4

(out of 5)

MORPHINES

Miosis, orthostatic hypotension, respiratory depression, pain suppression, histamine release, hormonal alterations, increased ICP,

nausea, euphoria, sedation

Nalaxone  (opioid overdose) = nonselective antagonist of opioid receptors

Methadone and Buprenorphine (substitution therapy for opioid addicts) = agonist/partial agonist at μ-opioid receptors

2

Euphoria, relaxation, feelings of well-being, grandiosity, altered perception of passage of time, visual distortions, drowsiness, diminished coordination, memory impairment.
May also create dysphoric state and lead to hallucinations, depersonalization, psychotic episodes

Dronabinol is a synthetic ∆⁹-THC analog that is an approved cannabinoid agonist

?

Before causing sedation and coma, GHB causes euphoria, enhanced sensory perceptions, a feeling of social closeness, and amnesia

n/a

1

Do not induce dependence or addiction

Perceptual distortion, psychosis-like manifestations (depersonalization, hallucinations, distorted time perception), dizziness, nausea, paresthesias, blurred vision, flashbacks up to several years later

Benzodiazepines for sedation; acidification

of urine may hasten PCP excretion

4

Withdrawal is mild and involves irritability and sleep problems

Varenicline (smoking cessation) = partial agonist of nicotinic ACh receptor of the α₄β₂- type

Bupropion (cessation therapy) = antidepressant drug

3

Symptoms of overdose include sluggishness, incoordination, difficulty in thinking, slowness of speech, faulty judgment, drowsiness, shallow breathing, and staggering. In severe cases, coma and death can result

Treatment can be supportive/observation or involve mechanical ventilation

May involve activated charcoal, IV, or alkalization of urine

3

Withdrawal can be severe =  (6-12 hours after cessation) trmor, nausea, vomiting, agitation; (12-24 hours) hallucinations; (24-48 hours) generalized seizures; (48-72 hours) delirium tremens associated with 5-15% mortality

Benzodiazepines such as oxazepam and lorazepam (attenuate withdrawal symptoms including delirium tremens) = enhances GABAergic synaptic transmission

Varies

Euphoria, increased excitability,

smooth muscle relaxation, enhanced

erection

Liver, kidney, peripheral nerve, &

brain damage; fluorocarbons may

cause sudden deaths from ventricular

arrhythmias or asphyxiation

Management of overdose remains supportive

5

Use leads to ↑BP, ↑HR, arrhythmias, hyperactivity, and ↑ risk of intracranial hemorrhage, stroke, MI, and seizures

Overdoes can lead to hyperthermia, coma, and death.Paranoid schizophrenia-like state;

delusions that bugs are under their skin.

Overdose treatment is supportive.

Weaning from stimulants with dopamine agonists, treatment with antipsychotic or

antidepressants may be necessary