Combining with alcohols

The industrial process for preparing the reagent usually permits a little hydrolysis to occur, and the product may contain a little free calcium hydroxide or basic chloride. It cannot therefore be employed for drying acids or acidic liquids. Calcium chloride combines with alcohols, phenols, amines, amino-acids, amides, ketones, and some aldehydes and esters, and thus cannot be used with these classes of compounds. 

Other Substances. Driving under the influence of alcohol cases are compHcated because people sometimes consume alcohol with other substances (11—13). The most common iUicit substances taken with alcohol are marijuana and cocaine (see Table 1) (14). In combination with alcohol, some dmgs have an additive effect. When a blood or urine alcohol sample is tested for alcohol and the result is well below the legal concentration threshold yet the test results are not consistent with the arresting officers observation that the subject was stuporous, further toxicological tests for the possible presence of dmgs are indicated. 

After washing with chlorhexidine skin cleanser for 15 seconds, a 99.9% reduction of transient contaminants was achieved (216). Chlorhexidine is sometimes combined with alcohol to achieve the rapid reduction obtained with alcohol and the residual effect of chlorhexidine. It is substantive to the skin, and repeated use results in lower levels of bacteria on the skin. 

Rosins are commonly combined with alcohols with more than one hydroxyl group such as ethylene glycol and diethylene glycol (two hydroxyl groups). 

Xylan sulphates, known also as pentosan polysulphates (PPS), are permanently studied with regard to their biological activities [3,419-422]. Usually, sulphuric acid, sulphur trioxide, or chlorsulphonic acid are employed as sul-phating agents alone or in combination with alcohols, amines or chlorinated hydrocarbons as reaction media [423]. 

TABLE 5. PCP-related deaths in combination with alcohol or... 

A disulfiram-type reaction may occur when these anti-infectives are combined with alcohol the reaction includes flushing, diaphoresis, tachycardia, headache, and increases in blood pressure avoid alcohol if these drugs are used. 

Where pain is worsened by muscle spasm, oral muscle relaxants may serve as a useful adjunct to therapy.25 These agents include baclofen, metaxalone, methocarbamol, carisoprodol, and cyclobenzaprine. Muscle relaxants may decrease spasm and stiffness associated with either acute or chronic musculoskeletal disorders. These agents should be used with caution because they all may cause sedation, especially in combination with alcohol or narcotic analgesics. 

Zajac CS, Abel EL. 1990. Lack of lead effects on fetal development and offspring learning when combined with alcohol in the Long-Evans rat. Teratology 41 33-41. 

Also known as methaqualone, Quaalude, ludes and wallbangers. This drug is addictive, sometimes fatal (especially when combined with alcohol) and is best left alone. 

The most commonly used therapies for anxiety and depression are selective serotonin reuptake inhibitors (SSRIs) and the more recently developed serotonin noradrenaline reuptake inhibitors (SNRIs). SSRIs, which constitute 60% of the worldwide antidepressant and antianxiety market, are frequently associated with sexual dysfunction, appetite disturbances and sleep disorders. Because SSRIs and SNRIs increase 5-HT levels in the brain, they can indirectly stimulate all 14 serotonergic receptor subtypes [2,3], some of which are believed to lead to adverse side effects associated with these drugs. Common drugs for short-term relief of GAD are benzodiazepines. These sedating agents are controlled substances with addictive properties and can be lethal when used in combination with alcohol. The use of benzodiazepines is associated with addiction, dependency and cognitive impairment. 

GHB has also been reported to have other medical benefits, such as a sleep aid for people suffering from temporary insomnia and for treating alcohol withdrawal and alcoholism. However, the risks and dangers of taking GHB, especially in combination with alcohol, have prohibited the FDA from approving its use for conditions other than narcolepsy. 

All of the psychological and physical effects of Rohypnol are dramatically increased when the drug is taken in combination with alcohol. In some instances, the combination can be lethal. 

Foo FI, Lemon J. (1997). Acute effects of kava, alone or in combination with alcohol, on subjective measures of impairment and intoxication and on cognitive performance. Drug Alcohol Rev. 16(2) 147-55. 

Toxicology. Disulfiram affects the central nervous system, thyroid, and skin in combination with alcohol it causes an Antabuse-alcohol syndrome. 

CNS-depressant effects Zolpidem, like other sedative/hypnotic drugs, has CNS-depressant effects. Because of the rapid onset of action, only ingest immediately prior to going to bed. Zolpidem had additive effects when combined with alcohol therefore, do not take with alcohol. 

The combination of pentazocine with the antihistamine tripelennamine results in a combination known to drug abusers as T s and blues. This combination produces heroinlike subjective effects, and heroin addicts use it in the absence of heroin. In addition, the use of pentazocine in combination with alcohol or barbiturates greatly enhances its sedative and respiratory depressant effects. 

In general, SSRI doses of 50 to 75 times the common daily doses result in minor symptoms. Higher doses cause serious symptoms of seizure, arrhythmias, and decreased consciousness only doses greater than 150 times the common daily therapeutic dose can result in death (Barbey and Roose, 1998). Overdose in combination with alcohol or other drugs increases toxicity and accounts for most fatalities involving the SSRIs. Nevertheless, compared to TCA medications, which annually results in 100 to 150 fatal overdoses reported to the American Association of Poison Control Centers (AAPCC), the SSRI agents accounted for only 16 fatal overdoses reported to that organization between 1987 and 1996 (Barbey and Roose, 1998). 

Frewer L, Lader M. The effects of nefazodone, imipramine, and placebo, alone and combined with alcohol in normal subjects. Int Clin Psychopharmacol 1993 8 13-20. 

Seizures have been reported after withdrawal of high doses of triazolam or relatively low doses combined with alcohol ( 347, 348 and 349). The FDA has reported a signal of an association for withdrawal seizures associated with triazolam ( 350). In a chart review of 150 consecutive patients withdrawn from BZDs, three of 25 triazolam patients experienced seizures, compared with two of 125 given other BZDs ( 351). Psychosis with delirium also has been reported after discontinuation of high triazolam doses (352). 

Bioactivation is a classic toxicity mechanism where the functional group or the chemical structure of the drug molecule is altered by enzymatic reactions. For example, the enzymatic breakdown of the analgesic acetaminophen (paracetamol), where the aromatic nature and the hydroxyl functionality in paracetamol are lost, yields A -acetyl-p-benzoquinone imine, a hepatotoxic agent. Paracetamol can cause liver damage and even liver failure, especially when combined with alcohol. 

Nordstrom (19) demonstrated that esters are formed primarily by a direct biosynthetic process during fermentation in which acyl-CoA compounds containing the particular fatty acid moiety combine with alcohols of the medium, which explains the predominance of ethyl esters. Ester formation during fermentation does not appear to be direct esterification between alcohols and free fattty acids. However, some direct esterification may occur on the plates of a distilling column where acids and alcohols are most concentrated. 

The simplest or lowest member of the fatly acid series is formic acid, HCOOH. followed by acetic acid, CHiCOOH. propionic acid with three carbons, butyric acid with four carbons, valeric acid with five carbons, and upward to palmitic acid with sixteen carbons, stearic acid with eighteen carbons and melissic acid with thirty carbons. Fatty acids are considered to be the oxidation product of saturated primary alcohols. These acids are stable, being very difficult [with the exception of formic acid) to convert to simpler compounds they easily undergo double decomposition because of the carboxyl group they combine with alcohols to form esters and water they yield halogen-subslitulion products they convert to acid chlorides when reacted with phosphorus pcntachloridc and Iheir acidic qualities decrease as their formula weight increases. 

Reaction LXXXI. Action of Hydrogen Chloride on a Mixture of an Aldehyde and an Alcohol. (B., 30, 3053 31, 545.)—The reaction is of the same type as the preceding. Under the influence of condensing agents, calcium chloride, hydrogen chloride, etc., aldehydes combine with alcohols to yield the ethers of the hypothetical dihydroxy compounds from which the aldehydes are derived. Ketones form these compounds only with difficulty. 

Rhabdomyolysis has been attributed to troglitazone in combination with alcohol (129). 

Rohypnol, developed by the pharmaceutical firm of Hoffmann-La Roche, is first sold in Switzerland as a sleeping aid for the treatment of insomnia. Reports begin surfacing that Rohypnol is abused as a recreational or party drug, often in combination with alcohol and/or other drugs. 

Since most codeine is dispensed as part of a compound preparation, potential side effects of the other drug(s) must also be considered. For instance, someone with stomach ulcers should not take codeine that is combined with a nonsteroidal anti-inflammatory drug (NSAID) such as aspirin or ibuprofen. Another type of risk from a compound preparation relates to codeine abuse. For instance, a person who abuses codeine might routinely take a dose of 100-200 mg of codeine to produce noticeable euphoria. Using Tylenol 3 to obtain this dose would also mean ingesting 1,000-2,000 mg of acetaminophen. Taking that amount of acetaminophen for any extended period presents a risk for liver damage, especially in combination with alcohol. 

For those who take GHB deliberately, the objective is to take the right amount to achieve the desired high. But the drug is unpredictable and users risk deadly overdose, which can occur within 15 minutes of ingestion. An overdose can result in such severe adverse effects as vomiting, difficulty breathing, seizures (especially when GHB is combined with methamphetamine), unconsciousness, coma (especially when combined with alcohol), and death. 

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