Misuse of OTC medicines

Question 1

what are the classes of highly misused OTC medications

Answer 1

Co-codamol and co-dydramol containing products

Codeine linctus / liquids containing morphine

Loperamide

Senna / other laxatives

Promethazine / diphenhydramine containing products

Dextromethorphan containing products(cough)

Phenylephrine / pseudoephedrine / ephedrine containing products

Acids /alkalis/ solvents / other ‘chemicals’

Question 2

why are opiate containing products abused

Answer 2

1- For psychotropic affect (A high)
2-May become dependant
3-Prevents effects of withdrawal from things like opiates (self- detox)
4- Loperamide – to prevent GI symptoms of opiate or other drug withdrawal

Question 3

Why are laxatives abused and what are the consequences

Answer 3

1-Changes in body image-weight loss due to chronic diarrhoea
2-associated with eating disorders such as anorexia or bulimia

Consequences: Dependence for bowl movement

Question 4

Why are anti-histamine abused

Answer 4

Dependence due to regular use

Due to Antipsychotic effect at very high doses

Question 5

Why is ephedrine abused

Answer 5

1.Body image – train harder in the gym

2.Psychotropic effects – ‘high’ (amphetamine-like effect) Also to ‘top-up’ illicit substances in addiction e.g. amphetamines

3. Use in the manufacture of amphetamines such as methamphetamine

Question 6

Why are cough suppressant abused

Answer 6

Accumulation of active metabolite dextrorphan (produced by n-demethylation at CYP 2D6) occurs at v high doses

Causes similar effects to ketamine and PCP via NMDA antagonism : Hallucinations, Loss of time, changed in body perception and disconnection

Question 7

What are the side effects of abusing Cough suppressants

Answer 7

psychosis, mania, increased sympathetic drive.

Question 8

what are the four stages of Dextromethorphan (Cough suppressant consumption)

Answer 8

1- First plateau between 100-200mg (Mild stimulation)

2- 200-400mg (Hallucination and Euphoria)

3-300-600m (motor coordination and distorted visual perceptions)

4-500mg -1500mg (experience dissociative sedation)

Question 9

Chemical abuse

Answer 9

Acids may be used to increase solubility of heroin, cocaine or amphetamines for injection.

Citric acid is said to produce an additional ‘high’ when injected

Used in the manufactures of illicit drugs

Can be used to make bombs (tricycloacetyl peroxide (TCPA) )