Download Recreational Drugs

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Recreational Drugs
Jeremy S. Heiner CRNA
Objectives:
 Review recreational drug categories and their associated signs and symptoms.
 Discuss withdrawal syndrome and possible treatments.
 Discuss anesthetic considerations when caring for patients with acute and chronic
substance abuse.
Approximately 20 million Americans used illicit drugs monthly in 2006
4 categories of recreational drugs:
1. CNS Depressants
a. Barbiturates
b. Benzodiazepines
c. Gamma hydroxybutyric acid (GHB)
d. Opioids
e. Marijuana
f. Synthetic depressants
g. Alcohol
2. CNS Stimulants
a. Sympathomimetics
b. Serotonergics
c. Synthetic stimulants
3. Hallucinogens
a. Dissociatives
b. Psychedelics
4. Inhalants
CNS Depressants
Flunitrazepam (Rohypnol)
 Ten times as Potent as Diazepam.
 AKA Date Rape Drug (associated with sexual assaults).
 Started appearing in the US in 1990’s.
 Not approved by FDA for medical use in the US.
 Often combined with alcohol (person appears very intoxicated).
 Enhances GABA receptor efficiency.
 Produces amnesia.
 Onset within 30 minutes and can last up to 8 hours.
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Signs and Symptoms:
 CNS: anxiolytic, hypnotic, amnesia, loss of inhibitions, memory impairment,
drowsiness, aggressive behavior, visual disturbances, dizziness, confusion.
 CV: Decreased blood pressure, possible decreased heart rate.
 Resp: Decreased respiratory rate and work of breathing.
 MS: muscle relaxant, in high doses loss of muscle control.
 GI/GU: disturbances, urinary retention.
Gamma hydroxybutyric acid (GHB)
 Originally developed as a sedative and anesthetic in the 1960’s.
 Approved by FDA in 2002 for the treatment of insomnia.
 Commonly available in small liquid vials.
 Has a salty, soapy taste so it is usually diluted in a flavored beverage.
 Used as a “date rape” drug.
 Naturally occurring substance in the body.
 Potency and purity of preparations varies.
 GHB is readily manufactured from its precursor, gamma-butyrolactone (GBL)
which is a solvent found in stain, nail polish, and super glue removers.
 Has anabolic effects (stimulates protein synthesis) and has been used by
bodybuilders to aid in fat reduction and muscle building.
 Acts on at least 2 sites:
o GABA receptor
o A specific GHB binding site
 Rapidly absorbed, peak concentrations occur within 20-60 minutes.
 Most effects fade after a few hours.
Signs and Symptoms:
 CNS: Disinhibition, enhanced social interactions, difficulty concentrating,
confusion, dizziness, agitation, anxiety, hallucinations, seizures.
 CV: bradycardia, arrhythmias, high or low blood pressure.
 Resp: Loss of gag reflex, decreased respiratory effort.
 MS: Loss of coordination due to loss of muscle tone, tremor, weakness.
 GI/GU: Nausea and vomiting.
Oxycontin, Fentanyl and Meperidine analogs, and Heroin
 Fentanyl and meperidine analogs
o 80-1000 times more potent than morphine.
o Rapid onset (1-4 min) short duration (30-90 min).
o Usually taken IV.
o Meperidine analogs can be neurotoxic and lead to S/S similar to severe
Parkinsonism (tremor is more pronounced).
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Oxycontin
o Sustained release formula- Abusers extract molecule from polymer
formula and inject or snort entire dose.
o Sells for $0.50 to $1.00 per milligram
 40 mg tablet - $25-40
 80 mg tablet- $65-80
Heroin
o Processed from morphine.
o Usually appears as a white or brown powder.
o Effects last for 2-4 hours (can be shorter or longer depending on purity).
o Associated with collapsed veins, infection of heart lining and valves,
abscesses, cellulites, liver disease, and pneumonia from poor health and
respiratory depression.
o Tolerance develops with regular use (abuser must use more heroin to
achieve same intensity).
o Withdrawal symptoms may occur within 8 hours in chronic users.
Signs and Symptoms:
 CNS: Euphoria, dysphoria, apathy, sedation, slurred speech, attention,
impairment, miosis, lacrimation.
 CV: Bradycardia, low blood pressure.
 Resp: Decreased respiratory effort, apnea in higher doses, rhinorrhea.
 MS: Motor retardation, muscle aches in higher doses.
 GI/GU: Nausea and vomiting, diarrhea.
Marijuana
 Most commonly used illegal recreational drug.
 Acute effects similar to alcohol.
 Main active chemical is Tetrahydrocannabinol (THC).
 Usually smoked as a joint (doobie) or in a pipe (bong).
 Can also be mixed with food or brewed as a tea.
 Called hashish in a more concentrated form.
 Has a pungent and distinctive sweet-and-sour odor.
 Contains 50-70% more carcinogens than does tobacco smoke.
 Medically used to treat glaucoma, malnutrition in the HIV patient, and nausea
during chemotherapy.
 Acts on cannabinoid receptors in the brain.
 Highest density of cannabinoid receptors are found in the parts of the brain that
influence pleasure, memory, thinking, concentration, sensory and time perception,
and coordination.
 Effects can last for days or weeks after initial effects of drug wear off.
 Rapidly dissolved into bloodstream from alveoli.
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Signs and Symptoms:
 CNS: Sedation, euphoria, decreased reactivity, sensory intensification, apathy,
hallucinations, disinhibition, decreased ability to perform complicated tasks,
amotivational syndrome, problems with learning and memory,
 CV: Tachycardia (by 20-100% for up to 3 hrs), palitations, arrhythmias
 Resp: Decreased respiratory rate and work of breathing
 MS: Impaired coordination
 GI/GU: Increased appetite, dry mouth
Synthetic Cannabinoid (K2 & Spice)
 Synthetic cannabis - derived of natural herbs sprayed with synthetic chemicals.
 Little is known about the detailed pharmacokinetics and toxicology of the
synthetic cannabinoids, and few formal human studies have been published.
 Evidence suggests that synthetic cannabinoids are more potent compared to
cannabis and could have longer half lives, potentially leading to prolonged
toxicological effects.
 Signs and symptoms reported from case studies:
o Seizures, altered mental status, agitation, hallucinations, anxiety,
tachycardia, inability to move arms, combativeness, N/V, syncope.
Alcohol
 70% of American adults use at least occasionally.
 Frequently alcohol is abused in combination with other recreational drugs.
 Alcohol potentiates the effects of CNS depressants.
 High concentrations induce pylorospasm and decrease gastric emptying.
 Fatal doses vary due to individual tolerance, but about 600 ml of pure alcohol
consumed in 1 hour will be fatal.
 Acute effects are sedation, decreased reactivity, disinhibition, decreased ability to
perform complicated tasks.
 Other adverse effects to consider: peripheral vasodilation, hypothermia,
hypotension, hypoglycemia, and dehydration.
ANESTHESIA CONSIDERATIONS
CNS depressants
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Care is supportive:
o Oxygen, good functioning IV, IV fluids
o Maintain blood pressure and heart rate
o Secure airway
o If doing RSI, may only need muscle relaxant
o Blood gas, electrolytes
o Benzodiazepine for seizure
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Induce emesis or lavage stomach within 1 hour of ingestion.
Activated charcoal (limits absorption).
Acute ingestion decreases anesthetic requirement.
Chronic ingestion increases anesthetic requirement.
IV access may be difficult.
IV use increases risk for HIV/AIDS and hepatitis.
For flunitrazepam intoxication:
o Flumazenil (Romazicon) 0.2-0.5 mg IV over 1 min, repeat up to 3 mg
 Duration may be less than benzodiazepine
 May precipitate seizures
For GHB intoxication:
o Naloxone 0.2-0.4 mg IV
For opioid intoxication and withdrawal:
o Naloxone: Titrate 20-40 mcg every few minutes until patients ventilation
improves up to 10 mg
o Naltrexone (ReVia): 50 mg/day to 100-150 mg/week
o Methadone (Dolophine): 60 mg PO daily
o Buprenorphine: 2mg and 8mg tablets that dissolve under the tongue
o Behavioral therapy
For marijuana intoxication:
o Benzodiazepine (diazepam 5-10 mg IV) for severe anxiety, panic, or
disorientation
o Research being done on cannabinoid system to ease withdrawal, block
intoxicating effects, and prevent relapse
When CNS depressants are combined with alcohol can result in lethal
hypoventilation and nausea and vomiting (potential for aspiration).
Withdrawal syndrome:
 Restlessness, sweating, muscle and bone pain, abdominal pain, diarrhea and
vomiting, mood swings, Flu-like symptoms, insomnia, hypertension, tachycardia,
and possible seizures.
 Major withdrawal symptoms peak between 48-72 hours after the last dose and
subside after 7-10 days.
 Sudden withdrawal by heavy users can be fatal.
 Causes stress on CV system, risk of aspiration, seizures with hypoventilation.
 Withdrawal treatment: methadone, naltrexone, buprenorphine, benzodiazepine
(diazepam).
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CNS Stimulants
Cocaine- benzoylmethylecgonine
 Obtained from the leaves of the coca plant.
 Crack is the street name for cocaine that has been processed into rock crystals for
smoking.
 Central nervous system stimulant (Serotonin-norepinephrine-dopamine reuptake
inhibitor).
 Causes release and inhibits reuptake of catecholamines.
 Pyrogenic
 Medically used as a topical anesthetic and vasoconstrictor in ophthalmic and
EMT surgery.
 Addictive properties come from affecting the mesolimbic reward pathway.
 Tolerance develops quickly.
 Users may increase dose to intensify and prolong euphoria.
 Can cause long-term changes in brain.
 Can be snorted, injected, inhaled, or ingested.
 Faster cocaine is absorbed into the bloodstream and delivered to the brain, the
more intense the high (but faster absorption means shorter duration of action).
 Injection and inhalation causes symptoms in 1-2 minutes and lasts 5-10 minutes.
 Ingestion cause symptoms in 20-30 minutes and lasts 15-30 minutes.
 Increased use can reduce period of stimulation.
 If ethanol is present during the metabolism of cocaine, cocaethylene is produced.
 Cocaethelyne intensifies cocaine’s euphoric effects and is associated with a
greater risk of sudden death than cocaine alone.
 Co-administration with an opioid such as heroin causes an intense rush of
euphoria with a high that combines both effects of the drugs, while excluding the
negative effects, such as anxiety and sedation.
 The effects of cocaine wear off far more quickly than heroin, and if an overdose
of heroin was used to compensate for cocaine, the end result is fatal respiratory
depression.
Signs and Symptoms:
 CNS: Intense euphoria, decreased fatigue, increased alertness, anxiety, psychosis,
delirium, mydriasis, seizures, stroke.
 CV: Tachycardia, arrhythmias, HTN or hypotension, constricted blood vessels,
and hyperthermia.
 Resp: Increased respiratory rate, pulmonary HTN, can exacerbate asthma or cause
wheezing, aspiration.
o Snorting can cause nasal passage anatomy distortion, nosebleeds, loss of
smell, problems with swallowing, hoarseness, chronic runny nose.
o Dental caries.
 MS: Motor agitation , rhabdomyolysis.
 GI/GU: Appetite suppressant, nausea and vomiting, severe bowel gangrene from
reduced blood flow (from vasoconstriction).
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Amphetamine/methamphetamine
 Synthesized from pseudoepedrine.
 Is a white, odorless, bitter-tasting crystalline powder.
 Can be taken orally, intranasally, intravenously, or inhaled by smoking.
 Medically used for treatment of attention deficit hyperactive disorder, narcolepsy,
and obesity.
 Produces an intense extremely pleasurable sensation.
 Can be followed by intense feelings of displeasure when it wears off.
 Increases norepinephrine and dopamine activity and inhibits MAO in brain.
 Chronic use leads to decreased amount of circulating catecholamines.
 Chronic use significantly alters how the brain functions.
 Onset is 3-5 min by IV, inhalation, or snorting; if ingested onset is 15-20 min.
 Effects can last several hours (cocaine lasts less than an hour).
Signs and Symptoms (similar to cocaine):
 CNS: Intense euphoria, decreased fatigue, increased alertness, anxiety,
aggressiveness, hostility, psychosis, delirium, mydriasis, seizures, stroke.
o With chronic use, changes can occur in areas of the brain involved with
emotion and memory as well as impaired verbal learning.
 CV: Tachycardia, arrhythmias, hypertension, hyperthermia.
 Resp: Increased respiratory rate.
 MS: Reduced motor skills.
 GI/GU: suppressed appetite (extreme weight loss), severe dental problems.
Methylenedioxymethamphetamine (MDMA)
 Developed in 1914 as an appetite suppressant, then used as a psychotherapeutic in
the 1970’s.
 Medically used to treat post-traumatic stress disorder.
 Blocks central serotonin 5-HT2 reuptake.
 Initial release of 5-HT² produces an early period of disorientation, then a rush,
then tingling may be experienced and jerking may occur. Finally, there is a
feeling of enhanced sociability.
 When effects wear off abuser can feel depressed and confused.
 When mixed with other drugs hyperpyrexia, muscle rigidity, sweating,
dehydration, DIC, acute renal or hepatic failure, rhabdomyolysis, and/or life
threatening ventricular arrhythmias or death may occur.
 Can lead to acute dehydration since the drug masks the normal senses of
exhaustion and thirst.
 Effects last 4-6 hours.
Synthetic Cathinones (Bath Salts)
 Stimulants structurally related to amphetamines that have effects similar to
cocaine and methamphetamine.
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These compounds may produce severe acute intoxication with high risk of fatal
consequences related to the powerful stimulation of the catecholaminergic system.
Desired effects include:
o Increased sociability, energy, libido sexual performance and capacity of
work, limited euphoria, empathy.
Untoward effects include:
o Prolonged panic attack, tremor, agitation, insomnia, nausea, headache,
tinnitus, vertigo, muscle twitching, dizziness, increased heart rate, altered
vision, confusion, short term memory difficulty, depression, suicidal
thoughts, psychosis, tolerance and dependence.
Acute toxicity includes neurological, cardiovascular, gastrointestinal, renal, and
psychopathological effects.
Therapeutic treatment includes:
o Low or moderate doses of benzodiazepines to control agitation or seizures.
o Antipsychotics or propofol to control severe agitation and psychotic
symptoms.
Hyperthermia should be treated with aggressive cooling and hyponatremia should
be treated with hypertonic saline and water restriction.
ANESTHESIA CONSIDERATIONS
CNS stimulants
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Care is supportive:
o Maintain blood pressure and heart rate
o Secure airway if needed
o Monitor for seizures, hyperthermia
o Blood gas, electrolytes, EKG, cardiac markers, CXR (chronic cough,
emphysema)
Caution with induction agent for RSI, may consider benzodiazepine and muscle
relaxant.
Gastric lavage within 1 hour of ingestion then activated charcoal.
Difficult IV access with IV abusers.
If patient is severely agitated may administer benzodiazepine and a muscle
paralytic.
Avoid beta blockers for hypertension.
Isolated beta-blockade leads to unopposed alpha-adrenergic activity, worsening
the hypertension and increasing mortality.
Administer oxygen, bronchodilators, and corticosteroids for pulmonary
complications.
Agitation and/or psychosis can be managed with haloperidol, benzodiazepines,
and/or phenothiazines.
Hyperthermia can be treated with cooling measures, if still hyperthermic consider
dantrolene.
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Hallucinogens
Ketamine
 Dissociative anesthetic.
 Available in 1960’s as an anesthetic.
 Used frequently as an adjunct for multimodal pain therapy and in obstetrics.
 Used extensively by veterinarians.
 Can be ingested, snorted, injected, or smoked.
 It is tasteless, odorless, and colorless.
 Another type of “date rape” drug.
 NMDA receptor antagonist.
 Also interacts with muscarinic, nicotinic, cholinergic, and opioid receptors.
 Chemically related to phencyclidine and produces similar effects.
 Lasts from 1-4 hours.
 May take 24-48 hours to feel “normal”.
Signs and Symptoms:
 CNS: Hallucinations, feeling of dissociation (floating over ones body with vivid
dreams), delirium, confusion, hostility, acute dystonic reactions, seizures,
increased intracranial pressure.
 CV: Increased blood pressure and tachycardia.
 Resp: Preserves ventilation, excessive secretions.
 MS: Muscular hypertonus (excessive level of skeletal muscle tension or activity).
Phencyclidine, Phenylcyclohexylpiperidine or PCP
 Patented and used in the 1950’s as an intravenous anesthetic.
 Dissociative psychedelic drug.
 NMDA receptor antagonist.
 Can be a contaminant in other recreational drugs.
 Psychoactive effects last for 2-4 hours.
Signs and Symptoms (similar to methamphetamines):
 CNS: Intense euphoria, decreased fatigue, increased alertness, anxiety, hostility,
psychosis (schizophrenics especially susceptible), delirium, miosis, nystagmus,
seizures, stroke.
 CV: Tachycardia, arrhythmias, hypertension, hyperthermia, hypoglycemia.
 Resp: Increased respiratory rate, apnea with overdose.
 MS: Paresthesias, muscle rigidity, motor agitation, rhabdomyolysis.
LSD or d-lysergic acid diethylamide
 Discovered in 1938.
 Manufactured from lysergic acid found in ergot, a fungus that grows on rye and
other grains.
 It is by weight the most potent drug discovered.
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Odorless and tasteless.
Usually taken by mouth.
May be mixed with other drugs.
Binds to serotonin receptors, dopamine receptors, and adrenoreceptors.
5-HT2 receptor agonism account for the psychedelic effects.
Medically used as an analgesic for chronic cancer pain and cluster headaches.
Effects are unpredictable due to variations in amount and composition of active
compounds (particularly in hallucinogens derived from plants and mushrooms).
Lasts 8-12 hours.
Signs and Symptoms:
 CNS: Psychedelic, affected by users personality, mood, expectations, and
surroundings; vivid colors, euphoria, delusions, flashbacks, mydriasis, sweating,
tremors, sleeplessness.
 CV: Increased or decreased heart rate and blood pressure.
 Resp: Excessive mucus production.
 GI/GU: Dry mouth, loss of appetite, nausea.
ANESTHESIA CONSIDERATIONS
Hallucinogens
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Support BP, HR, and airway.
Be aware that drug levels do not correlate with the severity of findings…can have
severe symptoms with minimal doses.
Activated charcoal if ingested.
Avoid beta blockers for hypertension.
Decrease stimulation.
Benzodiazepine for controlling agitation, combativeness, and seizures.
Aspiration prophylaxis.
Antisaligogue for excessive secretions (care with tachycardia).
Diphenhydramine for dystonic reactions.
May require psychological assistance during “bad trips”- reassurance from a
psychiatrist or psychologist or trusted friend.
Butyrophenones such as droperidol or haloperidol for extreme agitation or
delusions.
May need physical restraints.
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Inhalants
Volatile nitrates:
 Alkyl nitrites (sold as “poppers").
 Nitrous oxide is considered a dissociative hallucinogen.
 Solvent inhalants (Butane, Freon, Gasoline, Kerosene, Propane, etc).
 N2O is used in whipped cream canisters and as an inert gas to displace oxygen
when filling potato chip and snack bags.
 Highest use is among young teenagers and at clubs/raves.
 Effects include temporary stimulation and reduced inhibitions.
Signs and Symptoms:
 CNS: Dizziness, slurred speech, unsteady gait, drowsiness, hallucinations,
delusions, delirium with confusion, psychomotor clumsiness, emotional
instability, impaired thinking and reasoning, memory loss, neurological damage,
lightheadedness, ataxia, delirium, headache, syncope, sedation, anesthesia.
 CV: Tachycardia, ECG changes and dysrhythmias (inverted T wave, depressed
ST segment), profound vasodilation with hypotension.
 Resp: Irritation of lungs, sinuses, and nasal passages; Methemoglobinemia can
occur with prolonged use.
 GI/GU: Nausea and vomiting; volatile nitrates relax smooth muscle and internal
sphincters.
ANESTHESIA CONSIDERATIONS
Inhalants
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Treatment is supportive for cardiac and respiratory.
O2, anti-arrhythmics (beta blockers).
Caution with sympathomimetics use in presence of tachycardia.
May have airway reactivity or burns.
Potentially fatal interactions with phosphodiesterase inhibitors such as Viagra.
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Overall Anesthetic Considerations (The take home points):
 Accurate illicit drug history may be difficult to obtain.
 Patient may be taking combinations of illicit drugs.
 Anesthesia provider should suspect illicit drug abuse if the following signs or
symptoms are evident:
o Evidence of injection, thrombotic veins, phlebitis, subcutaneous skin
abscesses.
o Ophthalmologic changes such as papillary constriction from opioid use,
papillary dilation with amphetamine use, nystagmus from phencyclidine
(PCP) use.
o Lymphadenopathy secondary to nonspecific activation of the immune
system as a result of repeated injections of impurities and hepatitis B, C,
or HIV infection.
o Malnourishment as a result of amphetamine abuse.
o Poor dental hygiene and bruxism.
o Nasal perforation from cocaine abuse.
 Care is supportive for ABC’s.
 Aspiration risk.
 Use of illicit drugs can increase the risk for adverse consequences and drug
interactions during anesthesia.
 Emergency surgery only.
 Elective surgery should be delayed or cancelled if a patient is suspected of being
under the influence of illicit drugs.
 Monitor for withdrawal symptoms.
 Regional anesthesia should be considered whenever possible.
 Frequently associated with trauma.
 Monitor for hypovolemia and hypoglycemia.
 Obtain relevant laboratory analysis.
Effect of acute and chronic substance abuse on anesthetic requirements
Substance
Opioids
Barbiturates
Alcohol
Marijuana
Benzodiazepines
Amphetamines
Cocaine
Phencyclidine
Acute
Chronic
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0 or slight 
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0
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Characteristics of Recreational Drugs
Drug
Chemical
Name
Mechanism
Street
Name
Appearance
Signs and
Symptoms
Anesthetic
Considerations
Decreased anesthetic
requirement with acute use.
Increased anesthetic
requirement with chronic use
Provide supportive
hemodynamic and airway
care (secure airway)
Reactive airway, aspiration
prophylaxis
Benzodiazepine for severe
anxiety, provide supportive
hemodynamic care
Effects can last for days
Decreased anesthetic
requirement with acute use.
Increased anesthetic
requirement with chronic
use.
Provide supportive
hemodynamic and airway
care (secure airway)
Aspiration prophylaxis
Flumazenil (romazicon)
Decreased anesthetic
requirement with acute use.
Increased anesthetic
requirement with chronic
use.
Provide supportive
hemodynamic and airway
care (secure airway)
Aspiration prophylaxis
Naloxone
Possible seizures when
combined with stimulants
Decreased anesthetic
requirement with acute use.
Increased anesthetic
requirement with chronic use
Provide supportive
hemodynamic and airway
care (secure airway)
Aspiration prophylaxis
Naloxone (care not to induce
withdrawal)
Depressants
Cannabis/
marijuana/
hashish
Tetrahydrocannabinol (THC)
Binds to
cannabinoid
receptor
Pot, weed, grass,
heb, reefer, blunt,
ganja, doobie,
gangster, hash
cookie, majic
brownies, pot tea,
black, dope cake,
green dragon,
chocolate
A green or brown mix
of dried flowers and
leaves of the hemp
plant
Hashish can appear as
a soft to brittle brown
to black substance or
a honey colored oil
Euphoria,
drowsiness, appetite
stimulation, sensory
intensification,
tachycardia,
palpitations, impaired
coordination
Flunitrazepam
(Rohypnol)
2-Fluorophenyl
Enhance effects of
GABA
White or yellowish
solid crystals
Anxiolysis, hypnosis,
loss of inhibitions,
memory impairment
and amnesia,
drowsiness,
decreased BP and
HR, Bradypnea,
muscle relaxant
GHB
Gamma-hydroxybutyrate
Biphasic dopamine
response
Binds to GABA and
specific GHB
receptor
Rophy, Ruffles,
Roofies, Ruffies,
Ruff Up, Rib,
Roach 2, R2, R2Do-U, Roche,
Rope, Ropies,
Circles, Circes,
Forget It, ForgetMe-pill, Mexican
Valium
G, liquid X,
grievous bodily
harm, Georgia
homeboy, fantacy
White salty powder
Euphoria, enhanced
sociability, anxiety,
hallucinations,
sedation and
unconsciousness,
seizures, bradycardia,
HTN or hypotension,
respiratory
depression, loss of
gag reflex, loss of
muscle tone, nausea
Heroin
Diacetylmorphine
Mu-opioid agonist
Big H, smack,
junk, horse,
brown sugar,
mud, black tar
White to dark brown
powder or tar-like
substance
Intense euphoria,
sedation, miosis,
lacrimation,
respiratory
depression or apnea,
nausea, diarrhea,
muscle aches,
increased risk of
HIV/AIDS/Hepatitis
Difficult IV access
Withdrawal
treatment:
methadone,
naltrexone,
buprenorphine,
benzodiazepine
(diazepam)
Stimulants
Cocaine (Crack)
Cocaine
hydrochloride
Blocks reuptake of
dopamine,
norepinephrine, and
serotonin in brain
Blocks sodium
channels
Coke, blow,
snow, dust, flake,
nose candy,
crack, rock,
devils, dandruff
A pearl white salt, or
adulterated to an off
white to pink powder
Crack is a light brown
crumbly crystalline
rock or chips
CNS stimulant,
increased alertness
and energy,
mydriasis, seizures,
tachycardia, HTN or
hypotension,
tachypnea,
dysrhythmias,
myocardial
infarction,
hyperthermia,
dysphagia, altered
upper airway
anatomy, pulm HTN,
decreased appetite,
dental caries,
rhabdomyoliysis
Crystal Meth
Methamphetamine
hydrochloride
Inhibits monoamine
oxidase
Blocks reuptake of
norepinephrine and
dopamine in brain
Speed, crystal,
meth, crank,
chalk, ice, crypto,
glass
Odorless, bitter
tasting white or
yellow powder or a
colorless rocklike
crystalline solid that
flakes in glasslike
shards
CNS stimulant,
increased alertness
and energy,
mydriasis, seizures,
tachycardia, HTN,
tachypnea,
dysrhythmias,
encephalopathy,
decreased appetite
Increased anesthetic
requirement with acute use.
Decreased anesthetic
requirement with chronic
use.
Provide supportive
hemodynamic and airway
care (avoid beta blockers)
Aspiration prophylaxis
Monitor for dehydration, and
provide cooling measures
prn
Hyperactive airway, possible
poor dentition and altered
airway anatomy
Benzodiazepine for anxiety
or seizures
Caution when mixed with
alcohol (cocaethelyne)
Same as cocaine
considerations above
Possible difficult airway with
dental caries and poor overall
dentition
14
Drug
Chemical
Name
Mechanism
Street
Name
Appearance
Signs and
Symptoms
3,4Methylenedioxymethamphetamine
Blocks reuptake and
stimulates release of
serotonin
Ecstasy, E, X,
XTC, adam, eve,
bean
A pill form identified
by icons, names, or
logos stamped on
tablets
Disorientation,
enhanced sociability.
If mixed with alcohol
or hallucinogens can
cause: hyperpyrexia,
muscle rigidity,
sweating,
dehydration, DIC,
arrhythmias, or acute
renal failure
Same as cocaine
considerations above
Ketalar
Ketamine
(dissociative
anesthetic)
NMDA receptor
antagonist
K, special K,
vitamin K, kit kat,
kitty, bump, cat
valium
Clear liquid or
converted to white
powder and packaged
in baggies, capsules
or pills
Hallucinations,
dissociation,
dystonia, seizures,
coma, increased ICP,
HTN, tachycardia,
dysrhythmias,
excessive secretions,
muscular hypertonus
PCP
Phencyclidine
(dissociative
psychedelic)
NMDA receptor
antagonist
Angel dust, wet,
peace, embalming
fluid
White crystalline
powder or a liquid
that is dipped sprayed
on a leaf and smoked
LSD
Lysergic acid
diethylamide
(psychedelic)
Serotonin receptor
agonist
Adrenoreceptor
agonist
Acid, blotter, hits,
dots, trips, doses,
sugar cubes
Colorless, odorless,
slightly bitter liquid
absorbed onto blotter
paper, sugar cubes or
thin squares of gelatin
Provides sense of
invulnerability,
increased alertness,
anxiety, miosis,
seizures, tachycardia,
HTN, dysrhythmias,
tachypnea,
paresthesias, muscle
rigidity,
rhabdomyolysis
Illusionary visual
effects, moving
geometric patterns,
sleeplessness,
mydriasis, excessive
secretions, loss of
appetite, nausea
Psilocybin
4-PhosphoryloxyN, Ndimehyltryptamine
(psychedelic)
Serotonin receptor
agonist
Shrooms, magic
mushrooms
Dried mushroom caps
Provide supportive
hemodynamic and airway
care
Aspiration prophylaxis
Antisaligogue as needed
(careful with tachycardia)
Benzodiazepine for seizures
Diphenhydramine for
dystonic reactions
Butyrophenones for extreme
agitation
Provide supportive
hemodynamic and airway
care (avoid beta blockers,
decrease stimulation)
Aspiration prophylaxis
Decreased anesthetic
requirement with acute use
Benzodiazepine for seizures
Butyrophenones for extreme
agitation
Provide supportive
hemodynamic and airway
care (avoid beta blockers,
decrease stimulation)
Aspiration prophylaxis
Benzodiazepine for agitation,
haloperidol for extreme
agitation or combativeness
Provide cooling measures as
needed
Same as LSD considerations
above
Mescaline
3,4,5-Trimethoxyphenethylamine
(psychedelic)
Serotonin receptor
agonist
Cactus, Peyote
Pink powder
Dinitrogen oxide
(dissociative
hallucinogen)
Inhibits NMDA
receptor
GABA potentiation
and potassium
channel activation
Laughing gas,
nitrous, NOS
Colorless,
nonflammable,
slightly sweet
smelling
MDMA
Anesthetic
Considerations
Hallucinogen
Vivid enhancement
of colors, animation
of organic shapes,
anxiety,
hallucinations
Euphoria and dream
like hallucinations,
anxiety, increased BP
and HR, nausea,
headache
Same as LSD considerations
above
Inhalants
Nitrous Oxide
Dizziness,
drowsiness,
hallucinations,
sedation, memory
loss, tachycardia,
hypotension, airway
irritation,
methemoglobinemia,
nausea
Provide supportive
hemodynamic and airway
care
Airway reactivity or burns,
aspiration prophylaxis
May have barotrauma from
commercial use of high
pressure tanks
15
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