When adolescents and young adults when the phenomen of all-night dance parties commonly known as "raves" spread across the United States in the 1990's
In some areas, the term "rave" may be less common now, but the drugs are still used in what venues?
Bars, nightclubs, concerts, parties
What are the club drugs promoted to do?
enhance social interaction by giving the users euphoria, empathy, and a sense physical closeness and energy
The abuse if club drugs is now a worldwide public health problem extending to ______adults who are often involved in poly-substance abuse?
Club drugs are popular because of why?
they are relatively cheap and available in the form of small pills, powders or liquids that can be consumed orally
The club drugs are often distributed among peers and friends who promote them as what?
as safer alternatives than hardcore substances such as cocaine and methamphetamine (though in fact, club drugs are equally dangerous, harmful and addictive
Frequent use of club drugs among MSM increases what?
risky sexual behaviors such as multiple unacquainted partners and unprotected sex, thus increasing the risk of acquiring HIV and other STDs.
What is the concern for HIV infective patient on antiretroviral therapy?
there is a risk of significant drug interactions
Chronic abusers may exhibit what?
physical and psychological dependence, withdrawal syndromes, addiction, permanent damage to the CNS and death
What were the findings of the 2011-2014 Monitoring the Future Study of substance abusers among 8th, 10th, and 12th graders in the US?
report of a trend of a small decrease of consumption of various popular club drugs
List the four most prominent club drugs?
1) MDMA (3,4 methylenedioxymethamptamine) also known as Ectasy, X and Molly. 2) GHB (gamma-hydroxybutyrate) also known G or Soap. 3) flunitrazepam (Rohypnol) also known as Forget-me pill. 4) ketamine (Ketalar) also known as K or vitamin K
Club drugs are often adulterated with what?
other substances, mixed with cocaine or methamphetamine
What can occur if club drugs are mixed with alcohol and other illicit substances?
they are particularly dram heroes in producing unanticipated affects and unintentional drug overdoses
While flunitrazepam and ketamine have limited medical benefits, MDMA and GHB are schedule ____ drugs and are banned in the US?
3,4 Methylenedioxymethamphetamine (Ectasy)
Ectasy was developed in 1914 as what type of drug, but in 1985, it became the most widely used club drug in all-night dance parties?
What was the findings of the study of the prevalence of Ectasy use among attendees of raves?
65% of the samples were male, 75% were between 18-21 years, 98% were white and 88% had completed 12th grade. 18% reported using Ectasy within the 2 days before entering the study, and 89% reported lifetime use of th drug
a stimulant, chemically similar to amphetamine and mescaline, a hallucinogen.
MDMA is often adulterated with other substances, name these substances?
caffeine, dextromethorphan, pseudoephedrine, and other hallucinogens
What does the patient feel after one dose of MDMA (Ectasy)?
relaxed, emotionally warm and mentally stimulated with an increased sense of well-being and capacity of empathy
MDMA releases what from the presynaptic neurons in the brain and interrupts their metabolism by inhibiting monoamine oxidase?
serotonin, dopamine and norepinephrineMDMA takes hoe longer after oral ingestion and May last up to how many hours?
30-60 minutes; 8 hours
It is not uncommon for users to take a second dose after the effects of the first dose wean, true or false.
List the undesirable effects of MDMA?
anxiety, restlessness, irritability, impulsenrss, aggression, sleep disturbance, lack of appetite, thirst, reduced interest in and pleasure from sex and significant reductions in mental abilities
Why do MDMA users often suck on a lollipop or pacifier?
To reduce the unpleasant side effect of trismus and bruxism
*** The most concerning adverse effect of MDMA, is?
hyperthermia and associated serotonin syndrome
*** Define serotonin syndrome?
defined by the presence of clinical triad - changes of mental status, neuromuscular abnormalities (tremor, clonus, ocular clonus, muscular hypertonic its and hyperreflexia) and autonomic instability ( tachycardia, HTN, diaphorrdid, hyperactive bowel sound and diarrhea
MDMA also causes release of excessive antidiuretic (ADH), resulting in what?
acute onset of symptomatic hyponatremia (confusion, delirium, headache, irritability and seizure)
The above symptoms related to severe overdose of MDMA are often the result of what?
suboptimal management of underlying hyperthermia
What is the treatment for overdose of MDMA?
cooling blankets and IV hydration, cyproheptadine (a 5-hydroxtryptamine 2A (5-HT2A) antagonist but its effectiveness has not been well studied
*** For temp > 42.1 C, one may consider what agent to produce immediate muscular paralysis, followed intubation and mechanical ventilation?
MDMA can be addictive and most chronic users have what symptoms?
signs of dependence and withdrawal such as fatigue, anorexia, depression and poor concentration.
Can MDMA be detected in urine drug testing?
Is there any specific drug treatments for MDMA abuse?
What intervention is currently the most effective way to help patients with substance abuse?
cognitive behavior intervention
GHB was first synthesized in 1960 as what agent?
GHB is closely related to what inhibitory brain neurotransmitter?
GABA (gamma-aminobutyric acid)
GHB is the bioactive product of what substance, which has sedative properties?
What has GHB been promoted as to its use?
as a recreational club drug and as a nutritional supplement to bodybuilder
The claim of its use is based on release of what hormone?
GHB has limited medical utility in the treatment of narcolepsy and alcoholism, but it's nonprescription sale was banned in 1990, why?
because of unacceptable adverse effects such as respiratory and central nervous system depression
GHB gained public attention in 2000 with reports of what two things?
overdose fatalities and its use as a "date rape drug"
How is GHB sold as?
a salty powder
When GHB is mixed with water, what does it look like and taste like and what can mask it's taste?
1) colorless 2) unpleasant soapy taste. 3) masked in alcohol or flavored drinks
Effects of GHB begin within ____minutes of ingestion. It has a short half life of ____ to _____minutes?
Doses of GHB (20-30 mg per jog of body weight produce what?
euphoria, drowsiness, memory loss and sleep
Overdose with GHB is common because why?
it has a narrow margin of safety and the concentration of the solution is often unknown
GHB toxicity is further enhanced with what substance?
Among young people presenting with rapid onset of drug induced come, GHB was the culprit second to what substance?
*** Overdose of GHB is characterized by what symptoms?
profound coma of rapid onset, hypothermia, bradycardia, myoclonus, hypo ventilation and respiratory depression
Is there a specific antidote for GHB overdose?
What is the treatment for GHB overdose?
supportive and meticulous management of airway and breathing
Why should intubation be avoided in GHB overdose?
because of the risk of inducing large emeeis and aspiration during intubation
What medication is used to treat bradycardia?
Is routine urine drug testing helpful in detecting GHB? If not, what is?
no; gas chromatography can detect it in blood and urine
Rohypnol is available in what two countries?
Europe, Latin America
It belongs to what drug class?
What is it used for?
reduce anxiety, inhibition, and muscular tension but it is 10 times more potent than diazepam
A high single dose more than 1-2 mg causes what symptoms?
amnesia, loss of muscular control and unconsciousness
In the US, imported Rohypnol has been implicated as what since the 1990s?
date rape drug
The effects of Rohypnol are enhanced with concurrent use of what?
alcohol or sedating substances
What are the adverse effects?
dizziness, visual disturbance, hypotension, confusion and aggressive behavior
Chronic abuse us addictive and what are the withdrawal symptoms?
headache, anxiety, photosensitivity, numbness and tingling sensation of extremities and seizures
What is the antidote for Rohypnol?
Since 1960, ketamine has been used as what? How is it synthesized?
1) as a dissociative anesthetic 2) schedule III drug
What is its advantage?
it produces anesthesia without respiratory depression by inhibiting the neuronal reuptake of norepinephrine, dopamine, serotonin, with glutamate activation of N-methyl-D-aspartame receptors
Why does ketamine appeal to recreational drug users?
Because of its hallucinogenic effects
Is ketamine difficulty to synthesize?
It is often diverged from whom?
veterinary supplies where it is used for anesthesia
The effects of ketamine are rapid after ingestion in its liquid form of via inhalation a may last _____ to _______ minutes?
Users may experience what?
visual hallucination, out of body sensation, anterograde amnesia, delirium
Adverse effects of overdose may include what symptoms?
tachycardia, HTN, respiratory depression, apnea
Is there a specific antidote for ketamine overdose?
*** SUMMARY= List the most prominent club drugs and what are their street names?
1) 3,4 Methylenedioxymethamphetamine (MDMA) also known. As Ectasy, X and Molly. 2)gamma-hydroxybutyrate. Also known as G or Soap 3) flunitrazepam (Rohypnol) also know as forget me pill. 4) ketamine (Ketalar) also known as K or vitamin K
***SUMMARY = When consumer with alcohol and other illicit substances, club drugs are particularly idangerous in producing unanticipated effects and unintentional drug overdose? True or false
*** SUMMARY = Chronic abusers may exhibit physical and psychological dependence, withdrawal syndromes, addiction, permanent damage to what system and death?
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