Club Drugs

Question 1

d-Methamphetamine

Answer 1

Large crystals of pure D-isomer are often smoked, much like CRACK
snorted and IV use to
Long duration of action
Similar "runs" then crash
New "high-tech" drug
Longer acting than CRACK
Effective weight reduction

Question 2

Psychiatric Complications d-Meth

Answer 2

Acute anxiety
Acute paranoid psychosis
Chronic schizophreniform psychosis
Possible induction of panic attacks
not due to latent psychosis

Question 3

MDMA vs Molly

Answer 3

Molly more a pure form than MDMA
devoid of adulterants and is claimed to be safer and non-addictive
Molly is the powder form so it can be snorted
MDMA is typically sold as a pressed pill and is swallowed

Question 4

MDMA Effects

Answer 4

Induced altered state of conciousness
Patients receptive to psychotherapy
Facilitates communication skills and heightens empathy– spiritual pursuit
Adjunct to insight oriented psychotherapy
No memory deficits
Neuropsychological test performance is impaired with chronic use

Question 5

MDMA Abuse Liability

Answer 5

MDMA is self administered by rhesus monkeys and baboons
MDMA shared discriminative stimulus effects with amphetamine
MDMA is reinforcing in human volunteers

Question 6

MDMA USE Profile

Answer 6

Oral dose of 100-200 mg
Smoked, snorted, or injected
Stacking or piggybacking- taking 3 or more tablets at a time
Used at parties often with other drugs

Question 7

MDMA mechanism of action

Answer 7

Binds to 5-HT transporters in plasma membrane and secretory vesicle
Enter the vesicle and causes massive release of serotonin
Extra serotonin binds to receptors
Half life of 8-9 hours
Next day “pleasant”effects due to its MDA metabolite that exerts LSD like effects

Question 8

Effects of MDMA on serotonin

Answer 8

Once effects wane, users tempted to take another dose, but serotonin levels are low
Serotonin dip that may last days to weeks- depressed mood
Prolonged use will cause a depletion in serotonin
Continued use will also cause a down regulation of serotonin receptors
Likely cause of depression in MDMA users

Question 9

MDMA and other drugs

Answer 9

Some obtain Prozac to deal with depression
others get ritalin to increase concentration
Mix of drugs is dangerous
Tolerance develops to its effects with prolonged use

Question 10

Toxicity- MDMA

Answer 10

Psychiatric Toxicity
Induction of panic disorder
Long-lasting neuropsychiatric syndromes
Psychosis, visual illusions and hallucinations
Flashbacks
Neurotoxicity
Cerebral infarcts
Subarachnoid hemorrhage
Hyponatremia with stupor

Question 11

General Toxicity MDMA

Answer 11

Sympathomimetic reactions
hyperreflexia, hyperthermia and rhabdomyolysis
Kidney failure, seizures, coma and death
Hyperthermia secondary to neurotransmitter depletion
Fatal or near fatal reactions

Question 12

Mechanism of Toxicity MDMA

Answer 12

Mechanism unclear– first thought to be hypersensitivity reaction
Recognized as due to overdose
MDMA is metabolized to MDA, more potent neurotoxin

Question 13

Neuronal Damage MDMA

Answer 13

Can damage neurons that make serotonin
Damage is long lasting (6 years)
Neuronal damage persists long after effets have worn off
Nerve fibers regrow in some brain areas, but make abnormal connection, and some do not regrow

Question 14

Rohypnol

Answer 14

Roofies
Sedation, amnesia, muscle relaxation, slowed relexes
Often used in combination with ethanol, marihuana or cocaine to produce a very rapid and dramatic high
Used as a parachute with heroine and cocaine users when coming off the high
Inexpensive on the street, sold in bubble packets

Question 15

Gamma hydroxybutyrate

Answer 15

GHB does not act directly on GABA receptors
May inhibit release of dopamine, resulting in stored levels that are released later
Stimulates GH release and PRL rises

Question 16

PCP

Answer 16

Made in 1950s as anesthetic
Analgesia, muscle relaxation, no cardiovascular or respiratory depression, no amnesia after surgery
During recovery, many patients have emergent nightmares that last 4-5 days
PCP joints called sherms
Lab animals self administer PCP
NMDA receptor antagonist

Question 17

Ketamine

Answer 17

Analogue to PCP
Currently used in veterinary medicine
Applied as a powder to marihuana or tobacco cigarettes and smoked
Powder form is snorted like cocaine
IV has rapid onset
High doses can result in delirium, amnesia, impaired motor function, and sometimes fatal respiratory effects

Question 18

PCP and Ketamine Mechanism of Action

Answer 18

Antagonists at the NMDA receptor which binds glutamate and glycine to allow neural transmission to occur
Other drugs act in a similar manner to produce dissociative, hallucinogenic euphoria include dextromethorphan, methoxetamine and nitrous oxide

Question 19

Psychotomimetic

Answer 19

Agent that produces effects that resemble psychosis

Question 20

LSD Effects

Answer 20

Restlessness, dizziness, drunk
Stream of plastic and vivid images accompanied by intense splay of colors
altered sense of time
reduced sensory input
Synesthesia, mixing of senses
Higher doses: marked distortion of vision, unable to move and transformed senses

Question 21

LSD

Answer 21

4000 times more potent than mescaline
Used to model psychosis to improve treatment
Felt one could access the subconscious mind through dreamlike quality of the experience

Question 22

LSD uses

Answer 22

Adjunct to psychotherapy
Treatment for alcoholics
Help terminal cancer patients understand their mortality
LSD illegal

Question 23

LSD Pharmacology

Answer 23

Similar structure with serotonin suggests that it acts as an agonist at 5-HT receptors
Serotonergic antagonist do not block all of LSD effects and can act as an agonist or antagonist on different serotonergic systems
High correlation between binding potency in rat brain and potency to produce hallucinations in humans

Question 24

LSD Patterns of USe

Answer 24

Formulated as a powder, capsule, pill, or solution
Use is infrequent, tied to specific events along with friends
Recent increased use due to lower unit dose and fewer adverse effects

Question 25

LSD Adverse Reactions

Answer 25

Difficult to determine dose Panic reactions Flashbacks can occur months later Brief recurrence of either psychotic or nonpsychotic effects Mostly before sleep or under stress or after marihuana or barbiturates

Question 26

Prolonged Psychotic Reaction LSD

Answer 26

Prolonged psychotic reactions (Up to 3 weeks) Schizophrenic- like is most common, but catatonic depression paranoia and manic psychosis is all noted Reports after a single dose have appeared Originally though it happened with people with underlying psychiatric conditions- can occur in people with no psychiatric disorders

Question 27

Psilocybin

Answer 27

Dried mushroom contain 0.2-5% Effects similar to LSD Metabolized to psilocin, 1.5 times more potent Amateur production Taken with ethanol, effects difficult to percieve

Question 28

Psilocybin Use

Answer 28

Treating tobacco dependence

Question 29

Mescaline

Answer 29

Found in cactus Buttons softened in saliva and softened Active item is mescaline, one of 30 different psychoactive chemicals Need 20 mescal buttons to achieve average dose

Question 30

Mescaline Pharmacology

Answer 30

Binds and activates 5-HT receptors Absorbed orally but does not easily pass the blood brain barrier, high doses needed for psychoactive effects Doses of 200-250 result in pleasurable experiences while 350-450 mg produce frank hallucinations Blocked by 5-HT antagonists Cross tolerant with LSD

Question 31

Mescaline Effects

Answer 31

Mydriasis, hyperthermia, anxiety hallucinations and altered body image Body parts may disappear High doses induce bradycardia, reduced respiratory rate, smooth muscle contractions, in coordination, loss of time perception Effects persist for 10-12 hours

Question 32

Salvia Divinorum

Answer 32

Mexican herbal sage that produces type of divine innebriation Effects are not like any other drug- best used by those wanting deep meditation Salvinorum A- kappa opioid agonist and D2 receptor partial agonist with mild hallucinogenic properties Used in more quiet settings for introspective contemplation and meditation

Question 33

Salvia Divinorum Pharmacology

Answer 33

Buccal absorption via either chewing leaves or tincture takes longer to appear Most rapid onset via smoking, but need high temperature to release it Fortified leaf is preferred High LD50 so relatively safe Smoking produces effects nearly immediately, peak within 5-10 min

Question 34

Therapeutic Potential Salvia Divinorum

Answer 34

Modulator of opiate receptors that regulate dopamine levels- stimulant abuse Psychotherapy- not likely to be approved