PSUEDOEP HEDRINE

Austin Lowe Student Pharmacist Professional Year 2

History and Background

It was first characterized in 1889, by the German chemists Ladenburg and Oelschlägel who used a sample that had been isolated from Ephedra Vulgaris by the Merck pharmaceutical corporation of Darmstadt, Germany

Pseudoephedrine as we know it has been around since the 1920s Although the drug occurs naturally in certain plants (eg ma huang) the majority that is produced derives from the yeast fermentation of dextrose in benzaldehyde

Pharmacology

Pseudoephedrine causes vasoconstriction which leads to a decongestant effect. It has a short duration of action unless formulated as an extended release product. Patients should be counselled regarding the risk of central nervous system stimulation.

Pseudoephedrine is a sympathomimetic with a mixed mechanism of action direct and indirect. It indirectly stimulates alpha-adrenergic receptors causing the release of endogenous norepinephrine (NE) from the granularity of neurons while it directly stimulates beta-adrenergic receptors [11,12,13].

Drug Interactions

Some products that may interact with this drug include stimulants (such as caffeine, dextroamphetamine, methamphetamine, herbal products like ephedra/ ma huang), and terbutaline

Taking MAO inhibitors with this medication may cause a serious (possibly fatal) drug interaction Avoid taking MAO inhibitors (isocarboxazid, linezolid, metaxalone, methylene blue, moclobemide, phenelzine, procarbazine, rasagiline, safinamide, selegiline, tranylcypromine) during treatment with this medication Most MAO inhibitors should also not be taken for two weeks before treatment with this medication Ask your doctor when to start or stop taking this medication

Pseudoephedrine may decrease the effectiveness of blood pressure medications (such as beta blockers, calcium channel blockers, guanethidine, and methyldopa)

The Law

The Combat Methamphetamine Epidemic Act of 2005 has been incorporated into the Patriot Act signed by President Bush on March 9 2006 The act bans over-the-counter sales of cold medicines that contain the ingredient pseudoephedrine which is commonly used to make methamphetamine The sale of cold medicine containing pseudoephedrine is limited to behind the counter The amount of pseudoephedrine that an individual can purchase each month is limited and individuals are required to present photo identification to purchase products containing pseudoephedrine In addition, stores are required to keep personal information about purchasers for at least two years https://en.wikipedia.org/wiki/ Pseudoephedrine https://americanaddictioncenters.org/over-the-counter-medications/pseudoephedrine

Drug Screens

Pseudoephedrine is commonly used for sinus and nasal congestion, pseudoephedrine may cause false positive test results for amphetamine or methamphetamine.

Slang Terms

Pseudoephedrine has no street nicnames by it self its street names most coincide with what drug it is being used in to make. Some examples of those slang terms include Chalk, Crank, Meth, Speed.

Professional Opinion Abuse

Pseudoephedrine (PSE) is a drug with a long history of medical use; it is helpful in treating symptoms of the common cold and flu, sinusitis, asthma, and bronchitis Due to its central nervous system (CNS) stimulant properties and structural similarity to amphetamine, it is also used for non-medical purposes The substance is taken as an appetite reducer, an agent which eliminates drowsiness and fatigue, to improve concentration, and as a doping agent

According to the Pharmaceutical Journal “Pseudoephedrine is a proven nasal decongestant, for which there is subjective and objective evidence that it reduces blockage, improves breathing and helps patients feel better "

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The onset of action occurs after 30 min and after 1–4 hours the drug reaches its maximum concentration in the blood. When using the extended-release formulation, this time is twice as long.

Teens may be more likely to abuse pseudoephedrine and a common practice is to combine it with alcohol. This practice is very dangerous and may result in overdose because the stimulating effects of pseudoephedrine can dampen the effects of alcohol, making a person more likely to drink more than they normally would.

The most common form of pseudoephedrine abuse is using it to make methamphetamine This involves chemically altering the pseudoephedrine into an ingredient that can be used in the meth “cooking” process While the process of converting pseudoephedrine to make meth is fairly simple, it’s also extremely dangerous and can cause explosions or fires

Misusing pseudoephedrine in this way is extremely addictive and meth can cause serious physical and psychological side effects that can last for weeks, months, years, or even a lifetime

Although the Combat Methamphetamine Epidemic Act has made pseudoephedrine more difficult to acquire, the abuse of methamphetamine is still rampant in the U S and contributes to the number of ER visits, law enforcement resources used, crimes committed, and serious health problems plaguing Americans

References

Pseudoephedrine. React (Auckl). 1988;213(1):11-11. doi:10.1007/bf03280830

PubChem. Pseudoephedrine. Nih.gov. Accessed November 7, 2022. https://pubchem.ncbi.nlm.nih.gov/compound/Pseudoephedrine

Głowacka K, Wiela-Hojeńska A. Pseudoephedrine-benefits and risks. Int J Mol Sci. 2021;22(10):5146. doi:10.3390/ijms22105146

Bezrutczyk D. Drug street names. Addiction Center. Published November 8, 2018. Accessed November 7, 2022. https://www.addictioncenter.com/drugs/drug-street-names/ Drugs.com. Accessed November 7, 2022. https://www.drugs.com/druginteractions/pseudoephedrine.html Center for Drug Evaluation, Research. Legal Requirements for the Sale and Purchase of Drug Products Containing Pseudoephedrine, Ephedrine, and phenylpropanolamine. U.S. Food and Drug Administration. Accessed November 7, 2022. https://www.fda.gov/drugs/information-drugclass/legal-requirements-sale-and-purchase-drug-products-containing-pseudoephedrineephedrine-and Gragnolati AB. 10 medications that can cause a false positive on drug tests. GoodRx. Published July 18, 2017. Accessed November 7, 2022. https://www.goodrx.com/drugs/side-effects/thesemedications-can-cause-a-false-positive-on-drug-tests

Bryan J. Pseudoephedrine is a tough product to challenge as a nasal decongestant. The Pharmaceutical Journal. Published July 17, 2012. Accessed November 8, 2022. https://pharmaceutical-journal.com/article/news/pseudoephedrine-is-a-tough-product-tochallenge-as-a-nasal-decongestant

Pyro (nitazine)

Mariah McKinney, Student Pharmacist

History/Background:

• Nitazenes were developed about 60 years ago and were originally used for pain relief.

• Nitazenes are synthetic opioids- they are not naturally occurring.

• They are easy to manufacture and cheap to make

• They are being compared to fentanyl.

• Nitazenes are 20 times more powerful than fentanyl, which is 50 times more potent than other opioids!!

• They were originally sourced from China and recently brought into the United States.

Slang terms:

• There are no real slang terms because nitazene is “slang” for the synthetic benzimidazole

• Similar to fentanyl and fentanyl slang terms include: o Murder 8 o Shine o Friend o Goodfella o TNT o Percopop o China Girl https://www.dea.gov/stories/2022/2022-06/2022-06-01/newdangerous-synthetic-opioid-dc-emerging-tri-state-area.

Pharmacology/drug effects:

• In the form of a powder, ISO (isotonitazene) can look yellow, brown, or off-white in color.

• Side effects from Nitazenes overdoses can include: o shallow, slow, or stopped breathing o bluish nails or lips o pale or clammy skin o confusion o drifting in and out of consciousness o limp muscles o pinpoint pupils o vomiting o weak or no pulse https://www.dea.gov/stories/2022/2022-06/2022-06-01/newdangerous-synthetic-opioid-dc-emerging-tri-state-area.

Drug interactions/Toxicology:

• Nitazenes may be laced with illicit drugs o including illicitly sold marijuana.

• Nitazene overdose is common.

Laws:

• There are currently no laws specifically for nitazenes.

• However, o Illegal forms of fentanyl are usually in the form of powders or pressed into counterfeit tablets. o Fentanyl is illegal to possess if it is not prescribed to you. o Fentanyl is a schedule II drug since it has a high potential for abuse.

Monitoring/drug screens:

• Since nitazene is being compared to fentanyl, the fentanyl drug screens can be done with o Urine o Hair (past 90 days) o Blood (not as common)

References: https://www.americanaddictionfoundation.com/news/dangerous-opioid-nitazene-a-deadlynewcomer-in-the-current-drug-epidemic/. Published December 28, 2021. Accessed October 13, 2022. https://www.americanaddictionfoundation.com/news/nitazenes-new-opioids-20-times-strongerthan-fentanyl/. Published December 31, 2021. Accessed October 14, 2022. https://www.dea.gov/stories/2022/2022-06/2022-06-01/new-dangerous-synthetic-opioid-dcemerging-tri-state-area. Accessed October 14, 2022.

Professional opinion: This drug is new and recently introduced to the United States. With that being the case, there is not a ton of information available regarding this drug. I think it would be best for officials to get ahead of the making and distribution of this drug since it is being compared to fentanyl which is incredibly dangerous and has a high abuse rate.

1. Silverman SH. Dangerous opioid nitazene - a deadly newcomer in the current drug epidemic. American Addiction Foundation.

2. B M. Nitazenes: New opioids 20 times stronger than fentanyl. American Addiction Foundation.

3. New, dangerous synthetic opioid in D.C., emerging in Tri-State Area. DEA.

4. Opioid use terms. Opioid Help. https://www.opioidhelp.com/opioids/opioid-use-terms/. Published August 19, 2020. Accessed October 14, 2022.

5. FentanylDrugTest.NationalDrugScreening.https://www.nationaldrugscreening.com/fentanyldrug-test/.AccessedOctober 14,2022.