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Drugs and.Pharmacology

What to do if a GHB Overdose Occurs

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We must take care of our own. Talk about what to do if a GHB overdose occurs Since it's a more frequent occurrence that any of us would prefer...talking it through ahead of time can help those around you know what to do in case an overdose does happen. Contact the events EMT, they are there for you. Check their breathing. Turn the individual on their side so if they vomit while unconscious they won't choke. If there is reason to think they are in danger, call help immediately. The most dangerous period is between 20 and 120 minutes after ingestion. Try to find out what else they may have taken. Always lean on the side of caution and safety. Whenever someone becomes unconscious after taking a depressant, there is a risk of death. If someone begins vomiting and convulsing after taking GHB, the person should get medical attention immediately....

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Measuring the Concentration of GHB

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What a lot of people do to test the concentration of their gear is take 1-2ml to start off with, then wait 1.5-2 hours to see what happens. If they don't reach the desired effects, they take another dose 1ml higher than their last, wait 1.5-2 hours... And you get the idea.

If you've got 1,4-B, watch out because it doesn't mix entirely with water, and tends to sink to the bottom of the bottle if left to sit for a while. So when you're testing for concentration, you might find that the stuff at the top of the bottle is quite weak and assume the whole batch is... But as you near the bottom of the bottle, it will get stonger and stronger. So it's a good idea to give it a shake before you do anything with it.

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Buying Drugs in Nightclubs by Anonymous

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Let’s be honest here – buying drugs is a risky business as the best of times. If you don’t get arrested whilst trying to do it, you still have the risk of being ripped off by an unscrupulous drug dealer. Being sold short, or low quality is just one of the risks that you have to accept for as long as substance use remains against the law. But there is a way to take that risk to a new, more dangerous level – by buying drugs in nightclubs.

Drug dealers the world over all work on one basic premise. Profit. Dealers cover a broad spectrum of people, and are not necessarily the “scum of the earth” type of character that the anti-drug propaganda would have you believe. But they are all in the drug selling game for one reason, and that is to make money. And just like any other, more legitimate, business out there, they are...

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The Management Of Retrograde Ejaculation: A Systematic Review And Update.

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Abstract

OBJECTIVE: To determine the best management of retrograde ejaculation to optimize the chance of conception.

DESIGN: Systematic review.

SETTING: Tertiary reproductive medicine center.

PATIENT(S): Subfertile men with retrograde ejaculation.

METHOD(S): Systematic search of studies using search terms "management" or "therapy" or "treatment" and "retrograde ejaculation." We excluded case reports and papers not in English.

MAIN OUTCOME MEASURE(S): Pregnancy and live birth rates and rates of achievement of antegrade ejaculation.

RESULT(S): Thirty-four studies met our criteria. Studies were mostly observational. Descriptions of predictive and confounding variables were often insufficient. The treatment options included urinary sperm retrieval and medical management with anticholinergics and sympathomimetics. Successful pregnancies and live births were also achieved using surgical techniques and electroejaculation; however, numbers were small.

CONCLUSION(S): Many treatment options exist in the management of retrograde ejaculation; however, current literature is insufficient to allow firm...

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The Gastrointestinal Concealment Of Illegal Drugs

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Abstract

The clinical, radiological and analytical aspects, and the complications observed in 16 cases of swallowing or insertion into the rectum of illicit drugs ("body-packing") are described. The drugs detected were heroin (6 cases), cocaine (5 cases) and cannabis (5 cases). In 15 cases abdominal plain X-rays were useful in the detection of the drug packages, their position and progression in the gastrointestinal tract and the presence of complications. The most valuable finding for radiologic diagnosis was the presence of a radiolucent halo surrounding the drug packages, or "double condom" sign, which was observed in 13/15 cases (87%). Urine analysis was positive for opiates or metabolites of cocaine in 7/9 cases (78%). One case presented acute heroin intoxication and three subjects gastric or intestinal obstruction requiring surgical treatment. In another case a packet, which had been retained in the stomach for five days, was extracted by... .

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Common Anticholinergic Drugs Like Benadryl Linked To Increased Dementia Risk

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One long-ago summer, I joined the legion of teens helping harvest our valley’s peach crop in western Colorado. My job was to select the best peaches from a bin, wrap each one in tissue, and pack it into a shipping crate. The peach fuzz that coated every surface of the packing shed made my nose stream and my eyelids swell. When I came home after my first day on the job, my mother was so alarmed she called the family doctor. Soon the druggist was at the door with a vial of Benadryl (diphenhydramine) tablets. The next morning I was back to normal and back on the job. Weeks later, when I collected my pay (including the ½-cent-per-crate bonus for staying until the end of the harvest), I thanked Benadryl.

Today, I’m thankful my need for that drug lasted only a few weeks. In a report published in JAMA Internal Medicine,...

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Antihistamines

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Histamine is an important mediator of immediate hypersensitivity reactions acting locally and causing smooth muscle contraction, vasodilation, increased vascular permeability, edema and inflammation.  Histamine acts through specific cellular receptors which have been categorized into four types, H1 through H4.  Antihistamines represent a class of medications that block the histamine type 1 (H1) receptors.  Importantly, antihistamines do not block or decrease the release of histamine, but rather ameliorate its local actions.  Agents that specially block other H2 receptors are generally referred to as H2 blockers rather than antihistamines.

H1 receptors are widely distributed and are particularly common on smooth muscle of the bronchi, gastrointestinal tract, uterus and large blood vessels.  H1 receptors are also found in the central nervous system.  The antihistamines are widely used to treat symptoms of allergic conditions including itching, nasal stuffiness, runny nose, teary eyes, urticaria, dizziness, nausea and cough...

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Temporomandibular Joint Dislocation Due To Atypical Antipsychotic-induced Acute Dystonia: A Case Report

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Introduction

Dystonia is a movement disorder that causes sustained muscle contractions, repetitive twisting movements, and abnormal postures of the trunk, neck, face, arms or legs [Fahn et al. 1987]. It may be focal, segmental (multifocal), or generalized and may also be primary or secondary based on their etiology. It may manifest as oculogyric crisis, deviation of eyes in all directions, protrusion of tongue, trismus, lock jaw, torticolis, laryngeal spasm, difficulty in speaking, facial grimacing, opisthotonus, lordosis or scoliosis and tortipelvic crisis. Drug-induced dystonia are secondary dystonias which occur commonly with drugs with antidopaminergic effects such as antipsychotics and metoclopramide [Ropper and Samuels, 2009; Fadare and Owolabi, 2009]. They reportedly arise from a drug-induced alteration of dopaminergic–cholinergic balance in the nigrostriatum (i.e. basal ganglia). Most drugs produce dystonic reactions by nigrostriatal dopamine D2 receptor blockade, which leads to an excess of striatal cholinergic output. High-potency D2 receptor antagonists are most likely to produce...

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National Case Control Study Of Homicide Offending And Methamphetamine Use..

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Abstract

The purpose of this study is to examine the relationship between methamphetamine use and homicide. To carry out this study, data from the National Household Survey on Drug Abuse and Survey of Inmates in State and Federal Correctional Facilities were combined to create a case-control design. The main exposure measure is methamphetamine use and the main outcome measure is homicide. Results suggest that the odds of committing a homicide are nearly 9 times greater for an individual who uses methamphetamine. More importantly, the association between methamphetamine use and homicide persists even after adjusting for alternative drug use (i.e., alcohol, heroin, crack, cocaine, PCP, LSD), sex, race, income, age, marital status, previous arrests, military experience, and education level. Methamphetamine was the only drug use variable that was strongly correlated with homicide. These results support recent clinical studies that suggest methamphetamine use is different than other drug use in its effects on violence....

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Quaaludes

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What are Quaaludes?

Quaaludes (methaqualone) are a synthetic, barbiturate-like, central nervous system depressant. Methaqualone is an anxiolytic and a sedative-hypnotic drug. Quaaludes were introduced as a safe barbiturate substitute, but they later showed that the possibility of addiction and withdrawal symptoms were similar to those of barbiturates.

History of Quaaludes

Quaaludes were first synthesized in India in 1950's. It was introduced into America in the 1960's and by the late 1960's it became a popular recreational drug. The abuse potential of Quaaludes soon became apparent and in 1973 methaqualone was placed in Schedule II, making it difficult to prescribe and illegal to possess without a prescription. In 1984 it was moved to Federal Schedule I, so Quaaludes are no longer legally available in the United States.

Quaaludes that are sold for recreational use now are synthesized in illegal laboratories. Illegally produced Quaaludes can contain other central nervous system depressants such as benzodiazepines...

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Pharmacology of Neuromuscular Blocking Drugs

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Abstract

Neuromuscular blocking drugs (NMBDs) have become an established part of anaesthetic practice since Griffith and Johnson in Montreal first described the use of curare to facilitate muscle relaxation in a healthy man undergoing an appendicectomy in 1942....

Depolarizing NMBDs

Mechanism of action

Depolarizing drugs are agonists at ACh receptors. Succinylcholine is the only depolarizing NMBD in clinical use. It is effectively two ACh molecules joined through the acetate methyl groups. The two quaternary ammonium radicals bind to the two α-subunits of one nicotinic receptor, and depolarization occurs. When voltage-sensitive sodium channels sense membrane depolarization (as a result of activation of the ACh receptors), they first open (Fig. 1A(b)) and thereafter close and become inactivated (Fig. 1A(c)). The membrane potential must be reset before the sodium channels can be reactivated (Fig. 1A(a)). This is a very rapid process with ACh (1 ms), as it is hydrolysed by acetylcholinesterase (AChE) within the synaptic cleft...

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The LSD Syndrome—A Review

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Abstract

LSD (lysergic acid diethylamide) is a powerful bio-active substance related to serotonin in structure. Its actions generally affect autonomic, sensory and psychological functions. Autonomic stimulation is varied. Sensory responses are usually visual, involving heightened and distorted color perception and fusion of sensory impressions. Psychological responses include a feeling that a unique experience is occurring; feelings of depersonalization; pronounced fluctuation of mood; time and space distortions; autistic phenomena; fluctuation of aggressive drives (usually reduction); and spontaneous reoccurrence of the lsd experience.

The subjective responses can be related to three basic phenomena: (1) expectation; (2) loss of characteristic modes of perceptual and cognitive patterning; and (3) hypersuggestibility.

The major adverse reactions are: (1) chronic drug dependence including subsequent personality changes and depressive reactions; and (2) acute ego dissolution. These reactions usually occur in already emotionally ill people. Most of these users fall into two groups, those with unresolved identity problems and those with severe ego...

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Mechanisms Of Fatal Opioid Overdose.

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Abstract

There has been increasing recognition of the problem of fatal opioid overdose. This review examines the pharmacological basis of respiratory depression following opioid administration. Respiration is controlled principally through medullary respiratory centres with peripheral input from chemoreceptors and other sources. Opioids produce inhibition at the chemoreceptors via mu opioid receptors and in the medulla via mu and delta receptors. While there are a number of neurotransmitters mediating the control of respiration, glutamate and GABA are the major excitatory and inhibitory neurotransmitters, respectively. This explains the potential for interaction of opioids with benzodiazepines and alcohol: both benzodiazepines and alcohol facilitate the inhibitory effect of GABA at the GABAA receptor, while alcohol also decreases the excitatory effect of glutamate at NMDA receptors. Heroin and methadone are the major opioids implicated in fatal overdose. Heroin has three metabolites with opioid activity. Variation in the formation of these metabolites due to genetic factors and the use...

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Is Succinylcholine Really Superior for RSI?

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Background:

Intubation is arguably the most important procedure performed by Emergency Physicians (EPs). Ideally, it would be performed successfully on the first attempt each and every time, but this of course cannot always be the case. Rapid Sequence Intubation (RSI) has become the preferred method for emergency intubations, as it improves visualization of the vocal cords, and decreases complications such as aspiration and increased intracranial pressure. Succinylcholine, a depolarizing agent, is the most widely utilized paralytic due to its rapid onset and short half-life. However, there are certain circumstances in which succinylcholine is contraindicated, including suspected hyperkalemia, known prior adverse reactions, concern for head injury, neuromuscular disease, or spinal cord injury. Rocuronium, a non-depolarizing agent with a considerably longer half-life, is frequently used in these situations.

Prior studies evaluated by the Cochrane review suggest succinylcholine produces superior intubation conditions when compared to rocuronium.[1]However, there is concern that succinylcholine's advantage...

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Extended Release Drug Delivery Strategies in Psychiatry

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Abstract

Objective: An overview of the emerging field of long-term delivery strategies for improved convenience and adherence with psychiatric medications is provided. This review is motivated by the hypothesis that adherence to treatment is an important determinant of clinical outcomes in a wide range of settings and is particularly important in psychiatry practice where patients require treatment for months or years and premature discontinuation can have serious consequences for patient health and quality of life.

Design: The author reviews the relevant literature and highlights several approaches to providing improved access to continuous medication through new and innovative delivery strategies ranging from days to annual intervals.

Benefits and Disadvantages: Several solutions to the problem of discontinuous access to pharmacotherapy are being developed in the form of new, long-acting drug-delivery systems, which gradually release medication over a period of several days or weeks with a single application. Long-acting formulations of psychiatric medications offer...

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Fluoxetine Delayed Release Capsules

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WARNING: SUICIDAL THOUGHTS AND BEHAVIOR

 Antidepressants increased the risk of suicidal thoughts and behavior in children, adolescents, and young adults in short-term studies. These studies did not show an increase in the risk of suicidal thoughts and behavior with antidepressant use in patients over age 24; there was a reduction in risk with antidepressant use in patients aged 65 and older [see Warnings and Precautions (5.1)].  psy

In patients of all ages who are started on antidepressant therapy, monitor closely for worsening and for emergence of suicidal thoughts and behaviors. Advise families and caregivers of the need for close observation and communication with the prescriber [see Warnings and Precautions (5.1).

Fluoxetine is not approved for use in children less than 7 years of age [see Warnings and Precautions (5.1) and Use in Specific Populations (8.4)].  Indications and Usage for Fluoxetine Delayed Release Capsules

Fluoxetine delayed-release capsules are indicated for the treatment of: ...

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