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38 Cards in this Set
- Front
- Back
What is the common property of hallucinogens (psychedelics)? |
produce distortions of sensory perceptions or create false perceptions and sometimes produce false beliefs (delusions) |
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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) |
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What are the two major classes of psychedelics? |
Phenethylamine derivatives -resembles norepinephrine Indolealkylamines -resembles serotonin (5HT) |
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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 |
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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 |
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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 |
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How is LSD used mainly now? |
at low doses as a social intoxicant to give mild euphoria and perceptual distortions |
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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 |
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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 |
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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 |
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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 |
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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 |
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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 |
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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 |
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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 |
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Do psychological and physical dependence occur with LSD? |
psychological = rare -most experiment and then quit -frequent users called "acid heads" no physical dependence |
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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 |
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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 |
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What are the two main risks with LSD overdose? |
-panic reactions -acute psychotic reactions risk of death is almost non-existent |
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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) |
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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 |
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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 |
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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 |
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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 |
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What are the primary entactogens considered here? |
MDMA 3,4-methylene dioxymethamphetamine MDA methylene dioxyamphetamine MDE methylene dioxyethylamphetamine |
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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" |
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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 |
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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 |
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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 |
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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 |
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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 |
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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 |
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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) |
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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 |
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What occurs with MDMA overdose? |
-strong sympathomimetic effects -extreme agitation -seizures -respiratory depression -coma -death (rare, hyperthermia increases possibility) |
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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) |
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Does psychological and physical dependence occur with MDMA? |
psychological dependence -rare, usually taken only on weekends no physical dependence or withdrawal |
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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 |