Substances Of Abuse

Martin, GraceDela Cruz, KristelleTindongan, Ofelia

Amphetamine/ Metamphetamine• Aka - POORMAN’S COCAINE

- SHABU• Hypertension• Arrhythmias• Seizures• CNS stimulation & SympathomimeticTreatment• Seizures- Diazepam & Phenytoin• Psychosis/ Agitation- Chlorpromazine/Haloperidol, Diazepam• Hypertensive crisis- β-blockers, a-blocking agents• Arrhythmias: Propranolol, Lidocaine

Antidote: - Gastrointestinal decontamination with activated

charcoal is an early therapeutic option if the patient is seen within 1-2 hours of a potentially life-threatening ingestion of these agents.

- Whole bowel irrigation with polyethylene glycol solution both in patients who swallow prewrapped drugs.

Opioids

• Natural: Opium, Morphine• Semi-synthetic: Heroin & Codeine• Synthetic: Methadone & MeperidineSigns and Symptoms• Miosis• Comatose• Respiratory depression• Seizures (meperidine)

Treatment

• Naloxone• Naltrexone- which blocks opioid receptors and

prevents the drug from having an effect• Nalorphine• Nalmefen

* Competitive opioid antagonist but may precipitate withdrawal symptoms in an addict patient

SEDATIVES

BENZODIAZEPINES

• In addition with alcohol causes fatal CNS depression

Signs & Symptoms:- Drowsiness- Ataxia- ConfusionTreatment: - Flumazenil- reverses benzodiazepine effect in

the CNS

BARBITURATES• Used for induction of anesthesia and for seizures

Signs and Symptoms: - Mild: Slurred speech, ataxia, altered mental status- Severe: Comatose with absence of deep tendon

reflexes, Cheyne-Strokes (Irregular) respirationTreatment: - Forced alkaline diuresis- Hemodialysis

CHLORAL HYDRATE

• Aka (MICKEY FINN)• In vivo via alcohol dehydrogenase

Trichloroethanol• “knock-out drops”, similar to barbiturate

poisoningTreatment: Supportive

HALLUCINOGENS

LSD• Lysergic acid diethylamide, “acid”, an ergot

derivative

Mechanism of Action: inhibits serotoninergic firing sympathetic stimulation and hallucinations

Treatment:- Benzodiazepines for seizures

MORNING GLORY FAMILY

• Argyreia nervosa (wood rose) • Ipomea violacea (morning glory)

- Related to LSD but more GI effects

MESCALINE

• Peyote cactus (Lophophora williamsii)• “buttons”

ECSTASY• MDMA (methylenedioxymethamphetamine)• Smooth metamphetamine• It produces feelings of increased energy, euphoria, emotional

warmth and empathy toward others, and distortions in sensory and time perception.

MOA: serves as a false neurotransmitter release of catecholamines

& inhibition of MAO, also stimulates β and a receptors (similar to amphetamine)

Toxic Dose: 50-150 mgTreatment:- Labetalol- Nitroprusside- Nifedipine for HTP

PHENCYCLIDINE (PCP)

• “angel dust”• Dissociative anesthetic Signs & Symptoms:- Coma- Acute brain syndrome (disorientation, psychosis,

coma)Treatment:- Diazepam for seizures- Nitroprusside for HPN

MARIJUANA• - Mary jane, Grass, Pot session, MJ, Bang• Hashish or hash oil• Cannabis sativa• Most commonly used illegal drugActive Ingredient: tetrahydrocannabinol (THC)Signs & Sym: - Euphoria- daily cough and phlegm production- more frequent acute chest illness- lung infections

COCAINE

• Erythroxylon coca• Crack• coke• Free base- CNS and sympathetic stimulationTreatment:- benzodiazepines: seizure- Labetalol: HPN- Neuroleptics: pychosis

ETHANOL• Most widely abused recreational drug• Grain alcohol• Neutral spirit• Responsible for major medical and socio-economic

problems• Alcohol content:

- beer: 4-5 %- wine: 10-14%distilled spirits: (whiskey, vodka, rum, brandy) 30-50%

Metabolites:- Acetaldehyde - Acetic acid

ETHANOL• Signs & Symptoms:- CNS depression- Acid-base Imbalance- Impaired thermal regulation- Hypoglycemia• Treatment:- Thiamine (prevention of Wernicke-Korsakoff

syndrome)- Disulfiram (used to stop alcohol addiction)

NICOTINE

• Active ingredient of tobacco for the addictive effect• Lethal dose:

ADULTS: 40-60 mgCHILD: 1.5-2mg/kg

• Treatment: - Activated Charcoal- Gastric lavage- Lobeline

NITROUS OXIDE

• Laughing gas• May cause diffusional hypoxia• Hysterical laughingTreatment: Oxygen