Psychoactive Drugs: pharmacology, intoxication, withdrawal, and treatment

This is a brief video on psychoactive drugs, including the pharmacology of these drugs, intoxication symptoms, withdrawal symptoms, and relevant treatments.

Errata: error at 3:27; misspoke, should have said “agonize” not “antagonize”; proper word listed on slide.

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ADDITIONAL TAGS:
Anti addiction medications
1. cocaine
2. crack cocaine
3. methylphenidate (Ritalin)
4. ephedrine
5. MDMA (Ecstasy)
6. mescaline (cactus)
7. LSD blotter
8. psilocybin mushroom (Psilocybe cubensis)
9. Salvia divinorum
10. diphenhydramine (Benadryl)
11. Amanita muscaria mushroom
12. Tylenol 3 (contains codeine)
13. codeine with muscle relaxant
14. pipe tobacco
15. bupropion (Zyban)
16. cannabis
17. hashish
Depressants / sedatives
Alcohol, barbiturates, benzodiazepines
MoA: enhancement of GABA receptor
Intoxication: incoordination, ataxia, slurred speech, euphoria, nystagmus, attention impairment, behavior inhibition, coma, blackouts, AST = 2*ALT
Hypotension, respiratory depression → benzos and barbs
Treatment: flumazenil for benzo OD, supportive for others
Withdrawal: hallucinations, seizures, hypertension, nausea, sweating, insomnia, anxiety, agitation, tremors
Muscle cramps, twitches, tachycardia → benzos and barbs
Delirium tremens (2-4 days after last drink)→ fluctuating consciousness, high HR, seizures, tremors, anxiety
Treatment: benzodiazepines
Can be fatal

Opioids
Heroin, prescription pain meds (oxycodone, hydrocodone, etc)
MoA: agonize opioid receptor, especially mu subtype
Intoxication: motor slowness, slurred speech, euphoria, impaired attention and sedation, miosis, respiratory depression
Treatment: naloxone, naltrexone (opioid antagonists)
Withdrawal: depression/anxiety, diarrhea, cramps, sweating, piloerection, pupillary dilation, yawning, muscle aches
Treatment: supportive for pain and GI distress; methadone and buprenorphine (weaker agonists) can help
Not fatal
Heroin and oxycodone are most widely abused opioids → responsible for many deaths
Depressants / sedatives
Opioids
Stimulants
Cannabinoids (marijuana)
Hallucinogens (LSD)
Dissociatives (PCP)
Anti addiction medications

Stimulants
Cocaine, amphetamines, methamphetamines, MDMA (ecstasy), cathinone (bath salts), caffeine, nicotine
MoA:
Cocaine → block norepi and DA reuptake
Amphetamine → increase synaptic [norepi] and [DA] Nicotine → agonize PNS/CNS cholinergic receptors
Caffeine → enhance DA effect by blocking ADO receptors
Intoxication:
Amphetamines → behavioral (grandiose, euphoric, hypervigilant, paranoia, agitation); autonomic (inc BP/HR, chills, sweating, n/v)
Cocaine → add hallucinations of bugs on skin
Treatment: lorazepam (anxiety); haloperidol (psychosis); vitals
Withdrawal:
Amphetamines/cocaine → appetite, low HR, depression, fatigue
Nicotineappetite, low HR, dysphoria, anxiety, irritability
Caffeine mild dysphoria, headaches, anxiety
Treatment: supportive
Cannabinoids
Marijuana, hashish, synthetic blends (e.g., K2, spice)
MoA: delta-5-tetrahydrocannabinol (THC) binds to cannabinoid receptor, which inhibits adenylate cyclase and cAMP production
Intoxication: conjunctivitis, dry mouth, high BP/HR, appetite, euphoria, hallucinations at high doses, agitation
Treatment: lorazepam for agitation
Withdrawal: irritability, agitation, insomnia, nausea
Treatment: supportive
Unnecessary because not fatal
Social implications: maybe amotivational syndrome, gateway drug
Physiological changes: low testosterone in men, decreased ovulation in females, low birth weights in neonates, increased neonatal malformations
Medical form (dronabinol) used as supportive addition to with chemo (antiemetic) or AIDS treatment (stimulate appetite)

Hallucinogens
LSD (acid), psilocybin (shrooms), mescaline (peyote)
MoA: LSD activates serotonin receptors in the limbic system, neocortex, and brainstem
Intoxication: hallucinations, delusions, mydriasis, tachycardia, sweating, ataxia, tremor
Euphoria, paranoia → psilocybin
Psychosis, flashbacks → LSD
Treatment: lorazepam for agitation, haloperidol for psychosis
Withdrawal: none
Dissociatives
PCP, ketamine
MoA: both PCP and ketamine block glutamate NMDA receptors
Ketamine is used as an anesthetic (NMDA antagonist)
Intoxication: dissociation, hallucinations, impulsivity, analgesia, often violent behavior, high BP/HR, miosis, nystagmus, delusions, seizures
Benzodiazepines and antipsychotics → PCP
Monitor for serotonin syndrome and rhabdomyolysis
Alcohol addiction
Disulfiram (blocks aldehyde dehydrogenase)
Acamprosate (analog of GABA, NMDA receptor antagonist)
Naltrexone (opioid antagonist)
Endogenous opioid pathways play a key role in pathway that leads to reinforcement for alcohol addiction
Opioid addiction
Naltrexone (opioid antagonist)
Buprenorphine/naltrexone

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