Drugs of abuse

• Drugs of Abuse


  • Opiates and Opioids
  • Cocaine
  • Amphetamines
  • Marijuana
  • LSD and Other Derivatives
  • Others
• Opium


  A greek word meaning "juice" or the exudate from the poppy ("opium poppy plant" Papaver somniferum)
• Opiate


  A drug extracted from the exudate of the poppy
• Opioid


  A semi-synthetic or synthetic drug that binds to opioid receptors producing agonist effect
• Natural Opiates and Opioids

  • Opium
  • Morphine
• Heroin


  Commonly known as DIACETYLMORPHINE, a recreational semi-synthetic opioid
• Codeine


  Also known as METHYLMORPHINE, a semi-synthetic opioid with pharmaceutical use
• Hydromorphone


  A semi-synthetic opioid
• Oxycodone


  A semi-synthetic opioid
• Methadone


  A synthetic opioid used for chronic moderate to severe pain
• Meperidine


  A synthetic opioid used as an anesthetic for moderate to severe pain (Surgical pain)
• Opioid Receptors


  • Delta - Shows poor analgesia and little addictive potential, may regulate mu receptor activity
  • Mu - Activation leads to analgesia, respiratory depression, euphoria, decreased GI motility, physical dependence
  • Kappa - Activation leads to analgesia and dysphoria
• Morphine


  The classic opiate derivative used widely in medicine, first isolated by Friedrich Wilhelm Serturner in 1803, has strong agonist effect for the mu receptor
• Heroin (Diacetylmorphine)


  A highly addictive street narcotic that produces euphoria and can pass through the blood-brain barrier
• Codeine (Methylmorphine)


  Less susceptible to first pass effect due to the methyl group at carbon 3
• Hydromorphone (Dilaudid)


  A "Morphinan alkaloid"
• Oxycodone (OxyContin)


  Also has a methyl group in carbon 3, making it less susceptible to first pass effect
• Toxic Dose


  Varies depending on the specific compound, the route and rate of administration, and tolerance to the effects of the drug as a result of chronic use
• Clinical Presentation of Mild/Moderate Overdose


  • Lethargy
  • Pinpoint pupils
  • Decreased blood pressure and pulse rate
  • Diminished bowel sounds
  • Flaccid muscles
• Clinical Presentation of Higher Doses

  • Coma
  • Respiratory depression
  • Apnea
  • Noncardiogenic pulmonary edema
• Clinical Presentation After Opioid Overdose

  • Seizures (most associated with meperidine)
  • Mixed agonist and antagonist effects
• Opioid Triad


  Coma, respiratory depression, miosis
• Diagnosis


  • Qualitative screening of the urine (urinalysis)
  • Electrolytes, glucose, arterial blood gases or oximetry, chest x-ray, stat serum acetaminophen or salicylate levels (if ingested overdose was a combination product)
• Treatment


  1. Emergency and supportive measures

  2. Administer naloxone, a specific opioid antagonist

  3. Decontamination (ipecac-induced emesis, activated charcoal and cathartic)

  4. No enhanced elimination
• Cocaine


  A crystalline tropane alkaloid obtained from the leaves of the coca plant
• Cocaine Street Names


  • Crack
  • Freebase
  • Candy
  • C
  • Coke
  • Charlie
  • Bump
  • Blow
• Clinical Presentation of Cocaine Use

  • Increased alertness, feelings of well-being and euphoria, energy and motor activity, feelings of competence and sexuality
  • Negative effects: Anxiety, paranoia and restlessness, tremors, convulsions and increased body temperature
• Treatment of Cocaine Toxicity

  1. No specific antidote

  2. Benzodiazepines for seizures

  3. Labetalol (nonselective BB) for hypertension

  4. Neuroleptics for psychosis
• Amphetamines


  Psychostimulant drugs that produce increased wakefulness, focus, and decreased fatigue and appetite
• Amphetamine Street Names


  • Black Beauty
  • La Turnaround
  • Crosses
  • Hearts
  • Speed
  • Truck Drivers
• Pharmaceutical Amphetamines


  Dextroamphetamine (Dexedrine) and methylphenidate (Ritalin) used for narcolepsy and attention-deficit disorders
• Amphetamine-like Drugs


  Appetite suppressants used for severe obesity (benzphetamine, diethylpropion, phedimetrazine, phenmetrazine, and phenteramine)
• Recreational Amphetamines


  Methamphetamine, 3,4-methylenedioxymethamphetamine (MDMA, ecstasy), and other amphetamine derivatives used as illicit stimulants
• Toxic Dose of Amphetamines

  Acute ingestion of more than 1 mg/kg of dextroamphetamine should be considered potentially life-threatening
• Acute CNS Effects of Amphetamine Toxicity

  • Euphoria
  • Talkativeness
  • Anxiety
  • Restlessness
  • Agitation
  • Seizures
  • Coma
  • Intracranial hemorrhage
• Acute Peripheral Effects of Amphetamine Toxicity

  • Sweating
  • Tremor
  • Muscle fasciculations
  • Rigidity
  • Tachycardia
  • Hypertension
  • Acute myocardial ischemia and infarction
  • Vasospasm and gangrene
• Causes of Death from Amphetamine Toxicity

  • Ventricular arrhythmia
  • Status epilepticus
  • Intracranial hemorrhage
  • Hyperthermia
• Chronic Effects of Amphetamine Use

  • Weight loss
  • Cardiomyopathy
  • Stereotypic behavior
  • Paranoia
  • Paranoid psychosis
  • Psychiatric disturbances
• Amphetamine Withdrawal Effects


  • Fatigue
  • Hypersomnia
  • Hyperphagia
  • Depression
• Amphetamine Diagnosis


  • Can be detected in urine and gastric samples
  • Quantitative serum levels do not correlate well with severity
  • Electrolytes, glucose, BUN, creatinine, CPK, urinalysis, urine dipstick, ECG, CT scan