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23 Cards in this Set
- Front
- Back
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How does Rosen's classify hallucinogens?
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Sertonin-like agents (LSD & Tryptamines)
Entactogens (Amphetamines, Mescaline & Piperazine) Dissociative agents (PCP, Ketamine, Dextromethorphan) Marijuana Miscellanious (Salvia, Kratom, Iboga, Absinthe, Isoxazole Mushrooms) |
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What are tryptamines?
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Various natural and synthesized serotonin-like agents including:
DMT (beverage), 5-MeO-DMT (snake venom), Psilocybin & Psilocin (mushrooms) |
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How do serotonin-like agents work?
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Understanding is incomplete
They seem to act on serotonergic neurons increasing forebrain/cortex activity |
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How do patients using serotonin-like agents present?
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Generally with panic attacks and paranoid delusions
Can have sympathetic symptoms (mydriasis, elevated HR/BP, diaphoresis). Presumably, serotonin syndrome would also be possible |
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How is a patient presenting after ingesting a serotonin-like agent managed?
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Benzo's for pretty much everything
Helps agitation and stimulation |
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What are entactogens?
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If amphetamine and LCD had a baby, it would be an entactogen
Designer amphetamines (Ecstacy/MDMA, MDA, PMA), Mescaline, Piperazine & Nutmeg (wtf?) fall into this class |
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How do patients using designer amphetamines present?
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They experience "sensory enhancement"
Worst-case - hyperthermia/rhabdomyolysis, hyponatremia/seizures |
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What is Mescaline?
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Part of a South American cactus that causes vivid hallucinations (like LSD)
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What is Piperazine?
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"Legal E" that has similar but less potent effects. Ooriginally hoped to be an antihelminthic agent.
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How does MDMA cause hyponatremia?
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-excessive free water intake (raves!)
-MDMA-mediated release of ADH |
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How is a patient presenting after ingesting an entactogen agent managed?
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Similar to serotonin-like agent but with more concern for hyponatremia and hyperthermia. Monitor them and give them benzo's.
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What is PCP?
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Phencyclidine was supposed to be used for GA until the severe emergence reactions crushed it. Now it is less popular because it was unpredictable, caused dysphoria and people got violent.
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What is ketamine?
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Similar to what we use for sedation except often with added stimulants on the street.
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What is dextromethorphan?
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Similar in structure to PCP, but not actually dissociative.
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How do ketamine and PCP work?
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Multiple effects..
Antagonizes NMDA receptor, dopamine/NE/serotonin reuptake, opioid and cholinergic receptors. |
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How do patients present after ketamine and PCP ingestion?
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Varried.
From lethargic/calm/apneic To sympathetic syndrome with hyperthermia/rhabdo/seizures/arrhythmias Known for endowing superhuman strength due to dissociation and pain control. Note characteristic nystagmus |
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How do patients present after marijuana ingestion?
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Paranoia, psychosis
Watch for co-ingestions |
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What is salvia?
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Salvia is a herb that acts on the kappa-opioid receptors causing hallucinations comparable to LSD but does not work on serotonin receptors. It lasts 1h
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How do patients present after salvia ingestion?
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with hallucinations and "synesthesias."
Treatment is supportive. |
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What is kratom?
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A tree with extracts that have activity at mu and delta opioid receptors and produce euphoric, analgesic and respiratory depressive properties.
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What is Iboga?
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An African rain forest shrub that has multiple effects and is used to ease opioid withdrawal. Also causes vivid visual hallucinations.
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What is absinthe?
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A liqueur aged in wormwood that has an active ingredient that antagonizes the GABA receptor causing confusion, delirium, euphoria and hallucinations. May cause seizures.
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What are isoxazole mushrooms?
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Syberian mushrooms which contain glutamic acid and GABA analogues and can cause a mixed picture. Seizures are reported with an anticholinergic type toxicity.
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