ELIMINATION OF DEUGS 



and so accumulate in the body and cause poisoning. The so- 

 called Cumulative Action of a drug refers to the occurrence 

 of a sudden and violent effect during its medicinal adminis- 

 tration. This may be due, fl) to delayed followed by rapid 

 absorption; or (2) to slow — or sudden arrest of — elimina- 

 tion. The salts of the heavy metals, as lead, mercury, etc., 

 and arsenical preparations are eliminated slowly. Digitalis 

 and strychnine are said to be especially prone to produce a 

 cumulative action. Strychnine m'ay, however, be given sub- 

 cutaneously in gradually increasing doses without the likeli- 

 hood of poisoning. Digitalis may cause a cumulative effect in 

 being slowly oxidized in the body or in leading to contrac- 

 tion of the renal vessels and suppression of urine-elimination. 

 The drugs likely to cause a cumulative action must be ad- 

 ministered, infrequently, once, twice, or thrice daily ; whereas 

 medicines which are rapidly decomposed and eliminated 

 (alcohol, nitrites, etc.) may be given at very frequent inter- 

 vals if desirable. The term excretion is often used synony- 

 mously with elimination, but, strictly speaking, a drug is not 

 eliminated unless it has been first absorbed. On the other 

 hand, an insoluble drug passing unabsorbed throiigh the ali- 

 mentary canal is said properly to be excreted in the faeces. 



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