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Drug Abuse Self administration of Self administration of drug or drugs in manner drug or drugs in manner not in accord with not in accord with accepted medical or accepted medical or social patterns social patterns

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Page 1: Drug Abuse Self administration of drug or drugs in manner not in accord with accepted medical or social patterns

Drug Abuse

Self administration of drug or drugs Self administration of drug or drugs in manner not in accord with in manner not in accord with

accepted medical or social patternsaccepted medical or social patterns

Page 2: Drug Abuse Self administration of drug or drugs in manner not in accord with accepted medical or social patterns

Drug Abuse

Psychological Dependency (Habituation)Psychological Dependency (Habituation) Drug necessary to maintain user’s sense of Drug necessary to maintain user’s sense of

well-beingwell-being Physical DependencyPhysical Dependency

Physical symptoms if intake reducedPhysical symptoms if intake reduced

Page 3: Drug Abuse Self administration of drug or drugs in manner not in accord with accepted medical or social patterns

Drug Abuse

Compulsive Drug UseCompulsive Drug Use Preoccupation with obtaining drugPreoccupation with obtaining drug Rituals of preparing, using drug as important as Rituals of preparing, using drug as important as

drug effectsdrug effects ToleranceTolerance

Increasing doses needed to obtain drug effectIncreasing doses needed to obtain drug effect

Page 4: Drug Abuse Self administration of drug or drugs in manner not in accord with accepted medical or social patterns

Drug Abuse

AddictionAddiction IncludesIncludes

Psychological dependencePsychological dependence Physical dependencePhysical dependence Compulsive useCompulsive use ToleranceTolerance

Plus, complete absorption with obtaining, using Plus, complete absorption with obtaining, using drug to exclusion of all elsedrug to exclusion of all else

Page 5: Drug Abuse Self administration of drug or drugs in manner not in accord with accepted medical or social patterns

Drug Abuse

Suspect drug-related problem in patients with:Suspect drug-related problem in patients with: Altered LOCAltered LOC Bizarre behaviorBizarre behavior SeizuresSeizures

Page 6: Drug Abuse Self administration of drug or drugs in manner not in accord with accepted medical or social patterns

Drug Abuse

Ask Ask EVERYEVERY patient about recreational drugs. patient about recreational drugs. Be non-judgmental.Be non-judgmental. Keep drug box/cabinet secured.Keep drug box/cabinet secured. Use discretion.Use discretion. If held up, give them what they want!If held up, give them what they want!

Page 7: Drug Abuse Self administration of drug or drugs in manner not in accord with accepted medical or social patterns

Narcotics

OpiumOpium Opium derivativesOpium derivatives Synthetic opium substitutesSynthetic opium substitutes

Page 8: Drug Abuse Self administration of drug or drugs in manner not in accord with accepted medical or social patterns

Narcotics

ExamplesExamples OpiumOpium MorphineMorphine HeroinHeroin CodeineCodeine DilaudidDilaudid

Oxycodone (Percodan)Oxycodone (Percodan) Meperidine (Demerol)Meperidine (Demerol) Propoxyphene (Darvon)Propoxyphene (Darvon) TalwinTalwin FentanylFentanyl

Page 9: Drug Abuse Self administration of drug or drugs in manner not in accord with accepted medical or social patterns

Narcotics

EffectsEffects AnalgesiaAnalgesia CNS depressionCNS depression

EuphoriaEuphoria DrowsinessDrowsiness ApathyApathy

Antidiarrheal actionAntidiarrheal action Antitussitive actionAntitussitive action

Page 10: Drug Abuse Self administration of drug or drugs in manner not in accord with accepted medical or social patterns

Narcotics

OverdoseOverdose Mild to ModerateMild to Moderate

LethargyLethargy Pinpoint pupilsPinpoint pupils BradycardiaBradycardia HypotensionHypotension Decreased bowel Decreased bowel

soundssounds Flaccid musclesFlaccid muscles

SevereSevere Respiratory depressionRespiratory depression ComaComa AspirationAspiration Seizures with certain Seizures with certain

compounds (meperidine, compounds (meperidine, propoxyphene, tramadol)propoxyphene, tramadol)

Page 11: Drug Abuse Self administration of drug or drugs in manner not in accord with accepted medical or social patterns

Narcotics

OverdoseOverdose ManagementManagement

Support oxygenation/ventilationSupport oxygenation/ventilationVascular accessVascular accessD50W 50ccD50W 50ccNarcan 0.4 to 2.0 mgNarcan 0.4 to 2.0 mg

• Improve respirationsImprove respirations• Do Do NOTNOT awaken completely awaken completely• Restrain before givingRestrain before giving

Page 12: Drug Abuse Self administration of drug or drugs in manner not in accord with accepted medical or social patterns

Narcotics

Associated DangersAssociated Dangers Skin abscessesSkin abscesses PhlebitisPhlebitis SepsisSepsis HepatitisHepatitis HIVHIV EndocarditisEndocarditis

Adulterant toxicityAdulterant toxicity ““Cotton fever”Cotton fever” MalnutritionMalnutrition TetanusTetanus MalariaMalaria

Page 13: Drug Abuse Self administration of drug or drugs in manner not in accord with accepted medical or social patterns

Narcotics WithdrawalWithdrawal

InsomniaInsomnia RestlessnessRestlessness IrritabilityIrritability AnorexiaAnorexia TremorsTremors Back, extremity painBack, extremity pain

Watery eyesWatery eyes YawningYawning RhinorrheaRhinorrhea SneezingSneezing DiarrheaDiarrhea DiaphoresisDiaphoresis

Resembles Severe Influenza

Page 14: Drug Abuse Self administration of drug or drugs in manner not in accord with accepted medical or social patterns

Narcotics

WithdrawalWithdrawal Lasts 7 to 10 daysLasts 7 to 10 days NOTNOT life threatening life threatening

Page 15: Drug Abuse Self administration of drug or drugs in manner not in accord with accepted medical or social patterns

Sedative-Hypnotic Drugs

Page 16: Drug Abuse Self administration of drug or drugs in manner not in accord with accepted medical or social patterns

Categories

BarbituratesBarbiturates BenzodiazepineBenzodiazepine Barbiturate-like non-barbituratesBarbiturate-like non-barbiturates Chloral hydrateChloral hydrate

Page 17: Drug Abuse Self administration of drug or drugs in manner not in accord with accepted medical or social patterns

Mechanism of Action

Most overdoses of sedative-hypnotics are Most overdoses of sedative-hypnotics are from benzodiazepines, barbituratesfrom benzodiazepines, barbiturates

Both enhance effects of gamma-Both enhance effects of gamma-aminobutyric acid (GABA)aminobutyric acid (GABA)

GABA enhancement results in down-GABA enhancement results in down-regulation of CNS activityregulation of CNS activity

Page 18: Drug Abuse Self administration of drug or drugs in manner not in accord with accepted medical or social patterns

Sedative-Hypnotics

Use more then a week leads to tolerance to Use more then a week leads to tolerance to effects on sleep patternseffects on sleep patterns

Withdrawal after long term results in Withdrawal after long term results in “rebound” increase in frequency of “rebound” increase in frequency of occurrence, duration of REM sleep.occurrence, duration of REM sleep.

In high doses, sedative-hypnotics depress In high doses, sedative-hypnotics depress CNS to point of Stage III or general CNS to point of Stage III or general anesthesiaanesthesia

Page 19: Drug Abuse Self administration of drug or drugs in manner not in accord with accepted medical or social patterns

Sedative-Hypnotics

ToleranceTolerance Happens with all sedative-hypnoticsHappens with all sedative-hypnotics Appears very quickly even during short-term Appears very quickly even during short-term

use.use. Discontinuation will bring receptor response Discontinuation will bring receptor response

back to normal after drug has been metabolizedback to normal after drug has been metabolized Withdrawal symptoms may take up to a week Withdrawal symptoms may take up to a week

to see in some patientsto see in some patients

Page 20: Drug Abuse Self administration of drug or drugs in manner not in accord with accepted medical or social patterns

Chloral hydrate

““Micky Finn” when mixed with alcoholMicky Finn” when mixed with alcohol Rapidly absorbed, acts quicklyRapidly absorbed, acts quickly Drowsiness, sleepDrowsiness, sleep Alcohol, chloral hydrate compete for Alcohol, chloral hydrate compete for

metabolism by same enzymemetabolism by same enzyme Prolonged action for both when mixedProlonged action for both when mixed Not commonly abusedNot commonly abused

Page 21: Drug Abuse Self administration of drug or drugs in manner not in accord with accepted medical or social patterns

Barbiturates

Introduced in 1903Introduced in 1903 Replaced older sedative-hypnoticsReplaced older sedative-hypnotics Quickly became major health problemQuickly became major health problem In 1950’s-60’s barbiturates were implicated In 1950’s-60’s barbiturates were implicated

in overdoses; were responsible for majority in overdoses; were responsible for majority of drug-related suicidesof drug-related suicides

Page 22: Drug Abuse Self administration of drug or drugs in manner not in accord with accepted medical or social patterns

Barbiturates

Short-actingShort-acting AmytalAmytal PentathiolPentathiol

Intermediate-actingIntermediate-acting NembutalNembutal SeconalSeconal TuinalTuinal

Long-actingLong-acting PhenobarbitalPhenobarbital

Page 23: Drug Abuse Self administration of drug or drugs in manner not in accord with accepted medical or social patterns

Barbiturates

Initial overdose presentation Initial overdose presentation Slurred speechSlurred speech AtaxiaAtaxia Lethargy Lethargy NystagmusNystagmus Headache Headache ConfusionConfusion

Page 24: Drug Abuse Self administration of drug or drugs in manner not in accord with accepted medical or social patterns

Barbiturates

As overdose progressesAs overdose progresses Depth of coma increasesDepth of coma increases

Patient anesthetized with loss of neurologic functionPatient anesthetized with loss of neurologic function EEG may mimic brain deathEEG may mimic brain death

Respiratory depression occursRespiratory depression occurs Peripheral vasodilation occursPeripheral vasodilation occurs

Hypotension, shockHypotension, shock HypothermiaHypothermia

Blisters (bullae) form on skinBlisters (bullae) form on skin

Page 25: Drug Abuse Self administration of drug or drugs in manner not in accord with accepted medical or social patterns

Barbiturates

Early deathsEarly deaths Respiratory arrestRespiratory arrest Cardiovascular collapseCardiovascular collapse

Delayed deathsDelayed deaths Acute renal failureAcute renal failure PneumoniaPneumonia Pulmonary edemaPulmonary edema Cerebral edema Cerebral edema

Page 26: Drug Abuse Self administration of drug or drugs in manner not in accord with accepted medical or social patterns

Barbiturates

Overdose managementOverdose management Secure airwaySecure airway Support oxygenation/ventilationSupport oxygenation/ventilation IV with LR or NSIV with LR or NS Prevent heat loss secondary to vasodilationPrevent heat loss secondary to vasodilation Bicarbonate to alkalinize urine (long-acting Bicarbonate to alkalinize urine (long-acting

only)only)

Page 27: Drug Abuse Self administration of drug or drugs in manner not in accord with accepted medical or social patterns

Barbiturates

Withdrawal signs/symptomsWithdrawal signs/symptoms ApprehensivenessApprehensiveness AnxietyAnxiety TremulousnessTremulousness DiarrheaDiarrhea NauseaNausea VomitingVomiting SeizuresSeizures

Page 28: Drug Abuse Self administration of drug or drugs in manner not in accord with accepted medical or social patterns

Barbiturate-like, non-barbiturates

ExamplesExamples Doriden (glutethimide)Doriden (glutethimide) Quaalude (methaqualone)Quaalude (methaqualone) Placidyl (ethchlorvynol)Placidyl (ethchlorvynol) NoludarNoludar

Overdose produces sudden, prolonged apneaOverdose produces sudden, prolonged apnea Highly addictiveHighly addictive Withdrawal resembles barbiturate withdrawalWithdrawal resembles barbiturate withdrawal Only Placidyl, Doriden remain available in U.S.Only Placidyl, Doriden remain available in U.S.

Page 29: Drug Abuse Self administration of drug or drugs in manner not in accord with accepted medical or social patterns

Placidyl (ethchlorvynol)

““Pickles”, “jelly beans”, “Mr. Green Jeans”Pickles”, “jelly beans”, “Mr. Green Jeans” Produces vinyl-like odor on breathProduces vinyl-like odor on breath Concentrates in CNS, slow hepatic metabolismConcentrates in CNS, slow hepatic metabolism Half-life >100 hrsHalf-life >100 hrs Prolonged deep coma (100 to 300 hrs), hypothermia, Prolonged deep coma (100 to 300 hrs), hypothermia,

respiratory depression, hypotension, bradycardiarespiratory depression, hypotension, bradycardia EEG is flatlineEEG is flatline Keep patient on life support for a few days; they wake Keep patient on life support for a few days; they wake

up, are okup, are ok

Page 30: Drug Abuse Self administration of drug or drugs in manner not in accord with accepted medical or social patterns

Doriden (gluthethimide)

Abused in combination with codeineAbused in combination with codeine ““sets”, “hits”, “loads”, “fours and doors”sets”, “hits”, “loads”, “fours and doors” Prolonged coma (average 48 hours)Prolonged coma (average 48 hours) Hypotension, shock commonHypotension, shock common Anticholinergic signs: dilated pupils, tachycardia, Anticholinergic signs: dilated pupils, tachycardia,

dry mouth, ileus, urinary retention, hyperthermiadry mouth, ileus, urinary retention, hyperthermia

Page 31: Drug Abuse Self administration of drug or drugs in manner not in accord with accepted medical or social patterns

Benzodiazepines

Developed due to overdoses, deaths related Developed due to overdoses, deaths related to barbiturates, barbiturate-like non-to barbiturates, barbiturate-like non-barbituratesbarbiturates

Relatively few deathsRelatively few deaths In 1993, prescription rate for barbiturates In 1993, prescription rate for barbiturates

dropped to one-sixth that of benzosdropped to one-sixth that of benzos

Page 32: Drug Abuse Self administration of drug or drugs in manner not in accord with accepted medical or social patterns

Benzodiazepines

ExamplesExamples Valium (diazepam)Valium (diazepam) Ativan (lorazepam)Ativan (lorazepam) Versed (midazolam)Versed (midazolam) Librium (chlorodiazepoxide)Librium (chlorodiazepoxide) Tranxene (chlorazepate dipotassium)Tranxene (chlorazepate dipotassium) Dalmane (flurazepam)Dalmane (flurazepam) Halcion (triaxolam)Halcion (triaxolam) Restoril (temazepam)Restoril (temazepam)

Page 33: Drug Abuse Self administration of drug or drugs in manner not in accord with accepted medical or social patterns

Benzodiazepines

Adverse EffectsAdverse Effects WeaknessWeakness HeadacheHeadache Blurred visionBlurred vision VertigoVertigo NauseaNausea DiarrheaDiarrhea Chest painChest pain

Page 34: Drug Abuse Self administration of drug or drugs in manner not in accord with accepted medical or social patterns

Benzodiazepines

OverdosesOverdoses Relatively safe taken by themselves, even in overdoseRelatively safe taken by themselves, even in overdose Can be lethal with other CNS depressants especially Can be lethal with other CNS depressants especially

alcohol alcohol Look like other CNS depressant overdosesLook like other CNS depressant overdoses Antidote is Romazicon ( flumazenil )Antidote is Romazicon ( flumazenil )

Only recommended in known, controlled situationsOnly recommended in known, controlled situations Can lead to seizures that cannot be controlledCan lead to seizures that cannot be controlled

Page 35: Drug Abuse Self administration of drug or drugs in manner not in accord with accepted medical or social patterns

Benzodiazepines

Produce withdrawal syndrome similar to Produce withdrawal syndrome similar to barbiturate withdrawalbarbiturate withdrawal

Page 36: Drug Abuse Self administration of drug or drugs in manner not in accord with accepted medical or social patterns

Benzodiazepine-like non-benzos

BuSpar (buspirone)BuSpar (buspirone) Used for generalized anxiety disorderUsed for generalized anxiety disorder Less sedating than diazepamLess sedating than diazepam Less potentiation by other CNS depressantsLess potentiation by other CNS depressants

Ambien, Stilnox (zolpidem)Ambien, Stilnox (zolpidem) Used for short-term insomnia treatmentUsed for short-term insomnia treatment Toxic effects similar to benzosToxic effects similar to benzos

Page 37: Drug Abuse Self administration of drug or drugs in manner not in accord with accepted medical or social patterns

Neuroleptics

Antipsychotics, major tranquilizersAntipsychotics, major tranquilizers Used in treatment of schizophrenia, other Used in treatment of schizophrenia, other

psychosespsychoses ExamplesExamples

HaldolHaldol MellarilMellaril ThorazineThorazine StellazineStellazine CompazineCompazine

Page 38: Drug Abuse Self administration of drug or drugs in manner not in accord with accepted medical or social patterns

Neuroleptics

Extrapyramidal muscle contractions Extrapyramidal muscle contractions (dystonias)(dystonias) Bizarre, acute, involuntary movements, spasms Bizarre, acute, involuntary movements, spasms

of skeletal musclesof skeletal muscles Reversible with BenadrylReversible with Benadryl

Page 39: Drug Abuse Self administration of drug or drugs in manner not in accord with accepted medical or social patterns

Neuroleptics

Acute Overdose PresentationAcute Overdose Presentation CNS depressionCNS depression HypotensionHypotension Anticholinergic symptoms: flushing, dry Anticholinergic symptoms: flushing, dry

mouth, hyperthermia, tachycardia, urinary mouth, hyperthermia, tachycardia, urinary retentionretention

Ventricular arrhythmias, including TorsadesVentricular arrhythmias, including Torsades SeizuresSeizures

Page 40: Drug Abuse Self administration of drug or drugs in manner not in accord with accepted medical or social patterns

Neuroleptics

Acute Overdose ManagementAcute Overdose Management ABCsABCs Fluid, vasopressors for hypotensionFluid, vasopressors for hypotension Lidocaine, phenytoin for ventricular arrhythmiaLidocaine, phenytoin for ventricular arrhythmia Magnesium, isoproterenol for TorsadesMagnesium, isoproterenol for Torsades Benzodiazepines, phenobarbital for seizuresBenzodiazepines, phenobarbital for seizures

Page 41: Drug Abuse Self administration of drug or drugs in manner not in accord with accepted medical or social patterns

Neuroleptics

Neuroleptic malignant syndromeNeuroleptic malignant syndrome Life-threatening reactionLife-threatening reaction Signs, symptomsSigns, symptoms

HyperthermiaHyperthermia Muscular rigidityMuscular rigidity Altered LOCAltered LOC Tachycardia, hypotensionTachycardia, hypotension

Page 42: Drug Abuse Self administration of drug or drugs in manner not in accord with accepted medical or social patterns

Neuroleptics

Neuroleptic malignant syndromeNeuroleptic malignant syndrome ManagementManagement

ABCsABCs OxygenOxygen Assist ventilation, as neededAssist ventilation, as needed BenzodiazepinesBenzodiazepines Rapid coolingRapid cooling Volume for hypotensionVolume for hypotension

Page 43: Drug Abuse Self administration of drug or drugs in manner not in accord with accepted medical or social patterns

Stimulants

ExamplesExamples CocaineCocaine AmphetaminesAmphetamines

Benzedrine (bennies)Benzedrine (bennies) Dexedrine (dexies, copilots)Dexedrine (dexies, copilots) Methamphetamine (ice, black beauties)Methamphetamine (ice, black beauties)

EphedrineEphedrine CaffeineCaffeine RitalinRitalin

Page 44: Drug Abuse Self administration of drug or drugs in manner not in accord with accepted medical or social patterns

Stimulants

Produce Produce euphoriaeuphoria hyperactivityhyperactivity alertnessalertness sense of enhanced energysense of enhanced energy anorexiaanorexia

Page 45: Drug Abuse Self administration of drug or drugs in manner not in accord with accepted medical or social patterns

Stimulants

Overdose signs/symptomsOverdose signs/symptoms Euphoria, restlessness, agitation, anxietyEuphoria, restlessness, agitation, anxiety Paranoia, irritability, delirium, psychosisParanoia, irritability, delirium, psychosis Muscle tremors, rigidityMuscle tremors, rigidity Seizures, comaSeizures, coma Nausea, vomiting, chills, sweating, headacheNausea, vomiting, chills, sweating, headache Elevated body temperatureElevated body temperature Tachycardia, hypertensionTachycardia, hypertension Ventricular arrhythmiasVentricular arrhythmias

Page 46: Drug Abuse Self administration of drug or drugs in manner not in accord with accepted medical or social patterns

Stimulants

Overdose complicationsOverdose complications Hyperthermia, heat stroke Hyperthermia, heat stroke Hypertensive crisisHypertensive crisis CVACVA Acute MIAcute MI Intestinal infarctionsIntestinal infarctions RhabdomyolysisRhabdomyolysis Acute renal failureAcute renal failure

Page 47: Drug Abuse Self administration of drug or drugs in manner not in accord with accepted medical or social patterns

Stimulants

Chronic effectsChronic effects Weight lossWeight loss CardiomyopathyCardiomyopathy ParanoiaParanoia PsychosisPsychosis Stereotypic behavior: picking at skin Stereotypic behavior: picking at skin

(“cocaine bugs”) (“cocaine bugs”)

Page 48: Drug Abuse Self administration of drug or drugs in manner not in accord with accepted medical or social patterns

Stimulants

Overdose managementOverdose management Oxygen, monitor, IVOxygen, monitor, IV Activated charcoal for decontamination in first hourActivated charcoal for decontamination in first hour Valium for sedationValium for sedation Hypertension controlHypertension control

NiprideNipride PhentolaminePhentolamine Avoid beta-blockers, including labetolol (Why?)Avoid beta-blockers, including labetolol (Why?)

Body temperature reductionBody temperature reduction

Page 49: Drug Abuse Self administration of drug or drugs in manner not in accord with accepted medical or social patterns

Stimulants

WithdrawalWithdrawal DrowsinessDrowsiness Profound depression (“cocaine blues”)Profound depression (“cocaine blues”) Increased appetiteIncreased appetite Abdominal cramps, diarrhea, nauseaAbdominal cramps, diarrhea, nausea HeadacheHeadache

Page 50: Drug Abuse Self administration of drug or drugs in manner not in accord with accepted medical or social patterns

Hallucinogens

ExamplesExamples Indole hallucinogensIndole hallucinogens

LSD (acid)LSD (acid) Morning-glory Morning-glory

seedsseeds PsilocybinPsilocybin DMTDMT

Amphetamine-like Amphetamine-like hallucinogenshallucinogens PeyotePeyote MescalineMescaline DOMDOM MDAMDA MDMA (ecstasy)MDMA (ecstasy)

Page 51: Drug Abuse Self administration of drug or drugs in manner not in accord with accepted medical or social patterns

Hallucinogens

Produce altered/enhanced sensationProduce altered/enhanced sensation Effects highly variable depending on patientEffects highly variable depending on patient Increased dose does not intensify effectIncreased dose does not intensify effect Toxic overdose virtually impossibleToxic overdose virtually impossible

Page 52: Drug Abuse Self administration of drug or drugs in manner not in accord with accepted medical or social patterns

Hallucinogens

Some patients may experience “bad trips”Some patients may experience “bad trips” Depends on surroundings, emotional stateDepends on surroundings, emotional state Signs and symptomsSigns and symptoms

Paranoia, fearfulness, combativenessParanoia, fearfulness, combativeness Anxiety, excitementAnxiety, excitement Nausea, vomitingNausea, vomiting Tachycardia, tachypneaTachycardia, tachypnea TearfulnessTearfulness Bizarre ReasoningBizarre Reasoning

Page 53: Drug Abuse Self administration of drug or drugs in manner not in accord with accepted medical or social patterns

Hallucinogens

Moderate IntoxicationModerate Intoxication TachycardiaTachycardia MydriasisMydriasis DiaphoresisDiaphoresis Short attention spanShort attention span TremorTremor HypertensionHypertension HyperreflexiaHyperreflexia FeverFever

Page 54: Drug Abuse Self administration of drug or drugs in manner not in accord with accepted medical or social patterns

Hallucinogens

Life-threatening toxicity (rare)Life-threatening toxicity (rare) SeizuresSeizures Severe hyperthermiaSevere hyperthermia Hypertension, arrhythmiasHypertension, arrhythmias Obtunded, agitated, or thrashing aboutObtunded, agitated, or thrashing about Diaphoretic, hyperreflexicDiaphoretic, hyperreflexic Untreated hyperthermia can lead to hypotension, Untreated hyperthermia can lead to hypotension,

coagulopathy, rhabdomyolysis and multiple organ coagulopathy, rhabdomyolysis and multiple organ failurefailure

Page 55: Drug Abuse Self administration of drug or drugs in manner not in accord with accepted medical or social patterns

Hallucinogens

Management of “bad trip”Management of “bad trip” Rule out other causes of hallucinationsRule out other causes of hallucinations

HypoglycemiaHypoglycemia Alcohol, drug withdrawalAlcohol, drug withdrawal InfectionInfection

Quiet, supportive environmentQuiet, supportive environment Benzodiazepines, haldol for agitation, anxietyBenzodiazepines, haldol for agitation, anxiety

Page 56: Drug Abuse Self administration of drug or drugs in manner not in accord with accepted medical or social patterns

Phencyclidine (PCP)

Street namesStreet names Angel dustAngel dust Peace PillPeace Pill Hog Hog KrystalKrystal Animal tranquilizerAnimal tranquilizer

Used as veterinary anestheticUsed as veterinary anesthetic

Page 57: Drug Abuse Self administration of drug or drugs in manner not in accord with accepted medical or social patterns

Phencyclidine (PCP)

ActionsActions Dissociative anesthesiaDissociative anesthesia Generalized loss of pain perceptionGeneralized loss of pain perception Little or no depression of airway reflexes or Little or no depression of airway reflexes or

ventilationventilation CNS-stimulant, anticholinergic, opiate, and CNS-stimulant, anticholinergic, opiate, and

alpha-adrenergic effectsalpha-adrenergic effects

Page 58: Drug Abuse Self administration of drug or drugs in manner not in accord with accepted medical or social patterns

Phencyclidine (PCP)

Low DosesLow Doses Lethargy, euphoria, hallucinationsLethargy, euphoria, hallucinations Slurred speechSlurred speech Blank stareBlank stare Insensitivity to painInsensitivity to pain Midposition to dilated pupilsMidposition to dilated pupils Vertical and horizontal nystagmusVertical and horizontal nystagmus Occasionally bizarre or violent behaviorOccasionally bizarre or violent behavior

Page 59: Drug Abuse Self administration of drug or drugs in manner not in accord with accepted medical or social patterns

Phencyclidine (PCP)

High DosesHigh Doses DiaphoresisDiaphoresis SalivationSalivation HypertensionHypertension TachycardiaTachycardia HyperthermiaHyperthermia

Localized dystonic reactionsLocalized dystonic reactions Wide-eyed comaWide-eyed coma RigidityRigidity SeizuresSeizures

Page 60: Drug Abuse Self administration of drug or drugs in manner not in accord with accepted medical or social patterns

Phencyclidine (PCP)

TreatmentTreatment Maintain airwayMaintain airway Assist ventilations, as neededAssist ventilations, as needed Treat coma, seizures, hypertension, hypothermia as Treat coma, seizures, hypertension, hypothermia as

neededneeded Quiet environmentQuiet environment Sedation if needed to control agitationSedation if needed to control agitation

HaldolHaldol BenzodiazepinesBenzodiazepines

Page 61: Drug Abuse Self administration of drug or drugs in manner not in accord with accepted medical or social patterns

Inhalants

ExamplesExamples Hydrocarbons (solvents, paints, aerosols)Hydrocarbons (solvents, paints, aerosols) Gases (freon, halon fire extinguishing agent)Gases (freon, halon fire extinguishing agent) Metallic paints (“huffing”)Metallic paints (“huffing”)

Page 62: Drug Abuse Self administration of drug or drugs in manner not in accord with accepted medical or social patterns

Inhalants

EffectsEffects Dysrhythmias including VFDysrhythmias including VF CNS depressionCNS depression SeizuresSeizures Respiratory irritationRespiratory irritation Epinephrine may increase risk of dysrhythmiasEpinephrine may increase risk of dysrhythmias

TreatmentTreatment OxygenOxygen Treat symptomaticallyTreat symptomatically

Page 63: Drug Abuse Self administration of drug or drugs in manner not in accord with accepted medical or social patterns

“Date rape” drugs

Flunitrazepam (Rhohypnol)Flunitrazepam (Rhohypnol) Gamma hydroxybutyrateGamma hydroxybutyrate

Page 64: Drug Abuse Self administration of drug or drugs in manner not in accord with accepted medical or social patterns

Flunitrazepam (Rhohypnol)

Street namesStreet names RophiesRophies RoofiesRoofies R2R2 RoofenolRoofenol

RocheRoche Roachies Roachies La rochaLa rocha RopeRope RibRib

Page 65: Drug Abuse Self administration of drug or drugs in manner not in accord with accepted medical or social patterns

Flunitrazepam (Rhohypnol)

BenzodiazepineBenzodiazepine Similar to Valium but 10x more potentSimilar to Valium but 10x more potent Produced, sold legally in Europe, South Produced, sold legally in Europe, South

AmericaAmerica UsesUses

Short-term treatment of insomniaShort-term treatment of insomnia Sedative hypnoticSedative hypnotic Preanesthetic medicationPreanesthetic medication

Page 66: Drug Abuse Self administration of drug or drugs in manner not in accord with accepted medical or social patterns

Flunitrazepam (Rhohypnol)

EffectsEffects Disinhibition and amnesiaDisinhibition and amnesia Onset within 30 minutes, peak within 2 hours, Onset within 30 minutes, peak within 2 hours,

may persist 8 hours or moremay persist 8 hours or more Frequently abused with alcohol or other drugsFrequently abused with alcohol or other drugs Enhances high produced by heroinEnhances high produced by heroin

Page 67: Drug Abuse Self administration of drug or drugs in manner not in accord with accepted medical or social patterns

Flunitrazepam (Rhohypnol)

Adverse EffectsAdverse Effects DrowsinessDrowsiness DizzinessDizziness ConfusionConfusion Decreased BPDecreased BP Memory impairmentMemory impairment GI disturbancesGI disturbances Excitability, aggressive behaviorExcitability, aggressive behavior

Page 68: Drug Abuse Self administration of drug or drugs in manner not in accord with accepted medical or social patterns

Flunitrazepam (Rhohypnol)

Management of overdoseManagement of overdose Lethal overdose very unlikelyLethal overdose very unlikely Oxygenate, ventilateOxygenate, ventilate Intubate if necessary to control airwayIntubate if necessary to control airway Vascular accessVascular access ECGECG Fluid for hypotensionFluid for hypotension Dextrostick (rule out hypoglycemia)Dextrostick (rule out hypoglycemia) Treat trauma resulting from assaultTreat trauma resulting from assault

Page 69: Drug Abuse Self administration of drug or drugs in manner not in accord with accepted medical or social patterns

Flunitrazepam (Rhohypnol)

WithdrawalWithdrawal HeadacheHeadache Anxiety, tensionAnxiety, tension Numbness, tingling of Numbness, tingling of

extremitiesextremities Restlessness, Restlessness,

confusionconfusion Loss of identityLoss of identity

HallucinationsHallucinations DeliriumDelirium Seizures (up to a week Seizures (up to a week

after cessation)after cessation) ShockShock Cardiovascular Cardiovascular

collapsecollapse

Page 70: Drug Abuse Self administration of drug or drugs in manner not in accord with accepted medical or social patterns

Flunitrazepam (Rhohypnol)

Management of withdrawalManagement of withdrawal Oxygen/ventilationOxygen/ventilation Intubate if necessaryIntubate if necessary EKGEKG Vascular accessVascular access Fluid for hypotensionFluid for hypotension DextrostickDextrostick Diazepam for seizuresDiazepam for seizures

Page 71: Drug Abuse Self administration of drug or drugs in manner not in accord with accepted medical or social patterns

Gamma hydroxybutyrate

Street namesStreet names Cherry methCherry meth Liquid XLiquid X Liquid ecstacyLiquid ecstacy

Originally developed as anestheticOriginally developed as anesthetic Banned in 1991 because of side effectsBanned in 1991 because of side effects Promoted as aphrodisiacPromoted as aphrodisiac

Page 72: Drug Abuse Self administration of drug or drugs in manner not in accord with accepted medical or social patterns

Gamma hydroxybutyrate

EffectsEffects Odorless, nearly tastelessOdorless, nearly tasteless TremorsTremors SeizuresSeizures DeathDeath


Drug pollution or pharmaceutical pollution

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