Term
| what characterizes the anticholinergic drugs as psychotomimetics? |
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Definition
| diphenhydramine and doxylamine (weaker) as well as natural plant products like jimson weed which contain belladonna alkaloids may be psychotomimetic in high enough doses. effect: hypotension, cycloplegia, disorientation, *amnesia, and pseudohallucinations (auditory/visual) |
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Term
| what characterizes the tryptaminergic drugs as psychotomimetics? |
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Definition
| these include LSD (synthetic), psilocybin (mushrooms biotransform to psilocin), and DMT (dimethyltryptamine: from plants, poor PO absorption). similar to LSD: mescaline (peyote cactus) and DOM (synthetic drug: 2,5-dimethoxy-4-methylamphetamine, similar to mescaline). effect: HTN, affective shifts, paranoia, and pseudohallucinations (usually visual). |
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Term
| what are the common effects to both the anticholinergics and tryptaminergic drugs? |
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Definition
| ataxia, mydriasis, tachycardia, and hyperthermia |
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Term
| what are the physiologic and psychologic effects of LSD (tryptaminergic)? |
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Definition
| *physiological: sympathomimetic agent = tachycardia, HTN, and mydriasis. *psychologic: illusions (objects change shape/color, walls/objects appear to move, color seems brighter/more intense, halos around lights), hallucinations (false sensory perception, belief that vision is real, rare w/LSD), pseudohallucinations (user sees something but knows it isn't real, may see geometric forms/brilliant colors, more common), synesthesia (one type of sensory experience is transformed into another), emotional lability (frequent changes in emotion), time orientation (frequently affected), and no loss of consciousness. thoughts move more rapidly than normal, not necessarily logical. anything occurring under the influence frequently assumes an exaggerated sense of importance. opposites may appear as equals (person feels heavy and light at the same time). |
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Term
| what determines the ultimate effect of an LSD experience? |
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Definition
| set: attitude prior to the experience. setting: environment drug is taken. |
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Term
| what are the acute adverse psychological reactions associated w/LSD (bad trip)? |
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Definition
| users feel a loss of control of the drug trip (may lead to panic, attempts to escape). users may show poor judgment (feel like they can fly, go out a window etc). |
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Term
| how is a bad LSD (and other tryptaminergics, not PCP) trip managed? |
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Definition
| restriction of the pt in a supportive, non-threatening atmosphere. careful hx of drug intake. establish verbal contact (reassure and define reality). *pharmacotherapy: last resort or if no time available for a "talkdown", diazepam (avoids anticholinergic potentiation), antipsychotics+physostigmine (reverses anticholinergic crisis), or phenothiazines (risk orthostatic hypotension, contraindications: previous allergic reaction, presence of significant hypotension, consumption of anticholinergic agents). therapeutic effect of phenothiazine may be due more to its sedative effect, not anti-psychotic. |
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Term
| how is a bad LSD trip managed? |
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Definition
| most will end w/in 24-48 hrs. do not discuss immediately after it ends. even with optimal treatment, some 'bad trips' push the patient into prolonged psychotic episode that can be indistinguishable from a schizophrenic reaction. reliable sign of recovery: good night's sleep and an end of the state of tension. |
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Term
| what characterizes phencyclidine (PCP)? |
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Definition
| originally developed for clinical use, now withdrawn. can be retained in the body for days-weeks. acute pharm effects: tachycardia, HTN, CVA, **minor muscle tremors, convulsive seizures, sweating, **increased salivation, impairment of touch/pain sensations, euphoria, dizziness, impaired proprioception, disorientation, stereotypical behavior, exacerbation of psychoses. chronic toxicity: largely unknown, tolerance develops and death due to CVA or swimming under the influence. |
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Term
| what is the major psychoactive component of marijuana? |
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Definition
| delta-9-THC, which can remain in the body for weeks - determined by amount used and frequency. |
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Term
| what are the acute pharmacologic effects of marijuana? |
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Definition
| tachycardia, bronchodilation, conjunctival injection, reduction of IOP, increased appetite, increased awareness of colors/sounds/taste, euphoria, relaxation, reduced psychomotor activity, and reduced short-term memory. |
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Term
| what are the acute adverse psychological reactions of marijuana in a normal pt? |
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Definition
| panic reaction (occurs in a person fearful of doing something illegal, usually > 35 y/o), frightened by physiologic effects (tachycardia etc), toxic psychosis (psychotic reaction after consumption of potent marijuana) |
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Term
| what are the acute adverse psychological reactions of marijuana in a hallucinogenic drug experienced pt? |
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Definition
| precipitation of flashbacks. use of marijuana may trigger a memory of a 'trip' which occurred during prior use of a hallucinogen (e.g., LSD). user may then re-experience the 'trip' (usually less intense). |
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Term
| what are the acute adverse psychological reactions of marijuana in a pt w/a hx of psychosis? |
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Definition
| exacerbation of schizophrenia |
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Term
| what characterizes chronic toxicity due to marijuana? |
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Definition
| bronchial irritation (pre-cancerous changes?), reproductive abnormalities (male: decreased sperm, decreased sperm motility, increased abnormal forms. female: menstrual irregularities), reduced short term memory (alterations in brain cells?), and teratogenicity? |
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Term
| what are therapeutic uses of marijuana? |
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Definition
| anti-emetic during CA chemo. reduction of IOP in glaucoma pts. |
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