Hallucinogens Flashcards
Experience of LSD intoxication?
Perceptual disturbances, hallucinations, synesthesia, euphoria or lability. Y’all know about this stuff.
LSD time of onset? How long do effects last?
Takes about 45 minutes for effects to begin. They last for 4-12 hours, depending on the dose.
On what receptor is LSD thought to act? you should know this for the exam
5HT 2 post-synaptic receptor. you should really really know this for the exam
Effects of chronic LSD use?
May unmask vulnerability to depression and paranoid behavior.
May result in panic from fear of insanity.
Does NOT seem to cause permanent brain damage.
What’s the treatment for someone having a bad LSD trip?
Reassurance (hand-holding), benzos if necessary.
2 drugs similar to LSD?
Mescaline, psilocybin (shrooms)
What is phencyclidine (PCP) called in Philly?
“Wet”
Original use of PCP? Why? Why didn’t people like it?
Anesthetic.
Caused alert analgesia.
But people found the flat face, staring gaze, dissociative qualities (zombification) to be too uncanny.
Onset/plateau, duration, and recovery time for PCP?
Onset: 5 minutes, plateaus at 45 minutes
Duration: 4-6 hours
Recovery time: 24-48 hours
What Axis I disorder does PCP intoxication mimic?
SZ, especially the catatonic variety
What happens differently between low dose and high dose PCP?
Low dose: Euphoria, peaceful, floating detachment
High dose: People are paranoid and bat shit crazy.
Aside from flat affect and being uncommunicative, what are 3 signs of PCP intoxication? (not high-dose intoxication)
Slurred speech
Vertical nystagmus
Rolling gait (due to numb feet and hands)
What acutely bad things happen when large doses of PCP are taken? (4 things)
Hostility.
Excessive salivation without gag reflex.
Increased BP and tachycardia.
Coma and convulsions.
MoA of PCP? (one you know, plus one not mentioned as much)
NMDA receptor antagonist (like ketamine).
Blocks glutamate signaling.
(has a few other effects as well)
How long can cognitive dysfunction from PCP last after use?
2-3 weeks. Not a great study drug.
Treatment of PCP intoxication? (4-5 things, depending on severity)
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.
Why might at psychotherapist be interested in using MDMA as an adjunct to therapy?
Increases empathy.
Makes people disinhibited and drop defenses.
6 aspects of the MDMA experience?
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)
6 physical signs of MDMA intoxication?
Increased BP Increased HR Dry mouth Bruxism (grinding teeth) Fever? Dehydration? (unclear if these last 2 are just effects of being in a club)
MoA of MDMA?
Thought to increase release of both DA and 5-HT.
But this hasn’t been thoroughly studied.
Effects of chronic use of MDMA?
Long lasting, maybe permanent, destruction of serotonergic pathways -> depression.
Treatment for MDMA intoxication?
Supportive: reassurance, rehydration, education
In what context does anticholinergic toxicity usually happen?
Accidental self-administration or iatrogenic.
Usu. due to combining anticholinergic drugs.
4 characteristics of anticholinergic delirium?
Waxing and waning consciousness.
Impulsivity
Impaired judgment
Hallucinations
Some hallucinogenic effects of anticholinergic toxicity?
Illusions, dysphoria, estrangement, depersonalization, agitation, visual/auditory hallucinations.
6 physical signs of anticholinergic toxicity
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."
4 treatments for anticholinergic toxidrome?
Withdraw causative agents.
Protect patient from self/others. (chemical or physical restraint)
Gastric lavage.
Parenteral physostigmine. (recall that -stygmines are acetylcholinesterase inhibitors)
In what two hallucinogens is nystagmus seen?
Inhalants and PCP.
5 signs of inhalant intoxication?
Stimulation and Disinhibition Nystagmus Ataxia Perceptual distortions Hallucinations?
Inhalant MoA?
Similar to EtOH (and many others), acts on GABA-A. probably.
Effects of chronic use of inhalants?
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.
For what hallucinogens do you really have to protect people from the affects of acute toxicity? Treatment for them?
PCP (benzos, antipsychotics). Anticholinergic drugs (withdraw drugs, give physostigmine)
