Hallucinogens

Question 0

Experience of LSD intoxication?

Answer 0

Perceptual disturbances, hallucinations, synesthesia, euphoria or lability. Y’all know about this stuff.

Question 1

LSD time of onset? How long do effects last?

Answer 1

Takes about 45 minutes for effects to begin. They last for 4-12 hours, depending on the dose.

Question 2

On what receptor is LSD thought to act? you should know this for the exam

Answer 2

5HT 2 post-synaptic receptor. you should really really know this for the exam

Question 3

Effects of chronic LSD use?

Answer 3

May unmask vulnerability to depression and paranoid behavior.
May result in panic from fear of insanity.
Does NOT seem to cause permanent brain damage.

Question 4

What’s the treatment for someone having a bad LSD trip?

Answer 4

Reassurance (hand-holding), benzos if necessary.

Question 5

2 drugs similar to LSD?

Answer 5

Mescaline, psilocybin (shrooms)

Question 6

What is phencyclidine (PCP) called in Philly?

Answer 6

“Wet”

Question 7

Original use of PCP? Why? Why didn’t people like it?

Answer 7

Anesthetic.
Caused alert analgesia.
But people found the flat face, staring gaze, dissociative qualities (zombification) to be too uncanny.

Question 8

Onset/plateau, duration, and recovery time for PCP?

Answer 8

Onset: 5 minutes, plateaus at 45 minutes
Duration: 4-6 hours
Recovery time: 24-48 hours

Question 9

What Axis I disorder does PCP intoxication mimic?

Answer 9

SZ, especially the catatonic variety

Question 10

What happens differently between low dose and high dose PCP?

Answer 10

Low dose: Euphoria, peaceful, floating detachment

High dose: People are paranoid and bat shit crazy.

Question 11

Aside from flat affect and being uncommunicative, what are 3 signs of PCP intoxication? (not high-dose intoxication)

Answer 11

Slurred speech
Vertical nystagmus
Rolling gait (due to numb feet and hands)

Question 12

What acutely bad things happen when large doses of PCP are taken? (4 things)

Answer 12

Hostility.
Excessive salivation without gag reflex.
Increased BP and tachycardia.
Coma and convulsions.

Question 13

MoA of PCP? (one you know, plus one not mentioned as much)

Answer 13

NMDA receptor antagonist (like ketamine).
Blocks glutamate signaling.
(has a few other effects as well)

Question 14

How long can cognitive dysfunction from PCP last after use?

Answer 14

2-3 weeks. Not a great study drug.

Question 15

Treatment of PCP intoxication? (4-5 things, depending on severity)

Answer 15

Protection from self (may involve restraint - hand-holding doesn’t work here).
Definitely give benzos to prevent convulsions.
Antipsychotics for paranoia.
Acidification of urine and gastric suction, if needed, to increase secretion.

Question 16

Why might at psychotherapist be interested in using MDMA as an adjunct to therapy?

Answer 16

Increases empathy.

Makes people disinhibited and drop defenses.

Question 17

6 aspects of the MDMA experience?

Answer 17

Euphoria and loving feelings.
Loss of boundaries (feeling connected to people in the club).
Disinhibition.
Promotion of intimacy.
Cognitive slowing / apathy.
Perceptual changes (usually stuff like thinking the laser show looks super cool, can be hallucinations)

Question 18

6 physical signs of MDMA intoxication?

Answer 18

Increased BP
Increased HR
Dry mouth
Bruxism (grinding teeth)
Fever?
Dehydration? (unclear if these last 2 are just effects of being in a club)

Question 19

MoA of MDMA?

Answer 19

Thought to increase release of both DA and 5-HT.

But this hasn’t been thoroughly studied.

Question 20

Effects of chronic use of MDMA?

Answer 20

Long lasting, maybe permanent, destruction of serotonergic pathways -> depression.

Question 21

Treatment for MDMA intoxication?

Answer 21

Supportive: reassurance, rehydration, education

Question 22

In what context does anticholinergic toxicity usually happen?

Answer 22

Accidental self-administration or iatrogenic.

Usu. due to combining anticholinergic drugs.

Question 23

4 characteristics of anticholinergic delirium?

Answer 23

Waxing and waning consciousness.
Impulsivity
Impaired judgment
Hallucinations

Question 24

Some hallucinogenic effects of anticholinergic toxicity?

Answer 24

Illusions, dysphoria, estrangement, depersonalization, agitation, visual/auditory hallucinations.

Question 25

6 physical signs of anticholinergic toxicity

Answer 25

Fever
Warm, dry skin
Fixed, dilated pupils
Tachycardia
Decreased peristalsis
Atonic bladder.
"Hot as a hare, blind as a bat, dry as a bone, red as a beet, mad as a hatter."

Question 26

4 treatments for anticholinergic toxidrome?

Answer 26

Withdraw causative agents.
Protect patient from self/others. (chemical or physical restraint)
Gastric lavage.
Parenteral physostigmine. (recall that -stygmines are acetylcholinesterase inhibitors)

Question 27

In what two hallucinogens is nystagmus seen?

Answer 27

Inhalants and PCP.

Question 28

5 signs of inhalant intoxication?

Answer 28

Stimulation and Disinhibition
Nystagmus
Ataxia
Perceptual distortions
Hallucinations?

Question 29

Inhalant MoA?

Answer 29

Similar to EtOH (and many others), acts on GABA-A. probably.

Question 30

Effects of chronic use of inhalants?

Answer 30

Organ damage, depending on agent.
CNS damage: demyelination and cerebellar atrophy -> impairment in memory, attention, concentration, and non-verbal intelligence.
It’s a bad idea.

Question 31

For what hallucinogens do you really have to protect people from the affects of acute toxicity? Treatment for them?

Answer 31

PCP (benzos, antipsychotics).
Anticholinergic drugs (withdraw drugs, give physostigmine)