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Hallucinogens ­Life-Threatening Manifestations and Resuscitative Measures in the Intensive Care Setting

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Hallucinogens ­Life-Threatening Manifestations and Resuscitative Measures in the Intensive Care Setting CHAPTER 34. Ben-Abraham R, Szold O, Rudick V, Weinbroum AA: ‘Ecstasy’ intoxication: Hallucinogens life-threatening manifestations and resuscitative measures in the intensive care setting. Eur J Emerg Med 10: 309, 2003. Katherine M. Prybys 35. Turillazzi E, Riezzo I, Neri M, Bello S, Fineschi V: MDMA toxicity and pathological 188 consequences: a review about experimental data and autopsy findings. Curr Pharm Karen N. Hansen Biotechnol 11: 500, 2010. 36. Oesterheld JR, Armstrong SC, Cozza KL: Ecstasy: pharmacodynamic and pharmacoki- netic interactions. Psychosomatics 45: 84, 2004. 37. Halpern JH, Sherwood AR, Hudson JI, Gruber S, Kozin D, Pope HG Jr: Residual REFERENCES neurocognitive features of long-term ecstasy users with minimal exposure to other drugs. Addiction 106: 777, 2011. 1. Johnston LD, O’Malley PM, Bachman JG, Schulenberg JE: Monitoring the Future 38. Hall AP, Henry JA: Acute toxic effects of ‘Ecstasy’ (MDMA) and related compounds: national survey results on drug use, 1975-2010. Volume I: secondary school students. overview of pathophysiology and clinical management. Br J Anaesth 96: 678, 2006. Ann Arbor, MI. Institute for Social Research, The University of Michigan; 2011. 39. Bordo DJ, Dorfman MA: Ecstasy overdose: rapid cooling leads to successful outcome. 2. Johnston LD, O’Malley PM, Bachman JG, Schulenberg JE: Monitoring the Future national Am J Emerg Med 22: 326, 2004. survey results on drug use, 1975-2010. Volume II: college students and adults ages 19-50. 40. Moon J, Cros J: Role of dantrolene in the management of the acute toxic effects of Ann Arbor. MI. Institute for Social Research, The University of Michigan; 2011. Ecstasy (MDMA). Br J Anaesth 99: 146, 2007. 3. Milroy CM: “Ecstasy” associated deaths: what is a fatal concentration? Analysis of a case 41. Duffy MR, Ferguson C: Role of dantrolene in treatment of heat stroke associated with series. Forensic Sci Med Pathol 7: 248, 2011. Ecstasy ingestion. Br J Anaesth 98: 148, 2007. 4. Hill SL, Thomas SH: Clinical toxicology of newer recreational drugs. Clin Toxicol 42. Grunau BE, Wiens MO, Brubacher JR: Dantrolene in the treatment of MDMA-related (Phila) 49: 705, 2011. hyperpyrexia: a systematic review. CJEM 12: 435, 2010. 5. Peet M, Peters S: Drug-induced mania. Drug Saf 12: 146, 1995. 43. Mugele J, Nanagas KA, Tormoehlen LM: Serotonin syndrome associated with MDPV 6. Cole C, Jones L, McVeigh J, Kicman A, Syed Q, Bellis M: Adulterants in illicit drugs: a use: a case report. Ann Emerg Med January 9, 2012. [Epub ahead of print] review of empirical evidence. Drug Test Anal 3: 89, 2011. 44. U.S. Drug Enforcement Administration Office of Diversion Control. National Forensic 7. Tanner-Smith EE: Pharmacological content of tablets sold as “ecstasy”: results from an Laboratory Information System Special Report: Synthetic Cannabinoids and Synthetic online testing service. Drug Alcohol Depend 83: 247, 2006. Cathinones Reported in NFLIS, 2009-2010. Springfield, VA. U.S. Drug Enforcement 8. Mathias S, Lubman DI, Hides L: Substance-induced psychosis: a diagnostic conun- Administration Office of Diversion Control; September 2011. drum. J Clin Psychiatry 69: 358, 2008. 45. U.S. Centers for Disease Control and Prevention. Emergency department visits after 9. Caton CL, Drake RE, Hasin DS, et al: Differences between early-phase primary use of a drug sold as “bath salts”—Michigan, November 13, 2010-March 31, 2011. psychotic disorders with concurrent substance use and substance-induced psychoses. MMWR Morb Mortal Wkly Rep 60: 624, 2011. Arch Gen Psychiatry 62: 137, 2005. 46. Prosser JM, Nelson LS: The toxicology of bath salts: a review of synthetic cathinones. 10. Gable RS: Comparison of acute lethal toxicity of commonly abused psychoactive J Med Toxicol 8: 33, 2012. substances. Addiction 99: 686, 2004. 47. Rosenbaum CD, Carreiro SP, Babu KM: Here today, gone tomorrow…and back 11. Abraham HD, Aldridge AM, Gogia P: The psychopharmacology of hallucinogens. again? A review of herbal marijuana alternatives (K2, Spice), synthetic cathinones Neuropsychopharmacology 14: 285, 1996. (bath salts), kratom, Salvia divinorum, methoxetamine, and piperazines. J Med 12. Passie T, Halpern JH, Stichtenoth DO, Emrich HM, Hintzen A: The pharmacology of Toxicol 8: 15, 2012. lysergic acid diethylamide: a review. CNS Neurosci Ther 14: 295, 2008. 48. Wood DM, Davies S, Puchnarewicz M, et al: Recreational use of mephedrone (4-meth- 13. Blaho K, Merigian K, Winbery S, Geraci SA, Smartt C: Clinical pharmacology of lyser- ylmethcathinone, 4-MMC) with associated sympathomimetic toxicity. J Med Toxicol 6: gic acid diethylamide: case reports and review of the treatment of intoxication. 327, 2010. Am J Ther 4: 211, 1997. 49. Ross EA, Watson M, Goldberger B: “Bath salts” intoxication. N Engl J Med 365: 967, 2011. 14. Berrens Z, Lammers J, White C: Rhabdomyolysis after LSD ingestion. Psychosomatics 50. Maskell PD, De Paoli G, Seneviratne C, Pounder DJ: Mephedrone 51: 356, e3, 2010. (4-methylmethcathinone)-related deaths. J Anal Toxicol 35: 188, 2011. 15. Klock JC, Boerner U, Becker CE: Coma, hyperthermia, and bleeding associated with 51. Schedules of controlled substances: temporary placement of three synthetic cathinones massive LSD overdose, a report of eight cases. Clin Toxicol 8: 191, 1975. into schedule I. Fed Regis 76: 65371, 2011. 16. Halpern JH, Pope HG Jr: Hallucinogen persisting perception disorder: what do we 52. Hoiseth G, Hjelmeland K, Bachs L: [Phencyclidine—angel dust]. Tidsskr Nor Laege- know after 50 years? Drug Alcohol Depend 69: 109, 2003. foren 125: 2775, 2005. 17. Lott JP, Marlowe DB, Forman RF: Availability of websites offering to sell psilocybin 53. O’Shea B: Phencyclidine, ketamine, and khat phencyclidine (PCP, DOA, ‘angel dust’, spores and psilocybin. J Psychoactive Drugs 41: 305, 2009. ‘crystal’, ‘hog’). Ir Med J 93: 185, 2005. 18. Barbee G, Berry-Caban C, Barry J, Borys D, Ward J, Salyer S: Analysis of mushroom 54. McCarron MM, Schulze BW, Thompson GA, Conder MC, Goetz WA: Acute phency- exposures in Texas requiring hospitalization, 2005-2006. J Med Toxicol 5: 59, 2009. clidine intoxication: incidence of clinical findings in 1,000 cases. Ann Emerg Med 10: 19. Hasler F, Grimberg U, Benz MA, Huber T, Vollenweider FX: Acute psychological and 237, 1981. physiological effects of psilocybin in healthy humans: a double-blind, placebo- 55. McCarron MM, Schulze BW, Thompson GA, Conder MC, Goetz WA: Acute phency- controlled dose-effect study. Psychopharmacology (Berl) 172: 145, 2004. clidine intoxication: clinical patterns, complications, and treatment. Ann Emerg Med 20. Bickel M, Ditting T, Watz H, et al: Severe rhabdomyolysis, acute renal failure and pos- 10: 290, 1981. terior encephalopathy after ‘magic mushroom’ abuse. Eur J Emerg Med 12: 306, 2005. 56. Milhorn HT Jr: Diagnosis and management of phencyclidine intoxication. Am Fam 21. Frank H, Zilker T, Kirchmair M, et al: Acute renal failure by ingestion of Cortinarius Physician 43: 1293, 1991. species confounded with psychoactive mushrooms: a case series and literature survey. 57. Eastman JW, Cohen SN: Hypertensive crisis and death associated with phencyclidine Clin Nephrol 71: 557, 2009. poisoning. JAMA 231: 1270, 1975. 22. Halpern JH: Hallucinogens and dissociative agents naturally growing in the United 58. Stein GY, Fradin Z, Ori Y, Singer P, Korobko Y, Zeidman A: Phencyclidine-induced States. Pharmacol Ther 102: 131, 2004. multi-organ failure. Is Med Assoc J 7: 535, 2005. 23. Carstairs SD, Cantrell FL: Peyote and mescaline exposures: a 12-year review of a 59. Simpson GM, Khajawall AM, Alatorre E, Staples FR: Urinary phencyclidine excretion statewide poison center database. Clin Toxicol (Phila) 48: 350, 2010. in chronic abusers. J Toxicol Clin Toxicol 19: 1051, 1982. 24. CDC: Ecstasy overdoses at a New Year’s Eve rave—Los Angeles, California, 2010. 60. Devane WA, Hanus L, Breuer A, et al: Isolation and structure of a brain constituent MMWR Morb Mortal Wkly Rep 59: 677, 2010. that binds to the cannabinoid receptor. Science 258: 1946, 1992. 25. Capela JP, Carmo H, Remiao F, Bastos ML, Meisel A, Carvalho F: Molecular and cellular 61. Sinclair CF, Foushee HR, Pevear JS 3rd, Scarinci IC, Carroll WR: Patterns of blunt use mechanisms of ecstasy-induced neurotoxicity: an overview. Mol Neurobiol 39: 210, 2009. among rural young adult African-American men. Am J Prev Med 42: 61, 2012. 26. Jansen KL, Theron L: Ecstasy (MDMA), methamphetamine, and date rape (drug- 62. Kalant H: Adverse effects of cannabis on health: an update of the literature since 1996. facilitated sexual assault): a consideration of the issues. J Psychoactive Drugs 38: 1, 2006. Prog Neuropsychopharmacol Biol Psychiatry 28: 849, 2004. 27. Kaye S, Darke S, Duflou J: Methylenedioxymethamphetamine (MDMA)-related fatali- 63. Aryana A, Williams MA: Marijuana as a trigger of cardiovascular events: speculation ties in Australia: demographics, circumstances, toxicology and major organ pathology. or scientific certainty? Int J Cardiol 118: 141, 2007. Drug Alcohol Depend 104: 254, 2009. 64. Pratap B, Korniyenko A: Toxic effects of marijuana on the cardiovascular system. 28. Shenouda SK, Carvalho F, Varner KJ: The cardiovascular and cardiac actions of ecstasy Cardiovasc Toxicol December 23, 2011. [Epub ahead of print] and its metabolites. Curr Pharm Biotechnol 11: 470, 2010. 65. McGuinness TM: Update on marijuana. J Psychosoc Nurs Ment Health Serv 47: 19, 29. Sarkar S, Schmued L: Neurotoxicity of ecstasy (MDMA): an overview. Curr Pharm 2009. Biotechnol 11: 460, 2010. 66. Reece AS: Chronic toxicology of cannabis. Clin Toxicol (Phila) 47: 517, 2009. 30. Chang SH, Lai TI, Chen WJ, Fang CC: MDMA-induced acute pulmonary edema in a 67. Sontineni SP, Chaudhary S, Sontineni V, Lanspa SJ: Cannabinoid hyperemesis syn- patient without other organ dysfunction. Am J Emerg Med 24: 734, 2006. drome: clinical diagnosis of an underrecognised manifestation of chronic cannabis 31. Campbell GA, Rosner MH: The agony of ecstasy: MDMA (3,4-methylenedioxymeth- abuse. World J Gastroenterol 15: 1264, 2009. amphetamine) and the kidney.
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