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Title of Presentation Arial 50Pt Bold Erick Limmer, 26, Owned the apartment that the GHB overdose took place in. CONVICTED! Daniel Brayman, a senior, was one of two boys who picked up the freshman girls took them to the Party… CONVICTED! Nicholas Holtschlag, 18, allegedly handed drinks that were poisoned with GHB to Melanie Sindone and Samantha Reid. CONVICTED! Joshua Cole deliberately slipped the GHB into the girls non alcoholic drinks. CONVICTED! Had enough yet? Ketamine • Anesthetic • Approved for both human and animal use in medical settings since 1970 • About 90 percent of the ketamine sold legally today is intended for veterinary use. Ketamine- Street Names • Special K • Vitamin K • K • Jet • Cat Valium • Psychedelic Heroin Ketamine • Route - Oral - Injected - Snorted - Smoked with marijuana • Effects - Onset within seconds if smoked, 1-5 minutes if injected - Lasts up to 24 hours Ketamine- Signs and Symptoms • Low-dose • Impaired attention, learning ability, and memory. • High-dose - Delirium - Amnesia - Impaired motor function - High blood pressure - Depression - Potentially fatal respiratory problems - Excessive salivation and lacrimation Ketamine- Management • ABC’s • Risk for aspiration is high due to decrease level of consciousness and excessive salivation • Oxygenate (15L NRB or BVM) • IV access • Monitor DXM- Introduction • Yes, its in cough syrup OR COUGH TABS (CORICIDIN)”TRIPPLE C” • Dextromethorphan acts as a cough suppressant via its agonist (activating) activity at mu-opioid receptors. • In Canada: Contac CoughCaps (30 mg DXM) • Related in effects to Ketamine and PCP DXM • Yes, its in cough syrup OR cough tabs (CORICIDIN)”TRIPPLE C” • Dextromethorphan acts as a cough suppressant via its agonist (activating) activity at mu-opioid receptors. • In Canada: Contac CoughCaps (30 mg DXM) • Related in effects to Ketamine and PCP DXM- How is it used? • “Robo-ing” (Old Term from early 90’s) • DXM is available over-the- counter in tablet form in several countries as a cough med. Robitussin Maximum Strength Cough (not Robitussin DM) syrup • Users often refer to DXM in “plateaus” • Dose of Robitussin Maximum Strength Cough syrup is two to five full "shots" using the shot glass that comes with the bottle. DXM- Coricidin Toxicity • Coricidin Cough and Cold Caps, 30 mg DXM and 4 mgs of Chlorphineramine maleate • Chlorphineramine maleate is an anti- cholinergic drug like scopolamine. • Non Specific reports of “Respiratory Failure” at high doses. DXM- Coricidin Toxicity • Robo-Walk • Robo-Itch • Robo-Talk • Psychosis • Dialated Pupils DXM- Treatment • VOMIT • Symptomatic TX. • Be alert for and (Cautiously) treat hypertension or hypotension, and rarely, cardiovascular problems • Restraints (?) • Avoid Chemical Restraint (Haldol, Droperidol),Benzo’s are preferred (Be prepared to manage the airway) • Benadryl may be given for Dystonic reactions, and for s/s of histamine release. DXM- What does this mean to me? • Be Careful, take the same precautions you would with a PCP patient. • ALS eval is a must ( HTN, Hyperthermia, Respiratory Depression, and self harm) • DXM differs from other drugs. Its presentation of s/s extend well beyond simple CNS depression and hallucinations but into basic cognitive functions as well. • Understanding that DXM effects last well beyond the 4 hours of intoxication , and that side effects may include “Psychotic Breaks” will help determine deposition of patients. LSD-d-lysergic acid diethylamide “For about a week I couldn't walk through the lobby of A-entry at the dorm without getting really scared, because of the goblin I saw there when I was tripping….” ( …User, circa.1971, ) Background LSD • Lysergic Acid Diethylamide • Hallucinogen • Effects are very unpredictable depending on - amount taken - surroundings in which the drug is used - user's personality, mood, and expectations. Background • Discovered by Dr. Albert Hofmann in 1938 • Extensive study, use, and abuse by the government in the late 40’s. 50’s, and 60’s. (OSS/CIA, US Navy) • Some documented cases of CIA Operatives taking it to “Immunize” them selves to its effects in the 60’s. • Now that’s job satisfaction! LSD- Street Names • Acid • Blotter • Trips • Yellow sunshine • Boomers • “Candy flipping” refers to mixing LSD and Ecstasy Slang • Many names refer to the carrier or “brand”(image printed on blotter) • Blotter, Sugar, Sugar Cube, “cid, Acid • Bart Simpsons, Barrels, Tabs, Blotter, Heavenly blue, "L", Liquid, Liquid A, Lucy in the sky with diamonds, Microdots, Mind detergent, Orange cubes, Orange micro, Owsley, Paper acid, Sacrament, Sandoz, Sunshine, Tabs, Ticket, Twenty-five, Wedding bells, Windowpane, etc. Slang • Hit- Dose • Body Kinks- Unexpected physical side effects I.e. nausea, jitters, etc • Bad trip- A person on LSD who becomes depressed, agitated, or confused may experience these feelings in an overwhelming manner that grows on itself. • LSD psychosis: The effects of LSD exacerbate pre-existing psychological problems for several days. Methods • Usually taken Sublingually or orally on paper (“Blotter”) • The solution may also be injected s.c. or i.v.(RARE) The effect is identical with that of oral administration but sets in more rapidly. • Usual dose is 50-200 mcg, with “Transcending doses” as high as 500 mcg LSD • Route - Oral - Tablets, on sugar cubes, squares of gelatin, blotter paper • Action- unknown, effects the serotonin system of the brain • Effects - Onset 30-90 minutes - Lasts up to 12 hours How does it work? • Similar to other drugs that give hallucinations: • It affects the re-uptake of 5-HT similarly to SSRI (serotonin specific reuptake inhibiting) anti-depressants such as fluoxetine (Prozac), sertraline, and paroxetine • Agonist (stimulation rather than blocking) properties at the 5-HT2 receptor have been found to fairly universally be associated with other psychedelic drugs such as psilocybin and mescaline, and somewhat in MDMA LSD- Signs and Symptoms • Dilated pupils • Hyperglycemia • Hyperthermia • Rambling speech • Tachycardia • Distortion of • Hypertension sensory • Profuse sweating perception • Loss of appetite • Hallucinations • Dry mouth • Seizures • Tremors • Long term: - Psychosis • Nausea - “flash-back” LSD- Signs and Symptoms • Bad Trips - feeling of intense fear about being in a scary experience that you can't control - lasts for hours - can have an enjoyable trip one time, and a scary one the next time - some evidence that LSD can trigger a psychotic episode in someone who is already schizophrenic, or it can trigger the first episode in someone who is going in that direction. S/S OF AN OVERDOSE • Dilated Pupils • Vivid Auditory, tactile, and visual perception • Nausea • Mild drops in B/P • Hyperglycemia • Piloerection (Goosebumps) • Mild Hyperthermia • Bradycardia • May exacerbate pre-existing behavioral tendencies • Mild stimulatory effects After trip effects • Insomnia (common) • “Jitters” • Flashbacks (inconstantly proven and disproven in literature) LSD- Management • ABC’s • Reassure the patient • “talk down” the high patient • Protect from injury • Provide dark, quiet environment • Seizure precautions BASIC TREATMENT • Supportive • Protect the patient • Calm low key, low light, environment • Calm low key, low light environment • Calm low key, low light environment • Calm low key, low light environment • Oh yes… • Calm low key, low light environment Dependence, Detox, and withdrawal • No documented physical or psychological dependence • A rapid tolerance is built up (about 3-5 days) that just as rapidly disappears Take Home Information • Facilitate a low key trip, and all is well • The patients respond to your actions as much as we respond to them • Very little clinical problems from drug, just actions resulting from altered behavior Newer synthetics K2 or “Spice” Synthetic Marijuana K2 “Spice” • What is it? • Side Effects? • Mixture of herbal and spice plant, sold as • Severe agitation and potpourri vomiting • Sprayed with potent • Heart rate and blood psychotropic drugs, the pressure raises to most active JWH-018 & JWH-073 dangerous rates • Created for • Hallucinations experimental use in • Tremors or seizures animals and cell cultures- not humans • In extreme cases it • Compare: causes blackouts or - Marijuana in ’70-’80’s = 7-10% catalepsy- a nervous THC - Marijuana recently = 45-65% THC condition causing fix - K2 is equivalent to 100% THC body posture. Synthetic Cannabinoids • Synthetic drug • Chemical compounds similar to THC in Marijuana - Majority of the compounds were identified as JWH related varieties • JWH-018 (63%) • JWH-250 (14%) • JWH-073 (9%) • JWH-081 (5%) • JWH-200 (2%) • JWH-019, JWH-210, JWH-251, RCS-4, AM-2201, AM- 694, CP-47, CP-497, AM-356 • In 2010, 50% of the cannabinoid reports were from the midwest Synthetic Cannabinoids • Packaged: - Small, silvery plastic bags - Dried plant material with synthetic cannabinoids added - Labeled as incense or potpourri - “Not for Human Consumption” • Sold in: - Head shops - Gas stations or convenience shops - Tobacco shops - Over the internet • Several websites selling product are based in China Synthetic Cannabinoids- Street Names • K2 • Moon rocks • Spice • Skunk • Kush • Black mamba • Fake weed • Bombay blue • Bliss • Genie • Yucatan fire • Mad Hatter • Mix On the Streets Street Names… What Kids Do… • Bliss • K2 can be • Black Mamba smoked in a • Bombay joint, blunt, or • Fake Weed pipes • Genie • Spice • It can also be • Zohai brewed as a tea Synthetic Cannabinoids • Route - Smoked in joints or pipes - Brewed into a tea • Effects - Similar to marijuana - Stored
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