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38 Cards in this Set

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What is the common property of hallucinogens (psychedelics)?

produce distortions of sensory perceptions or create false perceptions and sometimes produce false beliefs (delusions)

Why is there disagreement about which drugs should be classed as hallucinogens or psychedelics?

the drugs don't always produce hallucinations (false perceptions)




classic: LSD, mescaline, psilocybin


weak: PCP, marijuana, MDMA (ecstasy)

What are the two major classes of psychedelics?

Phenethylamine derivatives


-resembles norepinephrine




Indolealkylamines


-resembles serotonin (5HT)

What receptors are bound by the hallucinogens or psychedelics?

-bind 5HT2A and 5HT2C receptors in the cerebral cortex


-strongly bind to DA1 and DA2 receptors

What is the epidemiology of abuse of LSD?

Lysergic Acid Diethylamine


(discovered by chemist Albert Hoffman, 250mcg)




-no use between 1943-1960, experimental


-popularized in 1960s by Harvard psychology professor Timothy O'Leary to expand consciousness


-abused in 60s-70s then declined


-popular again in 1996 and is now widely available


-now used mainly by students and some older people who continued their use



What is the overall difference of a full-dose psychedelic experience compared to other drugs of abuse? What is a permanent risk of the experience?

full dose is "cerebral, intellectual, esthetic"


-risk of temporary or permanent psychological damage

How is LSD used mainly now?

at low doses as a social intoxicant to give mild euphoria and perceptual distortions

Describe the vegetative or prodromal phase of LSD intoxication.

-begins 20-40 min after oral 100-200 mcg


-lasts about 1 hour


-mydriasis, dizziness, tachycardia, piloerection, increased body temperature, muscular weakness or tension, restlessness, cramps, N/V


-unpleasant effects subside before psychic effects begin except pupillary dilation and the increased heart rate

What is the time course of the psychic phase of LSD intoxication?

-begins 1/2 to 2 hours after


-peaks 2-6 hours


-wanes in wavelike fashion


-major effects gone 12 hours after


-all effects gone 24 hours after

What are the five types of effects described for the psychic phase of LSD intoxication? How would you generally describe each of these effects?

1. Distortions in perception


-intensification of colors, textures, relief perceptions, altered perception of space, faces, images, synesthesias, distortions of body/time




2. Pseudohallucinations


-almost entirely visual


-moving, colorful spots and patterns, shapes and people or animals, either good trip or bad (frightening images and insects)




3. Psychodynamic experiences


-remember forgotten experiences


-pseudohallucinations provide the characters


-often pleasant but can do psychological damage




4. Mood liability


-moods intensified and shift rapidly


-can occur with small changes like weather


-usually awe and euphoria


-why environment is important and LSD should be taken with an undrugged but well-experienced person present




5. Changes in thought content/process


-vary with trip and user


-paranoia is common even during good trip


-common "aha" or "eureka" moments which is called "pseudoprofundity"


-sense of unity, God, loss of self and ego

How do psuedohallucinations and hallucinations differ?

true hallucinations are perceptions that have no basis in reality but which are believed


-rare with LSD


-user usually retains full insight into the fact that what he sees is drug-induced

What are the major dose forms and routes of administration of LSD?

1. little squares of blotter paper with LSD solution spotted and dried


-eaten, other drugs not potent with this method




2. liquid


-placed on tongue, in drink, as eye drop




3. other: tablets, capsules, impregnated sugar cubes


-never as powder

What people with certain histories should avoid LSD in particular?

abnormal heart rhythm


-somatic effect (CAD or rhythm disorders)




history of mental disease or genetics


-psychosis, bipolar, depression

What is the duration and onset of the LSD psychic effects?

considerable variation but relatively long


-onset = 30 min to 2 hours


-peak = 2-6 hours


-duration = 8-14 hours

Describe the onset, degree and disappearance of LSD tolerance and cross tolerance.

rapid and extensive


-onset = 3-4 consecutive days of use


-tolerance lost rapidly


-cross tolerance to "classical" hallucinogens


-no cross tolerance to PCP or marijuana

Do psychological and physical dependence occur with LSD?

psychological = rare


-most experiment and then quit


-frequent users called "acid heads"




no physical dependence

What are the six major adverse effects described with LSD? Describe each one.

1. Somatic effects (vegetative phase)


-sympathomimetic effects


-possible cardiotoxicity in predisposed patients (CAD or rhythm disorders)




2. Acute panic reactions


-most common in novice users


-can occur in experienced users (unpredictable)




3. Activation of latent psychosis, bipolar disorder or unipolar depression


-previous history of mental disease or genetic load (serious risk)




4. Accidents due to distorted judgment


-trip-sitters are advisable




5. Acute psychotic reactions


-high dose of 400 mcg or more of LSD


-loss of contact with reality


-true hallucination (rare)


-lasts a day or two at most




6. Flashbacks


-simple flashbacks that are usually enjoyable visual disturbances and can occur weeks or months after a single LSD use


-may persist for 5 years or more


-stroboscopic vision may be permanent


-HPPD

What is HPPD?

Hallucinogenic persisting perceptual disorder


-flashback is distressing


-interferes with normal functioning


-anxiety and depressive symptoms


-benzodiazepines are best treatment but only partially

What are the two main risks with LSD overdose?

-panic reactions


-acute psychotic reactions




risk of death is almost non-existent

What is psilocin?

magic mushrooms or "shrooms"


-popular, especially on college campuses


-ingredient in mushroom is psilocybin and this is converted to psilocin in the gut = active


-often home grown = illegal (schdule 1)

In terms of effects, what are the main similarities and differences of psilocin and LSD?

physical and psychic effects are similar


-effect is much shorter than LSD which is often desirable (4-6 hours vs 8-14 hours)


-acute adverse effects similar and similar rapid tolerance as well as cross-tolerance to LSD and mescaline

What are the characteristics of mescaline? How does it compare to LSD?

peyote cactus, can be home grown


-peyote and mescaline are schedule 1


-used in sacred rituals by Native American Church and other uses are illegal


-effects are similar to LSD but causes more N/V


-shorter duration than LSD (4-8 hours)


-1000 fold less potent for dosage


-rare drug

What is salvorin-A? Is it illegal?

used for hundreds of years by Mexican Indians


-recently "discovered" by U.S. press and users


-found in Salvia divinorum, "magic mint"




Not a controlled substance


-but illegal in most states


-legal in California, Maine, Maryland


-legal to possess in Wisconsin

What are the characteristics of salvorin-A?

chewing leaves, decoction of tea, smoke leaves


-as potent as LSD


-no pure drug is available


-easy to make at high potency


-very few visual effects


-out-of-body experiences, floating, merging with objects, dissociation, depersonalization




-fast onset = 5-10 min


-duration = 30-60 min


-intense trips


-agonist at kappa opioid receptors

What are the primary entactogens considered here?

MDMA


3,4-methylene dioxymethamphetamine




MDA


methylene dioxyamphetamine




MDE


methylene dioxyethylamphetamine

What are the effects of MDMA (ecstacy)?

1. Acute psychotropic effects


-explains widespread use and popularity




2. Activation


-amphetamine-like stimulant




3. Enhanced insight and introspection


-why developed for psychotherapy




4. Increased empathy


-"empathogens"




5. Decreased inhibitions


-related to increased empathy, sexual acts




6. Increased sensory awareness


-enhanced vision, hearing, touch




7. Illusions and hallucinations (rare)


-not considered "classical" hallucinogen but fits the class of "psychedelics"

What is the mechanism of action of entactogens?

1. Taken up in 5HT terminals and promotes massive release of 5HT (serotonin)


-responsible for most of "entactogenic" effects




2. Lesser extent release of DA and NE


-responsible for amphetamine-like effects

Who tends to use entactogens and what are the primary problems with these preparations?

club drug used at raves


-used mainly just to get high




taken orally as tablet or capsule


-unpredictable MDMA content


-often contaminated with other drugs


-can also be snorted, injected or smoked

What are the dose parameters for a single dose of MDMA?

75-150 mg or 1-1.5 tablets


1-2 mg/kg


-onset = 30 min


-peak = 60-90 min


-duration = 3-4 hours

What are the doses of MDMA taken at events like raves?

long-lasting


2-3 tablets over the "session"


25% of users take 4 or more tablets

What are the acute problems taking MDMA?

sympathetic activation similar to amphetamine


-increased blood pressure, decreased appetite, palpitations, sweating, dry mouth and thirst, jaw clenching and bruxism, difficulty urinating, nausea, tremor, balance/gait issues, mydriasis, hyperthermia

Describe the hyperthermia and treatment associated with MDMA use.

primary threat of the drug


-due to disseminated intravascular coagulation or renal failure


-rhabdomyolysis and myoglobinemia


-seen at raves where people are dancing for hours in a hot environment


-can reach 110 F




-take frequent cooling off breaks and drink water or sports drinks

What are the after effects from using MDMA?

persist for 24 hours


-appetite suppression, jaw tension, bruxism,


-drowsiness, difficulty concentrating, muscle aches, paranoia, fatigue, anxiety, depressed mood (day or two)

Describe the adulterants used with MDMA and the problems that result.

adulterants can be as dangerous as MDMA


-paramethoxyamphetamine (PMA)


-LSD


-dextromethorphan (DXM) at high doses




-PMA and DXM doesn't produce empathogenic effect so can lead to overdose if more taken


-PMA and DXM can cause hyperthermia too


-DXM is strong hallucinogenic at high doses so can lead to dangerous behavior or panic

What occurs with MDMA overdose?

-strong sympathomimetic effects


-extreme agitation


-seizures


-respiratory depression


-coma


-death (rare, hyperthermia increases possibility)

Does tolerance occur with MDMA? Describe.

with repeated use


-starts after first dose


-can never recapture first use effects


-chronic users increase their dosage


-tolerance is pharmacodynamic (5HT depletion)

Does psychological and physical dependence occur with MDMA?

psychological dependence


-rare, usually taken only on weekends




no physical dependence or withdrawal

What are the effects of chronic MDMA use?

1. Neuronal degeneration (high MDMA doses)


-degeneration of long axonal projections of raphe 5HT neurons


-long lasting and possibly permanent




2. Depletion of 5HT in humans


-suggested by PET scans




3. Possible consequences of 5HT terminal degeneration


-tolerance development possibly to MDMA


-impairments in memory and cognition




should avoid MDMA and especially at high doses or chronically