Synthetic Cannabinoids OD

Question 1

Cannabinoids MoA

Answer 1

Bind and agonize the cannabinoid receptors

Question 2

Origin of phytocannabinoids

Answer 2

Plant-based

Question 3

Which part of the plant has more THC: hemp or MJ

Answer 3

MJ (the little fuzzy parts of the plant)

Question 4

Wanted effects of phytocannabinoids

Answer 4

Mood elevation, euphoria, relaxation, creative thinking, increased sensory awareness, appetite stimulation, nausea suppression

Question 5

Paradoxical effects of phytocannabinoids

Answer 5

Short-term memory difficulties, agitation, feeling tense, anxiety, dizziness, lightheadedness, confusion, loss of coordination

Question 6

How do you make a synthetic cannabinoid?

Answer 6

Mix and match a rink, link, core, and tail to form different combos

Question 7

THC is a _________ a CB1 receptors.

Answer 7

partial agonist

Question 8

THC effects

Answer 8

Mood elevation, euphoria, relaxation, creative thinking, increased sensory awareness

Question 9

Desired effects of synthetic cannabinoids

Answer 9

The same effects as THC

Question 10

Unwanted effects of synthetic cannabinoids

Answer 10

Pretty much anything else…

tachy/bradycardia, agitation/irritability, N/V, drowsiness, confusion, seizures, ischemic stroke, MI, cardiac arrest, tremors, hallucinations, respiratory depression, rhabdomyolysis….the list goes on but it’s not good

Question 11

Where are CB1 receptors expressed?

Answer 11

Brain regions

Question 12

Where are CB1 receptors not found and what does it explain?

Answer 12

The brainstem, which explains the lack of coma and respiratory depression seen

Question 13

Where are CB2 receptors expressed?

Answer 13

Periphery in immune cells

Question 14

Signs and symptoms of synthetic cannabinoid OD

Answer 14

CNS depression, disorientation, restlessness/agitation, hallucinations, generalized seizures, combativeness, anxiety, mydriasis, tachycardia, vomiting

Question 15

Lab abnormalities of synthetic cannabinoid OD

Answer 15

Decreased potassium

Increased BG, CK, WBCs, creatinine

Question 16

Supportive care for synthetic cannabinoid OD

Answer 16

Fluids/electrolyte management
Antiemetics
BZDs
Ketamine if the patient is profoundly agitated and aggressive
Intubation

Question 17

Patho of cannabinoid hyperemesis syndrome: what is dysregulated?

Answer 17

The endocannabinoid system

Question 18

Patho of cannabinoid hyperemesis syndrome: what happens as a result of endocannabinoid dysregulation?

Answer 18

Desensitization and downregulation of CB1 receptors that generally has antiemetic effects

Question 19

Patho of cannabinoid hyperemesis syndrome: what is altered

Answer 19

The TRPV1 receptor after chronic cannabinoid use

Question 20

Diagnosis of cannabinoid hyperemesis syndrome

Answer 20

Hx of regular cannabis use
Cyclic N/V
Generalized, diffuse, abdominal pain
Compulsive hot showers with symptom management

Question 21

Phases of CHS: pre-emetic/prodromal phase- how long is it?

Answer 21

Months-years

Question 22

Symptoms of pre-emetic/prodromal phase of CHS

Answer 22

Diffuse abdominal discomfort, feelings of agitation or stress, morning nausea, and fear of vomiting → increased use of MJ to treat

Question 23

Phases of CHS: hyperemetic phase- how long is it?

Answer 23

24-48 hours

Question 24

Symptoms of hyperemic phase of CHS

Answer 24

Cyclic episodes of N/V
Diffuse, severe abdominal pain

Question 25

Phases of CHS: recovery phase- when does it happen?

Answer 25

Upon TOTAL cessation of cannabinoids, may take ~1 month

Question 26

What to do in the recovery phase of CHS

Answer 26

Manage bowel regimens, fluids, electrolyte replacement

Question 27

Clinical management of CHS: non-pharm care

Answer 27

Hot showers, capsaicin topical cream on the abdominal area/stomach

Both will activate TRPV1

Question 28

Clinical management of CHS: anti nausea agents

Answer 28

Haloperidol, ondansetron

Question 29

Antinausea agents for CHS: which one’s better?

Answer 29

Haloperidol

Question 30

Clinical management of CHS: effects of using BZDs

Answer 30

inhibitory effects on medullary and vestibular nuclei associated with N/V

Question 31

Clinical management of CHS: supportive care

Answer 31

fluids, electrolytes

Question 32

Synthetic cannabinoids are _______.

Answer 32

full agonists