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Serotonin-like agents
Entactogens
Dissociative Agents
Marijuana, plants, fungi
100
the most common adverse reactions to psychedelics include:
What are: panic attacks and paranoid delusion, fear of impending death! ie "bad trip"
100
examples of entactogens include:
What is MDMA, bath salts, Molly, mescaline, nutmeg
100
the following common OTC medication may cause a false positive on the UDS for PCP.
What is dextromethorphan.
100
THC, tetrahydrocannabinol, is the active agent of cannabis (sativa, indica). which is the more efficient route of delivery - ingestion or inhalation? bonus - what % is absorbed in each route?
What is: inhalation (smoked) - 50% ingested - 6% duration of effects 2-4 hours when smoked, 6-12 hours when ingested
200
give 2 examples of drugs/substances in this class
What are: LSD - lysergic acid diethylamide tryptamines - DMT psilocybin and psilocin - naturally occurring in mushrooms. act to enhance serotonergic activity
200
describe the mechanism of action of drugs such as MDMA.
What is: they act particularly on 5-HT receptors and alter catecholamine neuotransmission, leading to release of serotonin, dopamine, and norepi.
200
rectal infusion of ketamine, widely known to achieve a profound high is known colloquially as:
What is "K-hole"!
200
these are the common physiologic effects of marijuana.
What is: tachycardia, conjunctival injection, dry mouth, increased appetite, relaxation, euphoria, urinary retention. adverse effects are rarely seen. no deaths have been attributed to marijuana use alone.
300
What is the management approach to LSD ingestions and adverse reactions in the ED?
What is: Supportive care. restrain patient or sedate as needed. Liberal use of benzo's, titrated to sedation to decrease agitation. may use haldol - but monitor qtc. avoid phenothiazines.
300
entactogens such as MDMA (ectasy) are commonly enjoyed at raves. what are the adverse effects typically seen if these patients present to the ED?
What is Rhabdomyolysis and hyperthermia. this is thought to be due to excess adrenergic activity and continuous muscle activity during the parties.
300
Describe the classic PCP presentation in the ED. what is the mechanism of action?
What are: sympathomimesis, severe agitation and strength, confusion, nystagmus, increased secretions. with severe ingestions --> hyperthermia, accelerated HTN, increased ICP, organ damage, rhabdo
300
compared to marijuana, synthetic marijuanas such as Spice have similar but more unpredictable effects, some of which are undesirable such as:
What is: panic attacks, paranoia, acute psychosis, vomiting
400
serotonergic agents cause sympathomimetic changes, including the following:
What are: dilated (mydriasis) reactive pupils, elevated BP, HR. rarely temp. generally no nystagmus, ataxia, rigidity
400
The following entactogen, also known as mescaline, is derived from this natural plant used in religious rituals of native mexican and south americans. It was also featured in the motion picture "Zoolander"
What is "Peyote" - a cactus native to the americas. it is a psychoactive alkaloid, causes vivid hallucinations. similar effects as LSD.
400
Describe the treatment approach to severe PCP or ketamine presentations
What is: liberal use of benzos (ie ativan) and haldol, titrated to sedation. restraints temporarily to facilitate iv access. cardiac monitor, pulsox, liberal use of IV fluids. core temp monitoring and active cooling if needed. labs: cbc, cmp, CK-total, tox screens goal: prevent injury to patient and staff, prevent rhabdo
400
A false positive THC on drug screen may be caused by:
What is efavirenz, ibuprofen, and naproxen!
500
Disposition for the majority of LSD, psilobycin ingestions?
What is: typically to home once observed and treated supportively for several hours. rarely may require admission for medical complications (ie. rhabdo, dehydration) or injuries sustained while under influence
500
a potentially dangerous electrolyte abnormality associated with MDMA ingestions.
What is severe hyponatremia - seizure, stupor death. excessive free water intake (ie at raves) + MDMA mediate release of antidiuretic hormone. this is not described in other amphetamines.
500
a drug screen may be positive for PCP how long after the last use?
What is 2-4 days after the last use, or as long as 1 week in chronic exposure.
500
T or F: screening tests for drugs of abuse are NOT essential or helpful in acute management of intoxications.
What is True! make the diagnosis clinically (toxidromes) and treat accordingly. Will a negative result (1, 2, 3 hours after patient arrival) change your treatment plan?