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THERAPEUTICS

ILLICIT DRUGS

ILLICIT DRUGS
METHAMPHETAMINE
Street names include:
—  Meth, Speed, Ice, Chalk, Crank, Fire, Glass, and
Crystal

Routes of administration include:


—  Inhalation, injection, oral

Pharmacology
—  Promotes increased levels of noradrenalin, dopamine
and serotonin

ILLICIT DRUGS
METHAMPHETAMINE
Related drugs
—  Amphetamine
—  Ecstasy
—  Ketamine

Meth(yl) group gives potentiation of effects compared to


amphetamine:

—  more lipid soluble … crosses blood brain barrier easier


—  more stable against enzymatic degradation by MAO

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ILLICIT DRUGS
METHAMPHETAMINE
Effects
—  potent CNS stimulant - acute effects resemble
adrenaline fight-or-flight response e.g.
—  increased heart rate and blood pressure, vasoconstriction
—  bronchodilation
—  hyperglycemia
—  increased focus, mental alertness, decreased fatigue
—  decrease in overall appetite

—  heavy use can lead to brain damage

ILLICIT DRUGS
METHAMPHETAMINE
Oral effects
—  Caries (extensive - meth mouth)
—  ? acidic nature
—  dry mouth

—  reported craving high-calorie, carbonated, sugary


beverages
—  ? extended periods of poor oral hygiene and lack of
attendance
—  pattern - smooth surfaces and interproximal of anteriors

ILLICIT DRUGS
METHAMPHETAMINE
Oral effects cont’
—  Increased periodontal disease
—  Increased bruxism and pain in muscles of mastication

—  Abnormal sensations (e.g. numbness and/or sensitivity


of teeth).
Other dental relevance
—  Potential interaction with local anesthetics, sedatives
—  Compliance

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ILLICIT DRUGS
METHAMPHETAMINE
Medical use under the brand name Desoxyn for:
—  Narcolepsy
—  Extreme obesity
—  Attention deficit hyperactivity disorder

•  not generally prescribed for ADHD unless other stimulants


such as methylphenidate (Ritalin®), have failed

ILLICIT DRUGS
CANNABIS
—  3 main forms: marijuana, hash and hash oil
—  psychoactive constituent THC (tetrahydrocannabinol)
—  Routes
—  Inhaled, Oral

—  Effects
—  CNS … acts on endogenous receptors
—  Cardiovascular e.g. tachycardia, also respiratory and
immune system effects
—  Acute and chronic effects on mental health for some

ILLICIT DRUGS
CANNABIS
Oral effects
—  increased risk of caries and periodontal disease

—  increased risk of pre-malignant lesions within the oral


mucosa
—  increased risk of oral infections
Concerns with patients intoxicated on cannabis:
—  can experience acute anxiety, paranoia.
—  adrenaline may prolong tachycardia induced by an
acute dose of cannabis

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ILLICIT DRUGS
COCAINE
Oral effects
—  hypertension, tachycardia - adrenalin potentiation
—  first injected LA …. also potent vasoconstrictor … cardio
vascular complications
—  mucosal ulceration
—  caries, erosion
—  acidic when mixed with saliva

—  snorted …. oronasal fistula


—  ?vasoconstriction, micronecrosis, infection, necrosis