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بنام خداوند بخشنده مهربان

بنام خداوند بخشنده مهربان. The Drugs of Abuse. "Drug-Use Is Life Abuse". The Drugs of Abuse. 1. Sedatives / Hypnotics 2. Hallucinogens 3. PCP (Phencyclidine) 4. Anabolic Steroids 5. Inhalants 6. Opioid 7. Alcohols. The Drugs of Abuse. 1. Sedatives / Hypnotics.

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بنام خداوند بخشنده مهربان

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  1. بنام خداوند بخشنده مهربان

  2. The Drugs of Abuse "Drug-Use Is Life Abuse"

  3. The Drugs of Abuse • 1. Sedatives / Hypnotics • 2. Hallucinogens • 3. PCP (Phencyclidine) • 4. Anabolic Steroids • 5. Inhalants • 6. Opioid • 7. Alcohols

  4. The Drugs of Abuse • 1. Sedatives / Hypnotics

  5. High Potency / Short Acting Most Addiction Sympt. / Severity -Alperazolam -Lorazepam -triazolm Low Potency / Short Acting Good Temporary Sleepers for Hosp. Patients. -Serax -Temazepam 1. Benzodiazepines

  6. High Potency / Long Acting Substitute for Short Acting in Withdrawal -Prosom -Klonepin Low Potency / Long Acting Addiction In High Doses -Valium -Librium -Tranxene Benzodiazepines

  7. 2. Barbiturates • Short Acting (Highly Lipid Sol.) -Pentobarbital (Yellows) -Secobarbital (Reds) -Amobarbital (Blues) • Long Acting -Phenobarbital -Substitute for Short In Tx.

  8. Benzodiazepines Equiv. Doses • Alprazolam (Xanax) 1mg • Triazolam (Halcion) 0.25mg • Temazepam (Restoril) 15mg • Lorazepam (Ativan) 2mg • Diazepam (Valium) 10mg • Phenobarbital 30mg

  9. MOA • GABA Receptor CNS Inhibition --Benzos Potentiate GABA --Barbs Potentiate + Agonists • Respiratory Depression --Benzos + Other CNS Depressants --Barbs Alone • Both With Anticonvulsant Activity

  10. CNS Inhibition • With Dose: 1. Decreased Anxiety 2. Sedation 3. Amnesia 4. Hypnosis 5. Anesthesia 6. Reduced Reflexes / Respiration 7. Death

  11. Metabolism • Benzodiazepines by Liver Microsomal Enzymes, Metabolites May Be Active Extending Half-life. • Barbiturates by Cytochrome P450 Enzymes, Commonly Induced With Resulting Breakdown of Alcohol , Steroids, Fat Soluble Vitamins, and Anticoagulants.

  12. Discontinuation. • Return: Of Original Symptoms • Rebound: Intense Orig. Symptoms • Withdrawal: (Long Use, High Dose) -Anxiety, Panic -Paranoia, Hallucinations -Tremor, Seizures, Delirium -Depression, Irritability, N&V

  13. Withdrawal Timing • Short Acting Barbs --Onset 1/2 Day --Peak 1-3 Days • Short Acting Benzos --Onset 1 Day --Peak 2-4 Days • Long Acting Barbs / Benzos --Onset 2 Days --Peak 5-8 Days

  14. Complications • Benzodiazepines -Memory Loss, Amnesia -Ataxia, Incoordination, Vertigo -Diplopia, Dizziness -Impairment in Driving -Depression, Suicidal Ideation • Relatively Contraindicated in Addiction

  15. Overdose • Signs & Symptoms: --Slurred Speech, Staggering --Nystagmus, Slow Reaction --Respiratory Depression • Barbiturates: 3-10 Mg / Dl • Benzodiazepines: 1-2 Gm or More --Less With Alcohol !!!

  16. Benzo OD Treatment • Flumazenil --Benzo Antagonist --0.2 Mg, Then 0.3 Mg, Then 0.5 Mg, IV, Max 3.0mg --May Precipitate Withdrawal • Supportive Measures --Airway Management, Etc.

  17. Detoxification • Gradual Dose Tapering Over Several Days to Weeks • Substitution of Long Acting Form: --Phenobarbital --Use Equivalent Dose and Taper by 30 Mg or 10% Per Day. (Max. 500mg / D)

  18. Detoxification-examples • Drug Daily dose PB dose Valium 40mg 30mg/10mg = 120mg Ativan 10mg 30mg/2mg = 150mg • PB is then tapered 10% / d X 10 d • Xanax requires slower tapering

  19. “Date Rape Drugs”Rohypnol & GHB Classified as depressants

  20. Rohypnol: Flunitrazepam • Benzodiazepine • Indirect GABA agonist • alcohol synergism • p.o. & intranasal administration • Dissolves easily in carbonated drinks • tasteless • odorless • Associated with sexual assaults

  21. Rohypnol: Flunitrazepam • Effects same as any benzodiazepine • feeling of well-being • lowered inhibitions • impaired judgment • Unique to Rohypnol • visual disturbances • no memory for period of intoxification(block any memory)

  22. GHB: Gamma-hydroxybutyrate • Homemade CNS depressant • “Grievous Bodily Harm” • GABA agonist • precursor • synergism with alcohol • Clear liquid, powder, tablet, capsule

  23. GHB: Gamma-hydroxybutyrate • Effects similar to benzodiazepines and barbiturates • Also • loss of consciousness • loss of reflexes • seizures, coma, death • Associated with sexual assault ~

  24. The Drugs of Abuse 2. Hallucinogens

  25. Hallucinogens • Alter Mood, Perception, Thinking. • Induce Delusions • Hallucinations Occur Infrequently 1. LSD 2. Psilocybin 3. Mescaline 4. MDMA 5.Marijuana

  26. MOA of Hallucinogens • LSD, Psilocybin, Mescaline: • Bind to Post-Synaptic Serotonin- 5-Hydroxy Tryptamine, (5-HT) Receptors • 5HT Agonists • Rapid Tolerance From Down Regulation of Receptors Occurs

  27. Lysergic Acid Diethylamide

  28. General specifications: • Very powerful hallocinogen • Alkaloied derivatives from (Psilocybe mexicana) • German word (Lyser Saure Diethylamide) • Ingestion( rote of misuse)

  29. At 10-30 Min. -Laugh / Cry -Euphoria -Paranoia -Impair Think. -Panic Attack -Tachycardia -Elev. BP -Tremors At 2-3 Hours -Hallucination -Synesthesia (Sounds Felt, Colors Heard) -Derealization -Distorted Time / Space -Blurring LSD Intoxication 8-12hr

  30. DDX of LSD Intoxication • Delirium, Dementia • Schizophrenia • Bipolar, Psychotic Disorders • Narcolepsy • Etoh, Marijuana, PCP Intoxication • Antiparkinsonian Drugs

  31. Lasting LSD Effects • Few Develop Florid Psychosis -A Pre-existing Disorder? • “Flashbacks” Occur in 16-57% -? CNS Pathology or Memory, Most Mild / Not Incapacitating • Physical Dependence and Withdrawal Do Not Occur

  32. Treatment LSD Overdose • “Bad Trip” --Quiet, Safe, Environment --Calm Supportive Friends --’Talk Down’ --Emphasize Effects Are From Drug and Temporary • Valium 10-20mg, Ativan 1-2mg

  33. MDMA (ecstasy)

  34. ECSTASY • MDMA(3,4 ETHYLENEDIOXYMETHAMPHETAMINE) • ADAM • X-TC • X- pill • SEX- PILL • CLARITY • ESSENCE • STACY • LOVER’S SPEED • EVE

  35. MDMA Effects • By 5HT Activity: --Minimal Hallucinations --Locomotor Hyperactivity --Hyperthermia

  36. MOA of MDMA • Increased Levels of 5HT, Dopamine and Norepinephrine by: --Increased Presynaptic Release --Inhibited Reuptake --Increased Dopamine Synthesis --Decreased Breakdown by Monoamine Oxidase Inhibition

  37. MDMA Intoxication • 5HT Activation: --Empathy & Insight --Sexsuality --Euphoria --Energy --Self Esteem

  38. MDMA Intoxication • Sympathetic Activation: --Diaphoresis --Mydriasis --Tachycardia --Hypertension --Increased Psychomotor Drive

  39. MDMA Neuro. Complications • Confusion, Paranoia, Panic • Psychosis, Acute and Chronic • Seizures, Status Epilepticus • Destruction of Serotonin Neurons With Long Term Use

  40. MDMA CV. Complications • Hypertension • Dysrhythmias • Pulmonary Edema • Cardiogenic Shock • Cerebral Hemorrhage • Mesenteric Ischemia

  41. MDMA Complications • Hyperthermia (>108 F) • Muscle Spasm • Rhabdomyolysis • Acute Hepatic or Renal Failure • DIC • Death

  42. MDMA Treatment • A, B, C’s • Alpha Blockers (Phentolamine) NOT Beta Blockers For Hypertension • Benzodiazepines (Agitation, Seizure) • Rapid Cooling to 39 C (Tepid H2O) • IV Fluids w Bicarb. To Alk. Urine

  43. "Shoot for the moon.  Even if you miss it, you will land among the stars."

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