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Medicine In Traveller - Drugs

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.

Universal Drug Profile - General Classifications

Code Classification of Drug Definition
A Anagathic Slows or stops the aging process
B Anti-infective Kill or limit the growth of pathogenic agents.
C Depressant Reduce the activity of an organ system
D Stimulant Increase the activity of an organ system
E Vaccine Bind to infective agents, toxins, or rogue cells, enabling their rapid neutralization
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.

Universal Drug Profile - Potency and Forms of Administration

Code Potency Form of Administration
1 micrograms Intravenous infusion
2 tens of micrograms Intravenous injection
3 hundreds of micrograms Intramuscular or subcutaneous implantation or injection
4 milligrams Oral (swallowed)
5 tens of milligrams Oral (sublingual [under the tongue] absorption)
6 hundreds of milligrams Inhaled
7 grams topical (applied to skin or intended area of effect)
8 tens of grams  

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.

Universal Drug Profile - Effects

Code System Affected Effect on System Duration of Effect
0 Multiple or General Severe Depressant  
1 Respiratory (lungs, throat, ear, nose) Moderate Depressant minutes
2 Cardiovascular (heart and circulatory system) Mild Depressant hours
3 Gastrointestinal (liver, stomach, gut) baseline days
4 Musculoskeletal Mild Stimulant weeks
5 Peripheral Nervous (from spinal cord to motor/sensory endings) Moderate Stimulant months
6 Central Nervous (brain, spinal cord, eyes) Severe Stimulant  
7 Genitourinary (kideys, ureters, bladderm accessory structures)    
8 Haemotological (bone marrow, blood components, clotting cascade)    
9 Skin    
A Endocrine/Metabolic (pituitary, thyroid, adrenals, pancreas, gonads)    

Examples of Stimulation and Depression

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)

Drug Overdose Severity Task Difficulty Modifiers

Normal Extent of Effect of Drug Task Difficulty Notes
Mild Average On failure, impose Minor damage to patient.
Moderate Difficult On failure, impose Major damage to patient.
Severe Formidable On failure, impose Destroyed damage to 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.

Effect of Abuse Potential
on Task Difficulty

Effect of Drug Abuse Potential Task Difficulty
Mild Low Easy
Moderate Average Average
Severe High Difficult

Dependency and withdrawal

To avoid dependence on a given drug
(abuse potential), (Int + End)/2

Modifiers to
Drug Dependency Task

Reason for Modifier Modifier
Peers abuse drug -2
Duration of drug effects measured in minutes -1
Duration of drug effects measured in days +1
Duration of drug effects measured in weeks +2
Duration of drug effects measured in months +4
Other situational modifiers may be applied at the referee's discretion.
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

Drug/Treatment Availability by Tech Level

Tech Level of First Availability Drugs or Treatments
3 "Folk" remedies, based on local plant and animal life. Potency and purity are poorly controlled.
4 inhaled general anaesthetics, narcotic analgesics, insulin
5 antibacterial agents, synthetic steroids and analgesics, immunization for common diseases, intravenous anaesthetics
6 antipsychotics, antidepressants, sedatives
7 immunosuppressants for transplant surgery
8 early antivirals
9 fast drug
10 growth accellerants, broad-spectrum vaccines
13 radiation treatment, reanimation
15 anagathics

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.

Effects of Poisons
Damage and Treatment Difficulty

Severity of Effect Damage Imposed Treatment Task Difficulty
Mild Minor Average
Moderate Major Difficult
Severe Destroyed Formidable

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).

Modifiers for Poison Treatment Tasks

Condition Modifier
Antidote specific to poison available. +4
Dialysis required and performed +3
If Absorption Limitation has been performed
TL10+ Broad Spectrum Vaccine used +3
TL13+ Broad Spectrum Vaccine used +4

 

Modifiers for Uncertainty of Poison Treatment

Condition Modifier
Laboratory Investigation at TL4 - TL5 +1
Laboratory Investigation at TL6 - TL8 +3
Laboratory Investigation at TL9 - TL11 +4
Laboratory Investigation at TL12+ (may also apply if using TL12+ medscanner or computer in field) +5

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.

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.

Universal Infectious Disease Profile

Code Agent Type Infectivity Routes of Transmission Incubation Period Systems Affected Severity: Frequency of Damage Severity: Amount of Damage
1 prion Very Low (5% or less) Body Contact Hours, e.g, plague Respiratory Only on Catastrophe Check  Spectacular Failure Superficial
2 viral Low (5-20%) Respiratory Droplets Days Cardio- vascular Only on Catastrophe Check any Failure Minor
3 incomplete bacteria Medium (20-40%) Water or Food Supply Weeks, e.g., tuberculosis Gastro- intestinal Automatic Major
4 complete bacteria High (40-75%) Blood/Infected Body Fluid/Mucous Membranes Months, e.g., leprosy Musculo- skeletal   Destroyed
5 amoeba or single-celled fungus Very High (75% or more) Insect or Animal Vector Years, e.g., Creuzfeldt-Jakobs Syndrome Peripheral Nervous    
6 parasite       Central Nervous    
7         Genitourinary    
8         Haemoto- logical    
9         Skin    
A         Endocrine/ Metabolic    
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:

To avoid infection, given appropriate exposure
Infectivity Task
1 - Very Low Easy, End
2 - Low Average, End
3 - Medium Difficult, End
4 - High Difficult, (End-1)
5 - Very High Formidable, End

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

Adjustments to
Disease Diagnosis Uncertainty

TL of Investigation Modifier to Uncertainty Roll
TL4 - TL5 +1
TL6 - TL8 +3
TL9 - TL11 +4
TL12 or greater (can be using micro lab or medical computer) +5
To treat an infectious disease
(difficulty), Medical, patient's End, (uncertain if disease organism unknown)

Treatment of Infectious Diseases
Task Difficulty

If the disease causes this damage Use this difficulty for the treatment task
Superficial Easy
Minor Average
Major Difficult
Destroyed Formidable

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

Treatment of Infectious Diseases
Modifiers to Task

Condition Modifier
Successful Resuscitation +2
Appropriate anti-infectives used +3
TL10 - TL12 Broad-spectrum vaccine used +3
TL13+ Broad-spectrum vaccine used +4

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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