Psychoactive drug

Psychoactive Drugs: pharmacology, intoxication, withdrawal, and treatment

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• published: 14 Aug 2016
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This is a brief video on psychoactive drugs, including the pharmacology of these drugs, intoxication symptoms, withdrawal symptoms, and relevant treatments. I created this presentation with Google Slides. Image were created or taken from Wikimedia Commons I created this video with the YouTube Video Editor. ADDITIONAL TAGS: Anti addiction medications 1. cocaine 2. crack cocaine 3. methylphenidate (Ritalin) 4. ephedrine 5. MDMA (Ecstasy) 6. mescaline (cactus) 7. LSD blotter 8. psilocybin mushroom (Psilocybe cubensis) 9. Salvia divinorum 10. diphenhydramine (Benadryl) 11. Amanita muscaria mushroom 12. Tylenol 3 (contains codeine) 13. codeine with muscle relaxant 14. pipe tobacco 15. bupropion (Zyban) 16. cannabis 17. hashish Depressants / sedatives Alcohol, barbiturates, benzodiazepines MoA: enhancement of GABA receptor Intoxication: incoordination, ataxia, slurred speech, euphoria, nystagmus, attention impairment, behavior inhibition, coma, blackouts, AST = 2*ALT Hypotension, respiratory depression → benzos and barbs Treatment: flumazenil for benzo OD, supportive for others Withdrawal: hallucinations, seizures, hypertension, nausea, sweating, insomnia, anxiety, agitation, tremors Muscle cramps, twitches, tachycardia → benzos and barbs Delirium tremens (2-4 days after last drink)→ fluctuating consciousness, high HR, seizures, tremors, anxiety Treatment: benzodiazepines Can be fatal Opioids Heroin, prescription pain meds (oxycodone, hydrocodone, etc) MoA: agonize opioid receptor, especially mu subtype Intoxication: motor slowness, slurred speech, euphoria, impaired attention and sedation, miosis, respiratory depression Treatment: naloxone, naltrexone (opioid antagonists) Withdrawal: depression/anxiety, diarrhea, cramps, sweating, piloerection, pupillary dilation, yawning, muscle aches Treatment: supportive for pain and GI distress; methadone and buprenorphine (weaker agonists) can help Not fatal Heroin and oxycodone are most widely abused opioids → responsible for many deaths Depressants / sedatives Opioids Stimulants Cannabinoids (marijuana) Hallucinogens (LSD) Dissociatives (PCP) Anti addiction medications Stimulants Cocaine, amphetamines, methamphetamines, MDMA (ecstasy), cathinone (bath salts), caffeine, nicotine MoA: Cocaine → block norepi and DA reuptake Amphetamine → increase synaptic [norepi] and [DA] Nicotine → agonize PNS/CNS cholinergic receptors Caffeine → enhance DA effect by blocking ADO receptors Intoxication: Amphetamines → behavioral (grandiose, euphoric, hypervigilant, paranoia, agitation); autonomic (inc BP/HR, chills, sweating, n/v) Cocaine → add hallucinations of bugs on skin Treatment: lorazepam (anxiety); haloperidol (psychosis); vitals Withdrawal: Amphetamines/cocaine → appetite, low HR, depression, fatigue Nicotineappetite, low HR, dysphoria, anxiety, irritability Caffeine mild dysphoria, headaches, anxiety Treatment: supportive Cannabinoids Marijuana, hashish, synthetic blends (e.g., K2, spice) MoA: delta-5-tetrahydrocannabinol (THC) binds to cannabinoid receptor, which inhibits adenylate cyclase and cAMP production Intoxication: conjunctivitis, dry mouth, high BP/HR, appetite, euphoria, hallucinations at high doses, agitation Treatment: lorazepam for agitation Withdrawal: irritability, agitation, insomnia, nausea Treatment: supportive Unnecessary because not fatal Social implications: maybe amotivational syndrome, gateway drug Physiological changes: low testosterone in men, decreased ovulation in females, low birth weights in neonates, increased neonatal malformations Medical form (dronabinol) used as supportive addition to with chemo (antiemetic) or AIDS treatment (stimulate appetite) Hallucinogens LSD (acid), psilocybin (shrooms), mescaline (peyote) MoA: LSD activates serotonin receptors in the limbic system, neocortex, and brainstem Intoxication: hallucinations, delusions, mydriasis, tachycardia, sweating, ataxia, tremor Euphoria, paranoia → psilocybin Psychosis, flashbacks → LSD Treatment: lorazepam for agitation, haloperidol for psychosis Withdrawal: none Dissociatives PCP, ketamine MoA: both PCP and ketamine block glutamate NMDA receptors Ketamine is used as an anesthetic (NMDA antagonist) Intoxication: dissociation, hallucinations, impulsivity, analgesia, often violent behavior, high BP/HR, miosis, nystagmus, delusions, seizures Benzodiazepines and antipsychotics → PCP Monitor for serotonin syndrome and rhabdomyolysis Alcohol addiction Disulfiram (blocks aldehyde dehydrogenase) Acamprosate (analog of GABA, NMDA receptor antagonist) Naltrexone (opioid antagonist) Endogenous opioid pathways play a key role in pathway that leads to reinforcement for alcohol addiction Opioid addiction Naltrexone (opioid antagonist) Buprenorphine/naltrexone Opioid partial agonist / opioid antagonist Nicotine addiction Bupropion (increase norepinephrine and dopamine) Varen