Street Drugs Guide Fall 2020 PHRM 48600 Purdue College of Pharmacy

STREET DRUGS GUIDE

Cultural groups in the class

Created by student pharmacists enrolled in PHPR 48600 Beyond ecstasy Compiled by Cynthia P. Koh-Knox Sharp, PharmD, RPh Purdue University College of Pharmacy Fall 2020

ABCs first day of class

ABCs last day of class

STREET DRUGS GUIDE 2020 TABLE OF CONTENTS Monograph topic Author Page 2C-B .......................................................Staley, A ...................................................................5 Acetaminophen ......................................Moon, S ....................................................................7 Amyl nitrate ...........................................Riley, L ....................................................................9 Anabolic steroids ....................................Awad, J .................................................................11 Anorectics (Rx) ......................................Liu, E......................................................................13 Anti-diarrheals........................................Salanio, G ...............................................................15 Ayahuasca ..............................................Blunier, A ...............................................................17 Barbiturates ............................................Byrd, N ...................................................................19 Bath salts ................................................Carpenter, G ...........................................................21 Benzodiazepines .....................................Chang, T .................................................................23 Bromo-dragonfly ....................................Chao, A ..................................................................25 Buprenorphine ........................................Kelly, J ...................................................................27 Caffeine ..................................................Civitello, A.............................................................29 Cannabidiol/THC ...................................Clark, L ..................................................................31 (Chloro)hydrocarbons ............................Jablonski, S ............................................................33 Cocaine...................................................Corley, B ................................................................35 Codeine ..................................................Trykall, C ...............................................................37 Cyclobenzaprine.....................................Mahan, R ................................................................39 Devil's breath..........................................Vyain, H .................................................................41 Dextromethorphan..................................Craig, K ..................................................................43 DHEA.....................................................Mulhall, A ..............................................................45 Diacetylmorphine ...................................Scholl, N ................................................................47 Diphenhydramine ...................................Motes, M ................................................................49 Disulfiram ..............................................Domingo, E ............................................................51 Diuretics .................................................Czarnik, J ...............................................................53 DMT .......................................................Struewing, M..........................................................55 Drug deterrent formulations ...................Nowaskie, J ............................................................57 Drug screens ...........................................Postma, S................................................................59 Drug tests ...............................................Dong, A ..................................................................61 Endocannabinoid system ........................Solomito, R ............................................................63 Energy drinks .........................................Zheng, J ..................................................................65 Ethyl alcohol ..........................................El-Afandi, A ...........................................................67 Ethylene glycol.......................................Yaeger, K ...............................................................69 Fentanyl and carfentanil .........................Galloway, B ...........................................................71 Flakka .....................................................Culver, R ................................................................73 Flumazenil ..............................................Grishin, L ...............................................................75 Gabapentin/pregabalin ...........................Gumm, D................................................................77 Gamma hydroxybutyrate (GHB) ...........Heng, YF ................................................................79

Monograph topic ...................................Author ................................................................ Page Goldenseal ..............................................Partee, M ................................................................81 Gray death ..............................................Raffa, J ...................................................................83 Hashish ...................................................Hope, H ..................................................................85 Heroin.....................................................Howard, N ..............................................................87 Hydrocodone ..........................................Lee, J ......................................................................89 Hydromorphone .....................................Oetting, K ...............................................................91 Ibogaine ..................................................Huynh, K ................................................................93 K-2 Spice................................................Jaworsky, N............................................................95 Ketamine ................................................Odendahl, R ...........................................................97 Khat ........................................................Batista, A................................................................98 Kratom....................................................Juhnke, N .............................................................100 Krokodil .................................................Kadi, B .................................................................102 Laxatives ................................................Nies, Z ..................................................................104 Lysergic acid diethylamide (LSD) .........Kawach, H............................................................106 MDMA ...................................................Kim, H..................................................................108 Methadone ..............................................Oropeza, D ...........................................................110 Methamphetamine ..................................Lahey, L ...............................................................112 Morning glory ........................................Park, Y .................................................................114 Naltrexone ..............................................Sarver, A ..............................................................116 Nicotine ..................................................Langemeier, M .....................................................118 Nightshade .............................................Leal, T ..................................................................120 Nitrous oxide/inhalants ..........................Eichler, C .............................................................122 Opium/poppy .........................................Reiber, J ...............................................................124 PDMP .....................................................Yoon, B ................................................................126 Peyote .....................................................Robinson, J ...........................................................128 Pink ........................................................Valentin, C ...........................................................130 Propofol ..................................................Dotson, L..............................................................132 Pseudoephedrine/phenylephrine ............Liang, J .................................................................134 Psilocybin ...............................................Sears, R ................................................................136 Salvia divinorum ....................................McCafferty, D ......................................................138 Scopolamine ...........................................Patel, A.................................................................140 Sedatives ................................................Mize, A ................................................................142 Sildenafil ................................................Mohamed, F .........................................................144 TCP ........................................................Speakman, B ........................................................146 Toad venom ............................................Monti, G ...............................................................148 Tramadol ................................................Persha, H ..............................................................150 Yohimbe .................................................Plumer, S ..............................................................152

Fall 2020

ACETAMINOPHEN (TYLENOL) Fall 2020

Seongwoon Moon

STREET NAMES: NONE When in combination with codeine/other opiates: T1 T2 T3 T4 Doors and Fours

HISTORY -

-

https://www.goodrx.com/tyleno l-extra-strength/what-is#images

1873: Acetaminophen developed, but not used medically.

1893: Found in the urine of people known to have consumed phenacetin.

Compound was isolated and concentrated.

1940s: researchers discovered the link between acetanilide and methemoglobinemia, a toxic blood condition. Acetaminophen did not have the same toxic effects.

1955: Acetaminophen sales begin in US as Tylenol.

1956: Acetaminophen introduced in UK as Panadol.

1984: FDA patent expired, allowing various generics of the drug.

Pharmacology: The mechanism is still debated.

-

Acts on the CNS, inhibiting the synthesis of prostaglandins, which are responsible for fever, pain, and inflammation.

The effects on the CNS raise the pain threshold.

It also acts on the brain’s temperature regulating center, reducing fevers.

It is metabolized by the liver. The drug itself is not toxic, but a metabolite can be toxic in large quantities. An overdose can cause liver damage.

Adverse Effects Skin rash Nausea Headache Stomach Pain

Drug Interactions

Contraindications

Metabolized mostly by CYP2E1.

Do not use with other drugs that may induce hepatotoxicity.

Do not use with other products containing acetaminophen.

Monitoring

Law

Serum acetaminophen levels; remain at or below 4g/day. Monitor liver function tests if patient is experiencing liver failure.

Acetaminophen is an OTC and Rx medication. The sale of acetaminophen is legal.

Professional Opinion Acetaminophen is a safe and effective medication to manage pain and fever. Do not exceed 4g/day and avoid alcohol when taking large doses of this medication.

-S. Moon

References: MedlinePlus. Substance use – prescription drugs. Accessed October 25, 2020. Available at: https://medlineplus.gov/ency/patientinstructions/000798.htm#:~:text=Street%20names %20for%20codeine%20alone,T4%2C%20and%20dors%20and%20fours.

Aplususapharma. The history of acetaminophen. Accessed October 25, 2020. Available at: https://www.aplususapharma.com/blog/the-history-of-acetaminophen/ Acetaminophen. Lexi-drugs. Lexicomp. Wolters Kluwer Health, Inc. Riverwoods, IL. Available at: http://online.lexi.com.ezproxy.lib.purdue.edu/lco/action/doc/retrieve/docid/patch_f/626 4?cesid=1Y0v45TZplO&searchUrl=%2Flco%2Faction%2Fsearch%3Fq%3Dacetaminophen% 26t%3Dname%26va%3Dacetaminophen#mop. Accessed October 25, 2020.

Acetaminophen. Interactions. Lexicomp. Wolters Kluwer Health, Inc. Riverwoods, IL. Available at: http://online.lexi.com.ezproxy.lib.purdue.edu/lco/action/interact/globalid/5549.

Accessed October 25, 2020.

Amyl Nitrate Lizzie Riley Student Pharmacist Fall 2020

Slang Terms Poppers Jungle juice Liquid gold Rush Purple haze Buzz

https://www.poppers-aromas.eu/content/9-thedifferent-types-of-poppers-aromas

History/Background      

  

Primarily used to facilitate sexual intercourse and/or produce euphoria 1859- discovered that inhaling amyl nitrate produces vasodilation effects 1867- used for relief of angina pectoris 1937- marketed as prescription drug in the US 1960- FDA eliminated prescription requirement for amyl nitrate 1960s- nitroglycerin started replacing amyl nitrate as preferred product for reliving angina pectoris o Pharmacists and drug manufacturers noticed widespread purchases of amyl nitrate among seemingly healthy young men 1968- FDA reinstated the prescription requirement for amyl nitrate 1970s- non-pharmaceutical manufacturers started producing butyl nitrites, marketing them as “room odorizers” 1988- Congress enacted the Anti-Drug Abuse Act of 1988, which banned the manufacture and retail sale of butyl nitrite o Product Safety Commission (not FDA) was in charge of enforcing this

Pharmacology 

Relaxes vascular smooth muscle o Dilating the blood vessels o Involuntary muscle relaxation- especially vaginal and anal sphincter

Side Effects     

Initial rush of euphoria Flushing of the face Increased heart rate Low blood pressure Blurred vision

Long Term Effects   

Methemoglobinemia Vision loss Skin irritation around eyes, nose, and mouth

Drug Interactions 



Phosphodiesterase type 5 inhibitors- hypotension o avanafil o sildenafil o tadalafil o vardenafil Soluble guanylate cyclase stimulators- hypotension o riociguat

Laws 





Monitoring

1988- Anti-Drug Abuse Act o Banned the manufacture and retail sale of butyl nitrites 1990- Omnibus Crime Bill o Banned the manufacture and retail sale of alkyl nitrites Nitrites are prohibited by the Consumer Product Safety Commission; however, they can still be found in adult bookstores and through mail order catalogs labeled as “video head cleaner,” “room odorizer,” “leather cleaner,” or “liquid aroma.”

 

Blood pressure Dizziness/lightheadedness, especially when getting up from a lying or sitting position

Drug Screens 

It will not appear on a drug test due to its short half life

Professional Opinion While amyl nitrate use to serve as a therapeutic option for angina pectoris, there are better treatments available that do not pose an abuse potential (i.e. nitroglycerin).

Therefore, I would not recommend the use of amyl nitrate. ~L. Riley

References        

Haverkos HW, Kopstein AN, Wilson H, Drotman P. Nitrite inhalants: history, epidemiology, and possible links to AIDS. Environ Health Perspect.

1994;102(10):858-861. doi:10.1289/ehp.94102858 Alcohol and Drug Foundation. Amyl Nitrite. Accessed October 13, 2020. Available at: https://adf.org.au/drug-facts/amyl-nitrite/ Nitrates. Drug Facts and Comparisons. Facts & Comparisons eAnswers. Wolters Kluwer Health, Inc. Riverwoods, IL. Available at: http://online.factsandcomparisons.com. Accessed October 13, 2020.

Amyl Nitrite. Micromedex Solutions. Truven Health Analytics, Inc. Ann Arbor, MI. Available at: http://www.micromedexsolutions.com. Accessed October 13, 2020.

Nee R, Fitzgerald M. Two cases of methaemoglobinaemia secondary to amyl nitrate use. Ir Med J. 2014;107(2):48-50.

Waychoff MF, April MD, Casmaer M. Sexual enhancer-induced vision loss. Am J Emerg Med. 2017;35(3):517.e5-517.e6. doi:10.1016/j.ajem.2016.09.012 RnCeus. Classes and Examples of Inhalants. Accessed October 13, 2020. Available at: https://www.rnceus.com/inhal/inclass.htm Clean and Healthy Me. Do Poppers Show Up in a Drug Test?. Accessed October 13, 2020. Available at: https://cleanandhealthyme.org/blog/dopoppers-show-up-on-a-drug-test.html#stay

Anabolic Steroids (Anabolic-Androgenic Steroids) Jessica Awad Student Pharmacist Fall 2020

https://www.verywellmind.com/basic-facts-about-anabolicsteroids-69352

https://mindpumppodcast.com/blog-post/should-i-consider -anabolic-steroids/

Street Names 

Gear



Juice



Roids



Stackers



Pumpers

https://www.drugabuse.gov/ publications/drugfacts/anabolicsteroids

History In 1935, testosterone was first synthesized in Germany ♦ During the 1954 Olympics, professional athletes began misusing anabolic steroids ♦ In response to increased illicit use, the Anabolic Steroids Control Act of 1990 was passed, which placed anabolic steroids into Schedule III of the Controlled Substances Act-was passed to ban over-the-counter steroid precursors

♦

Pharmacology

♦

Anabolic-androgenic steroids are synthetic variations of the naturally occurring male sex hormone testosterone.

♦

Anabolic steroids exert their effect by binding to the cytoplasmic androgen receptor. Once bound, it modifies the expression of androgenic and anabolic genes.

The resulting anabolic effects are responsible for muscle enhancement. The androgenic effects are responsible for increasing male sex characteristics.

♦

Adverse Effects Irritability/Aggression



Paranoia/Impaired Judgement



Gynecomastia

 ♦

♦

Several effects on male/ female sex characteristics ♦ Excessive facial and body hair Stunted growth in teens ♦

♦

Kidney and liver damage High blood pressure

Drug Interactions glucose lowering agents ♦ Corticosteroids ♦

Cyclosporine

♦

C1 inhibitors

♦ Dehydroepi-

androsterone ♦Vitamin

K antagonists

blood clots

 

https://www.mychoicematters.net/getthe-facts/anabolic-steroids/

Pregnancy Breastfeeding



New designer steroid drugs can often evade detection in testing samples. However, decreased levels of endogenous steroids in urine are often indicative of designer steroid use.

Law

Professional Opinion Due to the high adverse effect profile, I would not recommend the use of anabolic steroids in anyone for the purposes of physical and athletic performance enhancement. ~J. Awad

Breast cancer (males) 

Screening procedures are routinely done specifically among athletes to deter steroid use

Anabolic steroids are Schedule III drugs in the U.S. Controlled Substances Act. It is illegal to possess, use, produce, or sell these substances for nonmedical purposes.

Changes in blood cholesterol ♦ Increased risk of





♦ Blood

♦

Contraindications

Drug Screening

Prostate cancer

References •

National Institute on Drug Abuse. Anabolic Steroids DrugFacts. Accessed October 23, 2020. Available at: https:// www.drugabuse.gov/publications/drugfacts/anabolic-steroids.

•

Mayo Clinic. Performance– enhancing drugs: Know the risks. Accessed October 23, 2020. Available at: https:// www.mayoclinic.org/healthy-lifestyle/fitness/in-depth/performance-enhancing-drugs/art-20046134

•

DEA. Drug Facts: Steroids. Accessed October 23, 2020. Available at: https://www.dea.gov/factsheets/steroids

•

National Institute in Drug Abuse. Steroids and Other Appearance and Performance Enhancing Drugs (APEDs) Research Report: What is the history of anabolic steroid use?. Accessed October 23, 2020. Available at: https://www.drugabuse.gov/ publications/research-reports/steroids-other-appearance-performance-enhancing-drugs-apeds/what-history-anabolicsteroid-use

RX ANORETIC Emily Liu , Student Pharmacist Fall 2020

Background − Commonly used prescription (Rx) anorectics include phentermine (Lomaira), phentermine/topiramate (Qsymia), naltrexone/bupropion (Contrave), liraglutide (Saxenda), and orlistat (Xenical, Alli) − In 2016, approximately 660,000 obese patients were on a weight-loss medication − Addiction to Rx anorectics can be caused by eating disorder or other mental health disorders Slang Term -Diet Pills Adverse Effects phentermine: ↑BP, ↑HR, insomnia Qsymia: dry mouth, constipation, insomnia, tingling Contrave: N/V/D, insomnia, dry mouth, dizziness Saxenda: hypoglycemia, nausea, diarrhea,↑HR Orlistat: Oily rectal leakage, abdominal pain, gas, diarrhea

Contraindications -phentermine: Within 14 days of MAO-I, drug abuse hx, glaucoma, hyperthyroidism, CV disease, pregnancy -Qsymia: Within 14 days of MAO-I, glaucoma, hyperthyroidism, pregnancy -Contrave: Within 14 days of MAO-I, hx of abuse, bulimia or anorexia nervosa, pregnancy, seizure history, uncontrolled hypertension -Saxenda: Medullary thyroid carcinoma, MEN2, pregnancy -Orlistat: malabsorption syndrome, cholestasis, nephropathy, pregnancy

Pharmacology phentermine: Releases norepinephrine to decrease appetite and enhance satiety topiramate: enhances GABA activity to decrease appetite Contrave: activates serotonin receptors in the hypothalamus to decrease appetite Saxenda stimulates GLP-1 production to decrease appetite Orlistat: Lipase inhibitor to block dietary fat abosroption by 30%

https://www.honorhealth.com/healthy-living/diet-pills-2-things-you-need-know

Toxicology -Phentermine: MAO-I, Sibutramine, Acebrophylline -Qsymia: MAO-I, Azelastine, Carbonic Anhydrase Inhibitors -Contrave: MAO-I, Opioid Agonists, Mequitazine -Orlistat: Triheptanoin

https://www.doctoroz.com/article/truth-about-diet-pills

Professional Opinion -Although weight-loss medications may sound appealing to many patients, it was found that there was only about 3-5% greater weight loss compared to placebo. I would not recommend the use of weight loss medications unless patient meets the criteria for a good candidate and that the patient understands that this does not replace dietary change and physical activity. ~ E. Liu

Laws -The listed Rx Anoretics above are all FDA-approved for weight loss -Phentermine and Qsymia are controlled substances due to their abuse potential -Qsymia is a part of the REMS drug safety program because of its terotogenic effect on fetus -Qualifications for Rx anoretics: BMI ≼ 30 or BMI ≼ 27 with T2DM, CV disease, HTN, dyslipidemia, and/or sleep apnea Monitoring -For ALL: making sure patient has a negative pregnancy tests it is a contraindication -Phentermine: Monitor waist circumferences & weight very month for 3 months -Qsymia: monitor weight loss for at least 3% and 5%, at week 14 and week 24, respectively -Contrave: = monitor weight loss for at least 5% after 12 weeks of being on maintenance dose -Saxenda: monitor weight loss for at least 4% after 16 weeks

Reference -Obesity Drugs: Few Adults Used Prescription Drugs for Weight Loss and Insurance Coverage Varied. U.S. Government Accountability Office. Accessed October 25, 2020. Available at: https://www.gao.gov/.

-Diet Pill Abuse, Addiction and Treatment. Addiction Center. Accessed October 25, 2020. Available at: https://www.addictioncenter.com/.

-Phentermine. Lexi-Drugs. Lexicomp. Wolters Kluwer Health, Inc. Riverwoods IL. Accessed October 24, 2020. Available at: http://online.lexi.com.

-Phentermine/Topiramate. Lexi-Drugs. Lexicomp. Wolters Kluwer Health, Inc. Riverwoods IL. Accessed October 24, 2020. Available at: http://online.lexi.com.

-Bupropion/Naltrexone. Lexi-Drugs. Lexicomp. Wolters Kluwer Health, Inc. Riverwoods IL. Accessed October 24, 2020. Available at: http://online.lexi.com.

-Saxenda. Lexi-Drugs. Lexicomp. Wolters Kluwer Health, Inc. Riverwoods IL. Accessed October 24, 2020. Available at: http://online.lexi.com.

-Orlistat Lexi-Drugs. Lexicomp. Wolters Kluwer Health, Inc. Riverwoods IL. Accessed October 24, 2020. Available at: http://online.lexi.com.

-Pros and cons of weight-loss drugs. Mayo Clinic. Accessed October 25, 2020. Available at: https://www.mayoclinic.org/.

-Smith MW. Diet Pills, Prescription Weight Loss Drugs, Appetite Suppressants. WebMD. Accessed October 25, 2020. Available at: https://www.webmd.com/.

Ghenella Salanio Student Pharmacist, Fall 2020

ANTI-DIARRHEALS Loperamide or Imodium

SL A NG TERM S Lope dope Poor man's methadone

B A C KGROUND Loperamide,

or

Imodium,

is

an

anti-diarrheal

first

https://www.selleckchem.com/products/ Loperamide-hydrochloride.html

manufactured by Paul Janssen in 1973. It received its first

US

FDA

approval

in

December

1976

and

has

remained a popular OTC to treat diarrhea.

It acts locally in the intestines by binding to opioid receptors, but it can cross the blood-brain barrier when taken in very high doses. It can elicit the same effects

as

opioids,

oxycodone,

and

heroin

when

taken in excessive amounts to achieve a sense of euphoria. There has been reports of people using loperamide

in

dependence

to

symptoms.

This

high opioids

doses and

increases

the

to to

treat

lessen

risk

of

physical

withdrawal

cardiac

and

respiratory adverse effects, thus leading to death.

https://www.amazon.com/Imodium-D-DiarrheaSoftgels-Count/dp/B01HI7W5GO

PHARMACOLOGY Loperamide binds to opioid receptors in the circular and longitudinal intestinal muscles. It blocks the release of acetylcholine to prevent smooth muscles form contracting. This inhibits stomach peristalsis and prolongs transit time, which then slows motility in the intestines and lessens frequency of bowel movement.

DRUG INTERACTIONS Prolonged use and high doses of loperamide can cause cardiac adverse reactions.

Examples include prolonged QT interval, arryhthmias, cardiac arrest, etc. Use should be avoided in combination with agents that prolong QT like quinidine, haloperidol, and amiodarone.

Signs of Torsades de pointes, or heart rhythm abnormalities, may include chest pain, shortness of breath, dizziness, nausea, etc.!!

Caution!! US Box Warning:

Torsades de pointes and sudden death

SIDE EFFECTS PROFESSIONAL OPINION

Dizziness Abdominal cramps Constipation Nausea

Loperamide

MONITORING damage

and

for

cardiac

generally

a

safe

and

effective anti-diarrheal, so I support its clinical use. However, it is important to

Monitor for CNS toxicity in patients with liver

is

and

respiratory adverse reactions.

use in moderation and in appropriate doses to reduce the risk of developing addiction. I don't believe it should be used as treatment for opioid withdrawal

LAWS Loperamide

symptoms or as substitutes for opioids.

Doing so requires very high doses, which is

NOT

a

controlled

can lead to overdose.

substance and is sold as an OTC or via

~G. Salanio

prescription.

REF ERENC ES: Addiction Center. Loperamide Addiction and Abuse. Accessed October 18, 2020. Available at: https://www.addictioncenter.com/ drugs/over-the-counter-drugs/loperamide-addiction-abuse/.

Imodium. Package insert. Janssen Pharmaceutica Inc.; 1998.

Loperamide. Lexi-drugs. Lexicomp. Wolters Kluwer Health, Inc. Riverwoods, IL. Available at: http://online.lexi.com. Accessed October 18, 2020.

National Institute on Drug Abuse. Commonly Used Drugs Chart. Accessed October 18, 2020. Available at: https://www.drugabuse. gov/drug-topics/commonly-used-drugs-charts#over-the-counter-medicines-.

Oransky I. Paul Jannsen. Lancet. 2004;363(9404):251. doi:10.1016/S0140-6736(03)15357-3.

PHPR 486 - BEYOND ECSTASY

AYAHUASCA MONOGRAPH ra d flower g ackgroun

B

phics from

ABBIE BLUNIER STUDENT PHARMACIST FALL 2020

History:

A peculiar tea with ritualistic origins 1852 - Earliest record of the psychoactive effects of ayahuasca in the Brazilian Amazon used in traditional and religious contexts 1923 - A film of a yage ceremony was shown at the annual meeting of the American Pharmaceutical Association 1968 - hypothesis of mechanism that is a combination of naturally occurring monoamine oxidase inhibitors and DMT 2008 - Peru's government recognized ayahuasca as "one of the basic pillars of the identity of the Amazon peoples"

Slang Terms: Huasca YagĂŠ Kamarampi Huni The Vine Tea Daime La Purga

Pharmacology/Drug Effects: Drug Category: Tryptamines (a group of serotonergic hallucinogens) Contains: 2 ingredients - typically seen as a tea or brewed drink Psychotria viridis (chacruna): contains N,N-dimethyltryptamine (DMT) Banisteriopsis caapi (ayahuasca vine): contains beta-carboline alkaloids which are monoamine oxidase inhibitors (MAOIs) Mechanism: DMT is a serotonin agonist that binds predominantly to the 5HT2A receptor and causes hallucinations and euphoria. The presence of MAOIs gives the drug time to cross the blood-brain barrier and exert action without being broken down quickly in the stomach.

m canva.co

Monitoring and Drug Screening: It is common to see people going to South America for "Ayahuasca Retreats" in which they are closely monitored throughout their trip for safety.

This drug does not have typical monitoring parameters since it is not routinely used in the United States. (see warnings below) DMT is not monitored in standard drug tests for employment but can be found (often transiently) in the urine and hair follicles using more specific tests.

Drug Interactions and Toxicology: Selective serotonin reuptake inhibitors (e.g. fluoxetine, citalopram) - risk of serotonin syndrome Monoamine oxidase inhibitors (MAOIs) (e.g. selegiline) and stimulants (e.g. amphetamine salts and methylphenidate) - risk of increased blood pressure or hemorrhage.

Warning: Do not take if pregnant. Avoid in preexisting blood pressure or heart conditions.

Laws: The ayahuasca plant itself is not illegal in the United States, however, the active ingredient, DMT, is considered a Schedule I illegal substance.

Some have attempted to have the religious background of ayahuasca recognized in the United States, but no law changes have been made at this time.

It is recognized as a legal drug in several South American countries (such as Peru) as a religious and/or cultural tradition and should be utilized responsibly.

Professional Opinion: There is no standardized recipe for the ayahuasca brew and may contain more psychoactive ingredients than the two typical ingredients listed on page one.

For this reason and the illegality, I would caution users and not recommend use of ayahuasca. Individuals taking the medications that interact with ayahuasca should certainly avoid use.

-A. Blunier

References: Alcohol and Drug Foundation. Ayahuasca. Accessed October 23, 2020. Available at: https://adf.org.au/drug-facts/ayahuasca/.

BBC News. Why do people take ayahuasca?. Accessed October 23, 2020. Available at: https://www.bbc.com/news/magazine-27203322#:.

Healthline. What is Ayahuasca?. Accessed October 23, 2020. Available at: https://www.healthline.com/nutrition/ayahuasca#uses.

Lake Forest College. Cultural Context and the Beneficial Applications of Ayahuasca.

Accessed October 23, 2020. Available at: https://www.lakeforest.edu/news/ Laws. Ayahuasca.com. Accessed October 23, 2020. Available at: http://www.ayahuasca.com The Vaults of Erowid.Ayahuasca. Accessed October 23, 2020. Available at: https://www.erowid.org/chemicals/ayahuasca

Natalie Byrd (Student Pharmacist) Fall 2020 https://novarecoverycenter.com/drugs/barbiturates/

History:1 • 1st synthesized in 1864 by Adolf von Baeyer • Sharpened by Edouard Grimaux a French chemist in 1879 • Diethyl-barbituric acid, the first drug in this class, was brought to market in 1904 by Farbwerke Bayer & Co • Originally marketed to help with neurological and psychiatric disorders • Barbiturates were also found to be useful in aiding in sleep disorders.

• Were one of the first drug classes to manage epileptic seizures.

• More than 2,500 barbiturates have been synthesized. o Of these, around 50 are available to be used clinically o Roughly 20 are used on a day-to-day basis.

Slang Terms:2

Abuse:1

Downers

The only medications used as hypnotics and sedatives between 1920-1950’s.

Barbs Blue Devils Red Devils Yellow Jackets

Were thought to cause dependence as early as one year following the marketing of Barbital It was not until the 1950’s that actual evidence of drug abuse potential was obtainable.

Pharmacology: Barbiturates are agonists at the gamma-aminobutyric acidA (GABAA) receptor. This binding to the receptor causes chloride channels to open causing hyperpolarization. This hyperpolarization causes a negative charge in the transmembrane potential which causes the cells to be less prone to electrical impulses. 3 This decrease in signaling is why barbiturates are considered inhibitory neurotransmitters or depressants in the central nervous system. The binding at this receptor is also what causes dependence and tolerance.4

Symptoms of Overdose:5

Laws:6

Fever

All drugs in this class do require a prescription in order to obtain them.

Low Body Temperature

The barbiturates as a class vary in DEA Scheduling.

Slow Labored Breathing

• Primidone tablet (Mysoline) → No DEA Schedule • Amobarbital injectable (Amytal) → DEA Schedule II

Bradycardia Unusual Eye Movements

•

Contraindicated Drug Interactions:5

Monitoring:7

(6)

Vital Signs

Darunavir

Fluid Intake

Nisoldipine

Serum Electrolytes

Voriconazole

Blood Gases

Ranolazine

Symptoms of Overdose

Professional Opinion: Due to the significant risk of dependence and withdrawal effects from discontinuation, I would only recommend the use of this drug class when all other options have been exhausted. ~N Byrd

https://emedicine.medscape.com/article/813155-overview

References: 1.

López-Muñoz F, Ucha-Udabe R, Alamo C. The history of barbiturates a century after their clinical introduction. Neuropsychiatr Dis Treat.

2005;1(4):329-43.

2.

United States Drug Enforcement Administration. Barbiturates. Accessed October 17, 2020. Available at: https://www.dea.gov/factsheets/barbiturates.

3.

Nguyen VV, Dergalust S, Chang E. Epilepsy. In: Pharmacotherapy: A Pathophysiologic Approach. 11th Edition. DiPiro JT, Yee GC, Posey LM, Haines ST, Nolin TD, Ellingrod V, eds. Columbus, OH: McGraw-Hill; 2020.

4.

Ito T, Suzuki T, Wellman SE, Ho IK. Pharmacology of barbiturate tolerance/dependence: GABA a receptors and molecular aspects. Life Sci. 1996;59(3):169-95. doi: 10.1016/0024-3205(96)00199-3

5.

Barbiturates. Micromedex Solutions. Truven Health Analytics, Inc. Ann Arbor, MI. Available at: http://www.micromedexsolutions.com. Accessed October 17, 2020.

6.

Ghoshal M. Healthline. Barbiturates: uses, forms, side effects, and more. Accessed October 18, 2020. Available at: https://www.healthline.com/health/barbiturates.

7.

Barbiturates General Statement. AHFS DI (Adult and Pediatric). Lexicomp. Wolters Kluwer Health, Inc. Riverwoods, IL. Available at: http://online.lexi.com. Accessed October 18, 2020.

Grace Carpenter, student pharmacist | Fall 2020

Bath Salts SK YLI N E H I GH

N EW SLET T ER https://novarecoverycenter.com/trending-street-drugs/bath-salts-innocent-name-terrifying-effects/

BACKGROUND

PHARM ACOLOGY

ADVERSE EFFECTS

Synthetic Cathinones, also known as

Synthetic cathinones are

Adverse effects of bath salts

bath salts, are man-made and

structurally similar to

include paranoia, hallucinations,

structurally similar to cathinones

amphetamines, cocaine, and

increased sex drive, panic attacks,

MDMA.

delirium, rapid heart rate,

3,4-methylenedioxypyrovalerone

sweating, and nausea. Bath salts

(MDPV) is a common synthetic

are addictive, and withdrawals

cathinone that affects the brain

can cause depression, anxiety,

group of substances is unregulated,

10x more powerfully than

tremors, insomnia, and paranoia.

and has no use in the medical field.

cocaine. MDPV is the most

Bath salts are marketed as a cheap

common synthetic cathinone

alternatives to amphetamines and

found in the labs of patients

cocaine.

taking bath salts.

found in the khat plant grown in Africa and Arabia. Bath salts are often found in powder form and are part of a group of drugs called New Psychoactive Substances (NPS). This

SLANG TERM S Bliss Cloud Nine Lunar Wave Vanilla Sky White lightning Drone Energy-1 https://www.smithsonianmag.com/science-nature/no-bath-salts-wont-turn-you-into-cannibal-180953418/

DRUG INTERACTIONS

LAW S

&TOXICITY Bath salts are listed as schedule I drugs in the controlled substances Research about drug

act (AACC) which is the most restrictive category.

interactions relating to bath salts are not extensively

M ONITORING/ DRUG SCREENS

completed. However, since bath salts are a stimulant and

For safety, monitor heart rate, blood pressure, and mental status. In

alcohol is a depressant, it is

order to detect bath salts in a person's system, you can test through

believed that the bath salts

blood, urine, serum, and plasma. Because bath salts are a relatively

would mask the effect of of the

new class of drugs, there are so many new variations of bath salts

alcohol, creating a higher

which makes it easier to avoid detection.

chance of drinking excessive amounts of alcohol. Toxic effects that bath salts can

PROFESSIONAL OPINION

induce are raised heart rates,

My professional opinion is that bath salts are very unregulated, and

blood pressure, and chest pain.

should therefore be regarded as a dangerous substance. I don't think

Those experiencing delirium

that this should be used recreationally due to the high risk of adverse

can feel dehydrated, experience

effects while using it.

a breakdown of muscle, and kidney failure. Lastly, excess

- G Carpenter

use of bath salts can cause death.

REFERENCES 1. Department of Justice / Drug Enforcement Administration. Bath Salts. Accessed October 19, 2020.

Available at: https://www.dea.gov/sites/default/files/2020-06/Bath%20Salts-2020.pdf.

2. American Association for Clinical Chemistry. Bath Salts. Accessed October 19, 2020. Available at: https://www.aacc.org/cln/articles/2014/march/bath-salts.

3. Nova Recovery Center. Bath salts: innocent name, terrifying effects. Accessed October 19, 2020. Available at: https://novarecoverycenter.com/trending-street-drugs/bath-salts-innocent-name-terrifying-effects/.

4. American Addiction Centers. Mixing bath salts and alcohol effects. Accessed October 19, 2020. Available at: https://www.alcohol.org/mixing-with/bath-salts/.

F A L L 2 0 2 0

BENZODIAZEPINES BY: TESS CHANG, STUDENT PHARMACIST

https://adaa.org/sites/default/files/2019-10/How-Long-Do-Benzodiazepines-Stay-in-Your-System_-rvr.jpg

SLANG TERMS: BENZOS, DOWNERS, NERVE PILLS, TRANKS

The History BACKGROUND Benzodiazepines are a type of prescription medication commonly used for anxiety or

Pharmacology DRUG EFFECTS

Benzodiazepines work by raising the level of the inhibitory neurotransmitter by binding to gamma-aminobutyric acid (GABA) receptors in the brain.

This causes a drowsiness or calming effect. This can lead to side effects of drowsiness, dizziness, weakness, and slowed breathing.

insomnia treatment. They are federally approved to treat generalized anxiety disorder, insomnia, seizures, social phobia, and panic disorder. It is a sedative used to calm or sedate a person.

Common examples include diazepam (Valium), clonazepam (Klonopin), and alprazolam (Xanax).

The first benzodiazepine approved in 1960 was chlordiazepoxide. Statistics show that more than 30% of overdoses involving opioids also involve benzodiazepines. The number of this medication filled increased by 67% from 1996 to 2013.

Previously many patients were prescribed both types of medications concurrently, but there is now a black box waring discouraging the combined use.

Laws

Monitoring

The Centers for Disease Control and

Prescription drug monitoring programs

Prevention (CDC) issued new guidelines in

(PDMPs) are used at the state-level to

2016 regarding the prescribing of opioids.

help protect patients from abusing their

Clinicians were recommended to avoid

medication by regulating its

prescribing benzodiazepines concurrently

distribution. It tracks controlled

with opioids when possible. The two

substance prescriptions in a state.

medications now carry an FDA black box

The four common screening tests used

warning the dangers of using the drugs

to detect for benzos are the blood test,

together. On September 23, 2020 FDA

urine test, saliva test, and hair test. All

required the boxed warning update to

have been approved by the FDA.

improve safe use of benzodiazepines, including potential for abuse, addiction and other serious risks. They are controlled in Schedule IV of the Controlled Substances Act.

Professional Opinion My opinion as a student pharmacist is that benzodiazepines have their place in therapy and should be allowed for use. But their use should be monitored carefully to ensure patients are not abusing their medication and put themselves at risk. Health care

https://www.statnews.com/wpcontent/uploads/2018/02/Benzos-645x645.jpg

Drug Interactions TOXICOLOGY The concurrent use of opioids and benzodiazepines can be fatal. They both sedate users and suppress breathing which can lead to overdose fatality. Both impair cognitive functions as well. Studies have shown that the concurrent use of both drugs increases patient’s risk of visiting the emergency department or being admitted to a hospital for a drugrelated emergency. According to the FDA, abuse and misuse of benzodiazepines can result in overdose or death especially when combined with opioid pain relievers, alcohol or illicit drugs. Withdrawal reactions including seizures when the medication is abruptly stopped or reduced too quickly which can also be life threatening.

professionals should monitor patients who are prescribed benzodiazepines and given appropriate education about the medication.

~ T. Chang

References: 1. Centers for Disease Control and Prevention.

Opioid Overdose. Accessed at October 21, 2020.

Available at: https://www.cdc.gov/drugoverdose/pdmp/states.ht ml.

2. Drug Abuse. Benzodiazepines Opioids. Accessed October 25, 2020. Available at: https://www.drugabuse.gov/drugtopics/opioids/benzodiazepines-opioids.

3. Drug Enforcement Administration. Drug Fact Sheet: Benzodiazepines. Accessed at October 21, 2020. Available at: https://www.dea.gov/factsheets/benzodiazepines 4. Food and Drug Administration. Boxed warning update. Accessed October 21, 2020. Available at: https://www.fda.gov/drugs/drug-safety-andavailability/fda-requiring-boxed-warningupdated-improve-safe-use-benzodiazepine-drugclass.

5. Greenblatt DJ, Shader RI, Abernethy DR. Drug therapy. Current status of benzodiazepines. N Engl J Med. 1983;309(6):354-358.

Bromo-DragonFLY (Bromo-benzodifuranylisopropylamine) Alexander Chao

Student Pharmacist

https://www.sigmaaldrich.com

Fall 2020

Street Names/Slang Terms Fly, BDF, Bromo-DragonFLY, DOB-Dragonfly, ABDF, spamfly, placid, B-fly, 3C-Bromo-Dragongly

History/Background First synthesized in 1998 by Matthew Parker in lab of David Nichols at Purdue University Named after superficial resemblance to dragonfly

Pharmacology/Drug Effects

https://psychonautwiki.org/

Bromo-DragonFLY is a a compound related to phenethylamine that belongs to the benzo difuran class. It has high affinity binding to the 5HT2a receptor and exists in both stereoisomeric forms. It also acts as an agonist for the alpha-1 adrenergic receptor and serotonin receptor.

It causes psychedelic feelings and has been shown to be more potent than LSD in laboratory tests for rats. With LSD-like effects and amphetamine activation, users’ moods, senses, temperatures, muscle control, sleep, hunger, and sexual desires are affected.

Users have reported kaleidoscopic hallucinations, altered perceptions of space and time, high color visuals, shimmering lights, mild euphoria, and increased associative thinking.

Adverse Effects Confusion, disorganized thoughts, heart problems, hallucinations, vasoconstriction, seizure, paranoia, death, psychosis

Drug Interactions Cannabis, Lithium for bipolar disorder, Stimulants, Tramadol https://www.omicsonline.org/

Toxicology Dose range is between 100-2100 micrograms, where the light end is around 100 mcg and heavy effects start around 750 mcg. Durations may last from one to four days, with after effects lasting up to two days. Peak effect is around 6 hours. Deaths have been reported with the consumption of this drug in Sweden, Norway, Finland, Denmark, and the US.

Laws Bromo-DragonFLY is listed as a scheduled substance or classified as a narcotic drug in most countries, thus making it illegal to produce, sell, or use.

Monitoring/Drug Screens Can be detected in urine and vitreous humor. May also affect adrenergic effects including heart rate, visual and auditory reactions, and blood pressure.

Professional Opinion Due to the highly dangerous side effect profile with an increased possibility of death, I would not recommend Bromo-DragonFLY for use in anyone. – A. Chao

References 1. Coppola M, Mondola R. Bromo-DragonFly: chemistry, pharmacology and toxicology of a benzodifuran derivative producing LSD-like effects. J Addict Res Ther 3:133. doi:10.4172/2155-6105.1000133 2. PsychonautWiki. Bromo-Dragonfly. Accessed October 22, 2020. Available at: https://sychonautwiki.org/wiki/Bromo-DragonFLY 3. Sigma Aldrich. Bromo-Dragonfly. Accessed October 22, 2020. Available at: https://www.sigmaaldrich.com/catalog/product/cerillian/b049?lang=en&region=US 4. Briarwood Detox. 3 designer drugs to know | Bromo-Dragonfly, MXE & Benzo Fury. Accessed October 22, 2020.

Available at: https://www.briarwooddetox.com/blog/3-designer-drugs/#h-bromo-dragonfly-street-name

Buprenorphine Jack Kelly, Student Pharmacist - Fall 2020

The Food and Drug Administration reviewed and approved two new buprenorphine products for treatment of opioid use disorder under the brand names Suboxone® and Subutex®. The new products and FDA review changed buprenorphine from schedule V to schedule III product. Physicians with additional training and a special DEA waiver can prescribe buprenorphine for opioid use disorder through several laws like the Drug Treatment Act of 2000 and the Narcotic Addict Treatment Act in 2001, 2005, and 2006

2010

Buprenorphine was first approved in 1985 as an injectable formulation analgesic under the brand name Buprenex®

2000's

1985

Buprenorphine History The partial agonist and long-acting properties of buprenorphine brought Butrans® to market for managing chronic pain.

Slang terms • Buse • Sobos • Strips

• Orange • B • Bupe

Pharmacology and drug effects • Buprenorphine competes at mu opioid receptors with other opioid analgesics and reduces their efficacy or displaces them.

• Buprenorphine has very high affinity, but the analgesic effect plateaus at higher doses due to the partial agonist properties.

The partial agonist effect is intended to reduce the potential for abuse in patients who are addicted to opioids.

• Patients are unable to achieve the same level of euphoria and high compared to other full agonist opioids.

Drug interactions and Toxicology -

Major CYP3A4 substrate, which may lead to interactions with a significant number of drugs Buprenorphine is a CNS depressant which can be dangerous in combination with other CNS depressants Patients on high doses of opioids require special dosing considerations upon initiation. Before starting therapy, short-acting opioids require an abstinence period of 12 hours and long-acting opioids, like methadone, require 72 hours to reduce risk for serious withdrawal symptoms.

Laws -

-

-

Monitoring and Screening

As of 2002, buprenorphine and all other products containing buprenorphine are schedule III according to Controlled Substance Act Prescribing of buprenorphine containing products for opioid addiction is limited by certain regulations outlined in the Drug Addiction Treatment Act of 2000 (DATA) and the SUPPORT Act passed in 2018.

Physicians must prescribe in office-based opioid treatment and complete appropriate federally mandated training. In addition, physicians must register and obtain a DATA waiver (“X” DEA number).

-

-

-

Monitoring for diversion and misuse is considered when using the drug as treatment for opioid addiction. Opioid naive patients using buprenorphine for chronic pain relief may also be monitored for potential diversion or misuse.

Respiratory and CNS depression and mental status are important monitoring parameters to prevent potential adverse drug events.

Sufficient clinical response is considered in both chronic pain management and opioid addiction treatment.

Professional Opinion – Buprenorphine is an important drug in medication assisted therapy. Data supports efficacy of buprenorphine products for reducing illicit opioid use and overdose. Benefits of using buprenorphine outweigh the potential for diversion and I believe buprenorphine should continue to be used in patients with appropriate indication for use.

- J. Kelly

CAFFEINE Amanda Civitello Student Pharmacist Fall 2020

https://en.wikipedia.org/wiki/Caffeine

History Stone age- People first consumed beverages made from caffeine containing plants.

960-1279 AD- Tea containing caffeine became common place and travels across continents with monks and other voyagers.

1100 AD- First coffee tree was harvested and coffee was made from boiling the beans.

1668 AD- Coffee becomes New York’s favorite beverage, replacing beer.

1880 AD- First caffeinated soft drinks are made.

1995 AD- Coffee becomes the most popular beverage in the world, consuming more than 400 million cups per year across the world.

Other Names 1,3,7-trimethylxanthine Caffeine Anhydrous Cafcit

Trimethylxanthine Caffeine Citrate Keep Alert

Caffeine Sodium Benzoate Peyona Vivarin

Pharmacology Caffeine is a CNS stimulate that is known to block both GABA and adenosine inhibitory pathways in the brain. This leads to wakefulness, sustained intellectual activity, while also decreasing wakefulness.

https://www.foodsafetynews.com/2014/07/fda-warnsconsumers-about-pure-caffeine-products/

Drug Interactions -Stimulants: The use of caffeine and other CNS stimulants can cause increased heart rate and blood pressure, as well as nervousness.

-CYP1A2: Caffeine is broken down in the liver using CYP1A2. Drugs that influence CYP1A2 can increase or decrease the half-life of caffeine.

-Alcohol: Alcohol is a CNS depressant that inhibits CYP1A2. The use of caffeine and alcohol leads to a highly stimulated drunken state.

Adverse Effects -Insomnia -Nervousness -Restlessness -Stomach Ache -Increased Heartrate

Contraindications -Hypersensitivity to caffeine or its components -Neonates

Monitoring -Heartrate -Blood pressure -Anxiety/Nervousness -No clinically available test for blood caffeine level

Laws Caffeine is legal across the world. In the US, caffeine content is limited to 72mg per 12 fl. oz. beverage by the FDA. Energy drinks are marketed as dietary supplements and therefore are not limited in caffeine content.

Professional Opinion Caffeine is safe for long-term use, but does pose some risk of addiction. It should be used in moderation and avoiding large quantities should decrease risk of addiction and adverse events. ~ A.. Civitello

References -

-

Caffeine Timeline. Erowid. https://erowid.org/chemicals/caffeine/caffeine_timeline.php. Published April 25, 2005. Accessed October 25, 2020.

Nehlig A. Interindiviual Differences in Caffeine Metabolism and Factors Driving Caffeine Consumption.

Pharmacological Review. Https://pharmrev.aspetjournals.org/content/70/2/384. Published April 1, 2018.

Accessed October 25, 2020.

Caffeine for the Sustainment of Mental Task Performance. National Center for Biotechnology Information. 2001. doi:10.17226/10219 Caffeine: Uses, Side Effects, Interactions, Dosage, and Warning. WebMD. https://www.webmd.com/vitamins/ai/ingredientmono-979/caffeine. Accessed October 25, 2020.

Caffeine. In: Lexi-Drugs. Hudson, OH: Lexi-Comp, Inc. [Updated October 4, 2020; Accessed October 25, 2020]. http://online.lexi.com.ezproxy.lib.purdue.edu/lco/action/doc/retrieve/docid/patch_f/6497?cesid=3uFHZLNe81 h&searchUrl=%2Flco%2Faction%2Fsearch%3Fq%3Dcaffeine%26t%3Dname%26va%3Dcaffeine

https://www.shutterstock.com/search/cbd+structure

Leah Clark, Student Pharmacist Fall 2020

https://www.vectorstock.com/royalty-freevectors/formula-tetrahydrocannabinol-thcvectors

Slang: CBD History 2737 BC- first documented use of cannabis-derived medicine. Chinese Emperor Sheng Nung cannabis-infused tea 1839- Irish physician and medical researcher, William B. O’Shaughnessy, published a study which investigated the plant’s therapeutic effects, that researchers did begin to consider the medical applications of cannabis.

1940- British chemist Robert S. Cahn identified the full structure of Cannabinol (CBN) 1942- American chemist, Rodger Adams, he successfully isolated the first cannabinoid, Cannabidiol (CBD). His research is also responsible for the discovery of Tetrahydrocannabinol (THC).

1963- Dr. Raphael Mechoulam successfully identified the stereochemistry of CBD. 1964- Dr. Raphael Mechoulam discovered the stereochemistry of THC, which revealed the cannabinoids direct relationship to the euphoric effects associated with marijuana use, and disassociated CBD as a mind-altering compound.

1978- New Mexico passed the 1978 Controlled Substances Therapeutic Research Act, a bill which legally recognized the medicinal value of cannabis.

Pharmacology/ Drug effects •

• • • •

Stimulates cannabinoid receptors CB1 and CB2 in the CNS and dorsal root ganglia as well as other sites in the body. Cannabinoid receptors in the pain pathways of the brain and spinal cord mediate cannabinoidinduced analgesia. Peripheral CB2 receptors modulate immune function through cytokine release.

Protein binding: THC ~97% Metabolism: Hepatic, via CYP isoenzymes (2C9, 2C19, 2D6 and 3A4) to THC metabolite 11-hydroxytetrahydrocannabinol (11-OH-THC, psycho-active) and CBD metabolite 7-hydroxy-cannabidiol.

Half-life elimination: Biphasic Excretion: As metabolites in the urine and feces

Drug Interactions Include Anticholinergic agents, CNS depressants, cocaine, CYP2C9 inhibitors, CYP 3A4 inducers and inhibitors, grapefruit juice, hormonal contraceptives, St John’s Wort, sympathomimetics, and warfarin. https://www.analyticalcannabis.com/articles/cbd-vs-thc-what-are-the-maindifferences-297486

Laws

Monitoring / Drug Screens

CBD is one of many cannabinoids present in cannabis, and as such is in schedule I of the Controlled Substances Act. However, in December 2015, the FDA eased the regulatory requirements to allow researchers to conduct CBD trials. The Drug Enforcement Agency (DEA) stated that these modifications are intended to streamline the research process regarding CBD’s possible medicinal value and help foster ongoing scientific studies.

CBD does not show up on a drug test if it is pure.

Factors such as where the CBD extract comes from and how it is harvested might make THC contamination more likely. Certain types of CBD are less likely to have THC in them than others.

Drug tests do, however, screen for THC. Based on the testing material, hair, blood, urine, saliva, there is a different cut off to reduce false positives.

https://image.shutterstock.com/image-photo/cannabis-formula-cbdthc-600w-1085974532.jpg

Professional Opinion Due to the legal status and the current weak evidence surrounding potential medical benefits of CBD/THC, I would not recommend this product to patients. Once there are more trials and data supporting the supposed benefits and a better understanding of the long term and more frequent use risk, I will re-evaluate my stance.

-L. Clark References 1.

2.

3.

4.

5.

Cadena A. CBD Origin. The History of CBD: A Brief Overview. Accessed October 25, 2020. Available at: https://medium.com/cbd-origin/the-history-of-cbd-a-brief-overview-68545c05ccc9 Tetrahydrocannabinol and Cannabidiol. Lexi-Drugs. Lexicomp. Wolters Kluwer Health, Inc. Riverwoods, IL. Accessed October 24, 2020. Available at: http://online.lexi.com.

World Health Organization. CANNABIDIOL (CBD) Pre-Review Report. Geneva, Switzerland: World Health Organization; 2017.

Vandergriendt C. Healthline. Does CBD Show Up on a Drug Test?. Accessed October 25, 2020.

Available at: https://www.healthline.com/health/does-cbd-show-up-on-a-drug-test Caporuscio J. Medical News Today. Can CBD make you fail a drug test?. Accessed October 25, 2020.

Available at: https://www.medicalnewstoday.com/articles/does-cbd-show-up-on-a-drug-test

(chloro) hydrocarbons Sydney Jablonski, Student Pharmacist Fall 2020 BACKGROUND

Although over 22 million Americans age 12 and over have used inhalants, they remain the “forgotten epidemic� as inhalant abuse is the least-studied form of substance abuse.

Hydrocarbons are most commonly found in agents such as spray paint, gasoline, and spot remover.

SLANG TERMS

Street names for inhalants include: air blast, bold, chroming, discorama, glad, moon gas, poor man's pot, and whiteout.

There is varying slang for the act of using inhalants, like "sniffing" fumes from containers, "bagging" when inhaling a substance from a paper or plastic bag, and "huffing" when an inhalant-soaked rag is stuffed in the mouth.

PHARMACOLOGY AND EFFECTS

Hydrocarbons have low surface tension and viscosity, meaning they are able to deeply penetrate the lungs. They can also destroy surfactant, airway epithelium, alveolar septae, and pulmonary capillaries.

Effects on the brain can vary, although their mechanism of action is unknown.

In the short-term, inhaled hydrocarbons can cause slurred speech, disorientation, headache, ataxia, hallucination, nausea, and seizure activity.

Long-term exposure can cause neuropathy, reduction in brain size, and encephalopathy.

TOXICITY

Hydrocarbon poisoning can occur from ingestion or inhalation, resulting in aspiration pneumonitis.

Inhalation in adolescents can cause ventricular fibrillation. Hydrocarbons most likely to produce toxic effects have low viscosity (SSU <60) and better infiltrate tissues.

LAWS

Inhalants are not currently regulated under the Controlled Substance Act, predominantly due to the fact that it is difficult to regulate the distribution of household objects.

DRUG SCREENS

Inhalant use does not show up in usual urine drug tests. However, blood tests can show elevated liver enzymes after inhalant use.

PROFESSIONAL OPINION

The use of inhaled (chloro) hydrocarbons should be of greater concern to the general public due to its high rate of prevalence and lack of anti-abuse advocacy in American culture. ~ S. Jablonski

REFERENCES

Curtis J, Metheny E, Sergent SR. Hydrocarbon Toxicity. StatPearls. June 2020. https://www.ncbi.nlm.nih.gov/books/NBK499883/. Accessed October 25, 2020.

How are inhalants used? National Institute on Drug Abuse. https://www.drugabuse.gov/publications/research-reports/inhalants/how-are-inhalants-used.

Published April 13, 2020. Accessed October 25, 2020.

Howard MO, Bowen SE, Garland EL, Perron BE, Vaughn MG. Inhalant use and inhalant use disorders in the United States. Addict Sci Clin Pract. 2011;6(1):18-31.

Substance use - inhalants. MedlinePlus. https://medlineplus.gov/ency/patientinstructions/000794.htm. Published October 8, 2020.

Accessed October 25, 2020.

All graphics used are free-use from canva.com.

Brynna Corley Student Pharmacist Fall 2020

https://www.verywellmind.com/what-is-in-cocaine-21989

Pharmacology • Cocaine enhances the activity of dopamine by blocking reuptake into the nerve. Cocaine may also block reuptake of noradrenaline and serotonin.

• Cocaine acts as an anesthetic. It blocks sodium channel activity.

• Cocaine produces euphoria, increases energy, increases mental alertness.

History

• • • • • • • • •

1859: Cocaine was extracted from coca leaves 1880s: Cocaine popularized in the medical community Early 1900s: Cocaine used by all social classes 1903: Cocaine removed from Coca-Cola 1905: Popularity of snorting cocaine began 1912: 5,000 cocaine related deaths in one year 1922: Cocaine is banned 1970s: Cocaine is a popular drug among entertainers Late 1970s: Cocaine was smuggled into the US by Columbian drug cartels • 1980s: Cocaine was no longer a drug of choice for the wealthy • 2008: Cocaine second most trafficked illegal drug in the world

https://en.wikipedia.org/wiki/Cocaine

Slang Terms Blow Bump C /Big C Speedball Crack Dust Flake Sniff Line Nose Candy Pearl Rail Snow Coke White Rock

Toxicology

Interactions

• Results in increased sympathetic activity and vasospasm.

• Symptoms (mild): anxiety, chest pain, hallucinations, hypertension, palpitations, agitation • Symptoms (severe): seizures, severe agitation, hyperthermia, rhabdomyolysis, renal failure, hepatic injury, cardiovascular collapse

• Interacts with other medications that have effect on serotonin, can lead to a higher chance of serotonin syndrome.

• Interacts with sympathomimetic agents and can increase the effects

Professional Opinion In my opinion, cocaine interacts with many drugs and is hard to control the effects of and therefore should only be used in a medical setting with appropriate medical staff. ~BCorley

Law

Monitoring • In patients with renal impairment • Watch for adverse reactions, seizures, and vital signs (heart rate and rhythm) • Drug test: 4 panel drug test

• Cocaine possession, sale, or trafficking is a felony crime in nearly every state. Federal drug laws prohibit possession, manufacturing, cultivation, trafficking, and distribution.

• Cocaine is a schedule II substance. This means it has a high chance for abuse but has a medical accepted use of treatment with restrictions.

References Crane M. American Addiction Centers. Slang and nicknames for cocaine. Accessed October 21, 2020. Available at: https://americanaddictioncenters.org/cocaine-treatment Drugs.com. Cocaine. Accessed October 21, 2020. Available at: https://www.drugs.com/ingredient/cocaine Foundation for a Drug-Free World International. Cocaine: a sort history. Accessed October 21, 2020. Available at: https://www.drugfreeworld.org The Department of Health. Pharmacology of cocaine. Accessed October 21, 2020. Available at: https://www1.health.gov.au.

Cocaine. Lexi-Drugs. Lexicomp. Wolters Kluwer Health, Inc. Riverwoods, IL. Available at: http://online.lexi.com.

Accessed October 24, 2020.

Cocaine. Micromedex Solutions. Truven Health Analytics, Inc. Ann Arbor, MI. Available at: http://www.micromedexsolutions.com. Accessed October 24, 2020.

FindLaw. Indiana cocaine laws. Accessed October 24, 2020. Available at: https://statelaws.findlaw.com/indiana-law Saleh N. Verywell Mind. Does cocaine have any medical uses. Accessed October 24, 2020. Available at: https://www.verywellmind.com

Codeine Caia Trykall, Student Pharmacist Fall 2020

DRUG INTERACTIONS & TOXICOLOGY

Common adverse effects include constipation, nausea/vomiting, clouded mentation or sedation. pruritis, urinary retention, hypersensitivity, blurred vision, bronchospasm, tremor, weakness, abdominal cramps, and pancreatitis.

Codeine is a major substrate of CYP2D6.

Codeine has an extensive list of drug interactions, most commonly seen with CNS depressants.

Deaths have been related to toxicity, with a major proportion deriving from accidental overdose. Treatment of codeine toxicity depends on symptoms and degree of intoxication.

https://www.google.com/url? sa=i&url=https%3A%2F%2Fslideplayer.com%2Fslide%2F 6187720%2F&psig=AOvVaw2aPi92XN1ybt1W1YwIpbpa& ust=1603724667485000&source=images&cd=vfe&ved=0C AIQjRxqFwoTCOCo9ZiC0OwCFQAAAAAdAAAAABAE

Slang terms: Captain Cody Cody Lean Schoolboy Sizzurp Purple Drank

BACKGROUND/HISTORY

Opiates originally are derived from the opium poppy. The opium poppy has been used for thousands of years for medicinal purposes, dating all the way back to the era of Mesopotamia and the Sumerians. In the early nineteenth century, morphine was extracted from opium in its pure form.

Morphine was widely used during the American Civil War, and many soldiers became addicted. Codeine was first isolated in 1830 by Jean-Pierre Robiquet of France to replace raw opium in medical practices. Codeine is a less powerful than morphine, but still has addictive properties. Throughout nineteenth century, recreational use of opium grew, and in 1905, the United States Congress banned opium. However, with time, the Food and Drug Administration has approved synthetic opioids, like codeine, which mimic the body's own painkillers. Codeine today is used to treat pain, with off-label uses of cough, diarrhea, and restless leg syndrome.

PHARMACOLOGY

Codeine binds to opioid receptors, which are G-protein coupled receptors. When bound, a series of intracellular events takes place. This results in the inhibition of ascending pain pathways, which alters the perception of and response to pain.

The cough reflex is mediated through opioid receptors located in the medulla of the brain. Also, this mechanism produced general CNS depression. Codeine is available in four formulations: solution for injection, oral solution, controlledrelease tablet, and immediate-release tablet. Additionally, many cough suppressants include combinations with codeine.

LAWS

Codeine is classified as a Schedule II Controlled Substance (narcotic), meaning there is high potential for dependence and abuse. Codeine in combination formulations in some cough medicines are considered Schedule III-V Controlled Substances. Legally, codeine alone is available through a valid prescription.

Unauthorized possession is illegal.

MONITORING & DRUG SCREENS

Monitoring should include both subjective and objective assessment via laboratory testing. There should be documentation of pain intensity, level of functioning, progress toward treatment goals, adherence to therapy, and presence of any adverse effects. For patients who are using stable doses and have low risk for adverse events, it is recommended to monitor every 3-6 months, and high-risk patients may be monitored weekly. A urine drug test is often standard practice for detecting opioids. There are two main types of urine drug tests -- immunoassay and gas chromatography/mass spectrometry. An immunoassay test is most commonly used in typical point-of-care settings such as clinics and hospitals.

Professional Opinion

In my professional opinion, I think codeine is reasonable to use for pain and cough when there is stringent monitoring. Patients should be educated on the potential for abuse and the signs and symptoms of overdose. Providers should also discuss the effects of naloxone and how to obtain it. ~ C Trykall

References: Codeine. Lexi-Drugs. Lexicomp. Wolters Kluwer Health, Inc. Riverwoods, IL. Available at: http://online.lexi.com.

Accessed October 24, 2020.

Snohomish Health District. Street or Slang Names for Drugs. Accessed October 24, 2020. Available at: https://www.snohd.org/DocumentCenter/View/2516/Drug_Names_Slang_2019_05_09?bidId=.

Foundation for a Drug-Free World. Pain Killers: A Short History. Accessed October 24, 2020. Available at: https://www.drugfreeworld.org/drugfacts/painkillers/a-shorthistory.html#:~:text=Codeine%2C%20a%20less%20powerful%20drug,mainly%20as%20a%20cough%20remedy.

StatPearls. Codeine. Accessed October 24, 2020. Available at: https://www.ncbi.nlm.nih.gov/books/NBK526029/ Center for Disease Control and Prevention. Urine Drug Testing. Accessed October 24, 2020. Available at: https://www.cdc.gov/drugoverdose/pdf/prescribing/CDC-DUIP-UrineDrugTesting_FactSheet-508.pdf.

Cyclobenzaprine (Amrix, Fexmid, Flexeril) Ronald Mahan Student Pharmacist Fall 2020 https://corpina.com/cyclobenzaprine-high/

Street Names Mellow Yellow Cyclone Whitney Houston Flexies

https://en.wikipedia.org/ wiki/Cyclobenzaprine

Pharmacology • Central Nervous System muscle relaxant for pain, tenderness, and muscle spasms • Acts within the brain, not spinal cord • MOA: Similar to tricyclic antidepressants (reduces tonic somatic motor activity influencing motor neurons) • Can enhance other CNS depressant effects (alcohol, barbiturates, benzodiazepines, and narcotics)

History 1961: Merck & Company first synthesizes drug 1977: US Food and Drug Administration approval for muscle spasm treatment 2004: Drug Study review found benefits for fibromyalgia symptoms 2004: Study done to reveal 4.1 ED visits per 1,000 prescriptions were because of cyclobenzaprine 2012: Whitney Houston overdoses, cyclobenzaprine found in system 2012: United Kingdom takes cyclobenzaprine off the shelves 2017: Cyclobenzaprine becomes 43rd most commonly sold prescribed medication

Monitoring Parameters • CNS Depression • Serotonin Syndrome • Anticholinergic effects (glaucoma, urinary function) • Tachycardia • Heart Arrhythmias

Adverse Effects • Drowsiness • Dizziness • Dry Mouth • Constipation • Tiredness

Drug Interactions • Tricyclic antidepressants • MAO Inhibitors • Serotonin increasing drugs - Tramadol - St. John’s Wort - Antidepressants

Contraindications • • • • •

Hypersensitivity Hyperthyroidism Heart Failure Arrhythmias Conduction Disturbances • Acute Recovery Myocardial Infarction • Within 14 days of taking MAO Inhibitor

Law Cyclobenzaprine is not a scheduled drug within the United States, but there is still abuse potential, so patients should still take with caution.

Professional Opinion Cyclobenzaprine is a safe option for muscle relaxation, with less addictive properties than other drugs in its class, such as Soma, but it still has addictive properties so patients taking this drug should be educated on how to properly and safely take this medication. ~ R. Mahan

References Hom, Elaine. Cyclobenzaprine (Flexeril): Dosage & Side Effects. LiveScience, 2017 May 11. Available at https://www.livescience.com/41517-cyclobenzaprine.html. Accessed October 4, 2020 Drug Enforcement Administration. Cyclobenzaprine. Diversion Control Division, March 2020. Available at https://www.deadiversion.usdoj.gov/drug_chem_info/cyclobenzaprine.pdf. Accessed October 4, 2020 n.a. Cyclobenzaprine HCL. WebMD, n.d. Available at https://www.webmd.com/drugs/2/drug-88888087/cyclobenzaprine-oral/cyclobenzaprineoral/details#:~:text=Drowsiness%2C%20dizziness%2C%20dry%20mouth%2C,your%20doctor%20or%20pharmacist%2 0promptly. Accessed October 4, 2020 Durbin, Kaci. Cyclobenzaprine. Drugs.com, December 17, 2018. Available at https://www.drugs.com/cyclobenzaprine.html#:~:text=Cyclobenzaprine%20is%20a%20muscle%20relaxant,such%20as %20pain%20or%20injury. Accessed October 4, 2020.

Hannah Vyain Student Pharmacist Fall 2020

Burundanga Voodoo drug telegraph.co.uk

HISTORY 1880: Albert Ladenburg isolated scopolamine from the plant Scopolia carniolica 1902: Richard von Steinbuchel proposed the use of scopolamine in obstetric anesthesiology 1903: Carl Gauss coined the term â&#x20AC;&#x153;twilight sleepâ&#x20AC;? with use of the drug as a surgical anesthetic 1922: Dr. Robert House uses scopolamine to interrogate prisoners (claimed the drug to be a truth serum) December 31, 1979: FDA approval date for use in GI upset

PHARMACOLOGY Scopolamine is an anticholinergic agent.

It blocks the action of acetylcholine in smooth muscle, secretory glands, and the CNS. This increases cardiac output, dries secretions, and stops actions of histamine and serotonin

chm.bris.ac.uk

ADVERSE EFFECTS ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖

Drowsiness Confusion Pupil dilation Visual impairment Hallucinations Sore throat Nausea/vomiting Seizures Urinary retention

DRUG INTERACTIONS ❖ Anticholinergic agents may lessen the effect of acetylcholinesterase inhibitors ❖ Alcohol may increase the CNS effects of this drug ❖ CNS depressants may increase side effects of anticholinergic agents

CONTRAINDICATIONS ❖ ❖ ❖ ❖

Glaucoma Enlarged colon Myasthenia Gravis Stomach or bowel obstruction ❖ Heart failure ❖ Pregnancy ❖ Allergy to any components

Monitoring o o o o

Body temperature Heart rate Urinary output Intraocular pressure

northpointrecovery.com

allthatsinteresting.com

Law Although scopolamine is not illegal in the United States if it is used correctly, there can be legal repercussions if the drug is used in any way to harm another individual.

Professional opinion

thesun.co.uk

I would not recommend this medication because it has a large amount of potential interactions with several drug classes. This drug also has a high potential for misuse and has been used more criminally than therapeutically in the recent years. Overall, it is not a great therapeutic medication, and there are other alternatives out there with less drug interactions and potential adverse effects. ~ H. Vyain

References - Scopolamine. Lexi-Drugs. Lexicomp. Wolters Kluwer Health, Inc. Riverwoods, IL. Accessed October 25, 2020. Available at: http://online.lexi.com.

- Cotton, S. Bristol University School of Chemistry. Scopolamine. Accessed October 25, 2020. Available at: http://www.chm.bris.ac.uk.

- Kuroski, J. All That’s Interesting. Is devil’s breath the world’s scariest drug. Accessed October 25, 2020. Available at: http://allthatsinteresting.com.

- Northpoint staff. Northpoint Recovery. Scopolamine: the blowing powder. Accessed October 25, 2020. Available at: https://www.northpointrecovery.com.

D extromethorphan ( DXM)

Kelsey Craig F all 2020 S tudent Pharmacist

https://en.wikipedia.org/wik i/Dextromet horp han

History:

Street Names: • • • • • • • •

- 1954: successfully tested

Dex/Drex Dexing Orange crush Poor man’s PCP Red Devils Red hots Robo Skittles

- 1958: available without a prescription and approved by the FDA - 2012: prohibited for sale to minors in California - 2014: The national Agency of Drug and Food Control of Indonesia prohibited single-component drug sales with or without a prescription

Pharmacology: -

NMDA receptor antagonist

-

Exhibits antitussive activity

-

Crosses the blood-brain-barrier

-

Activates sigma opioid receptors on the cough center in the CNS

-

Suppresses cough reflex

ADVERSE EFFECTS: BLURRED VISION, DIFFICULTY IN URINATION, DROWSINESS, DIZZINESS, NAUSEA OR VOMITTING, SHAKINESS AND UNSTEADY WALK, SLOWED BREATHING, UNUSUAL EXCITEMENT OR NERVOUSNESS, RESTLESSNESS, IRRITABILITY

Contraindications: -

MAO inhibitor Systemic mastocytosis

DRUG INTERACTIONS:

-

COMBINING WITH ALCOHOL CAN INCREASE NERVOUS SYSTEM SIDE EFFECTS A TOTAL OF 275 DRUGS ARE KNOWN TO INTERACT WITH THIS DRUG (SOME COMMON ONES): O BENEDRYL O DOXYLAMINE O GABAPENTIN

Monitoring: Loss of coordination, slurred speech, dizziness, hallucinations, agitation

LAW: DXM is not scheduled under the controlled substances act (CSA)

Professional opinion: I would recommend using dextromethorphan if you have a cough – however, be sure to follow the recommended dosing – K Craig.

References: Drugs.Com. Dextromethorphan HBr Adult Formula (dextromethorphan) Drug Interactions . Accessed on November 16, 2020. Available at: https://www.drugs.com/druginteractions/dextromethorphan,dextromethorphan-hbr-adult-formula.html This Week In Drugs. DXM. Accessed on November 16, 2020. Available at: https://thisweekindrugs.org/index.html%3Fp=1085.html Clearing House. Drug Facts: DXM (Dextromethorphan). Accessed on November 16, 2020. Available at: https://www.ctclearinghouse.org/CustomerContent/www/files/PDFs/Drug_Facts_DXM__Dextromethorphan__2.pdf Grow by WebMD. Teen Slang for Cough and Cold Medicine Abuse. Accessed on November 16, 2020. Available at: https://www.webmd.com/parenting/glossary-dxm-

drug-abuse

DHEA (dehydroepiandrosterone) Alyssa Mulhall Student Pharmacist Fall 2020

STREET NAMES: ARNOLDS GEAR GYM CANDY JUICE PUMPERS ROIDS STACKERS WEIGHT GAINERS

HISTORY: THE DISCOVERY OF DHEA WAS A MAJOR RESEARCH BREAKTHROUGH IN BIOCHEMISTRY AND PHARMACOLOGY DURING THE EARLY PART OF THE 20TH CENTURY. THIS DISCOVERY LED TO ADOLF FREDERICK JOHANN BUTENANDT AND LEOPOLD RUZICKA TO WIN A NOBEL PRIZE IN 1939. THE KNOWLEDGE OF DHEA LED TO THE DISCOVERY OF OTHER STEROID COMPOUNDS. SCHERING AG, A PHARMACEUTICAL COMPANY, RESEARCHED HOW DHEA COULD HELP ENDOCRINE-RELATED DISEASES, WHILE THE EUROPEAN MEDICAL COMMUNITY TESTED DHEA IN WOMEN FOR POSTMENOPAUSAL DESPRESSION AND IN MEN FOR INCREASING MUSCLE MASS. SINCE RESEARCH SHOWS THAT DHEA LEVELS DECREASE AS AGE INCREASES, LOTS OF EXPERIEMENTS WERE AND STILL ARE BEING CONDUCTED TO SEE IF DHEA CAN PROTECT AGAINST VARIOUS DISEASES AND ILLNESSES.

PHARMACOLOGY DHEA IS A HORMONE PRODUCED BY YOUR BODYâ&#x20AC;&#x2122;S ADRENAL GLANDS. IT FUNCTIONS AS A PRECURSOR TO MALE AND FEMALE SEX HORMONES, INCLUDING TESTOSTERONE AND ESTROGEN. DHEA IS NEEDED FOR GROWTH AND DEVELOPMENT. AS PEOPLE GET OLDER, THEIR DHEA LEVELS START TO DECREASE. THERE IS RESEARCH GOING ON RIGHT NOW TO SEE IF TAKING DHEA INCREASES MUSCLE STRENGTH/MASS, SLOWS AGING, OR HELPS TREAT DISEASES. THERE IS LITTLE EVIDENCE THOUGH AT THE MOMENT TO SHOW THAT DHEA HELPS WITH ANY OF THESE THINGS.

https://en.wikipedia.org/wiki/Dehydroepiandrosterone

ADVERSE EFFECTS:

DRUG INTERACTIONS:

PERMANENT STUNTING OF GROWTH

BLOOD THINNERS

AGGRESSIVE BEHAVIOR MOOD SWINGS HIGHER BLOOD PRESSURE

ANTICONVULSANTS HORMONE THERAPY DIABETES DRUGS

LIVER PROBLEMS

DRUGS FOR HEART OR LIVER PROBLEMS

CONTRAINDICATIONS

MONITORING

PREGNANT OR BREAST FEEDING

MONITOR BLOOD PRESSURE

IF YOU HAVE ANY FORM OF CANCER OR AT RISK FOR CANCER

MONITOR BLOOD GLUCOSE LEVELS

HIGH CHOLESTEROL

MONITOR CHOLESTEROL LEVELS

HEART DISEASE

LAW: ITS USE IS BANNED BY SPORTS ORGANIZATIONS INCLUDING THE NFL, MLB, NCAA, AND THE INTERNATIONAL OLYMPIC COMMITTEE

PROFESSIONAL OPINION THERE IS NOT ENOUGH SCIENTIFIC EVIDENCE TO SUGGEST THAT THERE IS IMPROVEMENT WITH THE CLAIMS THAT ARE MADE FOR TAKING DHEA, ALONG WITH SOME SERIOUS UNWANTED SIDE EFFECTS, SO I WOULD NOT RECOMMEND TAKING DHEA. ~ A. Mulhall

REFERENCES: What are the risks associated with using DHEA supplements for athletic performance? WebMD. https://www.webmd.com/diet/qa/whatare-the-risks-associated-with-using-dhea-supplements-for-athletic-performance.

DHEA. Mayo Clinic. https://www.mayoclinic.org/drugs-supplements-dhea/art-20364199. Published December 14, 2017.

Dhea: Health Benefits, Uses, Side Effects, Dosage & Interactions. RxList. https://www.rxlist.com/dhea/supplements.htm. Published September 17, 2019.

Dhea: Uses, Side Effects, Interactions, Dosage, and Warning. WebMD. https://www.webmd.com/vitamins/ai/ingredientmono-331/dhea.

RA;, Klinge CM;Clark BJ;Prough. “Dehydroepiandrosterone Research: Past, Current, and Future.” Vitamins and Hormones, U.S. National Library of Medicine, 16 Mar. 2018, pubmed.ncbi.nlm.nih.gov/30029723/.

r o e n i h p r o lm

y t e c a i D

No

ist 1 c a m r a n t Ph e d u t S o ll ah Sch

r 2020 e b m e 6 Nov alamy.com

Diacetylmorphine is the scientific name for the medicinally pure form of heroin. Heroine is a purified form of opium which is merely the sap from the seed pods of opium poppies (Papaver somniferum). The purification process involves two boiling steps with lime and ammonia to produce morphine.1 The morphine is further processed via acetic anhydride, chloroform, sodium carbonate, activated charcoal and alcohol to create the final product, which is a white powder.1 Purity depends on the country of origin and can range from 36 to 71%.1 Heroin is normally sniffed, smoked, or heated with water and a weak acid to solubilize for injection.2. The opium poppy has been abused for centuries in various forms with heroin and prescription analgesics at the forefront in the 21st century. Heroin’s draw for the addict is the nearly instantaneous high that comes with intravenous injection.

deamuseum.org

luxury.rehabs.com

Slang terms – dope, smack, brown, H, junk, horse, skag, snow, china white, beast, hero, black tar, butter, coffee, poison, poppy, powder.3

steppingstonecenter.com

talktofrank.com dea.gov

Drug effects – “To answer your question, heroin feels nice. That’s all, it just feels very nice.

You can make the rest up for yourself.”(Anonymous)4 Diacetylmorphine acts primarily in the brain and in involuntary muscles such as the intestinal tract. Its action in involuntary muscle results in slower bowel movements, which with chronic use results in constipation. Its action in the brain is to block pain receptors and facilitate the release of dopamine which can result in feelings of pleasure, euphoria, and drowsiness. This over-stimulation causes natural dopamine levels to have less effect and leaves the addict with feelings of emptiness when not using. “I wish I could isolate a point in time when I knew I was addicted, but addiction is subtler than that. Drugs go from merely being a part of your life to becoming your life.” (Josh Moe)5. “Wake up, find money, get high, repeat.” (Josh Moe).5.

Toxicology - Heroin can kill you outright or slowly. Overdose results in slow and shallow breathing, until the addict just stops breathing altogether. Drug interactions with other CNS depressants exacerbate this effect; however, the true toxic effect of heroin is emotional and mental, which is why the drug is so insidious. Imagine it, a drug that will make anything and I mean anything go away and replace it with feeling nice. “A great many people use to self-medicate. And it’s very dangerous because not only will it remove your depression, it will replace it with euphoria. That’s a powerful incentive.” (Emily Carter Roiphe).6.

Laws - 948,000 Americans reported using heroin in 2016.7.

Diacetylmorphine is illegal in the United States, and does not have any FDA approved indications, including treatment of heroin addiction in the United States. Diacetylmorphine is a legal treatment option for heroin addiction in the United Kingdom, Switzerland, Spain, Germany, and the Netherlands. All of which have done numerous studies that demonstrate the efficacy of treatment while reducing crime and treatment cost.8

sfchronicle.com

vox.com

Monitoring/drug screens - Heroin is most commonly detected as an opioid on urine drug screens, nonspecifically along with other common prescription drugs such as hydrocodone and oxycodone. Home tests are available that use enzyme linked immunosorbent assays (ELISA), these tests contain antibodies to the drug and utilize an enzyme to create a color change that is able to be visually interpreted as positive or negative by the consumer.

Professional opinion - Drug abuse and addiction are often the product of intense physical or psychological pain. One addict described his start to heroin addiction as just $10 for a whole night of feeling nice, without any hangover or outrageous behavior.4.

Recovery requires medical care including medication and behavioral therapy, replacement therapy is commonly used in tobacco cessation programs to help addicts successfully quit. It is time that America addressed drug abuse with logical thought and scientific research. ~ N. Scholl thedoctorweighsin.com

References 1. Desert Hope. Opioids. Accessed: 11 October 2020.

Available at: https://deserthopetreatment.com/opioids/ 2. Ponton, Rhys, and Scott, Jenny. Injection preparation processes used by heroin and crack cocaine injectors." Journal of Substance Use 9.1 (2009): 7-19. Web. 3. Campus Drug Prevention. Slang words and code terms. Accessed: October 14, 2007. Available at: https://www.campusdrugprevention.gov/sites/defau lt/files/SlangTermsand-CodeWords.pdf 4. Ste. Genevieve County Health Department. 700 words that explain what it feels like to do heroin.

Accessed 25 October 2020. Available at: http://stegencohealth.org 5. Health Partners. A full-time job in hell: my journey in and out of opioid addiction. Accessed: October 24, 2020. Available at: https://www.healthpartners.com 6. MINNPOST. What’s it really like to withdraw from heroin and painkillers? Accessed: October 24, 2020. Available at: www.minnpost.com.

7. National Institute on Drug Abuse. Heroin research report. Accessed: 16 October 2020.

Available at: https://www.drugabuse.gov/researchreports/heroin/ 8. Fischer B, Oviedo-Joekes E, Blanken P, et al.

Heroin-assisted treatment (HAT) a decade later: a brief update on science and politics. J Urban Health. 2007;84(4):552-562. doi:10.1007/s11524007-9198-y

DIPHENYDRAMINE (BENADRYLÂŽ) Madeline Motes Student Pharmacist Fall 2020 https://psychedelia.fandom.com/wiki/Diphenhydramine

History

New molecular discovery by George Rieveschl at University of Cincinnati in 1946. Over time, the availability of the drug lead to illicit use for the desired calming, euphoric, and hallucinogenic effects. A recent 2020 internet challenge has been leading to increased abuse.

Street Names

- DPH - Sominex - Nytol - Benylin - Benadryl

Pharmacology

Diphenhydramine is a first generation anti-histamine. It competes with histamine, a molecule released during an allergic reaction, at the H1 receptor in the the body. Additionally, it blocks acetylcholine and causes "drying out" of watery eyes and runny nose. Since it is relatively nonselective and can cross the blood-brain-barrier, a common side effect is sedation which is the common reason for misuse.

https://en.wikipedia.org/wiki/Diphenhydramine

Interactions Interactions / / Adverse Adverse Rxn Rxn / / Monitoring Monitoring

- Enhances CNS depressant effects - Diminishes anticholinergic effects - Diminishes GI agent effects

Laws Laws

Diphenhydramine is not a controlled substance and is available for purchase over the counter. However, there has been a new FDA warning out in regard to the TikTok 'Benadryl challenge' which has caused hospitalization and death in teens.

- Respiratory congestion - Monitor mental alertness - Chest tightness - CNS depression or - Tachycardia stimulation - Seizures - May interfere with - Thrombocytopenia methadone and - Caution in elderly phencylidine detection in - GI issues urine drug screens - Risk of psychosis in schizophrenia Professional Professional Opinion Opinion

Since this is a commonly used antihistamine, I would recommend that patients take caution while using recognizing interactions can cause serious complications. Additionally, I would advise parents to educate their children on the dangers of misuse and to keep medications stored in a safe place. - M. Motes

References (Accessed Oct 16, 2020): 1. Diphenhydramine. Lexi-Drugs. Lexicomp.Wolters Kluwer Health, Inc. Riverwoods, IL. Available at: http://online.lexi.com.

2. WebMd. Diphenhydramine Capsule. Available at: https://www.webmd.com/drugs/2/drug-54004/diphenhydramine-oral/details.

3. Drugs.com. Diphenhydramine. Available at: https://www.drugs.com/pro/diphenhydramine.html. Accessed October 16, 2020.

4. Wikipedia. Diphenhydramine. Available at: https://en.wikipedia.org/wiki/Diphenhydramine#History. Accessed October 16, 2020.

5. Food and Drug Administration. Drug Safety and Availability. Available at: https://www.fda.gov/drugs/drug-safety-andavailability/fda-warns-about-serious-problems-high-doses-allergy-medicine-diphenhydramine-benadryl. Accessed October 16, 2020.

Disulfiram (Antabuse) Ella Domingo, Student Pharmacist (Fall 2020) History / Background o In the 1930s, rubber industry workers, who were dealing with tetraethylthiuram disulfide, became sick after drinking alcohol o In the 1940s, when disulfiram was given in a stomach ailment study, those who consumed alcohol also became sick o From then on, studies began confirming that disulfiram and alcohol were not a good combination1 o Indication: alcohol use disorder o Dosing and administration: o Initial: up to 500 mg once daily for 1-2 weeks o Maintenance dose: 250 mg po daily o Maximum: 500 mg/day o Warning: do not take this drug for at least 12 hours after drinking alcohol or taking drugs containing alcohol o Side effects: drowsiness, erectile dysfunction, acne, headache, changes in taste2 o Accessibility: no provider or pharmacy restrictions2 o Shown to increase retention in treatment of alcohol use disorder and duration of abstinence from alcohol use, in addition to supportive psychotherapy3 o More research needed, however, to support efficacy2

Slang Terms o None used Pharmacology / Drug Effects o Pharmacologic category: aldehyde dehydrogenase inhibitor o Mechanism of action: irreversibly inhibits an oxidation step in alcohol metabolism and produces headache, nausea, vomiting, chest and stomach pain (â&#x20AC;&#x153;disulfiram reactionâ&#x20AC;?) if alcohol is ingested2 o Effect on cravings: none

https://www.drugs.com/pro/disulfiram.html

Drug Interactions / Toxicology o Drug interactions: alcohol (ethyl) and alcoholcontaining products, bacampicillin, benznidazole, cocaine (topical), dronabinol, fexinidazole, metronidazole, paraldehyde, tinidazole, tipranavir o Contraindications: heart disease, psychoses, pregnancy o Treatment concerns: potential liver injury; black box warning for alcohol intoxication o Alcohol reactions possible up to 14 days since last dose2 Laws o Approved by FDA for alcohol use disorder indication on December 8, 1983, but there is no substantial evidence to support efficacy4 o Not a controlled substance

https://file.scirp.org/Html/7-1420219_41667.htm

Monitoring / Drug Screens o Monitoring parameters: liver function tests (baseline and after 10-14 days of treatment), complete blood count, serum chemistries, cardiac function at baseline if appropriate1 o Do not administer until patient has abstained from ethanol for 12 hours o Educate patient about disulfiram-alcohol reaction if alcohol is ingested

https://www.psycom.net/alcohol-use-disorder

https://coalitionrecovery.com/staff/matthew-federici-rmhci/

References 1. Disulfiram. Lexi-Drugs. Lexicomp. Wolters Kluwer Health, Inc. Riverwoods, IL. Available at: http://online.lexi.com. Accessed October 24, 2020.

2. Nichols M. Medication-Assisted Treatment. Presented at: Beyond Ecstasy Lecture; October 16, 2020; West Lafayette, IN. 3. Carroll KM, Nich C, Ball SA, McCance E, Rounsavile BJ. Treatment of cocaine and alcohol dependence with psychotherapy and disulfiram. Addiction.

1998;93(5):713-27. doi:10.1046/j.13600443.1998.9357137.x 4. Antabuse. Package insert. Teva Pharmaceuticals USA, Inc; 2020.

Professional Opinion o “Compared to other methods that aid individuals suffering from the disease of addiction, I believe disulfiram, and medication-assisted treatment (MAT) in general, is a safer and more effective alternative to help people break free from their Images addiction. Though more studies need to be 1. Scientific Research Open Access. ADH-alcohol conducted to further support this drug’s efficacy in dehydrogenase.jpg. Accessed October 24, 2020. reducing addictions, there are data that show Available at: https://file.scirp.org/Html/7suppression of substance abuse and lowering of 1420219_41667.htm.

2. Drugs.com. Disulfiram-250.jpg. Accessed October 24, overdose mortality.2,3 MAT helps recognize the 2020. Available at: harm that addictions cause, lowers the likelihood of https://www.drugs.com/pro/disulfiram.html. mortality, and actively aids individuals in taking 3. Coalition Recovery. MAT Infographic.jpg. Accessed steps toward a healthier life.”

October 24, 2020. Available at: - E. Domingo https://coalitionrecovery.com/staff/matthew-federici-

rmhci/.

4. Psycom. Alcoholism-Treatment-Statistics.jpg. Accessed October 24, 2020. Available at: https://www.psycom.net/alcohol-use-disorder.

Diuretics Julia Czarnik Student Pharmacist Fall 2020

Street Names Water pills Fluid pills

History

https://www.google.com/url?sa=i&url=https%3A%2F%2Fwww.dia betesselfmanagement.com

Pharmacology

Late 1800s- Organic mercury compounds used for diuresis in patients with heart failure.

1937- Carbonic anhydrase inhibitors discovered via the antibiotic sulfanilamide.

1958- Thiazides discovered by Sharp and Dohme to treat oedema with few side effects and lowered blood pressure.

1964- Loop diuretics discovered as the most potent compounds (ethacrynic acid and then furosemide).

1961-1968: Potassium-sparing diuretics found to prevent potassium loss caused by earlier diuretics.

Types of diuretics: • • •

Thiazides Loop diuretics Potassium sparing

https://www.google.com/url?sa=i&url=https%3A%2F%2Fwww.cvpharmacol ogy.com.

Diuretics help rid your body of sodium and water. They are a common treatment for high blood pressure.

Each class of diuretic affects a different part of the kidney, pictured above.

Some medications combine more than one type of diuretic or a blood pressure medication.

Drug Interactions -Concomitant use of diuretics with antidiabetic drugs, digoxin, ACE inhibitors, NSAIDs or lithium can cause adverse effects.

Law -Diuretics are often abused by athletes to excrete water for rapid weight loss and to mask the presence of other banned substances.

-Because of their abuse by athletes, diuretics have been included on the World Anti-Doping Agencyâ&#x20AC;&#x2122;s (WADA) list of prohibited substances. They are banned both in and out of competition.

References: Turner N. Blogspot.com. The invention of diuretics. Accessed October 11, 2020. Available at: http://historyofnephrology.blogspot.com/2017/11/the-inventionof-diuretics.html.

Mayo Clinic. Diuretics. Accessed October 11, 2020. Available at: https://www.mayoclinic.org/diseases-conditions/high-bloodpressure/in-depth/diuretics.com.

Ogbru AG. RxList. Diuretics. Accessed October 11, 2020. Available at: https://www.rxlist.com/diuretics/drugclass.htm#what_are_the_drug_interactions_of_diuretics.

Cadwallader AB, De la Torre X. Tieri A, et al. The abuse of diuretics as performance- enhancing drugs and masking agents in sport doping: pharmacology, toxicology and analysis. BJP. 2010;161(1):1-16. doi: 10.1111/j.1476-5381.2010.00789.x

Adverse effects -

Hypokalemia Increased urination Dizziness Headache Dehydration

Monitoring - Electrolyte levels (especially potassium) - Uric acid levels - BUN level - Blood pressure - Renal function

Professional Opinion Due to the low abuse potential, I would recommend diuretics to anyone who has high blood pressure or edema. ~ J. Czarnik

DMT (N,N-Dimethyltryptamine) Mitchell Struewing Student Pharmacist Fall 2020

https://thedrugclassroom.com/video/dimethyltryptami

Street Names

ne-dmt/

Effects

• Short duration (45-60 minutes) • Immersive experiences

• Dimitri

• Open eye visuals (kaleidoscope)

• Businessman’s Trip • Fantasia

• Powerful rushing sensation • Radical perspective shifting • Sound distortions (buzzing) • Color-shifting

Pharmacology N,N-DMT is a naturally occurring chemical in the tryptamine class.

DMT is a simple tryptamine hallucinogen. It’s structurally similar to melatonin and serotonin. It’s also similar to other hallucinogens, including 5-MeO-DMT. The oral bioavailability of DMT is very poor unless it is combined with a substance that inhibits its metabolism.

DMT affects the serotonin 5-HT1A, 5-HT2A and 5-HT2C receptors, the sigma-1 receptors, and the G-protein-coupled trace amine (TA) receptors.

History

Law

• 2080 BC- Archeological evidence suggests its use in snuff • 1500s- Europeans discovered it’s use in South America • 1931- First synthetic synthesis by Richard H.F Manske • 1960s- Became popular drug of abuse • 1971- Controlled Substances Act places it under federal control.

Adverse Effects • •

Overly intense

• DMT is Schedule I controlled substance, this means it is illegal to manufacture, buy, possess, or distribute in the United States.

Drug Interactions •

Hallucinogens (i.e LSD

Contraindications •

Preexisting mental

experiences

and magic

health conditions (i.e

Hard on lungs to

mushrooms)

schizophrenia)

smoke

•

Stimulants (i.e

•

Hypertension

•

Stomach discomfort

amphetamines and

•

History of Seizures

•

Overwhelming fear

cocaine)

•

Pregnancy

•

Agitation

•

Opioids (i.e tramadol)

•

Fast onset can cause

•

Antidepressants (i.e

fall risk and injury •

MAOI’s)

Increased heart rate

Professional Opinion While there is limited addiction potential for DMT, the large number of adverse effects and safety concerns are enough to not recommend DMT for anyone. -M. Struewing

References Brown, N. L. Dimethyltryptamine (DMT). Accessed October 15, 2020. https://www.sutterhealth.org/health/teens/drugs/dime thyltryptamine-dmt Diversion Control Division. N,N-DIMETHYLTRYPTAMINE PDF. Springfield, VA: Drug Enforcement Administration.

N,N-DMT. Accessed October 15, 2020. https://www.erowid.org/chemicals/dmt/dmt.shtml Santos-Longhurst, A. How safe is DMT? Accessed October 25, 2020. https://www.healthline.com/health/is-dmt-safe

Drug Deterrent Formulations (OxyContin) Lane Nowaskie Student Pharmacist Fall 2020 https://www.wptv.com/news/opioid-abuse

What are Drug Deterrent Formulations?

Changes in formulations of drugs that are frequently abused by preventing them from being crushed or dissolved into a liquid able to be injected.

History of OxyContin Abuse -Approved as analgesic in US in 1996.

Examples of Medications with Drug Deterrent Formulations • • • • •

OxyContin Hysingla ER MorphaBond ER Xtampza ER RoxyBond

2000,

-In large marketing campaign to use st Oxy for 1 line tx of different types of pain

2002

committee decided the Oxy was becoming a public health problem

2008

FDA admitted the formulation needed revaluation

2010

A new formulation was created and is still utilized today.

Slang – OxyContin • • • • • • •

Pharmacology Binds to opiate receptors in CNS, causing inhibition of ascending pain pathways, altering the perception of and response to pain; produces generalized CNS depression.

• • •

Cotton Pills Kickers OxyCotton Ox Orange County Oxys Killers

Beans Rushbo

Monitoring

Law

Pain relief, mental status, respiratory, blood pressure, bowel function, and signs of addiction.

It is a schedule II controlled substance. This means these drugs have a higher risk of being addictive leading to abuse.

Adverse Events • • • • •

Drowsiness Headache Pruritis Nausea Constipation

Drug Interactions

https://www.sciencedirect.com/

-Major Interactions with other drugs metabolized with CYP3A4.

Contraindications • Hypersensitivity to the drug • Respiratory depression • GI Obstruction

Professional Opinion I believe the use of OxyContin along with all opioids should be considered last line treatment after all previous treatment options have been exhasusted.

-L. Nowaskie

References Center for Drug Evaluation and Research. Abuse-Deterrent Opioid Analgesics. U.S. Food and Drug Administration. Accessed October 25, 2020. https://www.fda.gov/drugs/postmarket-drugsafety-information-patients-and-providers/abuse-deterrent-opioid-analgesics.

Drug Scheduling. DEA. Accessed October 25, 2020. https://www.dea.gov/drug-scheduling. Published 2020.

OxyContin. Drug Facts and Comparisons. Facts and Comparisons eAnswers. Wolters Kluwer Health. Inc. Riverwoods, IL. Accessed October 24, 2020. Available at: http://online.factasandcomparisons.com.

Staff AACE. OxyContin History. Luxury.Rehabs.com. https://luxury.rehabs.com/oxycontinrehab/history/ Accessed October 25, 2020. Published June 13, 2018.

Drug Screens Sophia Postma, Student Pharmacist, Fall 2020 Background -Drug screens are a method to test for various illicit substances or legal drugs in a person’s body. Commonly, these tests measure the concentration of substance present in someone’s urine. This is a relatively inexpensive, simple, and accurate testing method. (other available tests are saliva, blood, and hair). Commonly drug screens test for marijuana, cocaine, opioids, benzodiazepines, amphetamines, barbiturates, individual drugs.

-There are other available forms of the test (saliva, blood, and hair) -What the results mean: positive (detectable amount of substance in a person’s system), negative, inconclusive (test was not successful, may need to repeat)

http://www.denalihealthcaremi.com/wpcontent/uploads/2015/03/drug-test.jpg

History -After an Amtrak and Conrail train collided into each other in 1987, there was suspicion that the train’s engineer and operator were high. Thus, companies were encouraged to drug test their employees. This incidence encouraged companies to begin drug testing their employees to prevent any future mis happenings that could potentially endanger the company. Since then, there have been other uses found for drug screenings in sports, schools, and homes.

-Throughout the 1930s-1950s, the most common drug test was the salvia test (utilized microcrystalline testing). 1950s-1960s: thin layer chromatography (more specificity/sensitivity).

1980s: drug-specific immunoassays (provides additional sensitivity, pioneered what we use today)

.

Laws/legal information It is up to employer’s discretion whether they require drug testing before hiring. This can be difficult with medical marijuana being legal in some states. Some states have antidiscrimination laws in place to protect employees or new hires/applicants (not applied to federally funded employees) from being refused to be hired because they qualify as a patient who uses marijuana medicinally. Only two states have these antidiscrimination laws for recreational marijuana use (Nevada and Maine).

The most common law referenced was the Drug Free Workplace Act of 1988 stating that federal government employees and DOT (US Dept of Transportation) require mandatory testing.

https://www.es2.com/wp-content/uploads/2015/05/drug-test-results.jpg

Interesting case or article The article, “commonly prescribed medications and potential false-positive urine drug screens” states that commonly prescribed medications can cause a falsepositive result on a drug screening for abused substances.

Most commonly antihistamines, antidepressants, antibiotics, analgesics, antipsychotics, and nonprescription agents caused the false result. Requires other methods (gas chromatography-mass spectrometry) to be used just as a precaution/to confirm. No specific mechanism or reason for this.

Professional opinion I believe that if a company finds it important for future hires to be free from drug use then a drug screen is an effective method to do so. Certain drugs can impair one’s ability to perform and make cognitive decisions that could potentially negatively affect others. It is up to the discretion of the company, not the government. ~ S. Postma

References Brahm NC, Yeager LL, Fox MD, Farmer KC, Palmer TA. Commonly prescribed medications and potential false-positive urine drug screens. Am J Health Syst Pharm. 2010;67(16):1344-50. doi:10.2146/ajhp090477.

FindLaw. Legal Marijuana and Workplace Drug Testing. Accessed October 23, 2020. Available at: https://employment.findlaw.com/workplace-privacy/legal-marijuana-and-workplace-drug-testing.html Joyce C. TestVault. Accessed October 23, 2020. Available at: http://thetestvault.com/brief-history-drug-testing/ Kale N. Urine drug tests: ordering and interpretation. Am Fam Physician. 2019;99(1):33-39. https://www.aafp.org/afp/2019/0101/afp20190101p33.pdf.

Medical News Today. What to know about the 10-panel drug test. Accessed October 23, 2020. Available at: https://www.medicalnewstoday.com/articles/326305.

National Drug Screening, Inc. State Laws for Workplace Drug Testing. Accessed October 23, 2020. Available at: https://www.nationaldrugscreening.com/state-laws-for-workplace-drug-testing/ Truesdail Laboratories, Inc. Drug Testing: History. Accessed October 23, 2020. Available at: https://www.truesdail.com/drugtesting-history/

PHPR 486 Fall 2020

Angela Dong, Pharmacy Student Purdue University, College of Pharmacy, West Lafayette, IN

History/background1,2 -

-

Drug testing started in the military when the US Army discovered that many of the troops were using heroin. Drug testing process became implemented to ensure the quality performance within the forces. A no tolerance policy became implemented later in 1981 when an accident of Marine Crops jet crash lead to the death of 14 crew members. After the crew members were found positive for marijuana, it was thought to be a cause of the crash.

Drug testing process in the workplace first begin the railroad transportation industry after a growing amount of accidents associated with the use of marijuana resulted in the death of civilians.

The events listed above prompted a launch of large-scale drug testing legislations that are still in practice today.

Drugs that are detected4

Common types of drug tests3 -

-

Urine Drug Test (most common) Blood Testing (most accurate) Saliva Testing (detects recent drug use) Hair Testing (detects past drug use) .

Amphetamines (meth, speed, crank, ecstasy) - THC (marijuana) - Cocaine (coke, crack) - Opiates (heroin) - Phencyclidine (PCP, angel dust) Multi-panel drug test can used and test for wider range of drugs beyond the ones listed above.

Source: www.walgreens.com

Laws -

-

-

1988- Drug Free Workplace Act5 o Required federal agency contractors and grantees to certify they will provide a drug-free workplace a pre-condition of receiving a contract or grant from federal agency. o Allowed for pre-employment testing and testing based on reasonable suspicion.

1991- Omnibus Transportation Act 6 o Required drug and alcohol testing for certain employees holding commercial driverâ&#x20AC;&#x2122;s licenses who operate commercial motor vehicles. o Includes drug testing during pre-employment, post-accident, reasonable suspicion, return to duty and follow up testing.

There are no federal laws that requires drug testing for most private employers. 5

PHPR 486 Fall 2020

Professional Opinion

Although drug testing provides an objective and generally accurate way of establishing the status of oneâ&#x20AC;&#x2122;s drug use, workplace drug testing should be a justifiable course of action rather a routine screen to discriminate against certain employees. Generally speaking, as long as drugs are not consumed on the premises and that safety of the others around in addition to the quality and completion of work are not compromised, I think drug use is part of the employeeâ&#x20AC;&#x2122;s private life. ~ A. Dong

References 1. Reilly J. National Drug Screening Inc. A History of Drug Testing in the United States. Accessed October 16, 2020. Available at: https://www.nationaldrugscreening.com/blogs/a-history-of-drug-testing-in-the-united-states/.

2. Joyce C. Test Vault. Accessed October 16, 2020. Available at: http://thetestvault.com/brief-history-drug-testing/.

3. Safe Work Laboratories. The Different Types of Drug Test. Accessed October 16, 2020. Available at: https://safeworklaboratories.com.au/different-types-of-drug-test/.

4. Drug and Alcohol Testing Industry Association. Workplace Drug Testing. Accessed October 16, 2020. Available at: https://www.datia.org/datia-resources/27-credentialing/cpc-and-cpct/931-workplace-drug-testing.html#q5.

5. SAMHSA. Federal Laws and Regulations. Accessed October 16, 2020. Available at: https://www.samhsa.gov/workplace/legal/federal-laws.

6. SAMHSA. Considerations for Safety- and Security-sensitive Industries. Accessed October 16, 2020. Available at: https://www.samhsa.gov/workplace/legal/federal-laws/safety-security-sensitive.

7. Schwebach A, Ball J. Urine drug screening: minimizing false-positives and false-negatives to optimize patient care. US Pharm. 2016;41(8):26-30.

8. Walgreens. Drug Tests [image]. Walgreens website. https://www.walgreens.com/store/c/drug-tests/ID=361307-tier3.

Accessed October 18, 2020.

The Endocannabinoid System (ECS) Regina Solomito, Student Pharmacist Fall 2020

History and Background The endocannabinoid system is a network of receptors and compounds called cannabinoids that interact with each other to send signals throughout the body. Think of it like the nervous system, only it uses lipids instead of electrical signals. These cannabinoids can be found inside the body (endogenous 2-AG, anandamide) or outside the body (exogenous CBD and 9-THC, found in cannabis).

The most prominent receptor type in this system, CB1, is found mostly in the central nervous system and brain and influences motor and sensory control, memory, energy use, and reproduction.

CB2, another common type, mediates immune function in the peripheral nervous system and large organs.

CB1 was discovered in 1988 and is the most abundant of all neurotransmitter receptors in the brain. CB2 receptors and certain endocannabinoids were characterized in 1990 and 1992, respectively. The first recorded medical use of cannabis was 5000 years ago in China, however, and it became popular in Europe in the 19th century.

Missouri Marijuana Card. The Endocannabinoid System. Available at: https://www.missourimarijuanacard.com/the-endocannabinoid-system. Accessed Oct 23, 2020.

Laws and Regulations As a bodily system, the ECS is not regulated by the government, but cannabinoid compounds are strictly regulated.

1935 Marijuana Tax Act: First federal law regulates marijuana as a drug and limits its use.

1970 Controlled Substances Act: Designated Schedule I and outlawed in all 50 states, even medically!

[Decriminalized briefly by Carter; recriminalized in the 80â&#x20AC;&#x2122;s] 1996 Prop 215: Medical marijuana legalized in CA first.

2012: WA and CO become first states to legalize recreational marijuana. (Still prohibited federally under CSA of 1970).

Journal Evidence and Professional Opinion A fascinating article in the Journal of the American Heart Association cites strong evidence supporting the use of medical marijuana for pain, multiple sclerosis, chemoinduced nausea and vomiting, and even heart disease. The article also warns that engaging endocannabinoid receptors might be therapeutic in one organ but cause unwanted side effects in another. The article makes one final warning that marijuana is a complex mixture of active ingredients making it hard to standardize, but ultimately it calls for its continued research and use.

My professional opinion is that the endocannabinoid system shows real promise as a therapeutic mechanism. Medical marijuana is proven to be effective for certain disease states and not to cause significant harm; thus, it should be offered as a pain-relieving alternative to opioid therapies whenever possible. However, research should be prioritized to confirm the long-term effects of marijuana in order to decriminalize and regulate it, and to better understand its impact on the body. -Regina Solomito

https://www.researchgate.net/figure/Chemical-structures-of-delta-9-tetrahydrocannabinol-and-cannabidiol_fig1_256190766. Accessed Oct 25, 2020.

References Hanus, Lumir O. (2007). Discovery and Isolation of Anandamide and Other Endocannabinoids. Chemistry and Biochemistry. Vol. 4. Pages 1828-1841.

Moore, M. (2018). LabRoots. How the Endocannabinoid System was Discovered. Available at: https://www.labroots.com/trending/cannabis-sciences/8456/endocannabinoid-system-discovered. Accessed October 25, 2020.

Baldwin, Johnny. Weed News. Map of Marijuana Legalization by States in 2020 (Medical or Recreational).

Available at: https://www.weednews.co/marijuana-legality-states-map. Accessed October 25, 2020.

California Department of Public Health. Proposition 215: Text of Proposed Law. [Archived] Available at: https://web.archive.org/web/20091229153715/http://www.cdph.ca.gov/programs/MMP/Pages/Compassion ateUseact.aspx. Accessed on October 25, 2020.

Alfulaij N, Meiners F, Michalek J, Small-Howard AL, Turner H, Stokes A. Cannabinoids, the heart of the matter. JAHA. 2018; https://www.ahajournals.org/doi/full/10.1161/jaha.118.009099

Jenny Zheng | Student Pharmacist | Fall 2020

Background Caffeine, the primary ingredient of energy drinks is considered as a food addictive and drug by the US Food and Drug Administration (FDA)

Energy products like 5-Hour Energy, Monster Energy, and Rockstar are marketed as dietary supplements, and RedBull is marketed as conventional foods

Research conducted by the National Institute on Drug Abuse (NIDA) found that college students that regularly consume energy drinks are at greater risk for future alcohol disorder, cocaine use or misuse of prescription stimulants

Slang Terms/Brands

Adverse Effects

Monster, RedBull, RockStar,

Insomnia, nervousness,

Full Throttle, Bang, Xyience, etc.

headache, and tachycardia

Pharmacology Caffeine is a central nervous system stimulant that affects the adenosine receptors in the brain

Activation of these neural circuits causes the pituitary gland to secrete hormones that increase adrenal gland secretion of adrenaline. Adrenaline increases blood flow to the brain and muscles which stimulate the body to use sugar for energy

https://www.clipartkey.com/search/energy-drink/

Drug Interactions / Toxicology Major drug interactions include cocaine (nasal and topical), esketamine, and tizanidine

Caffeine withdrawal symptoms include headache, fatigue, anxiety, difficulty concentrating, depressed mood, irritability, tremors, and low energy

Laws

Monitoring The FDA recommends a maximum intake

There are no laws in place for energy

of 400 mg of caffeine per day

drinks. The FDA does not have specific regulations for energy drinks since they are marketed as dietary supplements or conventional beverages

Caffeine may have a negative impact on pregnancy, fertility, glucose control, and other health aspects

Professional Opinion Energy drinks are widely accessible caffeinated beverages. While these products may provide a short boost of energy, too much caffeine can lead to side effects and withdrawal symptoms. I believe that it is fine to consume energy drinks in moderation but the constant consumption of energy drinks may present with health problems. - J. Zheng

Citations Caffeine. Lexi-Drugs. Lexicomp. Wolters Kluwer Health, Inc. Riverwoods, IL. Available at: http://online.lexi.com.

Accessed October 13, 2020.

Ishak WW, Ugochukwu C, Bagot K, Khalili D, Zaky C. Energy drinks: psychological effects and impact on well-being and quality of life-a literature review. Innovations in clinical neuroscience. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3280075/. Published January 2012. Accessed October 13, 2020.

Generali JA. Energy drinks: food, dietary supplement, or drug? Hospital pharmacy. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3839443/. Published January 2013. Accessed October 13, 2020.

National Institute on Drug Abuse. Energy drinks and risk to future substance use. National Institute on Drug Abuse. Available at: https://www.drugabuse.gov/news-events/news-releases/2017/08/energy-drinks-and-riskto-future-substance-use. Published June 3, 2020. Accessed October 13, 2020.

https://www.amazon.com/Ethanol-EthylAlcohol-Heptane-15-5/dp/B088P9GVPF

Ameer El-Afandi Student Pharmacist Fall 2020

History - Use of alcohol dates back to 7000 BCE where wheat and barley based alcohol were found in stone jars in cave floors - 5400-3000 BCE: Traces of wine were offered to the Gods in civilizations such as ancient Persia and Egypt - 801-900 AD: Distillation techniques were becoming common in the Middle East -1500-present: Alcohol has Become a popular drink and is seen as way of socialization

Slang Terms Booze Fire water Hooch Spirit Liquid Courage Sauce

Pharmacology -Alcohol functions in the brain and increases the effects of GABA. -GABA is the major inhibitory neurotransmitter in the brain.

-By upregulating GABA alcohol suppresses the central nervous system.

Adverse Effects • Slurred speech • Drowsiness • Vomiting • Impaired vision and hearing • Diarrhea Drug Interactions • NSAIDs • Opiates • Antidepressants • Coumadin Contraindications • Liver damage • Heart problems • Pregnancy • Depression

Monitoring • Signs and symptoms • Heart rate • Liver function • Mental status • Blood levels can be checked through breathalyzer

Professional Opinion Consuming alcohol is seen as a social habit.

Alcohol is okay for consumption as long as it’s limited, the user is 21 years or older, and isn’t putting themselves in a position to endanger anyone. – A. El-Afandi https://www.clos19.com/ende/hennessy-vs-magnum-p100102

Law It is legal to own and consume alcohol in the United States as long as the consumer is 21 years of age or older. Buying and selling to anyone younger than 21 is illegal, along with the consumption.

References 1. Street Terms of Alcohol. Available at: https://www.alcohol.org/alcoholism/street-slang-terms-drunk-drink/ Accessed October 24.

2020 2. Treatment of Alcohol. Available at: https://www.uspharmacist.com/article/treatment-of-alcohol-withdrawal-syndrome. Accessed October 25, 2020 3. Ethyl Alcohol. Available at: https://www.drugs.com/alcohol.html. Accessed October, 24, 2020 4. Laws of Alcohol. Available at: http://www2.courtinfo.ca.gov/stopteendui/teens/educate/laws-regarding-drugs-alcohol-and-driving.

Accessed November 13, 2020

ETHYLENE GLYCOL (ANTIFREEZE) History of ethylene glycol Ehtylene glycol has been around since 1856 when it was created during World War I with the intended use as a coolant and a component in explosives.(1) To this day, the intended use of ethylene glycol is as a coolant for automobiles and home temperature maintenance systems. This compound has found several other uses throughout its history in the vitrification process, the production of vaccines, natural gas production, and the production of cleaning solutions among many other things.

(1) Along with these helpful uses, ethylene glycol does have an abuse potential similar to ethyl alcohol. There is evidence that ethylene glycol has played roles in homicides and suicides due to this potential.(2)

Pharmacology Ethylene glycol is absorbed in the gastrointestinal (GI) tract within one hour of ingestion of the substance.(3) The taste of the compound is not a deterant and makes the ingestion of antifreeze "easier" than anticipated. Ethylene compound concentration levels peak between one and four hours and has a half-life of three to nine hours.(2) This are important characteristics of antifreeze to understand because this means treatment needs to be prompt and timely to ensure prevention of the worsening response. Along with this, the main cause for toxicity within the body is the metabolites of ethylene glycol: glycolic acid and oxalate.(2)

Kayleigh Yaeger Student Pharmacist Fall 2020

Carl Roth. Ethylene glycol. Accessed October 25, 2020.

Available at: https://www.carlroth.com/com/en/a-toz/ethylene-glycol/p/6881.1

Slang Terms

Ethylene glycol does not have many slang terms associated with its existence. The most common name it is known as is antifreeze.

Laws

Because this is a common household item, there are little to no laws limiting the purchase or use of this item. There are no age restrictions when purchasing this item or any systems that track the purchase of ethylene glycol as well. This means that consumers are able to obtain as much as they would like of this substance.

Monitoring Parameters AutoWise. 9 best antifreeze and coolant car products.

Accessed October 25, 2020. Available at: https://autowise.com/antifreeze/

Toxicology When it comes to the toxicology of antifreeze, it is similar to that of alcohol intoxication. If a patient has ingested ethylene glycol they may experience an altered mental status, difficulty breathing, central nervous depression and hepatotoxicity.(2) Along with these symptoms of toxicity, a person who has ingested the substance may experience seizures and arrhythmias. Major organs that are affected by ethylene glycol's major metabolites are the brain, liver, kidneys and lungs.(3)

If ingestion of antifreeze is suspected, several clinical levels need to be monitored. These include an anion gap, a lactate gap, and an osmol gap.(2) Along with these gaps, if there is presence of needle-shaped crystals within the urine, ethylene glycol consumption could be suspected. At higher concentrations, these crystals may be envelopeshaped.(2)

Professional Opinion Due to the high toxicity rates and lack of indication of= use in people, I would not recommend the use of= ethylene glycol for any individual. This is a household= item not intended for consumption and should be kept= that way. Even though individuals may experience= similar effects as ethyl alcohol, this is not a safe= alternative that should be used. ~ K. Yaeger

References 1. Ethylene glycol. Ethylene glycol - New World Encyclopedia. https://www.newworldencyclopedia.org/entry/Ethylene_glycol.

Published 2017. Accessed October 25, 2020.

2. Singh R, Arain E, Buth A, Kado J, Soubani A, Imran N. Ethylene Glycol Poisoning: An Unusual Cause of Altered Mental Status and the Lessons Learned from Management of the Disease in the Acute Setting. Case Rep Crit Care. 2016;2016:9157393. doi:10.1155/2016/9157393 3. Patocka J, Hon Z. Ethylene glycol, hazardous substance in the household. Acta Medica (Hradec Kralove). 2010;53(1):19-23.

PMID: 20608228.

4. Centers for Disease Control and Prevention. Ethylene glycol: systemic agent. Accessed November 15, 2020. Available at: https://www.cdc.gov/niosh/ershdb/emergencyresponsecard_29750031.html

BRITTANY GALLOWAY, STUDENT PHARMACIST, FALL 2020

FENTANYL AND CARFENTANIL

WHAT IS FENTANYL AND CAFENTANIL? Fentanyl binds with stereospecific opioid receptors in the CNS Fentanyl increases pain threshold, alters pain reception and inhibits ascending pain pathways The fentanyl patch is absorbed into systemic circulation with a gradual increase in serum circulation over the first 24 hours Carfentanil is a derivative of fentanyl and is 100 times more potent than fentanyl Carfentanil is intended for use in large animals only

DRUG EFFECTS: Intense, short term high Temporary feelings of euphoria Causes slowed respiration and reduces blood pressure Nausea Fainting Seizures Death

STREET NAMES: APACE CHINA GIRL CHINA TOWN CHINA WHITE DANCE FEVER GOODFELLAS GREAT BEAR HE-MAN POISON TANGO & CASH

SCHEDULE II CONTROLLED SUBSTANCE Drug has a high potential for abuse with accepted medical use.

Abuse can lead to severe psychological and/or physical dependence

HTTPS://WWW.DRUGABUSE.GOV/DRUG-TOPICS/FENTANYL

HISTORY Early 20th century: Morphine and scopolamine are used as an anesthetic 1959: First synthesis of fentanyl by Janssen Pharmaceutica. This creates the foundation of understanding for narcotic structure-activity relationships 1974: Carfentanil is synthesized at Janssen Pharmaceutica 1990s: Fentanyl patch developed for pain management of cancer patients 2015: Over 6 million fentanyl prescriptions written. Most deaths stem from non-regulated, illegal manufactured versions 2017: Congress passes the Stop Trafficking in Fentanyl Act

MONITORING PARAMETERS Monitor pain relief, respiratory and mental status, blood pressure, heart rate, and signs of abuse

DRUG INTERACTIONS: SUBSTRATE OF CYP3A4 ALPHA, BETA AGONISTS MAY DECREASE THE SERUM CONCENTRATION OF FENTANYL AMPHETAMINES MAY ENHANCE THE ANALGESIC EFFECT OF FENTANYL ANTICHOLINERGICS MAY ENHANCE THE ADVERSE/TOXIC EFFECT OF FENTANYL

HTTPS://THECONVERSATION.COM/FENTANYL-WIDELY-USED-DEADLY-WHEN-ABUSED-60511

REFERENCES: DEA Drug Facts. Fentanyl. Accessed on October 17, 2020. Available at https://www.dea.gov/factsheets/fentanyl Stanley TH. The fentanyl story. J. Pain Symptom Manage. 1992;7(3):S3-7. doi:10.1016/0885-3924(92)90047-I Pride recovery center. Fentanyl: history, dangers, and treatment options.

Accessed on October 17, 2020. Available at https://priderecoverycenter.com/fentanyl-history-dangers-and-treatmentoptions/ FentaNYL Transdermal. Lexi-Drugs. Lexicomp. Wolters Kluwer Health, Inc. Riverwoods, IL. Accessed on October 17, 2020. Available at: http://online.lexi.com PubChem. Carfentanil. Accessed on October 17, 2020. Available at https://pubchem.ncbi.nlm.nih.gov/compound/Carfentanil

PROFESSIONAL OPINION: Because of the high abuse potential and the side effect profile, I would only support the prescription of this medication for management of severe chronic pain. ~ B. Galloway

Rielly Culver Student Pharmacist Fall 2020

Bath Salts Gravel Zombie Drug Scarface https://www.dea.gov/factsheets/flakka-alpha-pvp

Cloud Nine

Devilâ&#x20AC;&#x2122;s Drug

- Developed in the 1960s as a CNS stimulant and pressor agent.

- a-PVP is a Schedule I drug, thus it is illegal to sell, produce, or possess in the United States.

- Flakka strain went somewhat viral and became popular in 2015 in Florida.

- Usage continued to sporadically spike across the country in 2016.

https://www.nbcnews.com/video/surveillancevideo-captures-alleged-flakka-addicts-in-action428659267744

-

alpha-pyrrolidinopentiophenone, a synthetic cathinone Inhibits reuptake of norepinephrine and dopamine Emulates state of extreme psychosis Structurally similar to ephedrine and phenylethylamines, providing amphetamine-like effects https://en.wikipedia.org/wiki/Alpha-Pyrrolidinopentiophenone

Hyperthermia Dehydration Seizures Renal failure

-

Mental state Body temperature

Alcohol Other stimulants

Heart conditions Seizure disorder

- Due to dangerous effects on the brain and body, I would not recommend for use in any setting â&#x20AC;&#x201C; R. Culver

1. Salani D, Albuja LD, Zdanowicz MM. The explosion of a new designer drug, flakka. J Addictions Nursing.

29(4);255-259 Accessed October 24, 2020. Available at: https://nursing.ceconnection.com/ovidfiles/0006086720181000000005.pdf;jsessionid=79F2CA2D7283727A1ED91E81A4B53C74#:~:text=Flakka%20is%20a%20synthetic%20cathin one,which%20can%20mimic%20extreme%20psychosis doi: 10.1097/JAN.0000000000000252 2. What is Flakka? What are the symptoms and signs of abuse? Available at: https://www.medicinenet.com/flakka/article.htm 3. Flakka Facts Sheet. Available at: https://www.dea.gov/factsheets/flakka-alpha-pvp 4. Flakka Addiction and Abuse. Available at: https://www.addictioncenter.com/drugs/flakka-addiction-abuse/

Flumazenil (Romazicon ÂŽ) LANA GRISHIN|STUDENT PHARMACIST|FALL 2020

HIstory/ BACKGROUND

Discovered in 1979 in a program which aimed to find a selective anxiolytic In 1989 it entered the market by Hoffmann-La Roche under the trade name Anexate In 1991 it received FDA approval In 2008 the developer lost patented rights leading to generic formulations

https://mms.mckesson.com/product/501703/FreseniusUSA-63323042410

PHarmacology

First benzodiazepine deterrent formulation which became available for clinical use Competitive inhibitor of benzodiazepine and non-benzodiazepine substances that interact with the GABA/benzodiazepine receptor complex Can work to reverse the binding of benzodiazepines to their receptor Onset of action is 1-2 minutes with peak effect 6-10 minutes after administrations

https://en.wikipedia.org/wiki/ Flumazenil#/media/File:Flum azenil.svg

CAse

Schomer KJ, Duby JJ, Firestone RL, Louie EL, Sebat CM, Love DM, Cocanour CS, Albertson TE. Effect of Flumazenil on Hypoactive Delirium in the ICU: A Double-Blind, Placebo-Controlled Pilot Study. Crit Care Explor. 2020 Mar 24;2(3):e0085. doi: 10.1097/CCE.0000000000000085. PMID: 32259108; PMCID: PMC7098541.

In this phase 4 study the effects of flumazenil were tested on hypoactive delirium secondary to benzodiazepine exposure which is associated with increased mortality. The study hypothesized that flumazenil would reverse hypoactive delirium during the ICU admission however, findings did not show a positive correlation and the possible benefit remains unknown.

Laws

FDA approved for treatment of benzodiazepine overdose and reversal of postoperative benzodiazepine anesthetics Non-FDA approved for alcohol withdrawal syndrome, hepatic encephalopathy, stupor or toxicity of drugs

MOnitoring

The patient should be monitored for possible return of sedation Patients should also be monitored for respiratory depression and left over effects of benzodiazepines for at least two hours

Professional Opinion

Flumazenil is a benzodiazepine antagonist that provides a safe and effective way to reverse the effects following a benzodiazepine overdose either alone or when combined with other agents.

-L. Grishin

Citations

Haefely W, Hunkeler W. The story of flumazenil. Eur J Anaesthesiol Suppl. 1988;2:3-13. PMID: 2842141 Flumazenil. Lex-Drugs. Lexicomp. Walters Kluwer Health, Inc. Riverwoods, IL. Accessed October 17, 2020. Available at https://online.lexi.com.

Ncbi.nlm.nih.gov. 2020. Home - Books - NCBI online. Accessed 18 October 2020.Available at: https://www.ncbi.nlm.nih.gov/books.

Whitwam JG, Amrein R. Pharmacology of flumazenil. Acta Anaesthesiol Scand Suppl. 1995;108:3-14. doi: 10.1111/j.1399-6576.1995.tb04374.x. PMID: 869392

Hannah Vyain Student Pharmacist Fall 2020

Burundanga Voodoo drug telegraph.co.uk

HISTORY 1880: Albert Ladenburg isolated scopolamine from the plant Scopolia carniolica 1902: Richard von Steinbuchel proposed the use of scopolamine in obstetric anesthesiology 1903: Carl Gauss coined the term â&#x20AC;&#x153;twilight sleepâ&#x20AC;? with use of the drug as a surgical anesthetic 1922: Dr. Robert House uses scopolamine to interrogate prisoners (claimed the drug to be a truth serum) December 31, 1979: FDA approval date for use in GI upset

PHARMACOLOGY Scopolamine is an anticholinergic agent.

It blocks the action of acetylcholine in smooth muscle, secretory glands, and the CNS. This increases cardiac output, dries secretions, and stops actions of histamine and serotonin

chm.bris.ac.uk

ADVERSE EFFECTS ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖ ❖

Drowsiness Confusion Pupil dilation Visual impairment Hallucinations Sore throat Nausea/vomiting Seizures Urinary retention

DRUG INTERACTIONS ❖ Anticholinergic agents may lessen the effect of acetylcholinesterase inhibitors ❖ Alcohol may increase the CNS effects of this drug ❖ CNS depressants may increase side effects of anticholinergic agents

CONTRAINDICATIONS ❖ ❖ ❖ ❖

Glaucoma Enlarged colon Myasthenia Gravis Stomach or bowel obstruction ❖ Heart failure ❖ Pregnancy ❖ Allergy to any components

Monitoring o o o o

Body temperature Heart rate Urinary output Intraocular pressure

northpointrecovery.com

allthatsinteresting.com

Law Although scopolamine is not illegal in the United States if it is used correctly, there can be legal repercussions if the drug is used in any way to harm another individual.

Professional opinion

thesun.co.uk

I would not recommend this medication because it has a large amount of potential interactions with several drug classes. This drug also has a high potential for misuse and has been used more criminally than therapeutically in the recent years. Overall, it is not a great therapeutic medication, and there are other alternatives out there with less drug interactions and potential adverse effects. ~ H. Vyain

References - Scopolamine. Lexi-Drugs. Lexicomp. Wolters Kluwer Health, Inc. Riverwoods, IL. Accessed October 25, 2020. Available at: http://online.lexi.com.

- Cotton, S. Bristol University School of Chemistry. Scopolamine. Accessed October 25, 2020. Available at: http://www.chm.bris.ac.uk.

- Kuroski, J. All That’s Interesting. Is devil’s breath the world’s scariest drug. Accessed October 25, 2020. Available at: http://allthatsinteresting.com.

- Northpoint staff. Northpoint Recovery. Scopolamine: the blowing powder. Accessed October 25, 2020. Available at: https://www.northpointrecovery.com.

FALL 2020

YI FEI HENG, STUDENT PHARMACIST

GAMMAHYDROXYBUTYRATE GHB

STREET NAMES GHB G Blue Nitro Blue Verve Liquid X Liquid E Gamma-oh Gamma G Soap Scoop Goop Georgia Home Boy Everclear Fire Water Zonked

PHARMALOCOGY GHB is a central nervous system depressant that binds to GABA receptors.

As a depressant, it has similar effects to alcohol and can cause hallucinations, euphoria, and decreased anxiety.

GHB is normally taken in liquid form and is used as a date rape drug because of its clear and colorless qualities.

HISTORY

1960s GHB is developed as an anesthetic but is soon discontinued because of unwanted side effects

1980s GHB is available as an OTC sleep aid and a PAGE 11 | body CRUZbuilding FAMILY supplement

1981 The FDA bans GHB

2000 GHB becomes a federally Schedule I drug.

https://www.who.int/medicines/areas/quality_safety/4.1GHBcritical_review.pdf

FALL 2020

YI FEI HENG, STUDENT PHARMACIST

LAWS

TOXICOLOGY GHB has a small dose range with small overdoses causing comas that can lead to death.

The CNS depressant effects of GHB include: respiratory depression, hypothermia, bradycardia, aggression, and vomiting.

The effects of GHB can be increased with other CNS depressants like alcohol, opioids, hypnotics, cannabidiols, and benzodiazepines.

There are no reversal agents of GHB and treatment is supportive with the possibility of intuabation if there is severe respiratory depression.

GHB is a Schedule I drug and it is illegal to possess or sell the drug in the United States

http://clipart-library.com/free/gavelsilhouette.html

REFERENCES American Family Physician. Gammahydroxybutyrate (GHB): A Newer Drug of Abuse. Available at: https://www.aafp.org/afp/2000/12 01/p2478.html#:~:text=History,Jump%20to%20section&text=In%20t he%20late%201980s%2C%20GHB,%2 Dthe%2Dcounter%20sedative%20age nt. Accessed October 18, 2020.

https://www.newjerseycriminallawattorney.com/drug-crimes/gamma-hydroxybutyrate-and-ghb-charges/

MONITORING It is important to monitor breathing, heart rate and blood pressure.

Unconscious individuals should be turned on their side to avoid the possibility of aspirating on their own vomit

PROFESSIONAL OPINION GHB is a drug that has a narrow dose range and a small increase in dose can cause coma or death. It can be used for harm as a date rape drug. Because of these potential harms, I do not recommend for GHB to be used in anyone. ~ YF Heng

Busardò FP, Jones AW. GHB pharmacology and toxicology: acute intoxication, concentrations in blood and urine in forensic cases and treatment of the withdrawal syndrome. Curr Neuropharmacol. 2015;13(1):47-70. doi:10.2174/1570159X1366614121021542 3.Accessed October 18, 2020.

The Vaults of Erowid. GHB Basics.

Available at: https://www.erowid.org/chemicals /ghb/ghb_basics.shtml.

Accessed October 18, 2020.

United States Drug Enforcement Administration. GHB â&#x20AC;&#x201C; GammaHydroxybutyric Acid. Available at: https://www.dea.gov/factsheets/gh b-gamma-hydroxybutyric-acid.

Accessed October 18, 2020

STREET NAMES

Goldenseal (Hydrastis canadensis) Madeline Partee Student pharmacist Fall 2020

GOLDEN ROOT YELLOW ROOT EYE BALM https://www.healthline.com/health/golden seal-cure-for-everything

Adverse Events (in high doses only): -Nausea -Anxiety -Seizures -Depression

History

-Goldenseal was used by the Cherokee and Iroquois Indians in the 1700â&#x20AC;&#x2122;s or before as an antiseptic, treat snakebites, whooping cough, diarrhea, fever, digestive disorders, antimicrobial effects, etc.

-accepted as herbal treatment in 1800â&#x20AC;&#x2122;s -1991 overharvesting and deforestation placed it on endangered species list

Pharmacology/Drug Effects: Very limited studies have been done on the many claimed effects of goldenseal. Its mechanism is not known. Thought to be a CYP-450 metabolized compound, leading to many potential drug interactions. Has not been shown to affect a tox screen and no monitoring parameters exist.

Potential for abuse:

Some claims have been made saying that goldenseal covers up other drugs on a drug screening and causes a negative test. This has not been proven clinically.

These include: amphetamines, cocaine, and marijuana

Professional Opinion: Goldenseal has not been proven to be efficacious; therefore, it should not be expected to produce any kind of benefit. This will not help clear a drug test or any of it’s other claims to fame. No monitoring parameters exist. ~ M. Partee

MANY possible drug interactions:

-aripiprazole -blood pressure lowering agents -cyclosporine -dofetilide -flibanserin -other herbs -losartan -lomitapide -midazolam -nimodipine -oseltamivir -perhexiline -pimozide

Sources



Mecklenburg Extension Master Gardener℠ Volunteers. 2020. Goldenseal, Hydrastis Canadensis L.: A Long And Colorful Folk History Native Plant. [online] Available at: <http://www.mastergardenersmecklenburg.org/goldenseal-hydrastis-canadensis-l-a-long-and-colorful-folk-history-nativeplant.html> [Accessed 25 October 2020].



Goldenseal. Natural Products Database. Lexicomp. Wolters Kluwer Health, Inc. Riverwoods, IL. Available at: http://online.lexi.com. Accessed October 24, 2020.



Petre, A. (2020, June 18). Goldenseal: Benefits, Dosage, Side Effects, and More. Retrieved October 25, 2020, from https://www.healthline.com/health/goldenseal-cure-for-everything



Goldenseal: Uses, Side Effects, Interactions, Dosage, and Warning. (2020). Retrieved October 25, 2020, from https://www.webmd.com/vitamins/ai/ingredientmono-943/goldenseal

Goldenseal has been most popular to use for cold / flu symptoms recently. This is due to advertising and how the product is portrayed on the shelf

https://www.walmart.com/ip/Spring-ValleyEchinacea-Goldenseal-Blend-Capsules-900mg-75-Ct/

Laws: FDA does not regulate the efficacy of goldenseal or any other herbal products.

https://www.changestreatmentcenter.com/kill ing-on-contact-what-is-gray-death/

The combination of drugs known as Gray

•

The effects of Gray Death often last more than 5 hours and can still be seen up to 96 hours later due to delayed absorption through the skin.

•

The mix of powerful opioids binds to opioid receptors at many sites in the CNS and inhibits neurotransmitter release. This can cause inhibition of pain pathways, altered perception and response to pain, increased pain threshold, and general CNS depression.

Death emerged in the United States in only 2017. Reports of use and overdose have been multiplying across the country and this drug is thought to be one of the driving forces of the current and ongoing opioid crisis.

There are no other known names of the street drug called Gray Death. This is potentially due to the fact that “Gray Death” does not refer to one substance alone, but is often a mixture of several potent opioids including but not limited to heroin, fentanyl, carfentanil, and U47700 (also called Pink). Each batch of Gray Death differs in contents.

https://www.wabe.org/what-gray-death-andhow-does-it-kill/

Gray (Grey) Death Jess Raffa, Student Pharmacist Fall 2020

References

Interactions • • •

Monitoring •

Respiratory and mental status

•

Blood pressure and heart rate

May enhance CNS depressant effects of CNS depressants.

•

Pain control

May enhance the serotonergic effects of serotonergic agents.

Law

May increase serum concentration of CYP3A4 substrates.

Toxicology •

Drowsiness

•

Confusion

•

Trouble breathing

•

Sweating

•

Severe CNS damage/overdose likely

Gray Death is a mixture of potent and illegal opioids making it illegal to produce, possess, and sell in the United States.

Professional Opinion Gray Death has high abuse potential, is fatal even in small quantities, and is easily absorbed through skin or breathed air making it one of the most dangerous drugs on the street.

- J. Raffa

Drugs.com. Gray Death. Accessed October 25, 2020. Available at: https://www.drugs.com/illicit/graydeath.html American Addiction Centers. Gray death: the new killer on the street. Accessed October 25, 2020.

Available at: https://drugabuse.com/heroin/graydeath-crisis/ O’Malley PA. “Gray death” – the trojan horse of the opioid epidemic; historical, clinical, and safety evidence for the clinical nurse specialist. Clinical Nurse Specialist. 2017;31(6):304-308. doi:10.1097/NUR.0000000000000326 FentaNYL. Lexi-Drugs. Lexicomp. Wolters Kluwer Health, Inc. Riverwoods, IL. Accessed October 25, 2020. Available at: http://online.lexi.com.

Morphine (Systemic). Lexi-Drugs. Lexicomp.

Wolters Kluwer Health, Inc. Riverwoods, IL. Accessed October 25, 2020. Available at: http://online.lexi.com.

FentaNYL. Interactions. Lexicomp. Wolters Kluwer Health, Inc. Riverwoods, IL. Accessed October 25, 2020. Available at: http://online.lexi.com.

Morphine (Systemic). Interactions. Lexicomp.

Wolters Kluwer Health, Inc. Riverwoods, IL. Accessed October 25, 2020. Available at: http://online.lexi.com.

HASHISH Heather Hope Student Pharmacist Fall 2020

Background & History [2,3] Although there is no clear evidence of its first appearance, hashish is thought to have originated in the Middle East around 900 AD. It wasnâ&#x20AC;&#x2122;t until the 19th century, however, that it became popular in the Western world. https://sunrisehouse.com/quit-abusingmarijuana/hashish/

Slang Terms [1] Hash

How Its Made [1] Because of its high concentration of THC (tetrahydrocannabinol), the primary psychoactive agent of the cannabis plant, hashish is one of the most potent forms of cannabis.

Hashish is derived from the resin glands of the cannabis plant, known as trichomes, which contain the highest amounts of cannabinoids. After the resin glands are harvested from the cannabis plant, they are referred to as kief. Kief is typically pressed into "bricksâ&#x20AC;? which are then smoked or vaped.

Pharmacology [4,5] THC, the primary component of hashish, acts as an agonist at cannabinoid receptors (CB1 and CB2).

CB1 receptors are located mainly within the brain where they modulate the release of the neurotransmitters glutamate and gamma-aminobutyric acid (GABA). Activation of CB1 receptors is responsible for the euphoric effects of hashish.

https://www.royalqueenseeds.com/blog-cannabistrichomes-importance-n430

Drug Interactions [4,6] Barbiturates Cocaine Disulfiram Ethanol Protease inhibitors Sildenafil Warfarin Tricyclic antidepressants Selective serotonin reuptake inhibitors

Adverse Effects

[4,6]

Cardiac arrest Cognitive impairment Dizziness Hallucinations Tachycardia Seizures Myocardial infarction Dry mouth

Laws [7] The Marijuana Tax Act of 1937 made the possession of marijuana illegal in the United States. Although it is still illegal under federal law, many states have legalized medical and recreational use of marijuana.

Monitoring [8] The major metabolite of THC is detectable in the urine within 1 hour of use. According to Mayo Clinic, the approximate detection times are as follows: Single use: up to 3 days Moderate use (4 times/week): up to 5 days Heavy use (daily): up to 10 days Chronic heavy use: up to 30 days

Professional Opinion Professional Opinion Due to its high potency and increased Hashish is a potent form of studies cannabis risk of dependence, more are that has highly addictive needed to determine the safety of hashish. -H. Hope

[1] Lautieri A. Difference between hashish And marijuana. Sunrise House. https://sunrisehouse.com/quit-abusing-marijuana/hashish/. Published September 23, 2020. Accessed October 25, 2020.

[2] Elliot S. How weed becomes hash. Herb. https://herb.co/learn/how-is-hash-made/. Published December 20, 2019. Accessed October 25, 2020.

[3] Bennett P. What is hash? Leafly. https://www.leafly.com/news/cannabis-101/what-is-hashish. Published August 12, 2020. Accessed October 25, 2020.

[4] Cannabis. Natural Products Database. Lexicomp. Wolters Kluwer Health, Inc. Riverwoods, IL. Available at: http://online.lexi.com. Accessed October 25, 2020.

[5] NIDA. How does marijuana produce its effects? National Institute on Drug Abuse website. https://www.drugabuse.gov/publications/research-reports/marijuana/how-does-marijuana-produce-its-effects.

Published April 8, 2020. Accessed October 25, 2020.

[6] Marijuana timeline. PBS. https://www.pbs.org/wgbh/pages/frontline/shows/dope/etc/cron.html. Accessed October 25, 2020.

[7] Marijuana Î&#x201D;9-Tetrahydrocannabinol (THC). Drug Testing: Marijuana - Mayo Clinic Laboratories. https://www.mayocliniclabs.com/test-info/drug-book/marijuana.html. Accessed October 25, 2020.

\ ˈher-ə-wən

History

1874: English Research, C.R. Wright synthesizes heroin but halts research after suffering serious side effects.

1895: Bayer Pharmaceutical’s scientist, Heinrich Dreser, continues Wright’s studies and declares heroin successful in treating respiratory issues.

1924: Congress bans heroin’s manufacture, sale, and importation.

1930s: Crime syndicates step in and take over the production and distribution of heroin.

1940s: The Cold War causes a resurgence of heroin production and trafficking.

1950s & 60s: Illegal heroin use gains favor in beatnik and hippie culture.

1971: War on drugs begins as Nixon makes heroin a priority in his drug policy agenda.

1980s & 90s: Heroin use increases with alternate snorting or smoking intake.

1993: South America expands cocaine market by supplying large amounts of heroin.

2010-2014: Over ten thousand deaths result from heroin overdose.

2016: President Obama proposes $1.1 billion to address the epidemic of prescription opioid and heroin abuse.

Nicholas Howard Pharmacy Student Fall 2020

Slang Terms

Sack China White The Dragon H He

Smack Tar White House White Stuff Brown Sugar

https://americanaddictioncenters.org/heroin-treatment/how-long-in-system

Pharmacology - Drug Effects

Heroin binds to and activates specific receptors in the brain called mu-opioid receptors (MORs) that will cause an increase in the release of the neurotransmitter, dopamine.

Analgesia Drowsiness Euphoria/Sense of detachment Respiratory depression Nausea/vomiting Decreased GI motility Hypothermia

Drug Interactions/Toxicology

Major:opioid receptor agonists (Percocet, Vicodin, Dilaudid) Moderate: Concurrent use of benzodiazepines (Valium, Xanax, Klonopin), muscle relaxants (Flexeril, Topiramate, Gabapentin), and SSRIs (Zoloft, Seroquel, Lexapro) Heroin withdrawal symptoms include restlessness, muscle and bone pain, insomnia, diarrhea, vomiting, and cold flashes.

Monitoring/Drug Screens FDA recommends no standard medical use for heroin in the United States. Therefore, any use of it in a medical setting is prohibited. Heroin can be detected in standard urine drug analysis.

Laws

Currently, heroin is classified as a schedule I substance by the DEA which means punishments are severe. Possession charges can lead up to a year in prison, and trafficking charges can lead to a 5-year minimum sentence and large fines. States also have individual laws criminalizing heroin possession, use, and trafficking that can be even more severe.

https://www.banyanphiladelphia.com/2019/12/31/different-types-of-heroin/

Professional Opinion

Heroin is an illicit substance that has the potential to be extremely addictive and dangerous even with short-term use with small doses. While this product has shown to be effective at relieving pain, it should not be used for any medical purposes as it poses an extremely dangerous risk of respiratory depression and addiction. - N. Howard

References

American Addiction Centers. Heroin History and Statistics. Accessed October 14, 2020. Available at: https://drugabuse.com/heroin/history-statistics/ AddictionCenter. Drug Street Names. Accessed October 14, 2020. Available at: https://www.addictioncenter.com/drugs/drug-street-names/ emcdda. Heroin Drug Profile. Accessed October 14, 2020. Available at: https://www.emcdda.europa.eu/publications/drug-profiles/heroin_en Drugs.com. Heroin Drug Interactions. Accessed October 14, 2020. Available at: https://www.drugs.com/drug-interactions/heroin.html

Hydrocodone (Zohydro® ER, Hysingla® ER, Vantrela® ER) Jennifer Lee Student Pharmacist Fall 2020

https://www.dea.gov/galleries/drug-images/hydrocodone

Street Names Vike Bananas Fluff Hydros

History 1920 – Hydrocodone first synthesized by German pharmaceutical company 1923 – Hydrocodone patented 1943 – Approved for sale in the U.S. by the FDA 1971 – Listed as Schedule II controlled substance 2013 – Long-acting formulation approved for

https://flyclipart.com/four-bananas-royalty-free-vector-clipart-illustration-free-banana-clipart-783504

medical use in the U.S. 2014 – Hydrocodone combination products became Schedule II drugs

·

Acts as a full agonist, binding and activating opioid receptors at sites within the gray matter, ventromedial medulla, and spinal cord

·

Selective for the mu-opioid receptor; however, at higher doses, can interact with other opioid receptors

·

Resultant analgesic and antitussive effects

·

Semisynthetic opioid

·

Converted to hydromorphone by CYP2D6

https://pubchem.ncbi.nlm.nih.gov/compound/Hydrocodone

· - Constipation headache

· - Other Concomitant narcotics use of other

CNS depressants increase severity of adverse

· - N/V Dry mouth ·

- Dizziness & drowsiness

Nausea

- Headache

symptoms (e.g., stuffy · - Cold Vomiting

·

- Sedatives (e.g., diazepam,

nose, sore throat)

Diarrhea

- Serious: Respiratory

· depression, Reduced heartprolonged rate and syncope, QTblood interval pressure

· ·

·

·

·

· - Acute Use with other CNS or severe bronchial

depressants asthma

alprazolam)

· - Hypersensitivity Alcohol to any of the

CYP3A4pills metabolism, will - Sleeping

· components Pregnancy

interact with other drugs that undergo CYP3A4 - Drugs that increase metabolism - Muscle relaxants

serotonin levels

- Paralytic ileus or GI obstruction - Significant respiratory depression

Renal function (elderly patients) S/sx of respiratory depression, severe hypotension, decreased bowel motility

Hydrocodone is a Schedule II controlled substance, valid for limited medical purposes.

Due to the high abuse potential, I would recommend the use of hydrocodone only under close supervision and exercise an abundance of caution. ~ J. Lee

· American Addiction Centers, Inc. Hydrocodone History and Statistics. Available at: https://drugabuse.com/hydrocodone/history-statistics/. ·

Accessed October 25, 2020.

Cerner Multum, Inc. Hydrocodone (oral). Available at: https://www.uofmhealth.org/health-library/d03075a1. Accessed October 25, 2020.

Drug Enforcement Administration. Hydrocodone. Available at: https://www.deadiversion.usdoj.gov/drug_chem_info/hydrocodone.pdf. Accessed

· October 25, 2020.

IBM Corporation. Hydrocodone Bitartrate. Available at: https://www-micromedexsolutionscom.ezproxy.lib.purdue.edu/micromedex2/librarian/PFDefaultActionId/evidencexpert.DoIntegratedSearch?navitem=headerLogout#. Accessed October 25, 2020.

https://dailymed.nlm.nih.gov/dailymed/fd a/fdaDrugXsl.cfm?setid=b325028e-07224c8c-9fdb-ab6fb0dc460c&type=display

History/Background • Hydromorphone was synthesized, patented, and clinically introduced in Germany after World War I. • It was introduced to the United States in 1932 • It was believed to be more potent than morphine with less adverse reactions • It was briefly thought to be a cure for morphine addiction • In the 1970s, hydromorphone would become the opioid of choice for illicit drug use.

https://novarecoverycenter.com/drugs/dilau did-hydromorphone/

Slang Terms • • • • • •

Dust Juice Dillies Smack D Footballs

Pharmacology/Drug Effects • Hydromorphone is a semisynthetic opioid derived from morphine.

• It binds to opioid receptors in the CNS and causes inhibition of pain pathways • The analgesic effect of hydromorphone is felt within 1530 minutes of administration and can last up to 5 hours.

• It produces feelings of euphoria, relaxation, and reduced anxiety

Drug Interactions/Toxicology • May enhance CNS depressant effects if used with other CNS depressants • May diminish the effect of opioid agonists • Contraindicated in patients with a hypersensitivity to hydromorphone or any component of the formulation, significant respiratory depression, acute or severe bronchial asthma, and GI obstruction

References 1. Reisfield GM, Wilson GR. The metamorphosis of hydromorphone. J Opioid Manag. 2005;1(3):139-145. doi:10.5055/jom.2005.0033.

2. Drug Enforcement Administration.

Hydromorphone. Accessed October 25, 2020. Available at: https://www.deadiversion.usdoj.gov/dru g_chem_info/hydromorphone.pdf.

3. Hydromorphone. Lexi-Drugs. Lexicomp.

Wolters Kluwer Health, Inc. Riverwoods, IL. Available at: http://online.lexi.com.

Accessed October 25, 2020.

4. Drug Enforcement Administration. Drug Scheduling. Accessed October 25, 2020.

Available at: https://www.dea.gov/drugscheduling.

Laws • Hydromorphone is a schedule II-controlled substance.

• It has a high potential for abuse, with use leading to severe psychological or physical dependence.

Monitoring/Drug Screens • Monitor pain relief, respiratory and mental status, blood pressure, bowel function • Monitor for signs or symptoms of misuse, abuse, and addiction • Watch for signs or symptoms of hypogonadism or hypoadrenalism • This medication will show up in an opioid screening

Professional Opinion • Due to the high risk of misuse, abuse, and addiction associated with hydromorphone, I would avoid prescribing this medication if possible. -K Oetting

Kevin Huynh Student Pharmacist Fall 2020

https://azarius.net/encyclopedia/29/ibogaine/

https://catalystmagazine.net/heroin-and-ibogaine/

BACKGROUND/HISTORY •

• •

• •

•

•

Derived from the root of the Tabernathe iboga shrub commonly found growing in Central Africa 1864: first documented use of the iboga root in Gabon and the Congo Late 19th Century: Bwiti tribe is founded; uses the T. iboga root as part of its initiation 1901: ibogaine isolated from the T. iboga root by French scientists 1962-1963: Researcher Howard Lotsof investigates ibogaine’s ability to treat cocaine/heroin addiction Oct. 24, 1968: Possession of ibogaine made illegal at the federal level in the U.S. 1989: ibogaine considered a “doping substance” by the International Olympic Committee

LAW Ibogaine is classified as a Schedule I controlled substance by the U.S. Food & Drug Administration. This means the substance has “no currently accepted medical use” and a “high potential for abuse”

DRUG SCREENING INFORMATION •

•

Ibogaine is currently not tested for in any standard or extended drug tests o Most likely due to unpopularity of ibogaine Can be detected in urine, but would have to be a specific test looking for the ibogaine component

PHARMACOLOGY • • •

•

•

Very complex Acts on multiple neurotransmitter systems Interact with acetylcholine, serotonin, and dopamine systems Have shown affinity to receptors such as sigma, kappa, mu, and NDMA receptors When metabolized into noribogaine, it elevates serotonin levels in the brain

DRUG EFFECTS •

•

Low doses of ibogaine appear to cause sympathetic nervous system stimulation through action on the cerebella High doses can cause “vagal dominance” and intense psychedelic effects

TOXICOLOGY Large doses of ibogaine are known to cause these symptoms agitation, hallucinations, vomiting, ataxia, muscle spasms, seizures, paralysis, weakness, arrhythmias, urinary retention, respiratory insufficiency, cardiac arrest

PROFESSIONAL OPINION DRUG INTERACTIONS Medications that are metabolized by liver enzyme CYP2D6 (ex. metoprolol, diphenhydramine, dextromethorphan, venlafaxine, tramadol)

Until further information can be provided regarding ibogaine’s therapeutic uses as an opiate withdrawal medication, I do not recommend use of ibogaine as it can provide undesirable effects at high doses

-

REFERENCES Tabula Rasa Retreat. The Amazing History of Ibogaine. Accessed October 23, 2020. Available at: https://tabularasaretreat.com/amazing-history-ibogaine/ Erowid. Ibogaine Timeline. Accessed October 23, 2020. Available at: https://www.erowid.org/chemicals/ibogaine/ibogaine_timeline.php Erowid. Ibogaine Drug Testing. Accessed October 23, 2020. Available at: https://www.erowid.org/chemicals/ibogaine/ibogaine_testing.shtml Iboga. Natural Products Database. Lexicomp. Wolters Kluwer Health, Inc. Riverwoods, IL. Available at: http://online.lexi.com.

Accessed October 23, 2020.

Spice/K2 Nathan Jaworsky, Student Pharmacists, Fall 2020

Slang terms K2 Spice Black Mamba Bombay Blue Fake Weed Genie Zohai https://www.yourdrugtesting.com/drug-di ctionary-series-synthetic-cannabinoids/

Drug interactions/Toxicology Adverse effects: headaches, anxiety, depression, irritability, raised blood pressure, kidney damage, and seizures Drug interactions: synthetic cannabis is metabolized by the CYP3A4 and CYP2C9 enzymes. Anything that is metabolized by either of those cytochromes will have a lesser effect on the body.

History/background ● Charles Pfizer developed the first strand of K2 in the 1980s ● Hebrew University of Jerusalem developed another strand in 1988 that was 100-800 times more potent than THC. ● John W Huffman created another strand in 1995. ● US Drug Enforcement Administration controlled these chemicals and banned the substances in 2012.

Pharmacology/drug effects SCB is the synthetic version of THC. SCB binds to the cannabinoid receptors with a higher affinity than THC. This is what leads to the higher potency and toxicity than normal marijuana.

Laws On the federal level, President Obama signed an act that prevents the selling of synthetic drugs. Synthetic cannabis is now listed as a Schedule 1 controlled substance. On the state level, it is banned, in some way, in 41 states, but some states have had troubles with companies labeling K2 as â&#x20AC;&#x153;not for human consumptionâ&#x20AC;?.

Monitoring/drug screens Mood, anxiety, confusion, rapid heart rate, violent behavior, suicidal thoughts, depression, irritability

Personal Professional opinion As a student pharmacist, I would not recommend the use of K2, because of the higher risk of death and overdose compared to the use of marijuana. ~ N. Jaworsky https://www.the-scientist.com/news-opi nion/synthetic-cannabinoid-k2-overdos es-are-rampant--heres-why--64655 References: https://www.webmd.com/mental-health/addiction/news/20120924/k2-trend-not-slowing-down# 1 https://www.drugpolicy.org/are-synthetic-cannabinoids-legal https://www.drugabuse.gov/publications/drugfacts/synthetic-cannabinoids-k2spice https://www.cmaj.ca/content/192/9/E206 https://www.emsworld.com/article/1224020/pharmacology-101-spice-must-flow-what-know-ab out-synthetic-cannabinoids https://www.drugfreeworld.org/drugfacts/synthetic/synthetic-marijuana-short-history.html

ROBERT ODENDAHL Student pharmacist FALL 2020

KETAMINE STREET NAMES Ketamine has a variety of street names such as: Special K Kit Kat K Jet Cat Valium https://med.stanford.edu/news/allnews/2017/05/special-k-costly-off-label-option-toVitamin K treat-mental-disorders.html

HISTORY OF KETAMINE 1962: Ketamine is discovered 1964: Ketamine is tested on prisoners. Found to have dissociative anesthesia effects 1970: Clinical trials begin of ketamine in France as an anesthesia.

1970: FDA approves ketamine as field anesthetic in Vietnam war.

1995: Ketamine added to the DEA’s emerging drugs list 1999: Ketamine classified as a schedule III controlled substance

https://upload.wikimedia.org/ wikipedia/commons/thumb/0/ 0d/Ketamine2DCSD.svg/1200p x-Ketamine2DCSD.svg.png

KETAMINE PHARMACOLOGY https://www.npcourses.com/pharmacologypackages/fnp-pharmacology-package

· Ketamine is an NMDA receptor antagonist · NMDA receptor antagonism has shown potent analgesia and at high doses, hallucinations.

ADVERSE EFFECTS

DRUG INTERACTIONS

· Hallucinations · Psychosis · Kidney damage · Memory Loss · Unconsciousness

· Use of ketamine with other · Hypersensitivity CNS depressants increases · Pregnancy/Breast feeding risk of unconsciousness and · Alcoholism · Schizophrenia death

CONTRAINDICATIONS

· Use of ketamine with other psychoactive substances is cautioned

MONITORING PARAMETERS · Blood pressure and heart rate · Mental status changes

LEGALITY https://www.healthline.com/health/highblood-pressure-hypertension

· Ketamine is a schedule III substance, making it illegal to produce, use, and sell without doctor approval.

PROFESSIONAL OPINION "Because of the abuse potential, risk for physical and mental damage, and illegality, I would not recommend ketamine use without physician supervision" - Robert Odendahl REFERENCES · Ketamine. Dea.gov. Accessed October 25, 2020. https://www.dea.gov/factsheets/ketamine · History of ketamine. Ketamine.com. Published October 28, 2013. Accessed October 25, 2020. http://ketamine.com/history-of-ketamine/ · Ketamine abuse: Biliary dilatation: 2 case reports. React Wkly. 2013;1449(1):21-21. · Rosenbaum SB, Gupta V, Palacios JL. Ketamine. In: StatPearls. StatPearls Publishing; 2020.

ROBERT ODENDAHL STUDENT PHARMACIST FALL 2020

Alexandria Batista, Student Pharmacist â&#x20AC;&#x201C; Fall 2020

History of Khat -

-

Khat use was first reported in the 13th century in Abyssinia (Ethiopia). It was brought to Yemen in the Early 15th century and is still chewed for ~3-4 hours daily by most Yemenis 1930: Synthetic derivatives of khat are produced: Methcathinone (Ephedrone) and 4-methylmethcathinone (Mephedrone) 1980: Clinical use of cathinone derivatives results in the introduction of bupropion as an antidepressant 1991: Methcathinone abuse appears in the USA 2009: Growing concern about cathinone-derived â&#x20AC;&#x153;legal highsâ&#x20AC;?

2010: Legal restrictions are put on cathinone derivatives in several countries

Slang Terms Drone M-CAT Oat Meow Meow Abyssinian Tea African Salad https://azarius.net/media/images/encyclopedie/khat2.jpg

Pharmacology

Drug Effects -

The psychoactive compounds in khat are cathinone and cathine which are both classified as phenylalkylamines.

Cathinone is more active than cathine.

- Act as CNS stimulants, but have a lower potency than other phenylalkylamines due to the đ?&#x203A;˝-keto group that makes the molecule more polar and thus less capable of crossing the blood brain barrier.

Euphoria Hyperactivity Restlessness Hallucinations Paranoia Increased blood pressure Increased heart rate Dysphoria http://you.38degrees.org.uk/petitions/lift-the-ban-on-kat Sedation Appetite suppressant

Drug Interactions/Toxicology -

-

Reduced bioavailability of oral antibiotics (amoxicillin, ampicillin, cephradrine) and chloroquine Increased bioavailability of MAOIs and amphetamine derivatives Counteracts the effects of antihypertensives, antiarrhythmics, and local anesthetics. It has also been shown to offset the cardioprotective action of aspirin Increases the risk of seizures and is considered a cardiotoxin

Laws -

-

Banned in most European countries, the US, and Canada o It was declared illegal in the US in 1993 Legal in Somalia, Djibouti, Ethiopia, Yemen, and Israel

Monitoring/Drug Screens - Monitor HR, BP, withdrawal symptoms (nightmares, tremor, mild depression) - Detectable in the blood and urine

Professional Opinion Due to the lack of evidence of khat being useful in the clinical setting as well as it being an addictive compound that can lead to seizures and heart problems, I would not recommend the use of khat or its synthetic derivatives in anyone. ~A. Batista

Sources El-Menyar A, Mekkodathil A, Al-Thani H, Al-Motarreb A. Khat Use: History and Heart Failure. Oman Med J. 2015;30(2):77-82. doi: 10.5001/omj.2015.18 Gonzales M. Advanced Recovery Systems. Street Names for Drugs. Accessed October 4, 2020. Available at: https://www.drugrehab.com/addiction/drugs/street-names-drugs/ Kelly JP. Cathinone derivatives: A review of their chemistry, pharmacology and toxicology. Drug Test Analysis. 2011;3:439-53. doi: 10.1002/dta.313 European Monitoring Centre for Drugs and Drug Addiction. Synthetic cathinones drug profile. Accessed October 4, 2020. Available at: https://www.emcdda.europa.eu/publications/drug-profiles/syntheticcathinones_en United States Drug Enforcement Administration. Khat. Accessed October 4, 2020. Available at: https://www.dea.gov/factsheets/khat Abebe W. Khat: A Substance of Growing Abuse with Adverse Drug Interaction Risks. J. Natl Med Assoc. 2018;110(6):624-34. doi: 10.1016/j.jnma.2018.04.001

Kratom Nick Juhnke Student pharmacist FALL 2020

Slang Terms • Herbal Speedball • Ketum • Biak-Biak • Thom • Ithang • Kahuam

Pharmacology The most abundant indole alkaloid in Kratom is called Mitragynine. Mytragynine acts on supraspinal opioid mu and delta receptors. The drug can be overdosed on.

Background of Use Kratom is a tropical tree found in Southeast Asia, the Phillipines, and New Guinea. It was traditionally used by manual laborers who would chew the leaves or make tea out of it to increase productivity and prevent fatigue. It has also been used for centuries during socioreligious ceremonies. Recently the drug has become more popular in Western countries.

Side effects

Toxicology

• • • • • • • •

• 1-5 gram doses cause stimulating effects • 10-15 gram doses cause opioid effects including sedation, euphoria, and analgesia

Monitoring and Drug Screens Patient’s electrolytes should be monitored if vomiting and diarrhea occurs. Liver enzymes should be monitored in patients with abdominal pain or jaundice. Neuro status and respiratory function should be monitored after significant exposure.

These drugs are not detected in routine urine t i l

Nausea Itching Sweating Dry mouth Constipation Increased urination Seizures Hallucinations

Laws Related to Kratom Kratom is currently illegal in Wisconsin, Arkansas, Alabama, Vermont and Rhode Island.

Other states currently have regulations pending.

Professional Opinion Given that the drug has no medicinal purposes and can cause overdoses, I do not recommend taking Kratom.

-N. Juhnke References National Institute on Drug Abuse. Kratom DrugFacts. Accessed October 24, 2020. Available at: https://www.drugabuse.gov/publications/drugfacts/kratom Advance Recovery Systems. Street Names for Drugs. Accessed October 24, 2020. Available at: https://www.drugrehab.com/addiction/drugs/street-names-drugs/ Plants: Mitragyna. Micromedex Solutions. Truven Health Analytics, Inc. Ann Arbor, MI. Available at: http://www.micromedexsolutions.com. Accessed October 24, 2020.

Kraoma. Kratom Legality 2020: Map, Legal Status, and Ban Updates. Accessed October 24, 2020. Available at: https://kraoma.com/kratom-legality-united-states/ Graphic: https://en.wikipedia.org/wiki/Mitragynine#/media/File:Mitragynine.svg

DESOMORPHINE Bacil Kadi Student pharmacist FALL 2020

FEATURED STORIES THIS MONTH: Finding Joy in Sacrifice - 2

HISTORY/BACKGROUND

Desomorphine, or better known as “Krokodil” is an abused opioid that is known as a cheap heroine. The chemical was first synthesized in the USA in 1932 by Small and Morris. They patented the chemical in 1934, but quickly was discontinued. Fast forward a few years and it is reported being home made in Siberia. Quickly from then, it spread to Russia where rates of use increased 23 times between 2009-2011. It was known as a cheap, flesh eating heroine. It was able to be sold for 5 times cheaper than heroine because the production of it only required the purchase of OTC codeine tablets. Desomorphine got the name “Krokodil” due to abusers’ skin turning green and black and flacking off, like scales of a crocodile. These skin condition would occur around the site of injection.

To prepare it, all someone would need is a codeine product, extract the codeine(through boiling) while adding a strong base to reduce the chemical, then they could add an acid to finish the cooking. Users would on average, die within 2 years of using.

Slang Names Krokodil Crocodile

Side effectsof desomorphine Miosis flushing Constipation Urinary retention N/V

PHARMACOLOGY Desomorphine is an opioid analog which

Respiratory depression

Side effects of crocodil Septicemia

has slight chemical alterations which

Desguamination

make it more lipophilic. It is able to cross

(green scaly skin)

the blood brain barrier and bind to opioid

gangrene motor and speeach

receptors with similar PK distribution of

impariments

other alkaloids. It works as an analgesic

memory or

and sedative, with the sedative effect

personality changes

Laws

being about 15 times higher than that of morphine. It also has a faster onset and shorter half life. It binds to Mu, kappa, and delta opioid receptors throughout the body to produce analgesia, sedation, GI dysmotility, and euphoria. Analgesic effect is 8 fold higher than morphine.

References ¡

Florez DHĂ&#x201A;, Dos Santos Moreira AM, da Silva PR, et al. Desomorphine (Krokodil): An overview of its chemistry, pharmacology, metabolism, toxicology and analysis. Drug Alcohol Depend. 2017;173:59-68. doi:10.1016/j.drugalcdep.2016.12.021 Winborn J, Kerrigan S. Analysis of Desomorphine in Urine Using Liquid Chromatography-Tandem Mass Spectrometry. J Anal Toxicol. 2019 Jun 1;43(5):340-345. doi: 10.1093/jat/bky103. PMID: 30590627.

Schedule one narcotic 5g manufacturing quota

Drug screening New efforts are being put forth to make better screening methods for desomorphine. What is available now is urine testing through solid phase extraction and liquid chromatography with mass spectrum.

Laxatives Zach Nies Student Pharmacist Fall 2020 Photo By: Adrian Bryant, Now Loss

History of Laxatives • 1842 – The first laxative, Beecham’s Pills, were invented as a stimulant to produce a mild laxative effect • 1953 – Bisacodyl, a widely-used laxative that is still used today, was first marketed in London, UK

Slang Terms • Bisacodyl • Senna • Sodium picosulfate

Why Laxatives are Abused • The desire to feel empty • To reduce bloating & lose weight

Pharmacology & Drug Effects • Stimulates constriction and relaxation of the smooth muscle of the intestine • Alters water and electrolyte secretion, leading to fluid accumulation in the intestines. This softens stool and increases intestinal contractions.

Monitoring Drug Interactions • Antacids • Dichlorphenamide • Polyethylene GlycolElectrolyte Solution

• Laxatives may enhance the hypokalemic effect of dichlorphenamide, so monitor use • Bisacodyl may enhance the adverse/toxic effect of polyethylene glycol-electrolyte solution, so monitor use

Professional Opinion

Bisacodyl Structure

Even with the potential abusive factors in laxatives, I still recommend the use of laxatives for their intended use of softening stool and helping with constipation. ~ Z. Nies

Photo By: Sigma-Aldrich

References Bashir A, Sizar O. Laxatives. StatPearls [Internet]. Accessed October 25, 2020. Available at: https://www.ncbi.nlm.nih.gov/books/NBK537246/.

Law • In 1998, there was a reclassification of laxatives from category I (generally recognized as safe and effective) to category III (further testing is required) due to insufficient data available about the drug’s safety and effectiveness

Bisacodyl. Lexi-Drugs. Lexicomp. Wolters Kluwer Health, Inc. Riverwoods, IL. Available at: http://online.lexi.com. Accessed October 25, 2020.

Evans IL. Methods and techniques: the use of Bisacodyl suppositories in preparation for sigmoidoscopy. Gut. British Medical Journal. 1964;5:271-3. doi:10.1136/gut.5.3.271 Let’s Look Again. A CAPSULATED HISTORY OF BEECHAM’S PILLS. Accessed October 25, 2020.

Available at: http://letslookagain.com/2017/11/a-capsulated-history-of-beechams-pills/.

Murray K. Addiction Center. Laxative Abuse. Accessed October 25, 2020. Available at: https://www.addictioncenter.com/drugs/laxative-abuse/.

NHS. Overview Laxatives. Accessed October 25, 2020. Available at: https://www.nhs.uk/conditions/laxatives/#:~:text=hours%20to%20work.,They%20include%3A,sodium%20picosulfate.

U.S. Food and Drug Administration. Rulemaking History for OTC Laxative Drug Products.

Accessed October 25, 2020. Available at: https://www.fda.gov/drugs/status-otcrulemakings/rulemaking-history-otc-laxative-drug-products.

WebMD. Laxative. Accessed October 25, 2020. Available at: https://www.webmd.com/drugs/2/drug-170409/laxative-sennosides-oral/details.

LSD Monograph Hatem Kawach 10/15/20

https://tinyurl.com/y4wg488x

History/Background: LSD was first synthesized by Albert Hofmann, a chemist working for Sandoz Pharmaceutical in 1938, while looking for a blood stimulant. Its hallucinogenic effects were unknown until 1943, however, when Hoffman accidentally consumed some LSD. Due to its similarity to chemicals present in the brain and its similar effects in patients with psychosis, LSD was used in experiments from psychiatrists in the 40s, 50s and 60s.

While researchers failed to see any medical use for it, free samples were distributed broadly by Sandoz, leading to widespread use.

Eventually, the US banned LSD in 1967.

Slang Terms: Acid, Blotter, Boomers, Cid, Golden Dragon, Looney Tunes, Lucy Mae, Microdots, Tabs, Yellow Sunshine, L, Doses, Trips

Pharmacology/Drug Effects: The initial effects of LSD begin in about 20-40 minutes with a sense of euphoria and dizziness. Hallucinations then begin to occur, with the trip peaking about 4-5 hours after the drug is taken. LSD is best described as a drug that strikes down barriers. LSD causes users to feel detached from their ego, and people state they can cross between states of consciousness. The user's perceptions are altered, causing visual and auditory hallucinations. One may notice that the walls of room are "breathing" or that motionless curtains appear to be moving. Senses appear to mix. A user might see music, taste colors, or hear visual stimuli. Effects taper off after about 68 hours and are usually completely gone after a night’s sleep. LSD potently binds to human serotonin receptors 5HT1A, 5-HT2A, 5-HT2C, as well as dopamine D2, and α2 adrenergic receptors. LSD also less potently binds to α1 , D1, and D3 receptors. LSD is a partial agonist at 5-HT2A receptors, which primarily mediate the hallucinogenic effects of LSD. A key mechanism of LSD is the activation of frontal cortex glutamate transmission that is secondary to 5-HT2A receptor stimulation, however their interactions between the two are unclear.

https://tinyurl.com/y36y3sfg

Drug interactions/Toxicology: LSD sees many drug interactions with SSRI’s, which can lead to decrease in concentrations of LSD or increases depending on the specific SSRI used. Tricyclic antidepressants lead to an increase in response to LSD, while lithium lead to an increase in response as well. MAOI’s showed a decrease in response.

References: National Institute on Drug Abuse. “Commonly Used Drugs Charts.” National Institute on Drug Abuse, 7 Oct. 2020, www.drugabuse.gov/drugtopics/commonly-used-drugscharts.

National Institute on Drug Abuse.

“Commonly Used Drugs Charts.”

National Institute on Drug Abuse, 7 Oct. 2020, www.drugabuse.gov/drugtopics/commonly-used-drugscharts.

Liechti, Matthias E. “Modern Clinical Research on LSD.” Nature News, Nature Publishing Group, 27 Apr. 2017, www.nature.com/articles/npp201 786.

“The History of LSD - Acid, Albert Hoffman & Timothy Leary - DrugFree World.” Foundation for a Drug-Free World, www.drugfreeworld.org/drugfacts /lsd/a-short-history.html.

https://tinyurl.com/yxglmzw3

Monitoring/Drug Screens: LSD can be detected in your system for roughly 15 hours, while the metabolite of LSD, 2-oxo-3-hydroxy-LSD, can still be detected by drug screens for up to 5 days.

Freeman, Shanna, and Nathan Chandler. “How LSD Works.”

HowStuffWorks Science, HowStuffWorks, 27 Jan. 2020, science.howstuffworks.com/lsd8. htm'.

Bonson, Kit. “The Interactions Between Hallucinations and Antidepressants .” Erowid MAOI Vault : Info on Hallucinogens with Antidepressants, by Kit Bonson, 1995, www.erowid.org/chemicals/maois /maois_info4.shtml.

“Lysergic Acid Diethylamide (LSD).” Drug Testing: Lysergic Acid Diethylamide - Mayo Clinic Laboratories, www.mayocliniclabs.com/testinfo/drug-book/lsd.html.

Laws: LSD is a schedule one controlled substance in the United States, meaning it has been classified as having high abuse potential, and no current medical use. The federal penalty for the first offense of LSD possession is a maximum of one year in prison or a minimum fine of 1000 dollars. For selling or making, if the amount is over 10 grams, the offender can spend 5-40 years in jail and can face fines up to 2 million dollars. Higher amounts can result in a life sentence.

https://tinyurl.com/y4bex8jg

Professional Opinion: LSD is a substance that has been used for decades that has had a history of being used for recreation, and then later by the government as an attempt at chemical warfare. LSD’s effects last many hours and having a bad trip can result in hours of terrifying hallucinations. The fines and years in prison also do not make use of LSD appealing to the public.

Not enough research has been done on LSD’s effects on mental health medications and other medications that millions take every day, which makes me wary to suggest this to people. I feel that decriminalizing this substance and allowing more research to be done may find that LSD can be used for certain mental health conditions that we were not aware of in the 40s and 50s.

-H Kawach

MDMA Hyun Kim Student pharmacist Fall 2020 https://theconversation.com/mdma-makes-people-more-cooperative-but-only-with-those-they-trust-107113

SLANG TERMS - X,T, or XTC

HISTORY & BACKGROUND - MDMA was originally compounded by a German pharmaceutical

- Molly

company in 1912. This compound was originally called

- Vitamin X

â&#x20AC;&#x153;Methylsafrylaminc,â&#x20AC;? and the intended use was to control bleeding

- Adam

in patients.

- Even though the FDA banned MDMA, some psychiatrists used

- E-bomb

MDMA in the late 1970s and early 1980s, believing that it would

- Doctor

help with communication with patient. During this time, MDMA

- Love Doctor

became widely available on the street.

- Bean

- In 1985, the drug enforcement administration (DEA) banned MDMA and listed it as a Schedule I drug, meaning that it is likely to be abused by users while it has no medical use.

- The FDA approved the first human trial that tests if it alleviates pain in terminally ill patients in the early 1990s. These studies quickly established safety parameters that they are administered in controlled, clinical settings.

- Nowadays, 42 clinical trials are proceeding to find out if MDMA

PHARMACOLOGY & DRUG EFFECTS

would contribute to the treatment of anxiety and post-traumatic stress disorder (PTSD) in autistic patients as well as terminal illnesses such as cancer.

- The chemical compound of MDMA is structurally similar to amphetamines. While MDMA increases serotonin release, amphetamines inhibit the reabsorption of norepinephrine and secrete more norepinephrine.

- Drug effects such as an amplified sense of well-being are seen with the use of MDMA.

LAWS https://www.sandstonecare.com/resources/s

MONITORING & DRUG SCREEN

https://adf.org.au/drug-facts/pma-and-

ubstance-abuse/mdma

pmma/

- In 1988, the government officially

- Monitoring drug dependency

announced MDMA as a Schedule I

would be needed in patients

substance.

with a history of substance

- The sentencing guideline for

abuse program.

Ecstasy offenses is in progress.

- Drug screen is done by a

When MDMA is involved, the

urine screening test.

judges enforce more strict punishments.

- MDMAs have drug interactions with caffeine, marijuana, and alcohol, and these increase the half-life of the drug and cause enhanced adverse effects.

- The adverse effects (with high doses) include hypertension, panic attacks, faintness, tachycardia, blurred vision, confusion, and dehydration.

PROFESSIONAL OPINION

DRUG INTERACTION & TOXICOLOGY

- As drug addiction is a disease, we should not stereotype or make assumptions about the users who use MDMA. If a patient admits the use of MDMA, the main focus of the treatment should be motivational interviewing and why they should quit MDMA or any other illicit drugs that they might be using. ~H. Kim

REFERENCES

Casa Palmera Treatment Center. Nicknames, street names and slang for MDMA/Ecstasy. Casa Palmera Treatment Center. Accessed October 24, 2020. Available at: https://casapalmera.com/blog/nicknames-street-names-and-slang-formdmaecstasy/.

Clinical Pain Advisor. MDMA drug slang/code words. Haymarket Media, Inc. Accessed October 24, 2020. Available at: https://www.clinicalpainadvisor.com/home/dea-drug-slang-code-words/mdma-drug-slang-code-words/.

NIDA. What is the history of MDMA?. National Institute on Drug Abuse website. Accessed October 24, 2020. https://www.drugabuse.gov/publications/research-reports/mdma-ecstasy-abuse/what-is-the-history-of-mdma.

The Department of Health. Pharmacology of MDMA (ecstasy). Commonwealth of Australia. Accessed October 24, 2020.

Available at: https://www1.health.gov.au/internet/publications/publishing.nsf/Content/drugtreat-pubs-modpsytoc~drugtreat-pubs-modpsy-2~drugtreat-pubs-modpsy-2-3~drugtreat-pubs-modpsy-2-3-pmdm.

NIDA. What are the effects of MDMA?. National Institute on Drug Abuse website. Accessed October 24, 2020.https://www.drugabuse.gov/publications/research-reports/mdma-ecstasy-abuse/what-are-effects-mdma.

Schwartzbach M. Ecstasy laws. NOLO. Accessed October 24, 2020. Available at: https://www.criminaldefenselawyer.com/drug-possession-and-use/Ecstasy-mdma-pills-laws.htm.

Methadone (Dolophine) Delmar Oropeza Student Pharmacist Fall 2020

https://psychiatry.uams.edu/clinical-care/cast2/what-is-methadone/

Street Names Dollies/Dolls Meth Junk Jungle Juice Fizzies Maria Wafer Pastora Salvia Done

• • • •

History

• First developed during WWI to combat morphine shortage • 1947- Eli-Lily began to produce methadone • 1960- use of methadone for heroin addiction • 1970- methadone becomes schedule II drug • 1973-became controversial using one opioid for another

Pharmacology N-methyl-D-aspartate (NMDA) receptor antagonist Binds to opiate receptors in CNS, causing inhibition of ascending pathways Alters perception and response of pain Metabolized by hepatic pathways

https://encryptedtbn0.gstatic.com/images?q=tbn%3AANd9GcT3 D0uNzIKgKduzsL5PjKtUWMYqXEKKPc65PA&us qp=CAU

https://en.wikipedia.org/wiki/Methadone#/m edia/File:Methadone.svg

• • • • • •

• • • •

Adverse Effects GI effects (constipation, N/V) Confusion Dizziness Respiratory depression ECG changes Rash

Contraindications Severe bronchial asthma Hypersensitivity to methadone Significant respiratory depression GI obstruction

Law

• Schedule II drug- high abuse potential, leading to physiological and physical dependence • Illegal to obtain without a prescription in the United States

• • • •

• • • •

• • • • • •

Drug Interactions Substrate of CYP2B6 Substrate of CYP3A4 Inhibits CYP2D6 Additive effect w/ drugs that prolong QT interval

Monitoring Pain relief QTc interval Respiratory and mental status BP Liver function Misuse/abuse/dependence

Professional Opinion

• Under physician or medical supervision, I would recommend methadone for patients who do not experience pain relief with other analgesics. -D. Oropeza

References Methadone. Drug Facts and Comparisons. Facts & Comparisons eAnswers. Wolters Kluwer Health, Inc. Riverwoods, IL. Available at: http://online.factsandcomparisons.com. Accessed September 27, 2020.

SAMHSA. Methadone. Accessed September 27, 2020. Available at: https://www.samhsa.gov/medication-assisted-treatment/medications-counseling-relatedconditions/methadone.

Sundance. Methadone Treatment Center. Accessed September 27, 2020. Available at: http://www.chicagotreatmentcenters.com/americas-most-successful-heroin-treatment-a-brief-historyof-methadone.php.

UAMS. What is methadone. Accessed September 27, 2020. Available at: https://psychiatry.uams.edu/clinical-care/cast-2/what-is-methadone/.

Methamphetamine Lexi Lahey Fall 2020 History1

Slang terms2

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Pharmacology/Drug effects2-4 ● ● ●

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Drug Interactions/Toxicology3,5 Laws6 ●

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Monitoring4 ● ● ● ● ●

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Professional Opinion ~ L. Lahey

References

Screening7 ●

FALL 2020

NALTREXONE Addie Sarver, Student Pharmacist

Pharmacology

Naltrexone is a competitive opioid antagonist that can displace active opioid molecules in the CNS and maintain opioid blockade for longer periods of time than its analog, naloxone, known commonly as Narcan.

Naltrexone was first synthesized in It is a drug considered to have no agonistic effects 1963 based on the success of its analog, and because of this will not produce withdrawal naloxone. It was not formulated into drug symptoms. It is effective at blocking the euphoric product until 1972 when there became an effects of opiates that are natural, synthetic, interest in using lower maintenance medications and endogenous. This makes it helpful to use than methadone to treat opioid addictions. In in the treatment of both opioid dependence 1984 an oral formulation was given FDA disorder and alcohol dependence disorder. approval for use in treating heroin addiction, It is very important that patients who but it was not highly successful due to issues start using naltrexone to be with daily compliance, but it is still available to opioid-free for 7-10 days before this day. A long-acting injectable form starting this medication and was approved in 2006 and since not actively drinking alcohol then it has been used in many in order to reduce the medication assisted therapy programs risk of sudden for opioid use disorder and 2 withdrawal alcohol use disorder.

1 symptoms.

History

Fo rm s

1

3

Do sa ge

Oral Tablets

Oral Liquid (specialty compounded)

Extended-release Intramuscular Injection

Implantable Release Device (not yet FDA approved)

1

Sla ng ter Tra ms de & Na me ReV s ia Viv i De trol pa d LDN e NL 1,2,4 X

Drug Interactions

The use of opioid-containing medications is contraindicated when using any form of naltrexone as it decreases the effectiveness of opioid medications and the combination of these medications may also result in developing opioid withdrawal symptoms, which can be life threatening. Additionally, naltrexone use should be avoided if using other opioid antagonist medications, notably the If the long-acting intramuscular agents naloxegol and naldemedine, which injection form of naltrexone is are targeted antagonists for opioid selected as the agent for a patient receptors found in the gut. Concurrent receiving medication-assisted therapy in use of naltrexone with these agents treatment of opioid-use disorder, a Risk is associated with a increased Evaluation and Mitigation Strategy (REMS) will risk of going into opioid need to be completed. Regular drug withdrawal. The dietary screens are not required for the REMS supplement yohimbine program and naltrexone is not screened for on should not be taken standard screens. These patients with naltrexone will need to visit with their provider every four due to weeks for administration of injection. The oral increased pill form of naltrexone does not have such a 1 anxiety. program, but it is also not indicated for

Monitoring

use in patients with opioid use disorder, 1, 5 although sometimes used off-label.

Laws There are no laws restricting the prescribing or dispensing of naltrexone. Any physician may prescribe this drug, if within their scope of practice, and any pharmacist may dispense it from any licensed pharmacy.

Naltrexone is not a controlled substance as 5 defined by the U.S. Drug Enforcement Agency.

Professional Opinion

It is the opinion of this professional that naltrexone is a safe and effective drug to use in the treatment of opioid and alcohol use disorders. It is, however, important to note that patients should be adequately assessed for readiness to quit and understanding of need for compliance. The longacting form available as an intramuscular injection will likely provide the most success in preventing relapse through medication-assisted therapy.

Receiving adequate support from providers and community along with this treatment will illicit best response for long-term success. - A. Sarver

4. Naltrexone. Urban Dictionary. Accessed on October 1. Naltrexone. Micromedex Solutions. Truven Health Analytics, Inc. Ann Arbor, MI. 25, 2020. Available at: Available at: http://www.micromedexsolutions.com. Accessed October 24, 2020. https://www.urbandictionary.com/define.php 2. Srivastava AB, Gold MS. Naltrexone: A History and Future Directions. Dana term=LDN Foundation. October 23, 2018. Available at: https://www.dana.org/article 5. Naltrexone. SAMHSA. Accessed on October 24, naltrexone-a-history-and-future-directions/ 2020. Available at: https://www.samhsa.gov/ 3. Naltrexone structure. ChemSpider. Accessed October 25, 2020 Available at: medication-assisted-treatment/medicationshttp://www.chemspider.com/Chemical-Structure.4514524.html counseling-related-conditions/naltrexone

References:

NICOTINE________________________________________ Review by Mary Langemeier, Student Pharmacist Fall 2020

Introduction and Brief History:1,2 Nicotine is a psychoactive substance derived from the tobacco plant. Tobacco, both in the smokeless and smoked forms, is a known carcinogen. Nicotine is the main substance in tobacco leading to addiction and dependency.1 The first recorded instances of tobacco use have been traced back as far back as 6000 BC. By 1 BC, indigenous Americans were using tobacco for religious and medicinal purposes. Tobacco was first introduced to Europe in the late 1400s during the Columbian Exchange. Over the next few hundred years, tobacco use spread Tobacco Plants in a Field throughout the world.2 britannica.com/science/nicotine

Common Names and Slang:3 • • • • •

“Cigs” or “Smokes”(Cigarettes) “Snuff” (Intranasal, or Oral Smokeless Tobacco) “Dip” or “Chew” (Smokeless, Oral Tobacco) “Vape” (Tobacco Vaporized for Inhalation, e-cigarette) “Hookah” (Flavored Tobacco Inhaled via Water Pipe)

Dosage Forms: • •

•

Grizzly Chewing Tobacco csnews.com

Water Pipe Used to Smoke Hookah amazon.com

E-cigarettes are Used to Smoke Tobacco smoktech.com

Marlboro Cigarettes marianos.com

Pharmaceutical: lozenges, patches, gum, intranasal and oral inhalers.

Tobacco: Pre-rolled tobacco (cigarettes, cigars), loose leaves for smoking or chewing, packets for oral absorption, ground for intranasal use, or combined with flavoring to be smoked through a water pipe.

Electronic cigarettes: Flavored or unflavored nicotine liquid inhaled after it has been heated to its vaporization point. Usually called e-cigarettes.

Pharmacology/Toxicology:4,5 Nicotine acts as an agonist at the nicotinic acetylcholine receptors in the brain. It causes the release of dopamine via activating neurons in the mesolimbic pathway. The dopaminergic pathway is an important part of the reinforcement mechanism leading to dependency and addiction to nicotine containing products. It also is responsible for the anxiolytic and euphoric effects.4 In the sympathetic nervous system, nicotine activates receptors that release norepinephrine/epinephrine into the blood stream. As these chemicals enter the bloodstream, they cause an increase in blood pressure and heart rate. Common physiological and cognitive side effects are listed in the figure to the right.4 Overdose is rare when consumed in the smoked and smokeless form. The most common way for a person to overdose is when directly handling wet tobacco plants, e-cigarette liquids, or smoking cessation products in nicotine naïve persons. When tobacco plants are wet or nicotine is in liquid form, it can be absorbed through the skin. Overdose symptoms include arrhythmias, anxiety, high blood pressure, flushing, headache, nausea, and vomiting.5

Common Side Effects and Toxicities of Nicotine Consumption uicc.org

Drug Interactions:6

Disease Interactions:6

Nicotine generally does not significantly impact other drugs. Interactions potentially caused by nicotine include:

Nicotine should be avoided in individuals with:

• • •

Resistance to caffeine, insulin, and warfarin.

Induction of CYP1A2 substrates.

Synergy with central nervous system stimulants.

• • • •

Hypertension or cardiovascular disease.

Lung disease, including asthma and chronic obstructive pulmonary disease (COPD).

Malignancies of the mouth, throat, or lungs.

Pregnancy.

Asthma and COPD Are Exacerbated By Tobacco Products www.health24.com Tobacco Products Are Associated With Cardiovascular Disease www.theexprogram.org

Monitoring:7-9

Professional Opinion:11

Individuals who consume nicotine products should monitor for adverse reactions, shortness of breath, cough, upper respiratory infections, hypertension, COPD, and asthma exacerbations. It is difficult to determine whether nicotine alone is a carcinogen because it is often consumed alongside other carcinogenic substances in tobacco.7 However, chronic users of tobacco products are at risk for mouth, throat, and lung cancers. Monitoring for these cancers include routine dental screenings and X-rays if symptoms occur.7,8

Occasional use of nicotine products, in my professional opinion, is not significantly detrimental to an individual’s health. Nicotine itself has few drug interactions, side effects are transient, and overdose is rare. Literature suggests that nicotine on its own, in the form of lozenges, gum, and other replacement therapies, is not detrimental to one’s health, even when used chronically.11

Individuals who vape should monitor for general nicotine side effects, throat irritation, and pneumonia caused by additives in the e-liquids. It is unknown if e-cigarettes are associated with lung cancer or breathing difficulty.9

Overall, occasional purchase and consumption of nicotine products by adults of legal age should not be encouraged but carries little health detriment.

Chronic users of tobacco products can benefit from cessation or safer alternative nicotine products. ~ M. Langemeier

Routine chest X-rays and sputum cytology may have slight benefits for patients at high risk for lung cancer.8 Spirometers and peak flow meters can be used to monitor asthma and COPD symptoms.

Legal Status:10 As of 2020, consumption and purchase of tobacco products is legal for individuals over the age of 21 in the United States. Elsewhere in the world, legal age to buy nicotine products is generally either not regulated or the age of 18. Some European countries do not have a minimum age to consume tobacco products but do not allow sales to individuals under the age of 18.

In my professional opinion, nicotine products become problematic when they are consumed chronically. The habit-forming nature of tobacco products can cause occasional use to develop into chronic use. Smoking cessation is an effective way to reduce the health problems associated with chronic tobacco consumption.

References: 1. Nicotine. Encyclopaedia Britannica. Available at: https://www.britannica.com/science/nicotine. Accessed October 17, 2020.

2. History of Tobacco. academic.udayton.edu. Available at: https://academic.udayton.edu/health/syllabi/tobacco/history.htm. Accessed October 16, 2020.

3. National Institute on Drug Abuse. National Institutes of Health. Vaping, nicotine, and tobacco facts. Available at: https://easyread.drugabuse.gov/content/vaping-nicotine-and-tobacco-facts. Accessed October 17, 2020.

4. Nicotine. drugbank.com. Available at: https://go.drugbank.com/drugs/DB00184#pharmacology-header. Published June 13, 2005. Updated October 17, 2020. Accessed October 15, 2020.

5. Cherney, K. Nicotine poisoning. healthline.com. Available at: https://www.healthline.com/health/nicotinepoisoning#treatment. Published August 7, 2017. Accessed October 16, 2020.

6. Patel, S. How smoking affects medications. Pharmacytimes.com Available at: https://www.pharmacytimes.com/contributor/shivam-patel-pharmd-candidate/2016/05/how-smoking-affectsmedications. Published May 16, 2016. Accessed October 17, 2020.

7. Sanner T, Grimsrud TK. Nicotine: Carcinogenicity and Effects on Response to Cancer Treatment - A Review. Front Oncol. 2015;5:196. Published 2015 Aug 31. doi:10.3389/fonc.2015.00196 8. National Lung Screening Trial Research Team, Aberle DR, Adams AM, Berg CD, Black WC, Clapp JD, Fagerstrom RM, Gareen IF, Gatsonis C, Marcus PM, Sicks JD. Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med. 2011 Aug 4;365(5):395-409. doi: 10.1056/NEJMoa1102873.

9. Vandergriendt, C. Is vaping bad for you? And 12 FAQs. healthline.com Available at: https://www.healthline.com/health/is-vaping-bad-for-you#see-a-doctor. Published January 3, 2020. Accessed October 17, 2020.

10. Wikipedia contributors. Smoking Age. Wikipedia, The Free Encyclopedia. Available at: https://en.wikipedia.org/wiki/Smoking_age. Accessed October 17, 2020.

11. Price LR, Martinez J. Cardiovascular, carcinogenic and reproductive effects of nicotine exposure: A narrative review of the scientific literature. F1000Res. 2019;8:1586. Published 2019 Sep 4. doi:10.12688/f1000research.20062.2

NIGHTSHADE ATROPA BELLADONNA | TIMOTHY LEAL STUDENT PHARMACIST

https://www.britannica.com/plant/belladonn a

SLANG TERMS • • • •

Deadly Nightshade Devil’s Cherries/herbs Petit morel Naughty Man’s Cherries

USES • • • • • • •

Motion sickness Nausea and vomiting Ocular swelling Ulcers PUD and IBS Skin diseases Poison

HISTORY AND BACKGROUND OF USE Nightshade has been used medicinally, cosmetically, and as a weapon all throughout history. The Romans created a paste using nightshade that they would coat their weapons with to create deadly poisonous weapons. Both Roman emperors Augustus and Claudius were poisoned by their wives using this dangerous plant and it was even referenced by Shakespeare as a weapon to fell the Danes. During WWII it was synthesized into a nerve gas for use in war. Outside of use as a weapon, it was also used to dilate the pupils and redden the cheeks. It was given its scientific name and acknowledgement of value in society in 1753. Since then, it has been recognized to have some medicinal value, but its dark history still follows it today.

PHARMACOLOGY/DRUG EFFECTS This plant has naturally high levels of atropine, scopolamine, and hyoscyamine. These three molecules are classified as anticholinergics and work by blocking the binding and action of acetylcholine on its receptor (all muscarinic receptors M1-5) in the brain and in nerves ubiquitous throughout the body.

Hyoscyamine is often used for treatment of GI tract problems such as peptic ulcer disease and irritable bowel syndrome.

Scopolamine readily crossed the blood-brain barrier and has a high neurological effect.

https://www.woodlandtrust.org.uk/trees-woods-and-wildlife/plants/wildflowers/deadly-nightshade/

DRUG INTERACTIONS/TOXICOLOGY Due to its anticholinergic properties, it may result in an additive anticholinergic effect when used in addition to other antimuscarinic drugs such as Amantadine, antihistamines, and tricyclic antidepressants. By inhibiting GI tract motility, nightshade may also alter the absorption of drugs absorbed through the intestines and stomach.

Ex: Levdopa, meperidine, digoxin, antacids, corticosteroids

Monitoring/Toxicology Look for typical signs of antimuscarinic overdose: • • • • • • • •

Vision problems Restlessness Disorientation Delusion Overheating Urinary retention Tachycardia Constipation

LAWS Nightshade is not regulated or controlled in the United States. It is legal to grow, sell, and possess any and every part of the plant without a prescription. It is not scheduled or approved by the FDA, but if sold as a food or drug, it is regulated by the FDA. It has, however, been outlawed for cultivation, possession, or for aesthetics in Louisiana.

https://www.arkhamsbotanical.com/shop/seeds/atr opa-belladonna-deadly-nightshade-seeds/

PROFESSIONAL OPINION I would not recommend the use of nightshade as either a prescription or homeopathic remedy of any type, nor would I recommend it is use for cosmetic or poisonous purpose as well. There is not enough medical data to support its use for the treatments it is used for nor is it regulated enough for the potential toxic effects that it possesses. There are much more effective and well-documented drugs that are able to work as effectively and safer than nightshade can. It should not be used for decoration as its bright and appealing berries are attractive to kids but are fatal if just a few are consumed. ~ T. Leal

References: Ambius. Botany Gone Bad: The History of the Deadly Nightshade Plant. Accessed Oct. 25, 2020. Available at: https://www.ambius.com/blog/botany-gone-bad-the-history-of-the-deadly-nightshade-plant/.

Rxlist. Belladonna. Accessed Oct. 25, 2020. Available at: https://www.rxlist.com/belladonna/supplements.htm.

Demirhan A, Tekelioglu UY, Yildiz I, et. Al. Anticholinergic toxic syndrome caused by atropa belladonna fruit (deadly nightshade: a case report. NCBI. doi: 10.5152/TJAR.2013.43 The Vaults of Erowid. Nightshade. Accessed Oct. 25, 2020. Available at: https://erowid.org/herbs/nightshade/nightshade_law.shtml.

TUSOM. Antimuscarinics (Muscarinic Antagonists). Accessed Oct. 25, 2020. Available at: http://tmedweb.tulane.edu/pharmwiki/doku.php/antimuscarinics U.S. Forest Service. The Powerful Solanaceae: Belladonna. Accessed Oct. 25, 2020. Available at: https://www.fs.fed.us/wildflowers/ethnobotany/Mind_and_Spirit/belladonna.shtml.

NITROUS OXIDE INHALATION Catherine Eichler, Student Pharmacist History 1772: Discovered by Joseph Priestley 1800: Humphrey Davy publishes a book describing the psychotropic properties of N2O 1844: The anesthetic properties of N2O are first discovered 1881: Anxiolytic properties are found when using lower doses 1968: Large scale use of N2O by dentists mostly as a anxiolytic 1980s-2000s: N2O is researched in treating psychiatric and neurological conditions like addiction, depression, and schizophrenia.

FALL 2020

https://melscience.com/USen/articles/methods-synthesisnitrous-oxide/

https://medicalxpress.com/news/2018-12-nitrous-oxide-dangerous.html

Mechanism

Slang Terms

Its effects occur in the pain centers of the brain and spinal cord. It is thought to affect GABA cells which inhibit nerve cells and cause drowsiness.

It also seems to be related to the inhibition of pain transmission through the release of opioid peptides and serotonin .

Laughing Gas, Whippets, Cartridges, Hippy Crack, Nangs, Air blast, Aimies, Bullets, Moon Gas, Oz, Poppers, Snappers, Snotballs

Full mechanism is unclear

DRUG EFFECTS Respiratory: increases respiratory rate, decreases functional residual capacity, relaxes bronchia smooth muscle CV: myocardial depression, hypotension and decreased cardiac output

Monitoring

-Complete blood counts because nitrous oxide can cause blood dyscrasias when chronically exposed -Respiratory difficulties or the occurrence of nausea and vomiting could indicate toxicity

CNS: cerebral vasodilation and increased cerebral

Cautions

blood flow, increased cerebral blood volume

-Needs to be co-administered with oxygen to decrease adverse effects -Can cross placenta, so it can cause fetal respiratory depression

causing increased intracranial pressure.

ADVERSE EFFECTS Respiratory: respiratory depression, apnea, diffusion hypoxia CV: hypotension, arrhythmias CNS: dizziness, euphoria, increased CBF/ICP, neuropathy with chronic exposure GI: nausea, vomiting, ileus Other: bone marrow depression with chronic

Laws

Nitrous oxide is legal and regulated by the FDA for use as an anesthetic in medical and dental procedures. The majority of states in the US have laws that make it illegal to possess or sell nitrous oxide for the purpose of inducing an intoxicated state.

exposure, malignant hyperthermia

DRUG INTERACTIONS Methotrexate, CNS depressants like zolpidem, thalidomide, cannabidiol ropinirole, opioid agonists, metoclopramide, buprenorphine, azelastine nasal, and alcohol REFERENCES

Professional opinion:

Due to the range of effects and the therapeutic range requiring particular administration, I do not recommend nitrous oxide for recreational purposes. ~C. Eichler

1. Gillman, M. Mini-Review: Mini-Review: A Brief History of Nitrous Oxide (N2O) Use in Neuropsychiatry. Curr Drug Abuse Rev. 2019;11(1):12-20.

2. Healthcare UK. Medical nitrous oxide. Accessed October 25, 2020. Available at: https://www.bochealthcare.co.uk/en/products-andservices/products-and-services-by-category/medical-gases/medical-nitrous/medical-nitrousoxide.html#:~:text=The%20exact%20mechanism%20of%20action,cells% 20causing%20drowsiness%20and%20sleep.

3. Nitrous Oxide. Drug Facts and Comparisons. Facts & Comparisons eAnswers. Wolters Kluwer Health, Inc. Riverwoods, IL. Available at: http://online.factsandcomparisons.com. Accessed October 25, 2020.

4. Arise Network, Is Nitrous Oxide Legal? Accessed October 25, 2020. Available at: https://www.arisenetwork.com/news/2016/06/01/is-nitrous-oxide-legal/.

5. The Vaults of Erowid. Nitrous Oxide. Accessed October 25, 2020. Available at: https://www.erowid.org/chemicals/nitrous/nitrous_info1.shtml.

OPIUM POPPY Jordan Reiber, Student Pharmacist Fall 2020 History/Background Opium poppy, also known as Papaver somniferum, is a flowering plant whose properties have been known for millennia, dating back to the ancient Sumerians around 4000 BC. The Greeks, Romans, and ancient Minoans also understood the properties of the poppy.

In fact, two wars were fought between the Chinese

Slang Terms Tar, Black Stuff, Black Hash, Black Jack, Black Pill, Black Russian, Hard Stuff, Mud, Gum, Ope, Dreams, Toxy, among

many others

and British Empire for control of the distribution of this coveted plant. Famous figures used opium extract for various remedies such as Thomas de Quincey (notable 19th century writer), Hector Berlioz (19th century

Romantic composer), and even US President Thomas Jefferson, who grew poppy plants in his garden at Monticello.

https://opium.com/what-is-opium/

Pharmacology/Drug Effects Opium is metabolized into alkaloids derived from secondary metabolism into L-DOPA and

4-HPAA. L-DOPA reacts with 4-HPAA to form (S)-norcoclaurine through the benzylisoquinoline metabolic pathway. (S)-norcoclaurine is converted into (S)-reticulin, which is then converted to morphine through the morphinan pathway, and noscapine through the noscapine route. Since opium is metabolized to morphine, the drugâ&#x20AC;&#x2122;s effects would mirror morphine, causing sedation, analgesia, constipation, nausea and vomiting, skin irritation and itching, dry mouth, as well as dependence from long term use.

Drug Interactions/Toxicity Use along with alcohol can lead to significant toxicity and impairment. It should be avoided at all costs. Naltrexone is an opioid antagonist, which would work against the action of opium and should be avoided. Additionally, MAOIs should not

be taken concomitantly as it increases the risk for serotonin syndrome.

Monitoring/Drug Screens Patients on opioids should be monitored for respiratory depression, and patients are advised to have naloxone on hand in the event of an overdose. Patients should not drink alcohol and be cautioned with concomitant benzodiazepine use.

Opioids will show up on drug screenings in the urine anywhere from 2-4 days after administration

Laws Many governments ban the planting of opium on private property. Thomas Jeffersonâ&#x20AC;&#x2122;s Monticello home was raided in 1987 by the DEA because of the poppy plants still being planted in the gardens. In South Korea, there are harsh penalties for those who violate the no-planting rule. The derivatives of opium may be prescribed by a licensed physician with a valid DEA number and are classified as a Schedule II substance.

depending on the opioid taken. .

Professional Opinion In my professional opinion, opioids should only be used for patients with severe pain recovering from surgery, or in patients where all other pain management options have failed. Further, patients with a history of substance abuse disorder should not be started on opioids, and patients on benzodiazepines should not be administered opioids unless they are carefully monitored by their primary physician and with regular communication with other providers. ~J. Reiber

References 1.

2.

3.

4.

Morphine. Drug Facts and Comparisons. Facts & Comparisons eAnswers. Wolters Kluwer Health, Inc. Riverwoods, IL. Available at http://online.factsandcomparisons.com Smith HS. Opioid Metabolism. Mayo Clinic Proceedings 2009; 84:613-624. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2704133/?tool=pubmed What is opium? Opium.com. https://opium.com/what-is-opium/ Accessed November 15, 2020 Interpretation of Opiate Urine Drug Screens. HealthPartners. https://www.healthpartners.com/ucm/groups/public/@hp/@public/@ime/@content/documents/documents/c ntrb_031044.pdf. Accessed October 15, 2020

Prescription Drug Monitoring Program (PDMP) Brenden Yoon Student Pharmacist Fall 2020

What is PDMP? Prescription Drug Monitoring Program (PDMP) is an electronic database that tracks controlled substance prescriptions in a state.

This is mainly to provide the digital data for prescribers, pharmacies, and law enforcement officials to inform any abuse potential behaviors that can contribute to the chronic substance abuse.

Background •The United States has been experiencing opioid epidemics since 1990s.

•Fatal prescription drug overdoses involving opioids almost quadrupled from 1.4 deaths every 100,000 people in 1999 to 5.4 deaths every 100,000 people in 2011.

•The rate of emergency department visits involving prescription drug abuse of opioid medications doubled 2004 to 2011.

•In response this rising issues of opioid crisis, 49 states have developed and implemented Prescription Drug Monitoring Programs and it is a proliferating policy tool across the nation.

Law •Although PDMPs are designed to lower opioid overprescribing, prescriber utilization is low and not all enrolled prescribers regularly use the program •Consequently, 22 out of the 49 states with PDMPs now legally mandate prescribers to use the system before writing for controlled substances with recognized potential for abuse or dependence •Some states require prescribers to access a patient’s prescription history in the database if they suspect drug abuse

Interesting Fact (Indiana’s PDMP) •Effective August 24, 2017, Indiana implemented a statewide, comprehensive platform for healthcare professionals to review patients’ controlled-substance prescription history more quickly and efficiently.

•Statewide integration of the INSPECT platform is a key component of Indiana’s ongoing effort to tackle opioid crisis.

•However, prescription data submissions now being submitted through the Appriss Clearinghouse instead of Indiana PDMP.

Professional Opinion PDMP is utilized more frequently by the health care providers as substance abuse rate decreases but it should be used by every state to address the issues of overprescribing and drug abuse behaviors. However, the program still has its limitations to meet all practice settings and it needs more improvements. – B. Yoon

References -https://www.cdc.gov/drugoverdose/pdmp/states.html -Haffajee RL, Jena AB, Weiner SG. Mandatory use of prescription drug monitoring programs. JAMA. 2015;313(9):891-892. doi:10.1001/jama.2014.18514 -https://www.fox6now.com/news/monitoring-your-medications-when-you-get-a-prescription-who-can-see-it -https://www.clayhealth.com/251/Prescription-Drug-Monitoring-Program-PDM - https://jacohd.org/initiatives/prescription-drug-monitoring-program/ - https://www.ncsl.org/research/health/prescription-drug-monitoring-programs-postcard.aspx - https://www.in.gov/pla/inspect/

Peyote Jacob Robinson Student Pharmacist Fall 2020

Street Names

History

Britton

Stone carvings and other artwork from ancient Mexico referencing peyote have been found, suggesting their use of it for its psychedelic properties.

1896- Dr. Arthur Heffter isolates mescaline as the psychedelic component of peyote.

1919- Dr. Ernst Spath synthesizes mescaline in his lab.

1945- Mescaline is used in experiments in Nazi concentration camps.

1970- The US passes the Controlled Substances Act, which classifies mescaline and peyote as Schedule 1 substances.

1997-US military declares it will allow Native American soldiers to use peyote for religious purposes.

Half Moon Hikori Hikuli Hyatari Nubs Seni Tops

Pharmacology Mescaline will bind all serotonin receptors in the brain but experiences stronger affinity for the 1A and 2A/B/C receptors.

Its psychedelic effects are attributed to its effects on serotonin 2A receptors.

It is also structurally similar to LSD and the two are often compared.

Adverse Effects Drug Interactions Nausea

Contraindications

Tramadol

Anxiety

Immunomodulators

Paranoia

Alcohol

Pregnancy Hypertension

Monoamine Oxidase Inhibitors

Monitoring -Heart Rate and Blood Pressure -Mental Status and Alertness

Law Peyote is a Schedule 1, which means it is illegal to produce, sell, or possess in the United States. However, it is legal for members of the Native American Church and in Oakland, CA.

Professional Opinion Because peyote has no proven medicinal value and high abuse potential, I would not recommend its use in anyone.

-J. Robinson References: 1.

2.

3.

4.

Sober Recovery. Peyote Street Names. Accessed October 20, 2020. Available at: https://www.soberrecovery.com/addiction/peyote-streetnames/#:~:text=Peyote%20is%20marketed%20illegally%20under%20various%20street%20names,%20%20Peyote%20 %207%20more%20rows%20 Drug Times. History of Peyote and Mescaline Use Ancient and Modern. Accessed October 20, 2020. Available at: https://www.drugtimes.org/peyote-mescaline/history-of-peyote-and-mescaline-use-ancient-and-modern.html The Third Wave. The Ultimate Guide to Peyote. Accessed October 22, 2020. Available at: https://thethirdwave.co/psychedelics/peyote/ Peyote. WebMD. Accessed November 5, 2020. Available at: https://www.webmd.com/vitamins/ai/ingredientmono473/peyote#:~:text=Peyote%20is%20a%20small%20cactus.%20Parts%20of%20the,in%20religious%20ceremonies%20 of%20the%20Native%20American%20Church.

U-47700 (3,4-Dichloro-N-[2(dimethylamino)cyclohexyl]-Nmethylbenzamide) Christine Valentin Student Pharmacist Fall 2020 https://hillcountrydetox.com/blog/pink-dangerous-synthetic-opioid-drug/

History “U4” “Pink” “Pinky” “Fake Morphine”

❖ 1978 – U-47700 was first synthesized by the pharmaceutical manufacturer The Upjohn Company. ❖ 1982 – References to U-47700 begin to appear in academic literature ❖ 2015 – First reports of use found in the U.S. ❖ 2016 – U-47700 tablets are being misleadingly sold as Norco ❖ 2016 – DEA temporarily places U-47700 as a schedule I substance ❖ 2018 – DEA permanently places U-47700 as well as its related isomers, esters, ethers, and salts as a schedule I substance

https://www.facebook.com/SouthsideHarmReductionServices/posts/-update-on-pinku47700-yall-the-u47700pink-is-cutwith-fentanyl-this-has-been-ver/172185853472473/

Pharmacology ❖ U-47700 was originally developed as a non-addicting analgesic but was never tested on humans or brought to the market ❖ Instead, research has shown that U-47700 is a synthetic opioid selective for the mu opioid receptor and is about 7.5x more potent than morphine. ❖ U-47700 has demonstrated opioid like effects which are rapidly reversed with the opioid antagonist naloxone.

https://en.wikipedia.org/wiki/U-47700

❖ pinpoint pupils

Toxicology reports are

❖ respiratory

unavailable. Theoretical

depression

interactions include:

❖ cyanosis

❖ alcohol, muscle

❖ sedation

relaxers, and

❖ seizures

https://twitter.com/eliothiggins/status/ 897514514467491841

benzodiazepines

Monitoring

Drug Screens

Respiratory rate Mental status changes Pupil size Color of skin and nails

Currently U-47700 is not included on urine drug screens. However, it can be detected through gas chromatography and mass spectrometry (GC-MS).

U-47700 is a schedule 1 substance meaning it is illegal to sell, produce, or possess in the U.S.

Professional Opinion U-4770 has a high potential for abuse and addiction, and the abuse of this drug can lead to fatal side effects. Therefore, I would not recommend U-47700 for use in anyone. – C. Valentin

❖

Hill Country Detox. Pink: A Dangerous Synthetic Opioid Drug. Hill Country Detox. https://hillcountrydetox.com/blog/pink-dangerous-synthetic-opioid-drug/. Accessed November 20, 2020.

❖

U-47700 (Pink) Drug: Effects, Hazards &amp; Warnings. Drugs.com. https://www.drugs.com/illicit/u-47700.html.

Accessed November 20, 2020.

❖

U-47700 Critical Review Report - World Health Organization. https://www.who.int/medicines/access/controlledsubstances/4.1_U-47700_CritReview.pdf?ua=1. Accessed November 20, 2020.

❖

U-47700 – Backgrounder. https://albertahealthservices.ca/assets/info/res/if-res-mhr-U47700-backgrounder.pdf.

Accessed November 20, 2020.

PROPOFOL Luke Dotson Student Pharmacist Fall 2020

History: -

1973: Propofol was identified as sedative candidate by John B. Glen.

1986: Propofol approved for use in United Kingdom and New Zealand.

1989: Propofol (Diprivan) became FDA approved for use as a short-acting IV anesthetic.

2008: Fospropofol, a newer agent with less pain on injection, was approved the by FDA.

STREET NAMES

-

It is sometimes called by the nickname â&#x20AC;&#x153;Milk of Amnesiaâ&#x20AC;?

It is also referred to by brand names Diprivan, Fresenius Propoven

https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=fee3bd4a-ade3-41fa-839a-48e9af69bcf4&type=display

LEGISLATION - Unlike newer anesthetic, fospropofol, propofol is not currently scheduled by the DEA under the Controlled Substances Act (CSA).

- Due to increased abuse by healthcare workers, some states are beginning to track propofol even without controlled substance status.

HOW DOESITITWORK? WORK? HOW DOES -

-

-

Technical Terms: o Global CNS depression through GABAA receptor agonism o Possibly reduces glutamergic activity through NMDA receptor blockade o Possibly increases dopamine concentration in brain General Terms: o Slows down the nervous system and causes loss of consciousness. o Upon waking, there are common reports of light-headedness, / feelings of being â&#x20AC;&#x153;high.â&#x20AC;? elation, euphoria, and Monitoring: o Cardiac function, Blood pressure, and O2 saturation

https://connecticutsedationdentist.wordpress. com/2013/01/19/benefits-of-cerebraloximetry-monitoring-during-sedationdentistry/

INTERACTIONS/TOXICOLOGY -

Propofol has a total of 321 drug interactions (7 major, 307 moderate, 7 minor)

Common interactions include, but are not limited to: alcohol, antipsychotics, Cannabis, ciprofloxacin, opioids, blood pressure-lowering agents, CNS Depressants

BIG PICTURE Professional Opinion: Propofol may yet have some utility for use in procedural sedation, but I do not recommend its use for recreational or personal reasons. ~L. Dotson References: 1.

2.

3.

4.

Chidambaran V, Costandi A, D'Mello A. Propofol: a review of its role in pediatric anesthesia and sedation [published correction appears in CNS Drugs. 2018 Sep;32(9):873]. CNS Drugs.

2015;29(7):543-563. doi:10.1007/s40263-015-0259-6 Drug and Chemical Information. https://www.deadiversion.usdoj.gov/drug_chem_info/index.html. Published January 1, 2020. Accessed October 24, 2020.

Propofol (Professional Patient Advice). Drugs.com. https://www.drugs.com/ppa/propofol.html. Accessed October 24, 2020.

Strauss E. Discovery and development of propofol, a widely used anesthetic. http:// www.laskerfoundation.org/awards/show/discovery-and-development-propofol-widely-used-anesthetic/.

Published January 2020. Accessed October 24, 2020.

pseudoephedrine/

Street Names1 Crank Chalk

phenylephrine

Meth Speed

Jasmine Liang

https://www.sudafed.com/products/sudafedsinus-congestion-24-hour

Student pharmacist | Fall 2020 Pharmacology2,3 -

Pseudoephedrine o Stimulate alpha-adrenergic receptors of respiratory mucosa – vasoconstriction o Stimulate beta-adrenergic receptors to bronchial dilate, increase heart rate and increase heart contractility

-

Phenylephrine o Stimulate alpha-adrenergic receptors but does not stimulate betaadrenergic receptors – causes systemic arterial vasoconstriction

History4 16th century – Chinese dispensatory described ephedra as circulatory stimulant for coughs 1885 – Japanese chemist N Nagai isolated ephedrine in 4 forms chemically 1920 – KK Chen and CF Schmidt concluded that ephedra and ephedrine have similar actions to adrenaline but longer duration of action 1930 – ephedrine became a reliable asthma treatment 1990s – ephedra was used as dietary supplement and recreational drugs, having similar actions as amphetamine/methamphetamine

Drug Interactions/Toxicology2,3

Heading 1

-

Pseudoephedrine o Concurrent use with tricyclic antidepressant may enhance the vasopressor effect of alpha/beta agonists. o Concurrent use with fentanyl may decrease the serum concentration of fentanyl. o Concurrent use with cannabinoid containing products may enhance fast heartbeat effect.

-

Phenylephrine o Concurrent use with sympathomimetics may enhance the adverse effect of the sympathomimetic medication.

Monitoring2,3/Drug Screens6 -

Cardiac and CNS changes prior to

Law5 -

According to Indiana State Law, a person may not purchase pseudoephedrine containing products that is more than 3.6 grams in one day or 7.2 grams in 30-day period. A person also may not purchase more than 60 milligrams of the products in any one transaction in a convenience package.

-

There are no regulations for phenylephrine.

treatment and throughout treatment -

Blood pressure

-

Pseudoephedrine may appear false positive for amphetamine in drug tests.

Professional Opinion I would recommend consulting the pharmacist about using pseudoephedrine since it has such a high abusing potential. I would only recommend the use of it to treat nasal decongestant and suggest using alternatives such as phenylephrine since it does not have the same high abuse potential. Thus, phenylephrine can be purchased over the counter versus pseudoephedrine cannot. - J. Liang

References 1.

2.

3.

4.

5.

6.

Addiction Center. Drug Street Names. Accessed October 25, 2020. Available at: https://www.addictioncenter.com/drugs/drugstreet-names/ Pseudoephedrine. Lexi-Drugs. Lexicomp. Wolters Kluwer Health, Inc. Riverwoods, IL. Available at: http://online.lexi.com.

Accessed October 25, 2020.

Phenylephrine. Lexi-Drugs. Lexicomp. Wolters Kluwer Health, Inc. Riverwoods, IL. Available at: http://online.lexi.com.

Accessed November 20, 2020.

Mark Blumenthal. American Botancial Council. Epehdra and Ephedrine History. Accessed October 25, 2020. Available at: http://cms.herbalgram.org/herbclip/443/111145-html?ts=1603632150&signature=7434d7070ede06b3788b676d5 47b68e5&ts=1603651064&signature=f3934f34e56758bc4cd7885aea715ade Indiana Professional Licesning Agency. PSE and Ephedrine Retailer Requirements and Purchase Limits. Accessed October 25, 2020. Available at: https://www.in.gov/pla/3267.htm#:~:text=A%20person%20may%20not%20purchase,thirty%20(30)% 20day%20period.

GoodRx. These 14 medications can cause a false positive on drug tests. Accessed November 20, 2020. Available at: https://www.goodrx.com/blog/these-15-medications-can-cause-a-false-positive-on-drug-tests/#:~:text=Used%20for%20sinus% 20and%20nasal,tests%20for%20amphetamine%20or%20methamphetamine.

Psilocybin Ryan Sears Student Pharmacist Fall 2020 *Note: font is used to display hallucinogenic properties of drug AHMAD S.; 2020. https://samoonmd.com/understanding-thebuzz-about-magic-mushrooms-a-look-at-how-psilocybinaffects-the-brain/. Accessed October 14, 2020.

Street Names: • Magic mushrooms • Shrooms • Mushrooms

• • • • • •

History: 1000-500 BCE: Central American cultures build temples to mushroom gods and carve mushrooms stones 1799: First psychedelic mushroom experience documented in London. The group was seized with visions and laughter 1960: Sandoz Pharmaceutical begins producing psilocybin pills 1968: Possession of psilocybin is federally banned in US 1970: Psilocybin is classified as a schedule I drug 2006: Psilocybin has been shown to reduce severity and frequency of cluster headaches

• •

•

Pharmacology: Provides effect through acting at serotonin (5-HT) receptors in the brain.

When hallucinogens bind with receptors in cortical neurons, this changes cellular signaling and functioning via the excitatory amino acid glutamine.

The effect is a complex manifestation in consciousness.

Because of its hallucinogenic properties, it is lipid soluble as it can cross the brain. It is detectable in the blood 20 minutes after

Adverse Effects: • Panic reactions • Intensified feelings and sensory experiences • Increased blood pressure • Increased breathing rate • Uncoordinated movements Drug Interactions: • Concurrent use of other CNS depressants increases serotonin levels which can be deadly • Drugs that alter pH of the stomach will interact with this drug Contraindications: • Use with other CNS depressants • Alcohol • Pregnancy Laws: Psilocybin is a Schedule 1; thus, it is illegal to produce, sell, or have in the United States

•

Monitoring: Monitor respirations, blood pressure, and heart rate

• •

Mental status changes Muscle coordination

•

Professional Opinion: Because of the abuse potential and serious side effects I would not recommend Psilocybin to any patient. ~ R. Sears

References: 1. Erowid Psilocybin & Psilocin Vault. Erowid.org.

https://www.erowid.org/chemicals/psilocybin/psilocybin.shtml. Published 2020.

Accessed October 14, 2020.

2. Psilocybin (Magic Mushrooms) Uses, Effects & Hazards - Drugs.com. Drugs.com. https://www.drugs.com/illicit/psilocybin.html. Published 2020. Accessed October 14, 2020.

3. Barbara E. Bauer M. The Pharmacology of Psilocybin and Psilocin. Psychedelic Science Review. https://psychedelicreview.com/the-pharmacology-of-psilocybin-andpsilocin/. Published 2020. Accessed October 14, 2020.

4. Psilocybin. Dea.gov. https://www.dea.gov/factsheets/psilocybin. Published 2020.

Accessed October 14, 2020.

FALL 2020

SALVIA DIVINORUM Delaney McCafferty, Student Pharmacist

https://www.verywellmind.com/salvia-divinorum-a-legal-trip-3200920

History: -Herb in the mint family -Used for centuries in religious ceremonies by the Mazatec Indians. They were native people who originated in Oaxaca, Mexico.

They believed that salvia divinorum was an incarnation of the Virgin Mary Abuse: -Typically used as a recreational drug to produce hallucinations -Not particularly addictive Pharmacology: -Active ingredient is neoclerodane diterpene salvinorin A that acts as a Îş opioid receptor agonist

Slang Terms: -Divine Mexican Mint -Diviner's Mint -Divinorin A -Herb of the Virgin -Sally D -Sage of the Seers -Shepherdess -Maria pastora -Salvia

Drug Effects: -hallucinations -alteration of visual perception -mood swings -feelings of detachment from body

Drug Interactions: -No drug interactions have been found

https://www.avalonmagi cplants.com/smartshop/ salvia-divinorum/ensalvia-divinorum-extract10x-1-gram

Laws: -Legally sold as salvia divinorum in most states -Does not have approved medical use in the United States -Not controlled under the Controlled Substances Act -NOT legal to possess, transport, or sell in Indiana Monitoring/Drug Screening: -Screening through negative ion LC-MS/APCI -Lower limit detection using FDA guidelines of 2 ng/mL -Difficult to detect with routine testing

Toxicity: -Little to no toxicity associated with high doses of salvia divinorum in mice Personal Opinion: I gathered that salvia divinorum is not necessarily used for your typical recreational party drug experience. It is more so used for a ritualistic or philosophical experience. The effects of salvia divinorum put users in a more introspective state used for meditation, contemplation, and self-reflection. This stems from its history of use in religious ceremonies. Salvia Divinorum should not be used unless it is a part of a cultural or religious ceremony. ~D.McCafferty

https://sensiseeds.com/en/blog/salvia-divinorum-101-use-effects-history-science/

References: 1. Drug Enforcement Administration. Salvia Divinorum. Available at: https://www.dea.gov/factsheets/salvia-divinorum. Accessed September 30, 2020.

2. National Institute on Drug Abuse. Salvia Divinorum. Available at: https://www.drugabuse.gov/es/informacion-sobredrogas/sustancias-de-abuso-habitual#salvia. Accessed September 30, 2020.

3. Prisinzano TE. Psychopharmacology of the hallucinogenic sage Salvia divinorum. Life Sci. 2005;78(5):527-531. doi:10.1016/j.lfs.2005.09.008 4. WebMD. Salvia Divinorum. Available at https://www.webmd.com/vitamins/ai/ingredientmono-1043/salvia-divinorum. Accessed September 30, 2020

History Scopolamine has been used as a medication and poison since ancient times. It is found in a number of plants, including henbane and mandrake.

In the early 20th century, physicians started administering scopolamine before anesthesia and surgery to minimize secretions and provide sedation.

It was a popular treatment for labor pain and termed â&#x20AC;&#x153;twilight sleep,â&#x20AC;? introduced in 1907. In labor, it was combined with morphine in controlled doses.

Twilight sleep deeply sedated the mother and prevented her from forming memories of the childbirth experience.

Today, it is sometimes used to treat motion sickness, nausea and vomiting.

Scopolamine AMEE PATEL Student pharmacist Fall 2020

Pharmacology

https://en.wikipedia.org/wiki/Hyoscine

https://english.elpais.com/elpais/2016/09/22/ineng lish/1474538538_985157.html

Slang Terms THE DEVIL'S BREATH BURUNDANGA SCOPACE LADEMAR ZOMBIE DRUG

A belladonna alkaloid anticholinergic Acts as a competitive inhibitor at postganglionic muscarinic receptor sites of parasympathetic nervous system & on smooth muscles that respond to acetylcholine but lack cholinergic innervation.

Drug Interactions & Toxicology Interactions with: lorazepam atropine benadryl dramamine meclizine miraLAX morphine oxycodone acetaminophen phenergan,

Laws Surrounding Scopolamine Use Scopolamine is not classified by the DEA as a controlled substance.

Monitoring In patients with open-angle glaucoma, intraocular pressure should closely be monitored if taking scopolamine. Adjustments to glaucoma therapy should be made accordingly

Professional Opinion Due to scopolamine not being a controlled substance, and thus a low risk for addiction, I would recommend the use of this medication in instances deemed appropriate â&#x20AC;&#x201C;A Patel.

References Canada, T. (2013, September 03). The World's Scariest Drug. Retrieved November 22, 2020, from https://www.huffingtonpost.ca/2013/09/03/d evils-breathscopolamine_n_3860318.htmlGarcĂ­a, J. (2016, September 23).

Burundanga, the stealth drug making a name for itself in the US and Europe. Retrieved November 22, 2020, from https://english.elpais.com/elpais/2016/09/22 /inenglish/1474538538_985157.html Scopolamine - Medical Countermeasures Database - CHEMM. (n.d.). Retrieved November 22, 2020, from https://chemm.nlm.nih.gov/countermeasure_s copolamine.htm The Wood Library-Museum. (n.d.). Retrieved November 22, 2020, from https://www.woodlibrarymuseum.org/museu m/item/900/scopolamine

Amillia Mize-Student Pharmacist- Fall 2020

https://www.technologynetworks.com/dru g-discovery/news/predicting-the-

side-effects-of-drugs-336315

Sedatives History/abuse Pharmacology & Drug Effects A sedative is a substance that induces sedation. They are CNS depressants and interact with brain activity causing its deceleration. There are many different types of sedatives that have different mechanisms of action, but the majority of them affect the neurotransmitter gammaaminobutyric acid (GABA), which are brain chemicals performing communication between brain cells. Even though each sedative act in its own specific way, they all produce beneficial relaxing effects by increasing GABA activity in the brain.

Common Slang terms •

Christmas Rolls

•

Chorals

•

Dolls

•

Disco Biscuits

•

Gangster Pills

Sedatives have been around for a long time. They were abused in the late 1800s and early 1900’s and mixed with alcohol to enhance the effects of the drug such as barbiturates. Doctors would prescribe use of sedatives back then to deal with being overwhelmed with stress of the day, so they were commonly used . It didn’t take long to discover all the problems with dependence, tolerance and lethal overdosing as a product of overuse and mixing with other substances. In 1950s the first benzodiazepines (sedative-hypnotics) were marketed as valid substitutes for dangerous barbiturates This was a lie, long term use of benzodiazepines can have the same dangerous long-term effects as barbiturates. During the 1970s and 1980s, there was an epidemic of prescriptions written for sedatives. They are still one of the most prescribed classes of drugs, even though the medical community has become more aware of the problem.

Drug monitoring

Drug interactions The main drug interaction reported with sedatives is the concurrent use of other depressants such as alcohol or high dose opioids with the sedative prescription. The Center of Disease Control reported that between 1996 and 2013, the number of adults who filled a benzodiazepine (sedativehypnotic) prescription increased by 67 percent.

There is a large risk of overdose with the use of sedatives with alcohol. This involves thousands of hospitalizations every year. The CDC also reported more than 30 percent of overdoses involving opioids also involve benzodiazepines. Symptoms of overdose of sedatives or drug interactions that cause over sedation may include weakness, high fever, stupor, excessive confusion, tremors, and even seizures. Many overdoses result in death.

Laws .

The Controlled Substances Act (CSA) places all substances which were in some manner regulated under existing federal law into one of five schedules.

This placement is based upon the substance’s medical use, potential for abuse, and safety or dependence liability. More information can be found in Title 21 United States Code (USC) Controlled Substances Act. A majority of sedatives are considered to be a controlled substance usually a class 3 or 4. If a citizen is caught handling these control drugs without a prescription then charges can be brought against this person. Charges can also be brought against a person if they are caught selling their prescription medications to people on the street. This can result in time in jail or federal prison, heavy fines, community service, probation and a record that can effect your whole future.

A Sedative/Hypnotic drug panel can be completed upon admittance to any medical facility.

You can also buy an over the counter drug test that will screen for these drugs in a person’s system. In addition to most practitioners that prescribe sedatives make patients sign drug contracts that they will use the drug appropriately. They also reserve the right to have you complete a drug analysis if they think you are abusing the drug. To monitor for an overdose, you monitor respiratory rate.

Professional opinion Sedatives would not be prescribed if they had little or no benefit. Healthcare providers have the responsibility to access the risk vs. benefit of a patient when prescribing a new medication. I urge you to do your own research about the drug and realize the side effects and abuse potential. Don’t overuse these medications and when taking them chronically be aware that you should not mix them with alcohol or any narcotic because of the risk it poses to you. Take responsibility for your own health and management of medications and be proactive about knowing the risks of drug therapy. ~ A. Mize

Sources:

Dr. Tomislav Meštrović, P., 2020. What Are Sedatives?. [online] News-Medical.net.

Available at: <https://www.news-medical.net/health/What-are-Sedatives.aspx> [Accessed 1 October 2020].

Verywell Mind. 2020. Street Names For The Most Common Depressants. Available at:https://www.verywellmind.com/commonstreet-names-for-depressants-66581> [Accessed 1 October 2020].

Dea.gov. 2020. The Controlled Substances Act. [online] Available at: <https://www.dea.gov/controlled-substances-act> [Accessed 1 October 2020].

DrugAbuse.com. 2020. Penalties For Drug Abuse, Selling, And Smuggling In The USA. [online] Available at: <https://drugabuse.com/addiction/drug-abuse-penalties/> [Accessed 1 October 2020].

STREET NAMES

Sildenafil (Viagra)

Little blue pill Blue bomber Blue diamond Pleasure tabs Hard stop

Sildenafil. Wikipedia. https://en.wikipedia.org/wiki/Sildenafil.

Published October 15, 2020. Accessed October 24, 2020.

Fayrouz Mohamed Student Pharmacist Fall 2020

HISTORY In 1989, sildenafil was originally discovered for heartchest pain use such as hypertension and angina.

In 1998, sildenafil was FDA approved as Viagra. It was the first oral treatment used for erectile dysfunction. This is because further research was conducted and it was found that it is more effective at inducing ejections rather than treating hypertension or angina.

PHARMACOLOGY The drug acts by inhibiting phosphodiesterase type 5 (PDE-5) in the smooth muscle. This enzyme functions to promote the breakdown of cGMP to prevent blood flow to the penis not allowing erection.

Therefore, by inhibiting it, the concentration of cGMP increases.

This leads to vasodilation of the pulmonary bed, allowing blood flow to the penis, therefore ejection upon arrowsal.

Wimpory S, Kavanagh MJ, Sandor, et al. Buy Viagra (Sildenafil) Online - Online Doctor UK. Zava. https://www.zavamed.com/uk/viagra.html. Published October 7, 2020. Accessed October 24, 2020.

DRUG INTERATIONS

Sildenafil must never be used in combinations with other nitrates. Examples include nitroglycerin and recreational drugs called "poppers", like amyl nitrate and butyl nitrate. Their use together can lead to sever hypotension, and possibly death.

LAWS

Sildenafil is a schedule 4 of the Poisons Standards with low potential of drug abuse and low risk of dependency.

A prescription is required from the doctor in order to purchase sildenafil.

MONITORING Monitor blood pressure and heart rate when used with other medications that lower blood pressure.

Monitor any signs and symptoms of pulmonary edema.

Rx Sildenafil Citrate 20mg Tablets 90 count. www.LambertVetSupply.com. https://www.lambertvetsupply.com/Rx-SildenafilCitrate-20mg-Tablets-90-count_p_27830.html.

Accessed November 15, 2020.

PERSONAL OPINION

I believe that sildenafil should be used and prescribed by prescribers accordingly for erectile dysfunction. I do not recommend its use in men who have uncontrolled blood pressure and worsening heart related chest pain. Furthermore, it should not be advised for those who have had a previous heart attack. More evidence has shown some effects on hearing loss, so I do not recommend it for those experiencing it. ~ F. Mohamed

REFERENCES: Sildenafil. Wikipedia. https://en.wikipedia.org/wiki/Sildenafil. Published October 15, 2020. Accessed October 24, 2020.

Urban Thesaurus. Urban Thesaurus - Find Synonyms for Slang Words. https://urbanthesaurus.org/synonyms/viagra. Accessed October 24, 2020.

Viagra: How a Little Blue Pill Changed the World. Drugs.com. https://www.drugs.com/slideshow/viagra-little-blue-pill-1043. Accessed October 24, 2020.

Sildenafil Drug Interactions. Drugs.com. https://www.drugs.com/drug-interactions/sildenafil.html. Accessed October 24, 2020.

Viagra. Findlaw. https://injury.findlaw.com/product-liability/viagra.html. Published December 4, 2018. Accessed October 24, 2020.

Sildenafil. Lexi-Drug. Lexicomp. Wolters Kluwer Health, Inc. Riverwoods, IL. Available at: http://online.lexi.com/crlonline. Accessed October 24, 2020 Australian Government Department of Health. Therapeutic Goods Administration. 2.1 Sildenafil. Therapeutic Goods Administration (TGA). https://www.tga.gov.au/book-page/21-sildenafil. Published October 31, 2017. Accessed November 15, 2020.

Tenocyclidine Brandon Speakman, Student Pharmacist, Fall 2020

History/Background -Originally modified from phencyclidine (PCP) -Developed as anesthetic, but abandoned due to side effects -Considered to be more potent than PCP -Peak popularity during 1970s and 1980s

Slang Term

https://pubchem.ncbi.nlm.nih.gov/compound/Tenocy clidine

-TCP

Pharmacology TCP binds to NMDA receptors in the brain, causing hallucinogenic and stimulant effects https://health.clevelandclinic.org/do-you-have-aslow-or-racing-heartbeat/

Drug Effects In low to moderate doses, TCP can cause: -Confusion

-Sense of an â&#x20AC;&#x153;out of bodyâ&#x20AC;? experience -Tremors -Elevated blood pressure + heart rate

Drug Interactions/Toxicology TCP can interact with other medications that are active in the brain, especially alcohol.

Very high doses of TCP can cause visual and auditory hallucinations, memory loss, respiratory arrest, coma, and death.

Laws TCP is a schedule 1 controlled substance, meaning that is likely to be abused and has no known legitimate medical use.

Monitoring/Drug Screens -Urine detection: 2-5 days -Blood detection: up to 24 hrs -Saliva Detection: 1-5 days -Hair follicle detection: up to 90 days

https://www.verywellmind.com/how-long-does-tcp-stay-in-yoursystem-80330

My Professional Opinion In my professional opinion, TCP should not be used due to its extensive side effect profile and having no indicated use. -B. Speakman REFRENCES Drugs.com. TCP (Tenocyclidine). Available at: https://www.drugs.com/illicit/tenocyclidine.html. Accessed October 15, 2020.

Drugs Details. Tenocyclidine: Use, effects, street name, abuse, drug test. Available at: https://drugsdetails.com/tenocyclidine-use-effects-street-name-abuse-drug-test/. Accessed October 15, 2020.

Buddy T. Very Well Mind. How Long TCP Stays in Your System. Available at: https://www.verywellmind.com/how-long-does-tcp-stay-in-your-system-80330. Accessed October 15, 2020.

PubChem. Tenocyclidine. Available at: https://pubchem.ncbi.nlm.nih.gov/compound/Tenocyclidine. Accessed October 15, 2020.

GRACE MONTI Student pharmacist

FALL 2020

Toad Venom More about the drug How it Works:

Nonselective 5-HT agonist that blocks the reuptake of 5-HT. It has a higher affinity for the 5-HT1A receptor. It is metabolized by MAO-A and has the active metabolite bufotenine which is potent for the 5-HT2A receptor. Though it is unclear if it has any discernable psychactive effects.

Causes auditory, visual, time perception distrotion and emotional expirences

History and Background of Toad Venom In certain species of toads, their venom produces a chemical that can cause a high if smoked. In particular the species Bufo alvarius venom contains 5-MeO-DMT in

Slang Terms

a high enough quanitity that can be smoked directly. 5MeO-DMT is on of the most potent psychactive agents

1. Colorado river toad

concocted by nature. It was stated that only 1.2% of adults

2. Sonoran desert toad

in the general population reported any "psychedelic

3. Toad venom

tryptamine" use between 2009 and 2013. Most adults

4. Cane toad

report that they used it less than four times and mostly

5. Otac (the venom)

for spiritual exploration. People obtain this drug either directly from the frog or hirer outside sources

G. MONTI

Drug Interactions/Toxicology, laws, monitor/drug screens There are three major toxicities associate with toad venom. First is cardioactive glycoside effect that can lead to ventricular fibrillation. Second is the pressor effect (vasoconstriction) caused by bufotemines that constrict arterial blood vessels. The third toxicity is the hallucinogenic effect. You would want to monitor for these side effects. Also a high from this drug lasts 30 minutes where time, vision, and sound becomes disoriented. People equate this to being in contact with a higher power. Currently, 5-MeO-DMT is considered a schedule 1 controlled substance because it is an hallugcinogen and carries up to a 10 year prision sentance for possession. There are prelimonary studies at John Hopkins looking into using 5-MeO-DMT to treat deprssion or anxiety though it use it not recommended reconationally.

Professional Opinon: I would not recommend this drug due to the potential for abuse and with the little scientific evidence out there to support therapeutic benefit for toad venom. It should be an illegal substance.

-Grace Monti References: 1. The vaults of Erowid. Psychoactive toad venom. Accessed October 24, 2020. Available at: https://www.erowid.org/animals/toads/toads.shtml 2. Davis AK, Barsuglia JP, Lancelotta R, Gract RM, Renn E. The epidemiology of 5-methoxy-N, N-dimethyltryptamine (5-MeO-DMT) use: benefits, consequences, patterns of use, subjective effects, and reasons for consumption. J Psychopharmacol, 2018; 1-14.

3. PSR. 5-MeO-DMT. Accessed October 24, 2020. Available at: https://psychedelicreview.com/compound/5-meo-dmt/.

4. PSR. Bufo alvarius, the psychedelic toad of the sonoran desert is published Accessed October 24, 2020. Available at: https://psychedelicreview.com/event/bufo-alvarius-the-psychedelic-toad-of-the-sonoran-desert-ispublished/https://www.addictioncenter.com/drugs/hallucinogens/toad-venom-addiction-abuse/ 5. Addiction Center. Psychedelic toad venom is the new trendy hallucinogen. Accessed: November 19, 2020. Available at: https://www.addictioncenter.com/news/2019/10/trendy-psychedelic-toad-venom

G. MONTI

Tramadol (Ultram) Hanna Persha - Student Pharmacist Fall 2020

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Developed in 1962 by Grunenthal GmbH Approved in 1977 after 15 years of testing under the name Tramal Was not available in the US and UK until 1995 - approved in 1995 as a noncontrolled analgesic After reports of diversion and abuse, revisions were made to tramadolâ&#x20AC;&#x2122;s labelling and the FDA added warnings of abuse In 2017 and 2018, 1.6 million people aged 12 and up in the US misused tramadol products

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Chill pills Trammies Ultras

- Synthetic opioid analgesic with a dual mechanism of action - Binds to mu-opioid receptors All - Its metabolite has a higher affinity and is more potent - Inhibits the uptake of both norepinephrine and serotonin (acts as an SNRI)

- Converted to its active metabolite by CYP2D6- activity varies among individuals and ethnic groups - Can cause seizures due to its monoaminergic effects - Can cause serotonin syndrome when combined with other serotonergic drugs - Drug interactions: CYP2D6 inhibitors, monoamine oxidase inhibitors, and opioid antagonists

Placed in Schedule IV of the Controlled Substances Act on July 2, 2014

- Seizure frequency and severity - Signs and symptoms of respiratory depression - Signs of sedation - Suicidal ideation or worsening depression - Signs and symptoms of hypotension

Yohimbe Sam Plumer Student Pharmacist Fall 2020

History Yohimbe is a tree that is native to Western Africa.

The bark of the tree is thought to boost libido in men and women.

Yohimbe has been used for other conditions like: hypertension, fatigue, and various other heart conditions.

Laws Yohimbe is not controlled in the United States, therefore all parts of the plant are legal to grow, buy, possess, and distribute without a license or certification of any kind.

Drug Interactions - MAOIs – Yohimbine has similar effects compared to MAOIs, so taking then concomitantly may increase side effects and the effects of yohimbe itself.

- Clonidine – taking together will decrease the blood pressure lowering effects of clonidine - Guanabenz (Wytensin) – taking together may decrease the effectiveness - Any hypertensive medications – Yohimbe increases BP, so taking with any hypertensives may decrease the effectiveness - Naloxone (Narcan) – may increase the chances of anxiety, nervousness, trembling, and hot flashes when taken together - Stimulants – Yohimbe is a stimulant and may lead to increased HR and BP when taken with another stimulant like pseudoephedrine - Phenothiazines – both medications have same type of effects, therefore may increase the chances of side effects.

Slang Terms There are not many "slang terms" that you would hear as a typical "street name" for Yohimbe.

Some other names that you could hear are: 11-hydroxy Yohimbine, Alpha Yohimbine HCl, Corynanthe Yohimbe, Corynanthe Johimbe, Corynanthe johimbi, Corynanthe yohimbi, Johimbi, Pausinystalia yohimbe, Pausinystalia johimbe, Yohimbehe, Yohimbehe Cortex, Yohimbine, Yohimbine HCl, Yohimbinum Muriaticum.

Toxicology Toxicology is not very well known for Yohimbe, as it is not studied much.

Taking 15- 30 mg daily for sexual performance has been studied, up to 100 mg a day in some cases. At high doses like this, it is expected to have some very serious side effects, including death at these high doses.

Pharmacology and Drug Effects Yohimbine is a pre-synaptic alpha-2adrenergic blocking agent. The exact mechanism of action has not been fully discovered. Yohimbe exhibits a benefits on erectile ability by blocking the central alpha2-adrenergic receptors, producing an increase in sympathetic drive and an increase in norepinephrine release and in firing rate of cells in the brain. Yohimbe may also have beneficial effects on the release of dopamine and serotonin. Yohimbe is primarily metabolized in the kidney and liver, though it has not been studied extensively.

Monitoring and Drug Parameters Monitoring depends on what you are using yohimbe to treat. For Sexual performance you can monitor libido of patients. If someone is using it for heart problems or blood pressure, then blood pressure and heart rate should be monitored. It also may be important to check on mental status due to its similar effects as MAOIs.

Professional Opinion Due to the lack of studies on yohimbe, I would recommend that this not be someoneâ&#x20AC;&#x2122;s first line treatment for any condition but should seek other medical attention prior to trying this. As a last line treatment, it is shown that there may be beneficial effects from yohimbe when taken in small doses.

- Sam Plumer

References 1. Erowid Yohimbe (Pausinystalia yohimbe) Vault. Erowid.org. https://www.erowid.org/plants/yohimbe/. Published 2020. Accessed November 20, 2020.

2. Yohimbe. WebMD. https://www.webmd.com/diet/supplement-guideyohimbe#1. Published 2020. Accessed November 20, 2020.

3. Yohimbe: Uses, Side Effects, Interactions, Dosage, and Warning. Webmd.com. https://www.webmd.com/vitamins/ai/ingredientmono-759/yohimbe. Published 2020. Accessed November 20, 2020.

4. Yohimbine | DrugBank Online. Go.drugbank.com. https://go.drugbank.com/drugs/DB01392. Published 2007. Accessed November 20, 2020.