8/18/14 Introduc?on to Objecves Herbal Medicine ● Discuss history and role of psychedelic herbs Part II: Psychedelics, in medicine and illness. Legal Highs, and ● List herbs used as emerging legal and illicit Herbal Poisons drugs of abuse. ● Associate main plant and fungal families with Jason Schoneman RN, MS, AGCNS-BC representave poisonous compounds. The University of Texas at Aus?n ● Discuss clinical management of main toxic Schultes et al., 1992 compounds. Psychedelics Sacraments: spiritual tools or sacred medicine by non-Western cultures vs. Dangerous drugs of abuse vs. Research and clinical tools for mental and physical http://waynesword.palomar.edu/ww0703.htm disorders History History ● Shamanic divinaon ○ S;mulus for spirituality/religion http://orderofthesacredspiral.blogspot.com/2012/06/t- mckenna-on-psilocybin.html http://www.cosmicelk.net/Chukchidirections.htm 1 8/18/14 History History http://www.10zenmonkeys.com/2007/01/10/hallucinogenic- weapons-the-other-chemical-warfare/ http://rebloggy.com/post/love-music-hippie-psychedelic- woodstock http://fineartamerica.com/featured/misterio-profundo-pablo- amaringo.html History ● Psychotherapy ○ 20th century: un;l 1971 ● Recreaonal ○ S;mulus of U.S. cultural revolu;on http://qsciences.digi-info-broker.com http://www.uspharmacist.com/content/d/feature/c/38031/ http://en.wikipedia.org/nervous_system 2 8/18/14 Main Groups Main Groups Tryptamines LSD, Psilocybin, DMT, Ibogaine Other Ayahuasca, Fly agaric Phenethylamines MDMA, Mescaline, Myristicin Pseudo-hallucinogen Cannabis Dissociative Ketamine, Phencyclidine Anticholinergics Tropanes hallucinogens (PCP), Ibogaine, Salvia Lysergic Acid Diethylamide (LSD) Lysergic Acid Diethylamide (LSD) ● Ergot fungus (Claviceps purpurea ) ● Avoid in pre-exis;ng mental illness, ● Potent 5HT2A agonist par;cularly schizophrenia ● Colorless, odorless, tasteless and the most ● Psychotherapy for anxiety based disorders potent drug known on the planet (mainly end of life (cancer)) and addic;ons ○ 20 mcg can alter consciousness for 12 hours ● Cluster headaches Psilocybin ● Converted to Psilocin in body ● Found in many species of mushrooms ● 5HT2A agonist Ergot fungus ● Psychotherapy Claviceps purpurea ○ OCD ○ End of life anxiety (cancer) ○ MDD ○ Nico;ne addic;on http://en.wikipedia.org/wiki/Claviceps_purpurea ● Cluster headaches 3 8/18/14 Psilocybe cubensis N, N Dimethyltryptamine (DMT) ● Endogenous compound in humans ○ In near death experiences, DMT secreted from pineal gland ● Virola (Epena), Anadenanthera (Yopo), Psychotria, Bufo alvarius ● 5HT2A agonist ● Broken down by monoamine oxidases, so needs http://divawhispers.com/onthescene/ MAOI adjunct or bypass MAOIs http://www.amazon-indians.org/yanomami.html Schultes et al., 1992 Ibogaine ● Tabernanthe iboga (Apocynaceae) ● 5HT2A agonist, NMDA receptor antagonist, kappa opioid receptor agonist ● Psychotherapy ○ An;-addic;on: ETOH, cocaine, opiates/opioids Schultes et al., 1992 4 8/18/14 Mescaline ● From various species of cac; ● 5HT2A agonist, adrenergic, dopaminergic Peyote ● Psychotherapy Lophophora ○ Addicons williamsii http://fineartamerica.com/featured/close-view-of-peyote-cacti-lophophorus-ira-block.html MDMA (Ecstasy) Ayahuasca ● Synthesized from various plant precursors ● Mixture of two known hallucinogenic plants and ● 5HT1A, 5HT1B, 5HT2A agonist, adrenergic, many other admixture plants dopaminergic ● Bansteriopsis caapi: Beta carboline harmala ● Psychotherapy alkaloids and MAOIs ○ PTSD ● Psychotria viridis (Rubiaceae): DMT but needing ○ MDD (ECT replacement) MAOI to be ac;vated orally ○ Borderline personality disorder ● Ayahuasca churches http://en.wikipedia.org/wiki/Ayahuasca http://www.telegraph.co.uk/news/picturegalleries 5 8/18/14 Natural and Semi- Overdose Management Synthe;c Legal Highs ● Suppor;ve therapy ● Natural: not yet on radar of public and legislave ● BZDs: mainly A;van bodies ● Restraints? ● Synthe;c: The Controlled Substance Analogue ● Lab and diagnos;c tests: Enforcement Act of 1986, tacked on to Controlled ○ CBC, CMP, Tox screen, Cardiac enzymes, ECG, Substances Act of 1971: EEG ○ chemical structure must be structurally similar to other class I or IIs or acts same physiologically http://en.wikipedia.org/wiki/Autonomic_nervous_system http://en.wikipedia.org/wiki/Autonomic_nervous_system Synthe;c Cannabinoids Synthe;c Cannabinoids ● ‘Spice’ and many other common names ● Can bypass drug tests: used by law, fire and ○ Compounds synthesized and sprayed on inert armed forces plant material and sold as incense to bypass ● Many ;mes more potent than hash oil detec;on or legal scru;ny ● Has been associated with psychosis, seizures, ● Over 400 compounds from work of Dr. Huffman and MIs (creaon of cannabinoids for research) ● Treatment ● 2nd most abused recreaonal drug behind ○ BZDs and Trazodone Cannabis 6 8/18/14 Salvia ● Salvia divinorum (Lamiaceae) ● Ancient Mazatec herb for shamanic divinaon ● Kappa opioid receptor agonist, dopaminergic ● Kept from schedule I status: ○ due to being promising candidate for novel an;depressant and non-addic;ve analgesics and anesthe;cs http://winnipeg.ctvnews.ca/winnipeggers Salvia ● Used at greater rate than ecstasy in 18-24 y/o ● Smoked ● Has been associated with anxiety and psychosis ● Treatment: ○ BZDs http://en.wikipedia.org/wiki/File:Salvia_Divinorum Methedione/Methylone Methedione/Methylone ● Synthe;c derivaves of Cathinone found in Khat ● Causes: (Catha edulis) ○ Agitaon ○ nave to East Africa and Arabian peninsula and ○ Seizures chewed for millennia for amphetamine-like ○ Excessive sympathomime;c s;mulaon: quali;es ■ Tachycardia, confusion, psychosis, ● Known as “bath salts” hyponatremia ● Potent adrenergic and MAOI ● Treatment ● Snorted and injected ○ BZDs 7 8/18/14 http://www.jewishjournal.com/world/article/widespread_khat_addiction_threatens_yemens_future http://fauxsociety.com/bath-salts-and-the-taste-for-flesh-zombie/ An;cholinergics ● Datura, Brugmansia, Belladonna, Henbane ● Causes: ○ Tachycardia, HTN, restlessness, delirium, blurred vision ○ Hallucinaons: auditory, visual ● Treatment ○ Acetylcholinesterase inhibitor: ■ Physos;gmine Cholinergics: Isoxazoles ● Occur in the genera: Clitocybe, Inocybe and in two species of Amanita ● Muscimol: GABA agonist, seratogenic, dopiminergic ● Ibotenic acid: NMDA agonist ● Fatali;es rare but possible to die with inges;on of 10 or more mushrooms ● Treatment: suppor;ve http://en.wikipedia.org/wiki/List_of_Amanita_species 8 8/18/14 Other Legal Highs Other Legal Highs ● Kratom (Mitragyna speciosa) ● Betel nut (Areca catechu) ○ Mitragynine: adrenerigic, mu and kappa ○ Arecaidine and arecoline: adrenergic, GABA opioid agonist, NMDA antagonist, inhibitor, cholinergic agonist, highly seratonergic carcinogenic ● Morning glory (Ipomoea violacea) ● Nutmeg (Myris;ca fragrans) ○ LSA (d-lysergic acid amide): potent ○ Myris;n (MAOI): adrenergic, dopiminergic, seratonergic seratonergic Herbal Poisons ● Acute management of poisoning ○ Immediate stabilizaon, decontaminaon, exam and labs ○ Pay close aen;on to toxidrome, physical and verbal evidence for source of poisoning ○ Labs: CBC, CMP, UA, Coags, ECG, Cardiac enzymes, ABGs, Tox screen, EEG 9 8/18/14 Herbal Poisons Algae ● Gastric decontaminaon ● Pfiesteria piscicida (dinoflagellate): toxin 1000 ○ Ipecac: no longer recommended ;mes stronger than cyanide, AKA “fish Ebola”, ○ Gastric lavage: no longer recommended indirect toxicity via shellfish ○ Whole bowel irrigaon: not recommended in ● Signs and symptoms: fague, arthralgias, herbal poisoning paresthesias, nausea, open sores, memory loss ○ Charcoal: case by case basis, and only if can (las;ng 1-2 weeks aer exposure), disorientaon be administered in first 1-2 hours of herbal ● Treatment ingeson ○Supporve Pteridophytes ● Pteridium aquilinum: ○ Bracken fern ● Carcinogenic ptaquiloside and thiaminase: ○ neoplasms of the upper alimentary tract ●Found throughout east Texas and the mountains of west Texas ● Treatment: ○ Preven;on de.wikipedia.org/ wiki/Pfiesteria_piscicida Gymnosperms ● Cycadaceae: primarily Cycas revoluta (“Sago palm”) in Texas. ● Palm-like pinnate leaves, but dis;nct cone-like reproduc;ve structures ● Neurodegenerave azoxy glycosides and mutagenic cycasin 10 8/18/14 Gymnosperms ●Texas ornamental ●Signs and symptoms: ○icterus, jaundice, N/V, liver failure, weakness, seizures ●Treatment: ○Supporve Ephedra Ephedra ● Ephedra sp. (joinpirs, ma huang, mormon tea) ●Distribu;on is widespread in drier regions of the world, occurs in west Texas ○Thin ●Signs and symptoms: ○Onen light green to blue ○Headache, diaphoresis, hyperthermia, MI/ ○Jointed stems with small cone-like reproduc;ve Stroke, seizures, agitaon structures ●Treatment: ● Natural source of l-ephedrine and d- pseudoephedrine ○BZDs Angiosperms Monocots http://commons.wikimedia.org/wiki/ File:Ephedra_fragilis_3.JPG 11 8/18/14 Araceae Araceae ● Araceae (Anthurium, Arisaema (Jack-in-the-pulpit), ● Alocasia, Colocasia (Taro), and Xanthosoma eaten Arum (Lords and Ladies), Caladium, Colocasia, throughout Asia and South Pacific, some varie;es Dieffenbachia, Monstera, Alocasia, Philodendron) with significant raphides ● Raphides (cells) contain calcium oxalate crystals in ● Signs and symptoms: edema, erythema, bullae, the shape of needles and proteoly;c enzymes in altered speech, laryngeal occlusion some genera ● Treatment: ● Extremely diverse leaf morphology but generally ○Removal similar reproduc;ve structures (spathe and spadix) ○An;histamines ○Steroids http://forums2.gardenweb.com/forums/load/houseplt www.meemelink.com www.sarracenia.com/ Liliaceae