Phencyclidine

Question 1

The presentation of a patient with acute PCP intoxication is overwhelmingly that of. . .

Answer 1

. . . uncontrollable aggression and hostility, to the point of homicidality

This may come with lability, such that the patient is sociable and cooperative one minute, and extremely hostile and violent the next. Psychosis is also often present.

Question 2

Treating acute PCP intoxication

Answer 2

• Controlling behavior:
  
  • Patient should be kept in a quiet, dark room with minimal stimulation
  • Physical retraints should be avoided if possible, but are often necessary in the early stages
  • Atipsychotics are often required to control violent behavior, but can worsen delirium due to their anticholinergic effects.
  • For this reason, benzodiazepines should be considered first-line when psychosis is not present.
• Treat hypertension with IV antihypertensives
• Acidification of urine is no longer recommended

Question 3

Triad of PCP intoxication

Answer 3

• Hostility/aggression
• Dysarthria
• Nystagmus

Question 4

Phencyclidine

Answer 4

Various street names: angel dust, horse tranquilizer, supergrass, boat, tic tac, hog, ozone, rocket fuel, zoom, Sherman, wach, crystal, embalming fluid

Street versions are sometimes laced with marijuana. It is typically either smoked or injected intravenously.

It is a piperidine similar to ketamine. It is very potent, long-acting, and causes marked behvaioral, physiologic, and neurologic effects in humans: agitation, disorientation, hallucination, delirium.

Question 5

How long do the short-term effects of untreated PCP intoxication last?

Answer 5

~6 hours to days

Question 6

Findings of acute phencyclidine intoxication

Answer 6

• Psychiatric:
  
  • Agression, hostility, violence
  • Lability
  • Psychosis (can be hallucination, delusion, or disorganization)
• Physical:
  
  • Hypertension or tachycardia
  • Hyperthermia
  • Nystagmus
  • Dysarthria
  • Other ataxia
  • Hyperacusis
  • Muscle rigidity
  • Seizure or coma

Question 7

Most of the physical findings of PCP intoxication are present in . . .

Answer 7

. . . the first 6 hours, but dissipate after this

However, alterations in behavior and mood may last longer

Question 8

__ can look a lot like PCP intoxication in terms of behavior

Answer 8

Manic psychosis can look a lot like PCP intoxication in terms of behavior

However, the typical physical findings of PCP intoxication will be absent: nystagmus, dysarthria, ataxia, hypertension/tachycardia

Question 9

Hallucinations and heart block suggests intoxicaton with. . .

Answer 9

. . . flunitrazepam (Rohypnol)

Commonly referred to as a “date-rape” drug

Question 10

Patients sometimes ingest PCP. . .

Answer 10

. . . without knowing it

As it is sometimes added to street marijuana

Question 11

Individuals with PCP intoxication stangely exhibit extraordinary. . .

Answer 11

. . . physical strength