Freelance Traveller

Medicine In Traveller - Drugs

by Robert O'Connor

Over the years many medical treatments have arisen, ranging from diet and exercise to nanomachine based 'drugs'.

While some of the ailments have changed, the basic principles remain the same. Improved technology generally yields more efficacious treatments.

Drugs can be described using the "Universal Drug Profile", a concise string of letters and numbers that gives a reasonably clear idea of the characteristics of a particular drug.

A Universal Drug Profile appears as follows:

A00/00/000/000...

The code naturally divides into groups.  The first group, a letter and two digits, describes the genral classification of the drug, its potency, and its form of administration.

Potency

The amount of a drug required to obtain the desired effect.

 

Form of Administration

The method by which the drug is introduced into the system.

Typically, agents that can be adminstered by multiple routes have differing effective doses by each route. Roughly, the oral dose for those drugs which can be absorbed orally is ten times the intramuscular or subcutaneous does; the intramuscular or subcutaneous dose is ten times the intravenous dose. Drugs which can be applied topically are either not meant to be absorbed or the dose required approximates the oral one.

The second group in the Universal Drug Profile indicates the safety margin and abuse potential of the drug.

Universal Drug Profile - Safety Margins and Abuse Potential
Code	Safety Margin	Abuse Potential
1	5 or less	none or low
2	10	average
3	20	high
4	40
5	80
6	160 or more

Safety Margin

The ratio of dangerous dose to effective dose

 

Abuse Potential

The likelihood of a dependency forming, or that the drug will be used improperly for its side effects.

The third group of the Universl Drug Profile describes the intended use of the drug - the system that is affected, the effect that the drug has on that system, and the duration of that effect.

Examples of Stimulation and Depression

• Severe stimulation can lead to e.g. VF, hypertensive crisis, psychosis
• Moderate stimulation is caused by e.g. strong diuretic (increased urine flow)
• Mild stimulation is e.g. low dose caffeine's effect on the brain (as from a normal cup of coffee)
• Mild depression occurs in e.g. mild pain relief
• Moderate depression occurs in e.g. local anaesthesia, strong pain relief
• Severe depression results in e.g. coma (general anaesthesia), cardiac standstill

The fourth and subsequent groups refer to side effects of the drug. They are interpreted in the same way as the third group. Normally, side effects occur only on a Spectacular Failure from a catastrophe check.

Anagathics, antibiotics and vaccines are regarded as generally acting (system code 0) and have no stimulant or depressant effect (effect code 3), except perhaps as side effects.

Some systems are interrelated, and a drug intended to affect one such system will generally affect the related systems through feedback loops. These are considered part of the primary effect, and are not noted separately.
Nervous system <=> cardiovascular (rate, blood pressure)
Cardiovascular <=> genitourinary (renal blood flow has an effect on blood pressure)

If a dose exceeds the safety margin, the following check should be made:

To avoid the effects of a drug overdose

(Extent of effect), Med/First Aid (attendant), End (patient)

Treat as per trauma rules (Resusc, etc. as required), plus see Poisons, below.

Abuse potential: usually confined to drugs with central nervous system effects (moderate or better stimulants or depressants). Other substances, e.g., growth hormone (endocrine/metabolic, severe stimulant), may be abused, given the right circumstances.

When abuse potential affects the difficulty of a drug-related task, use the following table to determine the difficulty level to apply.

Note that in general, the intensity of effect of a drug is in a direct relationship with its abuse potential. If the abuse potential is unknown, use the intensity of effect in the table.

Dependency and withdrawal

To avoid dependence on a given drug

(abuse potential), (Int + End)/2

To avoid withdrawal symptoms :-

Difficult, (Int + End)/2

Check every 4th multiple of the duration of effect after discontinuation.
Failure :- all tasks at -1, reverse drug effects (e.g. if drug is a mild gut depressant, withdrawal leads to mild gut stimulation - diarrhoea).
Spectacular Failure :- all tasks at one difficulty level harder, reverse drug effects are severe (using the previous example, intractable nausea, vomitting and diarrhoea ensue).

Examples

1. A generic local anaesthetic

Potency is in tens of milligrams
It can be administered IV, by subcutaneous injection, topically
(special time release patch) or be inhaled (eg. spray the back of
the throat to permit passage of an airway).
Its primary effect is on peripheral nerve.
It is a moderate depressant of peripheral nerve activity.
Side effects are mainly central nervous (altered consciousness) and
cardiovascular (rhythm disturbances). A minor effect is increased
bleeding at the injection site.
Duration of effect is up to an hour.
Safety margin is 20.
Abuse potential is low.

The Universal Drug Profile for this drug would be C52/31/521/621/221/821. 
The first group could also read C53, C56, or C57, depending on the method of administration.

2. An analgesic agent

Potency is in milligrams.
It can be given by injection or orally.
It is a moderate depressant of peripheral nerve activity.
Side effects are on the central nervous (mild stimulant, with nausea
and vomitting), respiratory (mild depressant) and gastrointestinal
(mild depressant, causes constipation).
Duration of effect is up to three hours.
Safety margin is 10.
Abuse potential is average.

The Universal Drug Profile for this drug would be C42/22/522/652/132/332. The first group could also be C54.

3. Fast drug

Potency is in grams.
It can be given by injection or orally.
It is a severe depressant of metabolism.
Side effects are unconsciousness, muscle rigidity and incidental
hypothermia.
Duration of effect is two months.
Safety margin is 5.
Abuse potential is low.

The Universal Drug Profile for this drug would be C72/11/A15/415/615. The first group could also be C74.

For reference, the following drugs and treatments are initially available at the indicated tech levels

Poisons

Poisons can be regarded as drugs which are deliberately given in doses much larger than the safety margin. Potencies are typically of the order of tens of milligrams or less in acute poisonings ; grams may be required of heavy metals, etc. Routes of administration as above. Safety margins and abuse potential are not generally applicable. In a Universal Drug Profile, a poison is indicated by the second group (safety margin and abuse potential) of 00.

Immediate action :- as per trauma notes
Other manoeuvres include bandaging to trap venoms at bite site (block lymph drainage), neutralising poison (e.g., vinegar for stinging jellyfish, etc.).

To treat a patient for poison

(difficulty), Medical, patient's End, (uncertain if substance or animal/plant unknown).

 

Specific antidotes include antivenins (usually pooled human or animal antibodies) or chelating agents (for heavy metal poisonings).

However, most toxic substances have no specific antidote, or are present in the blood in concentrations higher than that which vaccines can safely neutralise (gram potencies or less).

In such cases, absorption needs to be limited (for ingested substances). If this can't be done, blood needs to be filtered (dialysis).

To treat a patient to limit absorption of poison

Average, Medical

Apply a DM of +2 if the patient has been successfully resuscitated.

Methods include introducing activated charcoal (TL 6+), and bowel lavage solution (polyethylene glycol, TL 7+). Gastric lavage (washing the stomach out) is employed between TL's 4-8, but is potentially very dangerous (-2 to catastrophe rolls).

Spectacular Success rolls back 2D of damage
Spectacular Failure causes 1D of damage
Failure : catastrophe check.

Recovery and aftercare as per trauma notes.

Examples

1. Generic snake venom

Potency is in milligrams
Primary actions : severe depressant of muscle activity (causes muscle to dissolve) ;
severe depressant of blood clotting (haemorrhage!) ;
severe depression of peripheral nervous system (paralysis).
Route of administration : must be injected
Duration is three to four hours.

The Universal Drug Profile for this poison would be C42/00/412/812/512.

2. Cyanide

Potency is in milligrams
Primary action : severe depression of respiratory system (prevents cells from using oxygen).
Side-effects : severe central nervous stimulation (fitting).
Routes of administration : oral, injected ; hydrogen cyanide can be inhaled.
Duration is hours without treatment (very tightly bound).

The Universal Drug Profile for this poison would be C44/00/112/672.
The first group could also be C42, or for hydrogen cyanide (a gas), C46.

Disease

This discussion will concentrate on infectious diseases. It is assumed that aging crises constitute acute exacerbations in degenerative processes.

The myriad of potential infectious diseases that could exist can be described by a small number of parameters.

• Agent type : general class of organism
• Infectivity : how readily disease can spread from one individual to another.
• Routes of transmission : how transmission is effected.
• Incubation period : the interval of time between infection and the development of symptoms.
• Systems affected : where does the bug act?
• Severity : the disability or death rate.

This suggests the use of a profile string, similar to the Universal Personal Profile,
the Universal Worlds Profile, and so on:

The Universal Infectious Disease Profile is a seven-character string indicating the characteristics from the list above, in the order given. The severity of a disease is indicated by the last two characters, representing the frequency and amount of damage, respectively.

Prion

Proteins which can transform host proteins into copies of itself, leading to damage, e.g., spongiform encephalopathies.

 

Virus

Require host cellular machinery to reproduce. These are the most common (70+%) infectious agents encountered.

 

'Incomplete' bacteria

Require host cells for shelter or energy supply, e.g., Chlamydia, Rickettsia species.

 

'Complete' bacteria

Most bacteria are 'complete'.

 

Parasite

Multicellular plant, fungus or animal.

Infection cannot occur without exposure to the appropriate agents under the appropriate conditions. When these criteria are met, roll the following task:

If vaccinated, maximum severity is 1-1 (Superficial Damage only on Spectacular Failure of Catastrophe check). Otherwise, apply damage as indicated by disease profile.

Viral respiratory infections are the most commonly encountered (60+%). Organisms transmitted by contaminated water or food typically dwell in the gastrointestinal system.

Example Symptoms

Fever is usual in most infections, but may not occur in the elderly, or in some infections.

Respiratory

running nose, earache, cough, sore throat, mouth ulcers, gum bleeding, chest pain, shortness of breath, coughing up mucus, phlegm, pus, blood or oedema fluid (pinkish froth from near terminal lung inflammation or heart failure).

 

Cardiovascular

unstable blood pressure (low or high) - dizziness, headache. Chest pain, sensation of heart racing (palpitations), shortness of breath (on mild exertion, on minimal exertion, at rest in order of increasing severity).

 

Gastrointestinal

nausea, vomiting (food, fluid, blood), abdominal pain, diarrhoea (fluid, mucus, blood), constipation, jaundice (skin yellowing from liver dysfunction), bruising (liver dysfunction)

 

Musculoskeletal

joint aches and pains, joint swelling, muscle aches, wasting, muscle breakdown (myolysis ; muscle attains leather or wooden consistency).

 

Peripheral nervous

disturbed sensation (decreased or increased), weakness without muscle wasting (early), instability of blood pressure, loss of sweating or sphincter control. Regionalised, unlike central problems, which are global.

 

Central nervous

headache, nausea, vomitting, altered state of consciousness (decreased or delirious), fitting, disturbed perception (e.g., vertigo, blurred or double vision, ringing in the ears), eye pain, tearing, and as per peripheral nervous system.

 

Genitourinary

flank or loin pain, frequency of urination, pain on passing urine, blood or pus in urine. Hypertension, fatigue and marked decrease in urine output with renal failure.

 

Haematological

fatigue, shortness of breath (anaemia), prominent lymph nodes in neck, armpits and groins with most infections (if not immunosuppressed), abdominal pain (?enlarged spleen), bruising or bleeding (platelet or clotting dysfunction).

 

Skin

rashes, blisters, boils, peeling, hair loss, etc.

 

Endocrine/metabolic

blood pressure instability, pain (neck, headache, abdominal), weight loss, dizziness (low blood sugar or low blood pressure).

Immediate action - take if required
Volume resuscitation mandatory in septic shock (Major+ damage).

To diagnose an infectious disease

Difficult, Medical, End, uncertain

Laboratory investigations can reduce uncertainty

To treat an infectious disease

(difficulty), Medical, patient's End, (uncertain if disease organism unknown)

Laboratory investigations reduce uncertainty; use table above from Diagnosis task.

Spectacular Success rolls back 2D of damage
Spectacular Failure causes 1D of damage
Failure : catastrophe check.

Recovery and aftercare as per Trauma notes.

Bugs and Drugs as Weapons

Biological warfare agents are usually bacterial or viral, optimised for trasmissibility (respiratory droplets), infectivity (very high) and severity (high lethality).

Chemical warfare agents can be regarded as highly potent, topically applied or inhaled poisons.

For example, contemporary 'nerve gases' are microgram potency, inhaled or topically active severe depressors of the respiratory system (increased secretions and bronchospasm), severe depressors of the cardiovascular system (slow pulse, low blood pressure) and severe stimulators of the gut, via mixed actions on the central nervous system.

Incapacitating agents are certainly possible.

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