a civilization of answerability that will hold up additional customary enforcement of international criminal law in the long-standing. This book critically defines the consequences of the Cold War, governments and human rights groups pressed for the formation of international legal systems to grasp persons accountable for war crimes, crimes against humankind, and genocide. The Yugoslav and Rwandan courts set significant models, and the 1998 acceptance of the Rome decree of the International Criminal Court offered latest institutional machines. In this helpful review of the emergent field of global criminal law, Broomhall positions these progressions in a wider situation. What is distinguishing about Nuremberg-enthused international criminal law is that it chairs liability on persons relatively than states and relies on such worldwide customs as "international harmony and defense" and "the communal ethics of mankind." These customs of justice, nevertheless, have heightened much more rapidly than have enforcement systems, which stay decisively in the hands of independent states, and in that laid the massage. Broomhal l however disagrees that globalization and the expansion of international civil culture have shaped a novel "legitimation atmosphere," in which governments are beneath greater than before stress to validate their results and tolerate by global customs of liability. This book by Broomhall clearly states pressures between liability and the law of the international globe and the continuing authority of state dominion. The worries inside and boundaries of a range of advancements to

Art history Essay Example | Topics and Well Written Essays - 250 words

Art history - Essay Example According to Hamilton, Richard Foster and Martin (35), pop art became so dominant and popular in London and New York in the mid 50s, the same time Richard made this painting. Jan van Eyck’s Arnolfini Portrait (Northern Renaissance) on the other hand, is a proof of the coming and birth of contemporary fashion as suggested by the woman in the portrait who is holding high her brightly colored dress. â€Å"The Arnolfini is filled with complex symbolism and interesting details,† (Seidel and Linda 21). Evidently, Jan’s painting is a Flemish painting from the bright colors used as it is commonly associated with the renaissance, which usually means re-birth. Re-birth was started in Florence and Italy, the same place where the particular painting is based on. The painting was done in 1434 by Jan van Eyck as one of the pioneers of oil painting. In Italy there are a lot of details of wealth from the same place like the rare species of the dog present in the painting, the wealthy clothes and the gleaming brass chandelier on the wall. The ornate Latin signature on the wall near the clock also has some resemblance of the modern day graffiti, which proves more of the birth of contemporary culture. There are several differences between Richard’s painting, â€Å"just what is it that makes today’s homes so appealing?† and Jan van Eyck’s Arnolfini Portrait in that, Richards painting is a true depiction of modern pop art with modern true day to day life among people like the free and liberal partnership between man and woman as depicted in the picture .Richard’s painting also narrows down the difference between fine and contemporary art while Jan’s painting depicts marriage, fidelity ,and wealth of the fourteenth century as mentioned by Bedaux and Ben( 43) These paintings are similar in style, in that they are bold, colorful interesting to look at and catchy. However, Richard’s

The Role of NCAA in the Rise of Intercollegiate Athletics Assignment

The Role of NCAA in the Rise of Intercollegiate Athletics - Assignment Example NCAA membership at the national office performs the role of assisting the underlying institutional members from diverse universities and corresponding colleges in comprehending different fundamental legislation of the NCAA. It majorly offers easier accessibility of the knowledgeable workers found within NCAA to the institutions and the public. The organization also organizes numerous workshops and educational conferences annually in an attempt to attain its institutional membership (Rader, 2009). NCAA membership services aid in managing and operation of the institutional athletes in connections with the federal legislation. It's linked with the federal government aid NCAA in examining of the present laws and underlying legislation. Â  NCAA is also charged with the organizing of the Youth Sports Programs at the national level thus enabling the disabled youths to access education and take part in the participation process annually. It also participates in numerous outreach activities that aid in the promotion of the underlying athletes’ administration thus offering equal opportunities of participation to its members notwithstanding of the race and ethnic. Organization of the NCAA provides scholarship programs to the student-athletes that encompass both undergraduate and degree programs to those who desire to learn while training. The programs that are normally offered by NCAA mainly entail instituting of the competition and impartial regulations for diverse sports as well as developing and maintaining of fundamental sports records and corresponding athletes historical statistics. Moreover, NCAA membership is mainly charged with the handling of the recruitment malpractices, competitiveness, impartiality an d corresponding athletes’ educational performance.

The irrepressible conflict chapter 7 in the imperiled union, by Essay

The irrepressible conflict chapter 7 in the imperiled union, by kenneth stampp(pages 191 to 245) - Essay Example In the social science, historical theories and concepts are criticized by current scholars in search of new knowledge. If new evidence is discovered, scholars critically analyze it in consideration to the past evidence provided. The reason for revisionism is history relies on past distant events, and very little evidence is used in postulating of theories, therefore, when more evidence is found, it call for revision of the earlier theories or critic their explanation to the past event. This essay focuses on the civil war and the views of the revisionist via a Vis Stampp disapproval of them. How and why do revisionists argue that the civil war was a needless or repressible war? The proponent of revisionism argued that the case for a civil was a moral judgment of whether slavery was right or wrong. In addition, the agitators for antislavery had questionable attitudes towards the issues of slavery as political issues. As Steven Douglas argued, slavery was an issue of the southern people , and it did not affect people in the north. Therefore, the issues of slavery were better left to the white in the south to deal with and not engage in an unnecessary war. Moreover, revisionist says that the moral indifference of slavery was not a big issue to fight over it. Men and women are created sane and would solve their differences in a sane manner and avoid unnecessary bloodshed. According to Ulrich Philips, the black people had no problem being slaves because, in their nature, they were submissive, amiable, and light-hearted, imitative, ingratiating, and they were not progressive by the fact that they were Negroes. Philips also argues that the case for the plantation system among the slave was nothing ethical but nostalgia. Therefore, slavery was not a cause for the alarm, to instigate civil war because it had nothing to excite (Stampp 191-245). Another revisionist, Frank L, Owsley says that slavery was a moral issue and was not economic determinism of civilization in the s outh. He says that the issue of slavery has been dragged in the wrong case of the causes of a civil war. Furthermore, Randall believed that the black slave in the south had adapted to bondage without much resistance, and performing their tasks cheerfully. Randall also argues that, the southern slaves were abused, and this amounted to mistreatment, but it was a lenient way of treating slave by their slave owners. Randall says that, in reality the slave’s owners were more enslaved than the black by the set out institutions (Stampp 191-245). Craven brought his assertion that the different between the West and East were much greater than that of the North and South. Craven argues that abolition of slavery hindered the understanding of the effect of slavery to the modern employee –employer relationship. According to Craven, the life American worker today is much like that of the slave. Craven note that, even during the debate of the relevancy of slavery in the south, the pa tient blacks continued with their tasks unconsciously never minding the merits of the system he was working. David Potter in his analysis of revisionism says that, the facts that slave were left to live and even to grow and expand in a new world, was better off than engaging in a war. David concedes that emancipation of four million slaves was of great value, but he says it came at a greater cost. According to David, for every

Experiential Exercise Case Study Example | Topics and Well Written Essays - 500 words

Experiential Exercise - Case Study Example This happened due to several reasons. The most important reason behind this was the switch of female employees to other organizations. When Metropolitan Hospital founded Task Force on Retention and Advancement of Female Executive Positions, it identified three main causes for leaving by female workers: Answer: Duncan Green (2014) has highlighted many benefits of addressing the underlying problems of organizational diversity issues. The changes addressed the underlying problems in a very effective and professional way. Among the three main causes for leaving of Metropolitan Hospital by female workers, the first two were so much important for Metropolitan Hospital and these problems were directly linked with the operations of Metropolitan Hospital. So they ran a retooling program to address these top two concerns. They provided proper guidance, attention and growth prospects to both males and females. In addition to addressing the first two problems, Metropolitan Hospital also tried to solve the third problem that was more linked with the personal lives of the women rather than the professional lives. Metropolitan Hospital offered flexible work time, reduced workloads, and flexible work arrangements to address the family issues and engagements of women. All these restructuring of di versity program delivered good results after some time. Answer: There are certain attributes and functions that are required by managers to successfully implement a diversity program. Department of the Interior Diversity and Inclusion Strategic Plan (2012) highlights the following priorities and actions required by managers to successfully implement a diversity program: Mangers should run a competitive recruitment process comprising on qualified and experienced group of potential candidates. This principle is important to get high performing workforce drawn from all segments of society Cultivate the seed of an organizational culture in which

The Views of Hilary Clinton and Barrack Obama Essay Example for Free

The Views of Hilary Clinton and Barrack Obama Essay Hilary Clinton and barrack Obama are the two Democrat presidential candidates who are on the race to the White House. They latest reports indicate a tightly held contest and an equally intense campaign to clinch the Democratic Party nominations. Both hold almost similar views as far as how the economy should be and issues about war and mostly on terrorism. They also hold different opinions in health matters. The candidate that musters more delegates is the one that will be the Democrat presidential candidate facing Mc Cain, the Republican presidential candidate in the 2008 election. My main interest in this essay is to analyze on their views on the economy, war and health issue. The two candidates have tried to portray themselves as different from each other, they are however both protectionists when it comes to the trade agreements. Clinton is sounding to be more anti-trade than how Obama sounds. Already Clinton is opposed to the proposed economic terms on trade on Colombia, Panama and South Korea. There are times where both agree on some points, for example they are both opposed to the idea of having a free trade with the Dominican Republic and the Central America in 2005. Obama is for the idea of America doing business with other nations. He believes that this is the only way through which the American economy would be strengthened . He promised that if he were elected as the president of U.S.A. he would try his best to provide and protect the free trade. He will open up more job opportunities by creating foreign markets. He will also set proper job and environmental standards for all nations in the world to follow and resist the idea of free trade that is being advanced by the Central American nations. Obama also promised to review the North American Free Trade Agreement if he will be elected the US president. He is not opposed to the idea of making Mexico and Canada to cooperate with American workers. This will address the issue of workers so that they could adapt to the dynamics of the economy. He will also make amendments to the trade adjustments assistance if elected the president come this 2008 presidential election so that workers would have refresher courses to live up to the times, giving them a competitive edge and job security. On the other hand, Hillary Clinton pledged to strengthen the small enterprises that she believes are the economy’s growth engine. She will dedicate her efforts towards creation of jobs for Americans. Hillary Clinton said that if elected the president, she would strengthen the manufacturing industries as the country is dependent on them and by doing this, Americans will have better living standards. She said that she would fully utilize the nation’s innovation and capital investment to widen economic base for the country. Clinton also pledges to strengthen the rural economy to reverse the trend of urban migration as these areas also contribute to the economy. To achieve this she said she would initiate programs that would enhance the rural economic growth. She also pledged to increase research and technology funding. She would ensure schools; homes and libraries will be equipped with the latest technologies so that they would be competitive in the global market. She criticized Bush’s administration of mismanaging the economy making the gap between the rich and the poor to widen but she promised to solve this problem once elected. She will also help the middle class Americans to stabilize in the economy. On the issues of health care both have similar opinions although in some issues they differ. According to Hillary Clinton she will ensure that every American will be entitled to health insurance but Barrack Obama does not share the same sentiment, as he believes the focus should be on children who should be provided with free insurance. He will also extend health care for the adults who are currently uninsured. Clinton estimates that the cost of implementing her plans would be a hundred and ten billion U.S dollars while Obama’s proposal ranges from 50 to 65 billion U.S dollars. The truth of the mater is that neither of them will provide full insurance cover for every American but both aspire to make this work. While attacking Obama, Clinton criticized his plan saying it is only targeting fifteen million Americans while hers will ensure most of the Americans have free health care. She said most Americans die because they cannot afford quality health care. In her plan, all drivers will be required by law to have auto insurance and promised that all families will be given tax credits so that they would meet their health insurance. If she will be voted in, all households would be able to meet the required health premium. The federal government according to Clinton will subsidize the health insurance for all those families that cannot afford it while businesses and organizations will be required to provide their workers with health insurance. She is quick to add that this plan will not affect small businesses but what will be required is that they will provide these businesses with tax credits to motivate them to do so. The health care providers will be required to pay for those people with huge bills without asking them for more money. Americans, according to Clinton, will be provided with similar private health care that the congress receives and this will be provided to citizens through the employees benefit program that will be a public program similar to that of Medicare. Obama on the other hand pledged to strengthen Medicare and Medicaid so that they would continue taking care of the vulnerable members of the society. These programs mostly target those citizens that are poor and uninsured. He pledged to amend the National Medic Act so that patients who are injured as a result of medical negligence would be compensated. He will also increase funds on research and development so that HIV/AIDS would be contained both in USA as well as in other parts. Both Clinton and Obama have taken issues with the Iraq war. Clinton is currently accusing Obama of not being consistent with opposing the Iraq War, as he was when he assumed the post of a senator. Obama has promised to withdraw American troops from Iraq if he becomes the next president in 2008 election. Obama was not opposed to all wars but was particularly opposed to the Iraq war. He accused president Bush of starting another war instead of finishing that on Osama but Clinton supported Bush to resort to military action if other methods such as diplomatic means failed to restore order in the nation. Currently, she is also advocating for the withdrawal of US troops from Iraq. We have seen that the two Democrat presidential candidates do agree and disagree on some issues. For example, they both agree that health care for all Americans would be vital but they differ in how the program would be implemented. They both promised to strengthen and widen the country’s economic base so that the quality of life of the Americans would improve and to end the war on Iraq and they both promised to end it once they will assume power. Work Cited. Associated Press. Hillary Clinton blasts Bush economy. May 29, 2007.Accessed at http://www.politics.com/news/stories/0507/4230.html on March 25, 2008 Friel et al. Obama: Most liberal senator in 2007. National Journal 31st Jan 2008; 16 Accessed at http://nj.nationaljournal.com/voteratings on March 25, 2008 Kelly P. Politics. New York Times. January 22, 2008.Retrieved an http://www.nytimes.com/2008/0122/us/politics/22clinton.html on 25 March 2008 Johnson G. Obama-Clinton politics of Health Mandate now playing in mass. Associated Press. Insurance Journal. 2008. Sklar R. Micro Debate: Clinton and Obama on Health care. Huffington Post

Drugs Affecting the Central Nervous System (CNS)

Drugs Affecting the Central Nervous System (CNS) Drugs acting in CNS were among the first to be discovered by primitive humans and are still the most widely used group of pharmacologic agents. In addition to their use in therapy, many drugs acting on the CNS are used without prescription to increase ones sense of well being. The mechanism by which various drugs act in the CNS have not been clearly understood. In last three decades, however, dramatic advances have been made in the methodology of CNS pharmacology. It is now possible to study the action of a drug on individual cells and even single ion channels with synapses. The information obtained from such studies is on the basis for several major developments in studies of the CNS. These are the classification of CNS acting drugs. In addition to many medical uses, drugs acting on the cns are using worldwide i.e. alcohol, nicotine, caffeine with various degrees of societal controls due to production of addiction or dysfunctional behaviours. We know that CNS acting agents mainly exert their effects by modulation of synaptic transmission of information between neurons. These actions alter the electrical exciteability of nerve cells by changing the movement of chemical ions across  nerve and neuron cell membrane. In general, these drugs ct on a receptor to directly or indirectly open or close ion channels in the cell membrane and thus make the nerve cell more exciteable with regard to its ability to send information. ION CHANNELS: The membrane of nerve cells contain two types of channels defined on the basis of the mechanism controlling their gating: voltage-gated and ligand-gated channels.Voltage gated channels see Table-1 are respond to changes in the membrane potential of the cell.In nerve cells, these channels are concentrated on the initial segment and the axon and are responsible for the fast action potential,which transmitthe signal from cell body to nerve terminal. There are many types of voltage-sensitive calcium and potassium channels on the cell body, dendrites and initial segment, which act on a much slower time scale and modulate the rate at which the neuron discharge. CHANNEL TYPE MODE OF TOXIN ACTION:  Tetrodotoxin VOLTAGE-GATED:  Blocks channel from outside MODE OF TOXIN ACTION:  Betrachotoxin VOLTAGE-GATED:  Slows inactivation MODE OF TOXIN ACTION:  Apamin VOLTAGE-GATED:  Blocks small Ca-activated K-channels MODE OF TOXIN ACTION:  Agatoxin VOLTAGE-GATED:  Blocks p-type channels MODE OF TOXIN ACTION:  Omega-conotoxin VOLTAGE-GATED:  Blocks n-type channels MODE OF TOXIN ACTION:  Charybdotoxin VOLTAGE-GATED:  Blocks big Ca-activated K-channels IDENTIFICATION OF CENTRAL NEUROTRANSMITTER: Because drug selectivity is based on the fact that different pathways use different transmitters, a primary goal of neuropharmacologists is to identify the transmitter in CNS pathways. Establishing that a chemical substance is a transmitter has been far more difficult for central synapses than for peripheral synapses. The following criteria have been established for transmitter identification: LOCALIZATION: Approaches prove that a suspected transmitter resides in the presynaptic terminal of the pathway uder study include biochemical analysis of regional concentrations of suspected transmitters and immunocutochemical techniques for enzymes and peptides. RELEASE: To determine whether the substance is released from a particular region, local collection of the extracellular fluid can sometimes be accomplished. In addition, slices of brain tissue can be electically or chemically stimulated in vitro and the released substances measured. To determine whether release is relevant to synaptic transmission, it is important to establish that the release is calcium-dependent. SYNAPTIC MIMICRY: Finally, application of the suspected substance should produce a response that mimics the action of the transmitter released by nerve stimulation. Furthermore, application of the selective antagonist should block the response. The excitatory neurotransmitter released from these cells is in most instances. The information is typically phasic and bursts of action potential. Microionophoresis, which permits highly localized drug administration, has been a valuable technique in assessing the action of suspected transmitter. Because of the complexity of the CNS, specific pharmacologic antagonism of a synaptic response provides a particular powerful technique for transmitter identification. DRUG CONCENTRATION AND INTESITY OF ITS EFFECTS: Intensity of pharmacological effect is given as, Intensity of effect= DRUGS ACTING UPON CNS: CAFFEINE: Caffeine and the chemically related xanthenes, theophylline and theobromine Decreases in the order given in their stimulatory action.They are over-the-counter drugs, used to block adenosine receptor as an antagonist. AMPHETAMINE: The stimulation caused by excessive release of norepinephrine from storage sites in the peripheral nervous system. It is not known whether the same action occurs in the CNS. Two other theories regarding for their action are that they are degraded slower than epinephrine or that they could act on serotonin receptor sites. NARCOTICS: Narcotic agents are potent and effective for the relief of severe pain. Analgesics are selective cns drug to reduce pain.Long term administration produces tolerance, pstchic and physical dependence. CENTRAL NERVOUS SYSTEM DEPRESSANTS AND STIMULANTS: CNS DEPRESSANTS: CNS depressants slows down normal brain functions. In higher doses, some CNS depressants can become general anesthetics. Tranquilizers and sedatives are example of CNS depressants. CNS depressants are based on two groups such as: CNS STIMULANTS: Stimulants increase alertness, attention and energy which are accompanied by increases in blood pressure rate and respiration. Stimulants were used to treat asthma and other respiratory problems, obesity, neurological disorder and a variety of other ailments. As their potential for abuse and addiction became apparent to wane. Now, stimulants are prescribed for treating only a few health conditions, include attention deficit hyperactivity disorder and depression that has not responded to other treatment. It is also used for short-term treatment of obesity and for patients of asthma. INTODUCTION TO SEDATIVE-HYPNOTIC: Interms of drugs, sedative refers to a substance that moderates the activity and excitement while inducing a calming effect, while hypnotic effect refers to a substance that causes drowsiness and facilitates the onset and maintenance of natural sleep. The term anxiolytic is sometimes applied to a sedative-hypnotic; however, be aware that many drugs especially the selective serotonin secretion reuptake inhibitors are useful as a chronic anxiolytic dug demonstrated by their efficacy in certain psychiatric disordres like generalized anxiety disorder. THERAPEUTIC EFFECTS OF SEDATIVE-HYPNOTICS: SEDATION: All drugs in this class produce sedation,, with relief of anxiety. Benzodiazepenes also exert anterograde amnesic effects (i.e the inhability to remember events occuring during the drug action ) at sedative doses. The amnesic action is a primary reason some benzodiazepenes ( i.e., midozam ) are commonly used for short duration invasive procedures. They donot provide pain relief however, and must be used in conjunction with analgesics. HYPNOSIS: Sedative-hypnotics promote sleep onset and increase the duration of sleep. All of the sedative-hypnotics will induce sleep if given in high enough dose. Rapid eye movement ( REM ) sleep stages are usually decreased at high doses. REM rebound can be detected following termination of sedative-hypnotics. ANESTHESIA: At high doses, sedative- hypnotic produce a loss of consciousness with amnesia at high level and a suppression of reflexes. Anesthsia can be produced by most barbiturates and some benzodiazepene, which is generally used frequently as a induction agent for general anesthesia. Only three, diazepam, midazolam and lorazepam are formulated I.V. ANTI-CONVULSANT AGENT: Most barbiturates and some benzodiazepene suppress seizures activity at high dose. However, often this occur along with marked sedation. Selective have anti-convulsant activity and can decrease the spread of epileptiform activity without CNS depression. Some are administered intravenously to treat status epilacticus. MUSCLE RELAXATION: Most sedative-hypnotics causes muscle relaxation at high doses. Diazepam is effective at sedative doses and is useful for treating specific spasticity state including cerebral palsy. TOLERANCE AND DEPENDENCE: TOLERANCE: Decreased responsiveness to a drug following repeated exposure commonly occurs with the continuous use of sedative-hypnotics. The mechanism of action of sedative-hypnotics are not well known. DEPENDENCE: Psychologicaaly dependence usually occurs wit h most of the sedative-hypnotics with leads to the compulsive use of these agents to reduce anxiety. Physical dependence is the development of withdrawal syndrome occurs when the drugs are discontinued. Withdrawal syndrome includes, tremors, hyper reflexia, and seizures. These symptoms occur most commonly with shorter acting drugs. EFECTS ON CNS WITH INCREASING DOSAGE: Calmness or drowsiness (sedation) Sleep (pharmacological hypnosis) Unconsciousness Coma Surgical anesthesia Fatal respiratory/ cardiac depression INTRODUCTION TO ANALGESICS: An analgesic also known as a painkiller is any member of the group of drugs used to relieve pain. Analgesic drugs act in various ways on the peripheral and central nervous system they include paracetamol and acetylaminophetol also known in the us as acetaaminophen, the NSAIDs such as the acetyl salicylic acid and opiods drugs such as morphine and opium. They are distinct from anesthesia who reversibly eliminate sensation. In choosing analgesics, the severity and response to the medication determines the pain ladder is originally developed in cancer-related pain is widely applied to find suitable drugs in a step wise manner. The choice is also determined by the type of pain, for neuropathic pain, traditional analgesics are less effective and there is often benefit from classes of drugs that are normally not considred analgesics such as tricyclic anti-depressants and anti-convulsants. WHAT IS PAIN ? Pain is physiological process that can be classified interms of its intensity ( mold, moderate, severe) its duration (acute, convulascent, chronic) its mechaism ( neurologic, nociceptive, physiologic) and its clinical context ( post surgical, malignancy) pain detection or nocicepter requires activation of specialized transducers called nociceptor, see Table-2, which are activating following thermal, mechanical or chemical tissue injury and initiate different transmission of action potential to the dorsal horn of spinal cord. Category:  Physiological Cause:  Brief exposure to a noxious stimulus Symptoms:  Rapid, yet brief pain perception Example:  Touching a pin or hot object Category:  Nociceptive Cause:  Somatic or visceral tissue injury with medication impacting on intact nervous system Symptoms:  Moderate to severe pain, described as crushing, stabbing, usually worsen after the first 24 hours Example:  Surgical pain, traumatic pain, sickel cell crisis Category:  Neuropathic Cause:  Damage of dysfunctional of peripheral nerves or CNS Symptoms:  Severe lancinating, burning or electrical shock like pain Example:  Neuropathy, chronic regional pain syndrome, postherpetic neuralgia Category:  Mixed Cause:  Combined somatic and nervous tissue injury Symptoms:  Combination of symptoms, soft tissue pain and radicular pain Example:  Low back pain, back surgery pain Analgesics are a class of drugs used to relief pain. The pain relief by analgesics occurs either by blocking pain signals or by interfering with the brain interpretation of the signalwithout producing anesthesia or loss of consciousness. There are basically two kinds of analgesics: KINDS OF ANALGESICS: It should be noted that some reference include aspirin and other non-steroidal anti inflammatory drugs (NSAIDs) in the class of analgesics because they have some analgesic properties. Aspirin and NSAIDs primarily have an anti-inflammatory affect, as opposed to being solely analgesic. NON-NARCOTIC ANALGESICS: Acetaminophen is the most commonly used over-the-counter, non-narcotic analgesic. Acetaminophen is a popular pain reliver because it is both effective for mild and moderate relief of pain and relatively inexpensive. It must be emphasized though that the safety of acetoaminophen is tied to proper use of the drug (use according to specific prescribed instructions). If acetoaminophen is not used according to the directions on the label, serious side effects and possible fatal consequences can occur. For example, taking more than 4000 mg/day or using it long term can increase the risk of liver damage. The risk of liver damage also increased by ingesting alcohol. Many people donot realize that acetoaminophen is found in more than 600 OTC. It can be found in combination with other active ingredients in many cold, sinus and cough medications. The commulative effect of acetaminophen must be considered if you are taking multiple drugs which contain acetaminophen. NARCOTIC ANALGESICS: There are two types of narcotic analgesics: The opiates (found in alkaloid, opium) The opioids (derivatives of opiates) Opiods are any medication which binds to opioid receptors in the CNS or gastrointestinal tract. There are four broad classes of opioids: Endogenous oopioids peptides (produced in the body: endorphins, dynorphins, enkephalins) Opium alkaloids (morphine, codeine, theibaine) Semi-synthetic opiods ( heroin, oxycodone, hydrocodone, dihydrocodeine, hydromorphone, oxymorphone) Fully synthetic opioids (pethidine, methadone, fentanyl, propoxyphene, buprenorphine) Opioids are used in medicine as strong analgesics, for relief of severe or chronic pain. There is no upper limit for the dosage of opioids used to achieve pain relief, but the dose must be increased gradually to allow for the development of tolerance to adverse effects ( for eg. Respiratory depression). According to emedicine: some people with intense pain get such high doses would be fatal if taken by someone who was not suffering from pain. PHARMACOLOGY OF SYSTEMIC ANALGESICS: Systemic administration of analgesic drugs is still the most widely used method for providing pain relief in acute painful situations. Opioids may be selected on the basis of their physicochemical characteristics and their diffusion index to the brain. But in clinical practice, their very steep concentration-analgesic effect relationship remains a critical aspect of opioid therapy. Thus, small fluctuations in plasma concentrations of opioids may lead to profound fluctuations in analgesic effect when their plasma and effect-site concentrations are near the minimum effective analgesic concentration (MEAC). Combining drugs acting on different mechanisms of nociceptive modulation offers benefits from additive/synergistic effects and will decrease the incidence of their adverse effects. Evidence-based reviews showed that effective pain relief using non-opioid analgesics relied on paracetamol supplemented with non-steroidal anti-inflammatory drugs (NSAIDs). The role of COX-2 selective inhi bitors (CSIs) in acute pain relief still requires further evaluation. NSAIDs, CSIs and paracetamol share the property of morphine sparing in situations of severe (post-operative) pain. CSIs may be beneficial in patients in whom post-operative bleeding is a major surgical risk as the effects of NSAIDs on coagulation may last for days. Finally, low-dose ketamine infusions remain a worthwhile addition to opioid therapy. Analgesic concentrations of ketamine are 1/5th to 1/10th the anaesthetic concentration and exert significant inhibition on N-methyl-d-aspartate (NMDA) receptor activation. There have been debates over the additine potential of opioids vs. the benefits of their analgesic properties for treating non-malignant chronic pain such as chronic arthritis. Some experts believe opioiods can be taken for years without addiction or toxic side effects. The enhanced quality of life which opioids may provide the patient must considered. Common SIDE EFFECTS and ADVERSE REACTION: Nausea Vomiting Drowsiness Dry mouth Miosis (contraction of pupil) Urinary retention Constipation or fecal impaction Orthostatic hypotension Less common SIDE EFFECTS and ADVERSE REACTION: Confusion Hallucinaation Hives Itch Bradycardia Hypothermia Raised intracranial pressure Tachycardia Flushing Muscle rigidity Most severe SIDE EFFECTS and ADVERSE REACTION: Respiratory depression Fatal overdose INTRODUCTION TO ANTI-SEIZURES: After stroke, epilepsy is the second common disorder of CNS affecting about 1% of the population worldwide. Most (80%+) cases can be well controlled with anti-seizures drugs. However, that leaves many characterized by periods of abnormal firing of CNS neurons and can be caused by many neurological conditions (i.e. tumors, injury, infection). In some cases, there is also agenetic predisposition to epilepsy. Anti-seizures medication were originally designed to help people who have epilepsy, but the nerve-calming quality of some of these drugs can also help quiet the burning, stabbing or shooting pain often caused by nerve damage. Nerve damage (neuropathy) can be caused by many factors, including: DIABETES: High blood sugar levels, common in diabetes, can damage the nerves throughout the body, but the first symptomatically is numbnessand pain in the hands and feet. SHINGLES: Anyone who has had chicken pox is at risk of shingles a rash of blisters that can be painful or itchy. A condition called postherpetic neuralgia occurs if shingles pain persists after the rash disappears. Because the risk of shingles increases with age, evryone everyone everyone age 60 or older should receive the zoster vaccine which can help prevent this painful condition. CHEMOTHERAPY: Some chemotherapy drugs can damage nerves causing pain and numbness that typically begins in the tip of toes and fingers. HERNIATED DISK: Nerve damage can occur if a herniated in your spine squeezes a nerve passing through your vertebrae too tightly. INHERITED NEUROPATHIES: Some neuropathies are passed on genetically and affects different nerves, depending upon the type of disorder. The most common hereditary neuropathy is Charcot-Marie-Tooth disease which affects motor and sensory nerves. MECHANISMS OF ANTI-SEIZURE DRUGS: Exact mechanism of anti-seizues drugs are not well understood but tese medications appear to interfere with the over react transmission of pain signals sent from damaged nerves. Some anti-seizures work particularly well for certain conditions. Carbamazepine is prescribed for trigeminal neurolgia, a condition that causes facial painn appears as electrical shocks. It is important note that FDA has issued a warning that all anti-seizures associated with a slight increased risk of suicidal thoughts or actions. Talk to your doctor if you are experiencing feeling of depression or suicidal thoughts. GABAPENTIN: Used with other epilepsy drugs to treat partial and some generalized seizures. Few lasting side effects. During the first week of treatment, a person may experience tiredness and dizziness. PHENYTOIN: Controls partial seizures and generalized tonic-clonic seizure. Also can be given by intravenously in the hospital to rapid control active seizures. Side effects include dizziness, fatigue, acne, slurred speech, rash, and increase hair. Over the long term the drug can cause bone thinning. VALPROIC ACID: Used to treat partial, absence and generalized tonic-clonic seizures. Common side effects include dizziness, nausea, vomiting, tremor, hair loss, reduced attention, depression in adults, irritability in children, a decrease in thinking speed. Over the long term, the drug can cause bone thinning, swelling of the ankles, liver damage, decreased platelets. INTRODUCTION TO ANTI-PSYCHOTICS: A person who is psychic out of touch with the reality. People with psychosis may hear voices or have strange and illogical ideas for eg, thinking that others can hear their thought or are trying to harm them or they are president o f us or some famous person. They may get excited or angry with no apparent reason, or spend lots of time by themselves or in bed, sleeping during the day and awake at night. The person may neglect appearance, not bathing or changing clothes, hard to talk to- barely talking or saying things that make non-sense. They often are initially unaware that their condition is an illness. These kinds of behavior are symptoms of a psychotic illness such as schizophrenia. Anti-psychotic drugs reduces these symptoms. These medications cannot cure the disease but they can take away many of the symptoms or make them mild. In some cases, they can shorten the course of episode of illness well. There are number of anti-psychotic medications available. These medications affect the neurotransmitter that allow communication between nerve cells. One such neurotransmitter, dopamine, is thought to be relevant to schizophrenia symptoms. All thes e medications have some effect for schizophrenia. The main differences are in their potency that is the dosage prescribed to produce therapeutic effect. Some people may think that thehigher doses of medication prescribed the more serious the illness but this is not always true. The 1990s saw the development of several new drugs for schizophrenia called atypical antipsychotics because they have fewer side effects than the older drugs, today they are often called and used as afirst line of treatment. The first atypical antipsychotic drug was introduces in 1990. In clinical trials, these medications were found to be more effective than conventional or typical Antipsychotic drugs in individuals with treatment-resistant schizophrenia, that is not responded to other drugs and the risk of tardive dyskinesia ( a movement disorder was lower). However because of the potential side effects of serious blood disorder -agranulocytosis, white blood cells loss that fight infection. Patient who are on clozapine must have a blood test on every 1 or 2 weeks. The inconvenience and cost of blood tests and the medication itself have made maintenance for adults for many people. Several other atypical antipsychotics have been developed since clozapine was introduced. INDICATIONS OF ANTI-PSYCHOTIC DRUGS: Common conditions with which antipsychotics might be used include schizophrenia, bipolar disorder and delusional disorder. Antipsychotics might also be used to counter psychosis associated with a wide range of other diagnoses, such as psychotic depression. However, not all symptoms require heavy medication and hallucinations and delusions should only be treated if they distress the patient or produce dangerous behaviors. For non-psychotic disorders: In addition, antipsychotics are increasingly used to treat non-psychotic disorders. For example, they are sometimes used off-label to manage aspects of Tourette syndrome or autism spectrum disorders. They have multiple off-label uses as an augmentation agent (i.e. in addition to another medication), for example in treatment-resistant depression essive, anti-impulsive, anti-suicidal and hypnotic (sleep) medications. Antipsychotics have also been increasingly used off-label in cases of dementia in older people, and for various disorders and difficulties in children and teenagers. A survey of children with pervasive developmental disorder found that 16.5% were taking an antipsychotic drug, most commonly to alleviate mood and behavioral disturbances characterized by irritability, aggression, and agitation. Recently, risperidone was approved by the US FDA for the treatment of irritability in children and adolescents with autism. Antipsychotics are sometimes used as part of compulsory treatment via inpatient (hospital) commitment or outpatient commitment. This may involve various methods to persuade a person to take the medication, or actual physical force. Administration may rely on an injectable form of the drug rather than tablets. The injection may be of a long-lasting type known as a depot injection, usually applied at the top of the buttocks. Those that are available in injectable form are haloperidol, olanzapine, and ziprasidone while those available as depot are haloperidol, flupenthixol, clopenthixol, and risperidone. Antipsychotics are among the biggest selling and most profitable of all drugs, generating $22 billion in global sales in 2008. By 2003 in the US, an estimated 3.21 million patients received antipsychotics, worth an estimated $2.82 billion. Over 2/3 of prescriptions were for the newer more expensive atypicals, each costing on average $164 compared to $40 for the older types. By 2008, sales in the US reached $14.6 billion, the biggest selling drugs in the US by therapeutic class. The number of prescriptions for children and adolescents doubled to 4.4 million between 2003 and 2006, in part because of increases in diagnoses of bipolar disorder. Due to the chronic nature of the treated disorders, antipsychotic medications, once started, are seldom discontinued, and the aim of the treatment is often to gradually reduce dosage to a minimum safe maintenance dose that is enough to control the symptoms. Only when the side-effects have become too severe and/or a patient have been symptom-free for a long periods of discontinuation carefully attempted. MULTIPLE MEDICATIONS: Antipsychotic medications can produce unwanted effects when taken with other medications therefore, doctor should be told about all the medications being taken including over -the-counter medications and vitamin, mineral, and herbal supplements and the extent of alcohol use. Some antipsychotic interfere with anti-hypertensive drugs (taking for high blood pressure), anticonvulsants (taken for epilepsy) and medicine used for parkinsons disease. Other anti-psychotic add to the effect of a alcohol and other CNS depressants such as anti-histamines, barbiturates, anti-depressants, some sleeping and pain medications and narcotics. OTHER EFFECTS: Long term treatment of schizophrenia with one of the older, or, conventional antipsychotics may cause to develop tardiye dyskinesia. Tardiye dyskinesia is a condition characterized by involuntary movements, most often around the mouth. It may range from mild to severe. In some people, it cannot be reversed, while others recoverd partially or completely. Tardiye dyskinesia is sometimes in people with schizophrenia who have never been treated with an antipsychotic medications is called spontaneous dyskinesia however, it is most often seen after long term treatment with older antipsychotic medications. The risk has been reduced with newer atypical medications. There is a higher incidence in women, and the risk increases with the age. The possible risks of long-term treatment with with an anti-psychotic medications must be weighed against the benefit in each case. The risk of TD is 5% per year with older medications. It is less with newer medications. PSYCHOTIC DISORDER CAUSES: Functional causes of psychosis include the following: Drug abuse amphetamines, cocaine, marijuana, http://en.wikipedia.org/wiki/Alcoholismalcohol among others. Brain damage Schizophrenia, schizophreniform disorder, schizoaffective disorder, brief psychotic disorder Bipolar disorder (manic depression) Severe clinical depression Severe psychosocial stress Sleep deprivation. Some traumatic events. DOSAGES AND SIDE EFFECTS: Some medications are very potent and prescribed in low doses, others are not as potent and higher doses are prescribed. Most side effects of antipsychotic drugs are mild. Many common ones lessens or disappear after the first week of treatment. these includes drowsiness, rapid heart beat and dizziness when posture changes. Some people may gain weight while taking medications and need to pay extra attention to diet or exercise to control their weight. All anti-psychotic drugs tend to block D2- receptors in the dopamine pathways of the brain. This means that dopamine released in these pathways has less effect. Excess release of dopamine in the mesolimbic pathway has been linked to psychotic experiences. It is the blockade of dopamine receptors in the pathway that is thought to control psychotic experience. Typical antipsychotic are not particularly selective and also block dopamine receptors in the mesolimbic pathway, tuberoinfundibular pathway and the nigrostriatal pathway. Blocking D2- receptor s in these pathway is thought to produce some of the unwanted effects which typical antipsychotics produce. LITHIUM, MOOD STABILIZING DRUGS, AND OTHER TREATMENT FOR BIPOLAR DISORDER: Bipolar disorder once known as manic-depressive illness, was conceived of as a psychotic disorder distinct from schizophrenia at the end of the 19th century. Before that both of these disorders were considered part of a continuum. It is ironic that the weight of the evidence today is that there is profound overlap in these disorders. This is not to say that there are no pathophysiology important difference or that some drugs treatment are differentially effective in these disorders. According to DSM, they are separate disease entities while research continues to define the dimensions of these illnesses and their genetic and other biological markers. TYPES OF BIPOLAR DISORDER There are several types of bipolar disorder. Each type is identified by the pattern of episodes of mania and depression. The treatment that is best for you may differ depending on the type of bipolar disorder you have. Your doctor will look carefully to determine where your symptoms fit. Bipolar I Disorder (mania and depression) Bipolar I disorder is the classic form of the illness, as well as the most severe type of bipolar disorder. It is characterized by at least one manic episode or mixed episode. The vast majority o