DEXTROMETHORPHAN

TIANA DUNCAN, Student pharmacist FALL 2022

History And Background

Dextromethorphan is a cough suppressant for treating dry cough. It has been available over the counter since 1958 and is found in over 120 cough and cold products. It has overtaken codeine as the most widely used cough suppressant. Abuse traditionally involved drinking large volumes of the liquid cough syrups. However, new tablet and gel capsule formulations containing higher doses makes it much easier to consume and conceal at school or work. Dextromethorphan powder is another formulation that is sold over the Internet, which offers snorting as another route of administration. Dextromethorphan can also be illicitly manufactured and dispensed in tablets mixed with other drugs, like pseudoephedrine or met hamphetamine. Abuse is most prevalent in teenage and young adult population, but is still misused by individuals of all ages. Since 2010, the prevalence of OTC cough medicine abuse has been declining due to efforts by the Consumer Healthcare Products Association to raise awareness to teens and their parents.

Slang Terms

o DXM o robo o rojo o velvet o skittles

Pharmacology

Dextromethorphan belongs to the antitussive medication group. It exerts its pharmacological action by crossing the blood-brain barrier to activate sigma opioid receptors in the medullary cough center. It desensitizes the cough receptors and therefore, suppresses the cough reflex. It is structurallly related to codeine and a non-opioid derivative of morphine.

https://www.youtube.com/watch?

v=ACSur7II7SQ&ab_channel=D emystifyingMedicineMcMaster

Drug Effects

When taken at high doses, dextromethorphan has a hallucinogenic effect that induces euphoria and other psychoactive effects, including confusion, agitation, sedation, loss of motor coordination and paranoia. Typical adverse effects are dizziness, drowsiness, nausea, and stomach upset.

Drug Interactions

o MAO inhibitors o SSRIs o memantine o disulfram o CNS depressants (alcohol) o quinine o methotrimeprazine

Monitoring And Drug Screening

Dextromethorphan can cause falsepositive results for PCP urine drug screens. However, it is unlikely that consumption of dextromethorphan will produce a false-positive for opiate urine drug screens. Many states now require patients to be 18 years or older to purchase products containing dextromethorphan.

References

Dextromethorphan is a legally marketed cough suppressant sold over-the-counter without a prescription. It is not considered a controlled substance and is not regulated under the Controlled Substance Act.

Professional Opinion

When used at the recommended doses and for its intended purpose, dextromethorphan is safe and effective. It can be sold behind the counter, like pseudoephedrine, in order to keep track of how much and how often someone is buying it. This could provide context for recognizing a pattern of behavior, so we can talk to patients to see what they are using it for and help them understand the risks of taking too much. ~

T. Duncan

1. Spangler DC, Loyd CM, Skor EE. Dextromethorphan: a case study on addressing abuse of a safe and effective drug. Subst Abuse Treat Prev Policy. 2016;11(1):22. Published 2016 Jun 23. doi:10.1186/ s13011-016-0067-0

2. DXM drug fact sheet. Department of Justice/Drug Enforcement Administration. Accessed October 5, 2022. Available at: https://www.dea.gov/sites/default/files/2020-06/DXM-2020.pdf

3. Intelligence bulletin DXM (dextromethorphan). US Department of Justice. Accessed October 5, 2022. Available at: https://www.justice.gov/archive/ndic/pubs11/11563/11563p.pdf v=ACSur7II7SQ&ab_channel=DemystifyingMedicineMcMaster

4. The misuse of dextromethorphan. Demistifying Medicine McMaster. Accessed Ocotober 5, 2022. Available at: https://www.youtube.com/watch?

5. Dextromethorphan. Lexi-Drugs. Lexicomp. Wolters Kluwer Health, Inc. Riverwoods, IL. Accessed October 5, 2022. Available at: https://online.lexi.com

6. Michael F. Neerman, PhD, FACB, Chinemerem L. Uzoegwu, BSN, RN, Is Dextromethorphan a Concern for Causing a False Positive During Urine Drug Screening?, Laboratory Medicine, Volume 41, Issue 8, August 2010, Pages 457–460, https://doi.org/10.1309/LMC384VVWIPJFXCZ

7. Storrow AB, Magoon MR, Norton J. The dextromethorphan defense: dextromethorphan and the opioid screen. Acad Emerg Med. 1995;2(9):791-794. doi:10.1111/j.1553-2712.1995.tb03273.x

DIHYDROEPIANDROSTERONE (DHEA)

BRETT DUNCAN

SECOND YEAR PROFESSIONAL STUDENT

FALL 2022

HISTORY:

A GERMAN BIOCHEMIST NAMED ADOLF BUTENANDT FIRST ISOLATED DHEA IN THE 1930S. DHEA IS USED AS AN ANABOLIC STEROID FOR BOOSTING IN SPORTS.

PLAYERS WOULD USE IT TO INCREASE PERFORMANCE. THESE PLAYERS LIKE BARRY BONDS WOULD GAIN MASS AMOUNTS OF MUSCLE AND WOULD BREAK RECORD AFTER RECORD IN THEIR RESPECTIVE SPORTS

BACKGROUND:

DHEA IS A NATURAL HORMONE FOUND IN THE BODY. IT IS PRODUCED IN THE ADRENAL GLANDS AND IS A PRECURSOR TO OTHER HORMONES LIKE TESTOSTERONE.

SLANG TERMS/OTHER NAMES:

ANABOLIC STEROIDS

DHEA

PERFORMANCE ENHANCEMENTS

3B-HYDROXY-ANDROST-5-ENE-17-ONE

ANDROSTENOLONE

DEHYDROEPIANDROSTERONE

DHEA-S

GL701 PRASTERONE.

HTTPS://FINESTGEARS.TO/HOW-ANABOLICSTEROIDS-CAME-TO-BE/

LAWS:

THE FDA BANNED DHEA SALES THAT WERE OTC BUT SINCE THE IMPLEMENTATION OF THE DIETARY SUPPLEMENT HEALTH AND EDUCATION ACT OF 1994 DHEA IS AVAILABLE AND SOLD AS A DIETARY SUPPLEMENT. THIS PRODUCT IS BANNED UNDER WORLD ANTIDOPING CODE AND THE NATIONAL COLLEGIATE ATHLETIC ASSOCIATION.

HTTPS://ALONGTHEBOARDS.COM/2020/ 05/28/ANABOLIC-STEROIDS-FOR-SALE/

DRUG INTERACTIONS/ TOXICOLOGY:

• ANTIPSYCHOTICS

• CARBAMAZEPINE

• ESTROGEN

• TESTOSTERONE

• LITHIUM

• SSRIS

• TRIAZOLAM

• VALPROIC ACID

DHEA HAS BEEN SHOWN TO BE A CARCINOGEN IN RODENTS BUT NOT IN HUMANS. OTHER STUDIES SHOW CANCER PROTECTIVENESS. SIDE EFFECTS INCLUDE HIRSUTISM, GYNECOMASTIA, TESTICULAR WASTING, REDUCED HDL, INCREASED BLOOD PRESSURE

PHARMACOLOGY/DRUG EFFECTS:

DHEA IS USED TO HIT MANY DIFFERENT RECEPTORS INCLUDING NMDA, GABA, T-TYPE CALCIUM CHANNELS, PPAR-ALPHA, AND MANY MORE. THIS PRODUCT IS ALSO METABOLIZED TO FORM ESTROGEN AND TESTOSTERONE FOR MUSCLE BUILDING, SEX HORMONES, AND MUCH MORE.

MONITORING/SCREENING:

PLAYERS IN THE NCAA AND OTHER SPORTS ORGANIZATIONS ARE SCREENED YEAR-ROUND. TYPICALLY, SEVEN PLAYERS ARE RANDOMLY PICKED EACH WEEK FOR SCREENING. THEY ARE SUBJECTED TO A DRUG TEST TO SEARCH FOR VARIOUS DRUGS INCLUDING DHEA.

PROFESSIONAL OPINION:

HTTPS://WWW.NORTHCOUNTRYPUBLICR ADIO.ORG/NEWS/NPR/11662481/BONDSSHATTERS-BASEBALL-S-BIGGEST-RECORD

IN MY PROFESSIONAL OPINION I WOULD SUGGEST USING THIS PRODUCT FOR VAGINAL ATROPHY, DEPRESSION, AGEING AND OSTEOPOROSIS THE USE OF DHEA AS A PERFORMANCE ENHANCEMENT SHOULD NOT BE ALLOWED BECAUSE IT GIVES PEOPLE MORE OF AN ADVANTAGE. DHEA COULD ALSO LEAD TO FURTHER COMPLICATIONS IF USED INCLUDING ACNE AND HIRSUTISM IN WOMEN, GYNECOMASTIA AND TESTICULAR WASTING IN MEN, UNFAVORABLE EFFECTS ON LIPID METABOLISM LIKE REDUCED HDL, AND INCREASED BLOOD PRESSURE IN BOTH GENDERS.

~B Duncan

References

1. KLINGE CM, CLARK BJ, PROUGH RA. DEHYDROEPIANDROSTERONE RESEARCH: PAST, CURRENT, AND FUTURE. VITAM HORM. 2018;108:1-28. DOI:10.1016/BS.VH.2018.02.002

2. DEHYDROEPIANDROSTERONE. PEDIATRIC DRUGS ONLINE. LEXICOMP. WOLTERS KLUWER HEALTH, INC. RIVERWOODS, IL. ACCESSED SEPTEMBER 14, 2022. HTTP://ONLINE.LEXI.COM

3. DHEA. DRUGS.COM. PUBLISHED FEBRUARY 12, 2021. ACCESSED OCTOBER 11, 2022. HTTPS://WWW.DRUGS.COM/MCA/DHEA

4. 2. NCAA BANNED SUBSTANCES. NCAA.ORG. PUBLISHED JULY 14, 2022. ACCESSED OCTOBER 11, 2022. HTTPS://WWW.NCAA.ORG/SPORTS/2015/6/10/NCAABANNED-SUBSTANCES.ASPX

History& Background

N,N-dimethyltryptamine

N,N-dimethyltryptamine

HunterDuncan StudentPharmacist Fall 2022

WheredoesDMT originate?

DMT was first synthesized by Richard Manske in 1931, but its hallucinogenic properties were discovered in 1956 when Stephen Szara extracted DMT from the Mimosa hostilis plant and injected intramuscularly.

WhyDMT?

Hallucinogenics like DMT are commonly sought out as they impact effects on perception and behavior. Hallucinatory experiences are thought to help better understand the human brain.

Pharmacolo��

haveneverseenamental healthproviderbefore. https://www.talktofrank. com/drug/dimethyltrypta mine

Slang terms

Businessman'sTrip Fantasia

https://www.thelancet.com/ journals/lanonc/article/ https://adf.org.au/drugfacts/dmt/

Laws

DMTis a Schedule1 controlled substancewhich meansitisillegal tomanufacture, distribute,buy,or possess DMT. Thereareinstances whereDMTcanbe approvedfor studiestoconduct medicaluse research.