 Assessment of Drug abuse

o Know the agent responsible for that overdose to ensure necessary treatment
 Screening test only detects recent drugs use
o Abstinence

 Amphetamines
 Indication:
o Treatment of narcolepsy and attention-deficit disorder
 Effects: mental alertness and physical activity
 Leads to a “pleasant feeling”
 E.g. amphetamines, methamphetamine and methylphenidate (Ritalin)(hyperactive children)
 Acute intoxication has hyperpyrexia (high fever)
 Anti-histamine (false-positive)
 Acute Psychotic Syndromes:
o Auditory and visual hallucinations, suicidal tendencies, paranoia
 Toxic effects:
o Palpitations, HTN, cardiac arrhytmias, convulsions

 Methylenedioxyamphetamine
 MDMA: administered orally
 Half-life: 8-9 hours
 Elimination: hepatic metabolism
 Onset of effect: 30-60 minutes
 Confirmatory test: GC-MS
 Screening test: immunoassay

 Anabolic steroids

 Chemically-related to testosterone
 Used as a treatment for male hypogonadism
 Toxic effects:
o Chronic hepatitis
o Atherosclerosis
o Abnormal platelet aggregation
o Cardiomegaly
o Ischemia (local anemia)
 Effects:
o Male: testicular atrophy, sterility, impotence
o Female: hirsutism, breast reduction, sterility
 Screening test:
o Testosterone: epitestosterone (T/E ratio)
 Cannabinoids
 Hashish
 Marijuana
o Came from Cannabis sativa

 Tetrahydrocannabinol
 Most active component of marijuana
 Lipophilic substance which is rapidly removed from the blood steam
 It is a hallucinogen
 Leads to memory impairment and intellectual functions
 Half-life:
o 1 day (single use)
o 3-5 (chronic use)
 Metabolite: THC-COOH (11-nor-deltatetrahydrocannabinol)
o 3-5 days (single use)
o Up to 4 weeks (for chronic user)
 Physiologic effects:
o Reddening of the conjunctiva
o Increased pulse rate
 Toxic effects:
o Paranoia
o Disorientation
o Altered physical senses
o Bronchopulmonary disorders

 Cocaine
 “crack”; extracted from “coca plant”
 Local anesthetic for nasopharyngeal surgery
 Active CNS stimulant
 Half-life: 0.5-1hr
 Undergoes rapid hydrolysis
 Converted into inactive metabolite
 Could lead to:
o Mental retardation
o Slow mental development
o Drug dependence in newborns
o Malformations in the uterus
o Sudden death – because directly affects the myocardium
 Induces platelet aggregation, vasoconstriction, and synthesis of plasminogen actvator inhibitor
 Treatment: benzodiazepine
 Toxic effects: HTN, arrhythmias, seizures, MI
 Urine metanolite: benzoylecgonine
  Half-life: 4-7 hours
 Detected in the urine up to 3 days
 Inhibitor: fluoxetine
 Confirmatory test: GC-MS

 Opiates
 Capable of analgesia, sedation, and anesthesia
 Source: opium poppy
 Naturally occurring opiates include:
o Opium
o Morphine
o Codeine – anti-tussive (cough)
 Most commonly tested opiates
o N-acetyl morphine – common metabolite for
 Chemically modified opiates:
o Heroin HL: 6-8 minutes, rapidly metabolized into morphine, capable of passing the
blood-brain barrier
o Hydromorphone:
o Oxycodone (perdcodan)
 Common synthetic opiates:
o Methadone (dolophine)
o Meperidine (demerol)
o Propoxyphene (Darvan)
o Pentazocine (talwin)
o Fentanyl (sublimaze)
 Withdrawal symptoms:
o Cold seats
o Nightmares
o Hypothermia
 Anatagonist: naloxone (narcan)
 Toxic effects: respiratory acidosis, myoglobinura, cardiopulmunary failure, “pin-point pupils”

 Phencyclidine
 Characteristics: stimulant depressant, anesthetics. Hallucinogenic
 Physiologic effects: analgesia and anesthesia
 Major metabolite: phencyclidine HCl
 Mode of treatment: isolation
 Toxic effects:
o Tachycardia
o Seizure
o Coma
 Confimatory: GC-MS
 Sedative Hypnotics

 Used as a therapy and depressants

 E.g. barbiturates and benzodiazepines
 Commonly used barbiturates:
o Valium (diazepam)
o Librium
o Lorazepam (ativan)
 Commonly abused barbiturates:
o Phenobarbitals
o Secobarbital
o Pentobarbital
o Thiopental

 Lysergic Acid Diethylamide

o “lysergide:
o Effects are experienced at low doses
o Most common adverse effects: panic reaction
o Toxic effects: blurry vision, synesthesia

 Methaqualone
o Has possess sedative-hypnotic property
o Can be removed from the circulation using activated charcoal
o Barbiturates

 Piperazines
o Toxic effects:
o Tachycardia
o HTN
o Hyperthermia
o Psychomotor agitation
o Sore nasal and throat passages

 Tryptamines
o E.g. N,n-dimethyltryptamine (DMT), psilocin
o inhalation
o Toxic effects:
o HTN
o Tachycardia
o Dystonia
o Seizures
o Paralysis
o Rhabdomyolysis and derived from serotonin