Dissociative Anaesthetics

Dissociative Anaesthetics Jerry D. Smith Jr. 14 June 2005

Dissociative Anaesthetics “…distort perceptions of sight and sound and produce feelings of detachment—dissociation—from the environment and self.” - US Dept. of Health and Human Services

Dissociative Anaesthetics How They Work: •

Alter distribution of glutamate throughout the brain

•

Glutamate is involved in perception of pain, responses to the environment, and memory

Dissociative Anaesthetics Who They Are Prescription Drugs: Ketamine Tiletamine Amantadine

Dissociative Anaesthetics Ketamine AKA:

Ketamil (vet medicine), Ketalar, Amidate, Brevital, Diprivan, E-thrane, Fluothane, Forane, Penthrane, Pentothal Forms: liquid Use: veterinary and human anaesthetic FYI: agent of choice in paediatrics, shock patients, asthmatics, and burn patients because depressed respiration is uncommon; effective in treating Postherpetic Neuralgia (Douglas, Johnson, & Cunningham, 2004; Brown, Lovato, & Parker, 2005)

Dissociative Anaesthetics Tiletamine AKA:

Zoletic, Telazol

Forms: tablet, liquid Use: veterinary anaesthetic FYI: similar to ketamine and phencyclidine in chemical structure and action (Rench-Mullen, Lehmann, Bohacek, & Fisher, 1987)

Dissociative Anaesthetics Amantadine Amantadine

AKA:

Symmetrel

Forms: capsule, tablet, syrup Use: Antidyskinetic, Antifatigue (specifically in multiple sclerosis), Antiviral; used to treat Parkinson's disease, influenza, Hepatitis C, aspiration in the elderly; used to temporarily limit or reverse weight gain associated with olanzapine (Zyprexa) treatment in patients with schizophrenia, schizoaffective disorder, schizophreniform disorder, or bipolar I disorder (Masi, 2004; “Amantadine for weigh”, 2005; “Alternatives to the flu”, 2004; Smith, Riley III, Devenyi, Bingaman, Kunelman, 2004; Kikawada, Iwamoto, Tarasaki, 2005) FYI: ongoing research indicates may be effective in treatment of cocaine users with high withdrawal severity (Sofuoglu & Kosten, 2005)

Dissociative Anaesthetics Who They Are Street Drugs: Phencyclidine Ketamine Dextromethorphan

Dissociative Anaesthetics Phencyclidine

AKA: Forms: Effect:

Treatment: FYI:

PCP, Angel Dust, Embalming Fluid, PeaCe Pill, Boat, Dummy Dust, Love Boat, Supergrass, Killer Weed, Ozone, Rocket Fuel, Wack, etc. powder, liquid, tablet, or on smoking material Numbness, slurred speech, loss of coordination, rapid and involuntary eye movements, auditory hallucinations, image distortion, severe mood disorders, amnesia, in some users PCP use may result in acute anxiety, a feeling of impending doom, paranoia, violent hostility, and in some it may produce a psychoses indistinguishable from schizophrenia (“Phencyclidine,” 2001) Symptoms are treated with anti-psychotics, particularly Haloperidol (Haldol) Originally designed as a human anaesthetic and later produced only as a veterinary anaesthetic, PCP is no longer produced or used for legitimate purposes because of postoperative psychoses (“Phencyclidine,” 2001)

Dissociative Anaesthetics Ketamine

AKA: Forms: Effect:

Treatment: FYI:

K, Special-K, Vitamin-K, Jet, Super Acid, Green, Cat Valium liquid, powder At lower doses it has a mild, dreamy feeling; users report feeling floaty and slightly outside their body; numbness in the extremities is also common; higher doses produce an effect referred to as "K-Hole," an "out of body," or "near-death" experience; use of the drug can cause delirium, amnesia, depression, and longterm memory and cognitive difficulties (“Ketamine,” 2001) Symptoms are treated with anti-psychotics, particularly Clozapine Analogue of PCP; the only known source of Ketamine is via diversion of pharmaceutical products (“Ketamine,” 2001); in a 2004 NY survey of club-drug users, 72% reported having

Dissociative Anaesthetics Dextromethorphan

We’re Getting There

Dissociative Anaesthetics Who They Are Over-The-Counter and Quasi-Legal Drugs: Dextromethorphan Nitrous Oxide

Dissociative Anaesthetics Dextromethorphan

AKA: Forms: Effect:

Treatment: FYI:

DXM, Orange Crush, Triple C's, C-C-C, Red Devils, Skittles, Dex, Vitamin D, Robo, Robo-trippin', Robo-dosing capsule, liquid, liquid gelatin capsule, lozenge, tablet, powder High dose will cause users to feel very spacey and “out of it”; impairs motor control and causes robot-like movements; can produce panic attacks and audio and visual hallucinations; can cause nausea and itchy skin (“DXM,” n.d.); can cause death as well as other serious adverse events such as brain damage, seizure, loss of consciousness, and irregular heart beat none noted often sold as ‘Ecstasy’; high doses of DXM have contributed to numerous cases of rave-related heatstroke (“DXM,” n.d.); DXM is an ingredient

Dissociative Anaesthetics Nitrous Oxide Nitrous Oxide

AKA: Forms: Use/Effect:

Treatment:

Laughing Gas; Cartridges; Hippy Crack; N2O Gas Anaesthetic (primarily in dentistry); The primary dangers of nitrous inhalation are: oxygen deprivation, frost bite, loss of motor control, vitamin B12 interference, folic acid interference, respiratory depression, apnea, diffusion hypoxia, hypotension, arrhythmias, dizziness, euphoria, increased cerebral blood flow/intracranial pressure, neuropathy with chronic exposure, nausea, vomiting, ileus, bone marrow depression with chronic exposure, malignant hyperthermia none noted

Dissociative Anaesthetics What's mistake but a kind of take? What's nausea but a kind of -usea? Sober, drunk, -unk, astonishment. Everything can become the subject of criticism -- how criticise without something to criticise? Agreement -- disagreement!! Emotion -- motion!!! By God, how that hurts! By God, how it doesn't hurt! Reconciliation of two extremes. By George, nothing but othing! That sounds like nonsense, but it's pure onsense! Thought much deeper than speech...! Medical school; divinity school, school! SCHOOL! Oh my God, oh God; oh God! The most coherent and articulate sentence which came was this: There are no differences but differences of degree between different degrees of difference and no difference.

Dissociative Anaesthetics Guess Who… WILLIAM JAMES Father of American Psychology & Nitrous Oxide Enthusiast

Dissociative Anaesthetics Questions 1) Dissociative Anaesthetics work by altering the levels of what neurotransmitter?  Glutamate  Epinephrine  Acetylcholine  Norepinephrine

Dissociative Anaesthetics Questions 2) Depressed respiration is uncommon with this anaesthetic making it more suitable for use with children.  DXM  PCP  Tiletamine  Ketamine

Dissociative Anaesthetics Questions 3) Research suggests that this anaesthetic may prove beneficial in the treatment of cocaine addiction.  Ketamine  Glutamate  Amantadine  Phencyclidine

Dissociative Anaesthetics References (No date). DXM. E-Z Test. Test. Retrieved June 12 2004 from www.eztest.com/cms/index.php?option=com _content&task=view&id=28&Itemid=53. (2001) Ketamine. DEA: U.S. Drug Enforcement Administration. Administration. Retrieved June 11, 2005 from www.usdoj.gov/dea/ketamine_factsheet.html (2001) Phencyclidine (PCP). DEA: U.S. Drug Enforcement Administration. Administration. Retrieved June 11, 2005 from www.usdoj.gov/dea/ketamine_factsheet.html. (2004 November). Alternatives to the flu vaccine. Cortland Forum, Forum, Vol. 17 Issue 11, p20. (2005 May). Amantadine for weight gain during olanzapine treatment. Brown University Psychopharmacology Update, Update, Vol. 16 Issue 5, p4. (2005 February). Club drugs: Study explores reasons for use by young adults. DATA: The Brown University Digest of Addiction Theory & Application, Vol. 24 Issue 2, p1. Brown, T.B., Lovato, L.M., Parker, D. (2005 January). Procedural Sedation in the Acute Care Setting. American Family Physician, Physician, Vol. 71 Issue 1, p85. Dextromethorphan (DXM). Streetdrugs.org. Streetdrugs.org. Retrieved June 13, 2005 from www.streetdrugs.org/dxm.htm. Douglas, M.W., Johnson, R.W., Cunningham, A.L. (2004). Tolerability of Treatments for Postherpetic Neuralgia. Drug Safety, Safety, Vol. 27 Issue 15, p1217.

James, William. (1882). Subjective Effects of Nitrous Oxide. Mind, Vol 7. Kikawada, M., Iwamoto, T., Takasaki, M. (2005). Aspiration and Infection in the Elderly: Epidemiology, Diagnosis and Management. Drugs & Aging, Aging, Vol. 22 Issue 2, p115. Masi, G. (2004). Pharmacotherapy of Pervasive Developmental Disorders in Children and Adolescents. CNS Drugs, Drugs, Vol. 18 Issue 14, p1031. Rench-Mullen, J.M., Lehmann, J., Bohacek, R., Fisher, R.S. (1987). Tiletamine is a potent inhibitor of N-methyl-aspartate-induced depolarizations in rat hippocampus and striatum. American Society for Pharmacology and Experimental Therapeutics, Therapeutics, Volume 243, Issue 3, pp. 915-920. Sofuoglu, M., Kosten, T.R. (2005). Novel Approaches to the Treatment of Cocaine Addiction. CNS Drugs, Vol. 19 Issue 1, p13. Smith, J.P., Riley III, T.R., Devenyi, A., Bingaman, S.I., Kunselman, A. (2004 June). Amantadine Therapy for Chronic Hepatitis C. Journal of General Internal Medicine, Medicine, Vol. 19 Issue 6, p662.