The Drugs of Abuse II - دانشگاه علوم پزشکی ...

The Drugs of Abuse II - دانشگاه علوم پزشکی ...

The Drugs of Abuse "Drug-Use Is Life Abuse" The Drugs of Abuse

1. Sedatives / Hypnotics 2. Hallucinogens 3. PCP (Phencyclidine) 4. Anabolic Steroids

5. Inhalants 6. Opioid 7. Alcohols The Drugs of Abuse 1. Sedatives / Hypnotics 1. Benzodiazepines High Potency / Short Acting

Low Potency / Short Acting Most Addiction Sympt. / Severity -Alperazolam -Lorazepam -triazolm

Good Temporary Sleepers for Hosp. Patients. -Serax -Temazepam Benzodiazepines High Potency / Long Acting

Low Potency / Long Acting Substitute for Short Acting in Withdrawal -Prosom -Klonepin

Addiction In High Doses -Valium -Librium -Tranxene 2. Barbiturates Short Acting (Highly Lipid Sol.) -Pentobarbital (Yellows) -Secobarbital (Reds)

-Amobarbital (Blues) Long Acting -Phenobarbital -Substitute for Short In Tx. Benzodiazepines Equiv. Doses

Alprazolam (Xanax) Triazolam (Halcion) Temazepam (Restoril) Lorazepam (Ativan) Diazepam (Valium) Phenobarbital

1mg 0.25mg 15mg 2mg 10mg 30mg MOA GABA Receptor CNS Inhibition --Benzos Potentiate GABA

--Barbs Potentiate + Agonists Respiratory Depression --Benzos + Other CNS Depressants --Barbs Alone Both With Anticonvulsant Activity CNS Inhibition With Dose: 1. Decreased Anxiety 2. Sedation

3. Amnesia 4. Hypnosis 5. Anesthesia 6. Reduced Reflexes / Respiration 7. Death Metabolism Benzodiazepines by Liver Microsomal Enzymes, Metabolites May Be Active Extending Half-life.

Barbiturates by Cytochrome P450 Enzymes, Commonly Induced With Resulting Breakdown of Alcohol , Steroids, Fat Soluble Vitamins, and Anticoagulants. Discontinuation. Return: Of Original Symptoms Rebound: Intense Orig. Symptoms

Withdrawal: (Long Use, High Dose) -Anxiety, Panic -Paranoia, Hallucinations -Tremor, Seizures, Delirium -Depression, Irritability, N&V Withdrawal Timing Short Acting Barbs --Onset 1/2 Day --Peak 1-3 Days Short Acting Benzos

--Onset 1 Day --Peak 2-4 Days Long Acting Barbs / Benzos --Onset 2 Days --Peak 5-8 Days Complications Benzodiazepines -Memory Loss, Amnesia -Ataxia, Incoordination, Vertigo

-Diplopia, Dizziness -Impairment in Driving -Depression, Suicidal Ideation Relatively Contraindicated in Addiction Overdose Signs & Symptoms: --Slurred Speech, Staggering --Nystagmus, Slow Reaction --Respiratory Depression

Barbiturates: 3-10 Mg / Dl Benzodiazepines: 1-2 Gm or More --Less With Alcohol !!! Benzo OD Treatment Flumazenil --Benzo Antagonist --0.2 Mg, Then 0.3 Mg, Then 0.5 Mg, IV, Max 3.0mg --May Precipitate Withdrawal

Supportive Measures --Airway Management, Etc. Detoxification Gradual Dose Tapering Over Several Days to Weeks Substitution of Long Acting Form: --Phenobarbital --Use Equivalent Dose and Taper by 30 Mg or 10%

Per Day. (Max. 500mg / D) Detoxification-examples Drug Valium Daily dose 40mg PB dose

30mg/10mg = 120mg Ativan 10mg 30mg/2mg = 150mg PB is then tapered 10% / d X 10 d Xanax requires slower tapering Date Rape Drugs

Rohypnol & GHB Classified as depressants Rohypnol: Flunitrazepam Benzodiazepine Indirect GABA agonist alcohol synergism p.o. & intranasal administration

Dissolves easily in carbonated drinks tasteless odorless Associated with sexual assaults Rohypnol: Flunitrazepam Effects same as any benzodiazepine feeling of well-being lowered inhibitions

impaired judgment Unique to Rohypnol visual disturbances no memory for period of intoxification(block any memory) GHB: Gamma-hydroxybutyrate Homemade CNS depressant Grievous Bodily Harm

GABA agonist precursor synergism with alcohol Clear liquid, powder, tablet, capsule GHB: Gamma-hydroxybutyrate Effects similar to benzodiazepines and barbiturates

Also loss of consciousness loss of reflexes seizures, coma, death Associated with sexual assault ~ The Drugs of Abuse 2. Hallucinogens

Hallucinogens Alter Mood, Perception, Thinking. Induce Delusions Hallucinations Occur Infrequently 1. LSD 2. Psilocybin 3. Mescaline 4. MDMA 5.Marijuana

MOA of Hallucinogens LSD, Psilocybin, Mescaline: Bind to Post-Synaptic Serotonin5-Hydroxy Tryptamine, (5-HT) Receptors 5HT Agonists Rapid Tolerance From Down Regulation of Receptors Occurs Lysergic Acid Diethylamide

General specifications: Very powerful hallocinogen Alkaloied derivatives from (Psilocybe mexicana) German word (Lyser Saure Diethylamide) Ingestion( rote of misuse) LSD Intoxication 8-12hr At 10-30 Min.

-Laugh / Cry -Euphoria -Paranoia -Impair Think. -Panic Attack -Tachycardia -Elev. BP -Tremors At 2-3 Hours

-Hallucination -Synesthesia (Sounds Felt, Colors Heard) -Derealization -Distorted Time / Space -Blurring DDX of LSD Intoxication

Delirium, Dementia Schizophrenia Bipolar, Psychotic Disorders

Narcolepsy Etoh, Marijuana, PCP Intoxication Antiparkinsonian Drugs Lasting LSD Effects Few Develop Florid Psychosis -A Pre-existing Disorder? Flashbacks Occur in 16-57% -? CNS Pathology or Memory, Most Mild / Not Incapacitating

Physical Dependence and Withdrawal Do Not Occur Treatment LSD Overdose Bad Trip --Quiet, Safe, Environment --Calm Supportive Friends --Talk Down --Emphasize Effects Are From Drug and Temporary

Valium 10-20mg, Ativan 1-2mg MDMA (ecstasy) ECSTASY MDMA(3,4

ETHYLENEDIOXYMETHAMPHETAMINE) ADAM X-TC X- pill

SEX- PILL CLARITY ESSENCE STACY LOVERS SPEED EVE MDMA Effects By 5HT Activity: --Minimal Hallucinations

--Locomotor Hyperactivity --Hyperthermia MOA of MDMA Increased Levels of 5HT, Dopamine and Norepinephrine by: --Increased Presynaptic Release --Inhibited Reuptake --Increased Dopamine Synthesis --Decreased Breakdown by

Monoamine Oxidase Inhibition MDMA Intoxication 5HT Activation: --Empathy & Insight --Sexsuality --Euphoria --Energy --Self Esteem

MDMA Intoxication Sympathetic Activation: --Diaphoresis --Mydriasis --Tachycardia --Hypertension --Increased Psychomotor Drive MDMA Neuro. Complications

Confusion, Paranoia, Panic Psychosis, Acute and Chronic Seizures, Status Epilepticus Destruction of Serotonin Neurons With Long Term Use

MDMA CV. Complications Hypertension Dysrhythmias

Pulmonary Edema Cardiogenic Shock Cerebral Hemorrhage Mesenteric Ischemia MDMA Complications

Hyperthermia (>108 F) Muscle Spasm Rhabdomyolysis Acute Hepatic or Renal Failure DIC Death

MDMA Treatment A, B, Cs Alpha Blockers (Phentolamine) NOT Beta Blockers For Hypertension Benzodiazepines (Agitation, Seizure) Rapid Cooling to 39 C (Tepid H2O) IV Fluids w Bicarb. To Alk. Urine "Shoot for the moon. Even if you miss it, you will land among the

stars." Marijuana Cannabis sativa Response Variables

Dose Route of administration Setting Experience Expectations Individual vulnerability

Route of Administration Oral IV Smoke The High Early stages Euphoria Uncontrollable

laughter Time/sense alterations Depersonalization Late stages

Relaxation Introspective Dreamlike state Difficulty thinking CNS Effects Marijuana causes some parts of the brain, including those governing emotions, memory and judgement to lose balance and control.

General CNS Effects Acute

Short-term memory Confusion Depersonalization Balance/stability Hunger Dry mouth Sharper imagery REM sleep

Chronic (Amotivational Syndrome) Apathy Dullness Judgment Concentration Memory Personal appearance and goals

Cardiovascular Effects Dose-dependent in pulse rate. Reddening of the Conjunctiva Endocrine Effects Decreases Luteinizing hormone

Follicle-stimulating hormone Prolactin Growth hormone Adrenocorticotrophin hormone

testosterone testicular weight spermatogenesis sexual behavior Respiratory Effects Acute: bronchodilator

Chronic: bronchoconstriction Medical Marijuana Dronabinol Antiemetic Medical Marijuana Approved

Antiemetic (cancer) AIDS wasting syndrome Suggested

Glaucoma Pain Asthma Multiple sclerosis The Drugs of Abuse 3. Anabolic Steroids Anabolic Steroids -Types Long Acting, Given IM:

Testosterone Esters Synthetic Nandrolones Orally Active Forms: --Methyltestosterone --Danazol, Stanozolol --Methandrostenolone, Etc. Anabolics-Metabolism Protein Bound in Bloodstream Unbound Forms Must Be

Metabolized to Become Metabolically Active Dihydroxytestosterone (DHT) Is Very Active, Estradiol Also Active Anabolics MOA Cellular Receptors --Stimulate Intranuclear Effects Intranuclear Effects -Increase Protein Transcription

-Decrease Protein Breakdown Euphoria / Aggression, Fatigue But No Increased Aerobic Capacity! Anabolics - Addictive? Positve Reinforcing Effects: Athletic Performance Physical AppearanceSelfconfidence Negative Reinforcing Effects: Fatigue, Depression Decreased Libido, Muscle Pain

Headache, Craving Male Complications Azoospermia Testicular Atrophy

Gynecomastia = Bitch Tits Erectile Dysfunction Female Complications May Not Reverse With Stopping: --Hirsuitism --Male Pattern Baldness --Breast Reduction --Clitoral Hypertrophy --Amenorrhea / Dysmenorrhea

--Acne --Deepened Voice Behavioral Complications With Use: --Aggression, Violence --Mania, Hypomania, Panic --Psychotic Symptoms With Discontinuation: --Depression

--Suicidal Ideation Medical Complications

Hypertension Serum Lipids: LDL, HDL Myocardial Infarction, Stroke Cholestatic Jaundice Peliosis Hepatitis (Blood Cysts) Liver Cancer Anabolic Use - Diagnosis Exam: Jaundice, Acne, Facial Edema, HBP, Clitoral

Hypertrophy Testicular Atrophy, Hepatomegaly Lab: Urine Screen, Elevated Glucose, LDL, or Liver Enzymes The Drugs of Abuse 4. PCP (Phencyclidine) PCP - Phencyclidine

A Dissociative Anaesthetic -Related to Ketamine Antagonist at N-methly, D-aspartate (NMDA) Receptor Angel Dust, Crystal, Space Base (Combined With Cocaine) PCP Intoxication Onset 5 Min Smoked, 1 Hr. PO: -Distorted Body Image

-Disorientation, Euphoria -Aud./ Vis. Hallucinations -Paranoia, Belligerence -Analgesia, Self-destructive < 5mg: Ataxia, Nystg, Blank Stare >20mg: Seizures, Coma, Death PCP - Withdrawal Can Occur With Only 2 Weeks Use. Lasts 24-48 Hours

Peaks at 12-16 Hours --Depression -Drug Craving --Increased Appetite --Increased Need for Sleep PCP Complications Self-destruction (Fractures Not Felt Due to Analgesia) Injury to Others Psychosis Lasting 2-3 Weeks PCP Delirium, Mood Disorders Acute Psychosis >> Hallucinogens

PCP Treatment Do Not Talk Down Isolate Patient + Restraints Valium 10-30 Mg PO (If No Other CNS Drugs Present) Haldol 5 Mg BID (Psychosis) Acidify Urine The Drugs of Abuse II

5. Inhalants Inhalants - Types 1. Volatile Organic Compounds: Hydrocarbons, Fuels, Ethers, Glues, Paints, Aerosols..... 2. Nitrates: Volatile Nitrates: Amyl Nitrate, Poppers, Etc.

3. Nitrous Oxide: Whippets, Etc. Inhalants - Metabolism Nitrates and Hydrocarbons Are Metabolized by Liver Microsomal Enzyme Systems. Some Metabolites Are Active. Other Inhalants Excreted by Lungs and Kidneys.

VOCs Peak Use 11-13 Yrs (Experiment)

Male, Low Economic sniffing (From Container) Huffing (From a Rag) Bagging (Highest Concentration) Act by Disrupting Neural Function VOCs - Addictive? Specific Addiction to These Agents Is Relatively Unusual Highly Rewarding for Some

Use Associated With: -- ASPD 63% -- Alcoholism 68% -Later Drug Use 5-10X Risk VOCs - Consequences Sudden Sniffing Death Cardiac or Respiratory Depr. Cognitive Loss / Brain Atrophy -Memory / Concentration

Accidents, Falls VOCs - Consequences

Huffers Rash Pneumonitis Myopathy, Neuropathy Kidney Failure Aplastic Anemia AML (Benzene) b. Nitrates Volatile Nitrates: --Developed for Angina

--Vasodilators --Rush --Sexual Excitement --MOA Is CNS Hypoxia, and ? Volatile Nitrates - Effects CNS: --Euphoria, Disorientation --Headache, Tinnitis --Dizziness, Syncope

--Visual Yellow Haze Other: --Tachy / Bradydysrhythmia -- BP, Wheezing --Hemolytic Anemia --Methemaglobinemia c. Nitrous oxide (NO) Products With NO:

Whipped Cream Whippets Cook. Spray Fire Extinguish. Anesthesia Tanks

Adolescents Those With Gas Available: Dentistry Anesthesia Nitrous oxide - Actions Affects Neuron Membranes to Depress the CNS, and Respiration 30 X Solubility of Nitrogen in Body Exhaled Unchanged From Body

Highest Risks Are Asphyxiation, Barotrauma, Pneumomediastinum NO - Acute Effects CNS: --Euphoria --Headache --Confusion --Syncope --Seizure --Coma Respiratory: --Asphyxiation

--Frostbite --Air Emboli Misc: --Anemia -- Immunity --Spontaneous Abortion NO - Chronic Effects CNS: --Spinal Cord Degeneration --Numbness

--Weakness --Ataxia --Clumsiness Respiratory: Hematologic: --Pneumonitis --Agranulocytosis --Aplastic Anemia

Epidemiology 12.5% of Us Pop Use Each Year 2% of Us Pop Use on Any 1 Day

1/2 of All Scripts by Primary Drs. Non-medical Use up to 1.9% / Yr. Benzodiazepines Most Common Drug Prescriptions. Epidemiology Benzodiazepines Replaced Barbiturates Females / Males = 2 / 1 Most Over 50 Years Old

Benzodiazepine Over-dose Is Most Common Suicide Attempt. Barbiturates Equivalent Doses: Butalbital (Fiorinal)

Pentobarbital (Yellows) Secobarbital ( Seconal) Phenobarbital 100mg 100mg 100mg 30mg The Drugs of Abuse

A. MOA B. Intoxication C. Withdrawal D. Complications

E. Treatments a.Volatile organics (VOC) Epidemiology: (1993-4) 17% of HS grads had used 3% of these are chronic users

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