Psychedelic misuse

Question 1

Psychedelics (preferred over hallucinogenics)

Answer 1

-produce non-ordinary and variable forms of conscious experiences
-changes in moods, thoughts, sensations

Question 2

Delusion

Answer 2

-fixed, false belief, unresponsive to logic
-paranoia

Question 3

Hallucination

Answer 3

-false perception arising from internal stimuli
-creates false reality

Question 4

Illusion

Answer 4

-misperception of external stimuli

Question 5

Psychedelic classes

Answer 5

-classical: phenethylamine (MDMA) and trytamine derivatives (LSD, DMT)
-dissociative: phencyclidine, ketamine, muscimol

Question 6

Phenethylamine derivatives

Answer 6

-mescaline
-MDA
-MDMA

-classical

Question 7

Derivatives of tryptamine

Answer 7

-DMT
-5-MeO-DiPT
-LSD
-Ibogaine

-classical

Question 8

Naturally occuring classical psychedlics

Answer 8

-Dimethyltyrptamine (DMT)
-5-MeODMT
-psilocybin prodrug of psilocin

-classical

Question 9

Mescaline

Answer 9

-3,4,5-trimethoxyphenethylamine
-peyote

Question 10

Mescaline and Phenethylamine (peyote)

Answer 10

-combo LSD and MDMA efffects
-amphetamine like (MDMA, bathsalts)
-inc release of 5-HT > DA, NE
-empathogens/entactogens (more hallucinogenic than stimulatory)
-llowest potency
-long lasting
-cross tolerance to LSD

Question 11

most classical psychs MOA!!

Answer 11

-5-HT2A agonists!!
-pretreatment w antagonists blocks effects
-BUT MDMA stimulates 5HT2A release
-increase global integration, communication patterns of CNS

Question 12

Clinical manifestations of psychedelics

Answer 12

-sensory illusions
-highly pleasurable state of self-dissolution (oceanic boundlessness) bliss/peace
-anxious ego-dissolution = bad trip

Question 13

Psychedelic ADRS

Answer 13

-physical: tachycardia, HTN, tremors, dry mouth, Nausea, hyperthermia
-dysphoric: terrifying thoughts, fears of insanity, loss of control, death
-psychotic: flashbacks, enduring changes in personality, exacerbate underlying psych probs, instigate prolonged psych disorder
-rate of psychosis after LSD 1-5%

-tolerance, no addiction
-mood changes

Question 14

Enduring ADRs of psychedelics

Answer 14

-anxiety, fear, personality changes 1 week to upto 3+ years later

Question 15

Potential therapeutic uses of psychedelics

Answer 15

-cancer psychological distress
-PTSD
-depression
-alcohol substance uses

Question 16

short-comings of clinical trials

Answer 16

-small sample
-lack of adequate control (antihistamines used)
-selection bias (those experienced w psychedelic drug use)
-over 90% of volunteers excluded (not reflective of population)

Question 17

Dissociative psychedelics

Answer 17

-inhibit NMDA receptors
-inhibit GABA release
-inc glutamate release

-ketamine
-dextromethorphan
-PCP
-muscimol (GABA agonist)

Question 18

Ionotropic glutamate receptors

Answer 18

-NMDA ANTAgonist
-induce anesthesia and analgesia

Question 19

Ketamine

Answer 19

-NMDA ANTAgonist (dissociative)D
-S+ more active
-fast/short acting
-esketamine for treatment resistant depression
-used in opioid tolerant pt for chronic pain

Question 20

Dextromethorphan (DXM)

Answer 20

-NMDA ANTAgonist (dissociative)
-also SERT inhibitor
-abused by 4% of high schoolers
-dose for cough 60mg
-dose for high 100-600mg

Question 21

Phencyclidine (PCP)

Answer 21

-NMDA ANTAgonist (dissoiation)
-more potent than ketamine
-D2 agonist
-cig or blunt dipped in liquid PCP 4-6h (ppl dont know laced)
-severe dissociation and analgesia (self-mutilation w/o recognition)
-psychotic reactions
-misuse associated w violence and suicide

Question 22

Muscimol

Answer 22

-GABA-A agonist (dissociative)
-contrast benzo and alcohol modulators
-

Question 23

Psychedelic predominantly cause:

Answer 23

-illusions

Question 24

Classical Psychedelic MOA

Answer 24

-serotonin agonists

Question 25

Dissociative psychedelics + MOA

Answer 25

-Antagonists of NMDAR: ketamine, dextromethorphan, phencylidine (PCP) -Agonist of GABAA (Muscimol)

Question 26

Psychoactive inhalants

Answer 26

-liquids (paint thinner, glue, gas, markers) -aerosols (spray paint) -gases (whipped cream, chlorophorm, NO, propane) -nitrites (poppers, NO, leather cleaner, room deodorizer, food preservatives)

Question 27

Alkyl Nitrites (poppers)

Answer 27

-cleaning solutions, room deodorizers -NO release = smooth muscle relaxation -relax anus, enhance erections, euphoria -high abuse among gay men -methemoglobinemia risk

Question 28

Volatile Solvents

Answer 28

-liquid at room temp and evaporate quickly -Toulene: glues, spray pain -Acetone -Benzene: cleaning spplies, rubber cement, tire tube kits -Butane: cig lighters, hairspray, spray pain -highest use in adolescents (prob access)

Question 29

Volatile solvent MOA

Answer 29

-not really known -Toluene best known -GABA A activated

Question 30

Clinical effects of volatile solvents

Answer 30

-locomotor stimulation -euphoria -exileration -high dose: CNS depression, slurred speech, disorientation, weakness, sedation

Question 31

Risks of inhalant abuse

Answer 31

-asphyxiation from fumes displacing O2 -suffocation: blocking air from lungs, plastic bag over head -convulsions/sz from electrical discharges in brain -coma: brain shuts down -choking: inhalation of vomit -Fatal injury: DUI -100-200 fatalities per year in US -compulsive use (not addiction) -neurotoxicity

Question 32

Sudden Sniffing Death Syndrome

Answer 32

-fatal arrhythmia within minutes of inhalation

Question 33

Inhalant MOA summary

Answer 33

-nitrites: NO release -solvents: GABA-A potentiation?

Question 34

means of inhalation

Answer 34

-sniffing -huffing -bagging -dusting

Question 35

Inhalant toxicities summary

Answer 35

-nitrites: methemoglobinemia -Solvents: asyphixia, sudden death, choking, neurotoxicity

Question 36

Types of inhalants summary

Answer 36

-volatile solvents -aerosols -sprays -nitrites