Clinical Toxicology

when a person is exposed to a substance that can

damage their health or endanger their life
the harmful effect that occurs when a toxic substance
is swallowed, is inhaled, or comes in contact with the
skin, eyes, or mucous membranes, such as those of
the mouth or nose
the most common cause of nonfatal accidents in the
home
Sources: Drugs (OTC, Prescription, Illicit), gases,
household products, agricultural products, plants,
industrial chemicals, vitamins, animal venom, and
foods (particularly certain species of mushrooms and
fish)

Poison-related
Patient-related

POISON-RELATED

Route of Administration
Concentration
Solubility

PATIENT-RELATED

Age of patient
Habit
Tolerance
Idiosyncrasy / Unknown
cause

FACTORS AFFECTING THE EFFECT OF POISONS

Principle: injected poison (IV) is more toxic

than orally administered poison (PO)
IV: absorbed completely (100%),
PO: 1st pass effect

Ex. Saponins:
Administered PO used as tonics
Administered IV toxic hemolytic agents

Principle: as dose or concentration is

increased, toxicity is also increased

Principle: the higher the lipid solubility, the

higher the toxicity
Ex. Nerve gases (absorbed; via skin and
inhalation

FACTORS AFFECTING THE EFFECT OF POISONS

Pediatric: liver (and other organ systems) not

fully developed, so, toxicity is increased
Geriatric: metabolizing rates; renal function
compromised compared to aged 20-40

Smokers and chronic Alcoholics: Enzyme

induction, so, decreased effect of drug

Apparent state of decreased responsiveness

to a pharmacologically active agent
resulting from repeated exposure to the
agent
increase the dose to have the same effect
Ex. Nitrates: Monday disease
Nicotine: a true poison, but due to constant
exposure, the human body has well-tolerated
the poison, increasing their threshold levels

Genetic defects may lead to toxicity

Ex. G6PD deficient: develop hemolytic
anemia with sulfonamides, quinine, etc.

TYPE
ACUTE

CHARACTERISTICS
prompt, immediate (usually,
due to high amount)
marked disturbance of function,
or death within a short period of
time
exposure: < 24 hours (route: IP,
IV, SQ)

SUBACUTE

exposure:
repeated for 1 month

SUBCHRONIC

exposure:
repeated for 1 3 months

EXAMPLES
excessive
single dose
strong / true
poison
gases

TYPE
CHRONIC

CHARACTERISTICS

EXAMPLES

gradual; progressive deterioration of heavy metals

functioning tissues
produced by taking small amounts for
a long period of time
exposure: repeated for > 3 months
CUMULATIVE chronic subtype of poisoning
poisoning which suddenly increases in
its intensity of action when a certain
limit is reached
organophosphates
COMBINED both acute and chronic effects
Acute effect:
muscarinic effects
Chronic effect:
neurotoxic

Circumstantial evidence from various events,

but are not very reliable
Post-mortem after an autopsy is performed;
after death use of tissue, organs, or body
fluids
Experimental administering suspected
substance to living animal, and noting the effect
or symptoms
Chemical detection of suspected substance via
analysis of sample of body fluids collected
Symptomatic poisoning signs and symptoms
are observed

POISON TYPE EFFECT

Cause tissue necrosis on
Irritants
contact; caustic effect
Neurotics
Affect CNS
Carcinogenic Stimulate proliferation of
cancer cells
Asphyxiants
Cause dyspnea; Cause
complete suspension of
respiration

EXAMPLES
Acids and alkalis
Hallucinogens
Nitrosamines,
aflatoxins
CO, methane gas

POISON TYPE EFFECT

EXAMPLES

Lacrimators

Cholinergics, Carbamates,
Organophosphates
Strychnine, Veratrine

Sternutators
Asthenics
Narcotics

Stimulate flow of tears from

lacrimal glands
Stimulate excessive
sneezing
Produce muscular
weakness; Exhaustives
Produce mental weakness
and depression, stupor,
coma, respiratory
depression

Tubocurarine, NM blockers
Opioids

CLASS OF DRUG

TOXIDROME

ANTICHOLINERGICS

Dry as a bone (dry mucosa) Atropine

Hot as a hare
(hyperthermia)
Blind as a bat (mydriasis)
Mad as a hatter (delirium)
Red as a beet (flushed skin
due to vasodilation to
eliminate body heat)
DUMBBELS / SLUDGE
Organophosphate
Diarrhea, Urination,
Carbamates
Micturition
Bradycardia,
Bronchoconstriction,
Emesis
Lacrimation, Salivation,
Sweating

CHOLINERGICS

EXAMPLE

CLASS OF DRUG

TOXIDROME

EXAMPLE

SYMPATHOMIMETICS

Mydriasis, Tachycardia
Hypertension,
Hyperthermia, Seizures
Triad: Miosis (pinpoint),
Hypotension, Coma
Hyerventilation,
Bradycardia
Mydriasis, Tachycardia
Hypertension,
Hyperthermia, Seizures

Amphetamine
Cocaine

OPIATES

SYMPATHOMIMETICS

Morphine, Heroin

Amphetamine
Cocaine

SAMPLE CHEMICAL TESTS

POISONS DETECTED

Beilstein Test
Benzoldt Gunning Test
Bromine water Test
Liebens iodoform Test
Marquis Test
Marsh / Reinsch Test
Modified Duquenois Test
Nessler Test

Halogens
Acetone
Aniline
Differentiate methanol and ethanol
Opium alkaloids
Arsenic
Marijuana
Differentiate chloral hydrate and
chloroform
Bismuth

Nylander Test

SAMPLE CHEMICAL TESTS

POISONS DETECTED

KI Test
Scherer and Mitscherlich Test
Schonbein-Pagenstecher and
Picrate test
Schwartz Resorcinol Test
Tollens Test
Xanthogenate Test
AAS (Atomic Absorption
Spectroscopy)
Phenylisocyanide Test

Mercury
Phosphorus
Prussic acid
Chloroform
Reducing Substances
Differentiate CS2 and H2S
Heavy metals
Nitrobenzene

ABNORMAL STAINING OR
DISCOLORATION OF SKIN
Yellow
Bleaching white
Ash gray
Deep brown
Brown black
Bluish gray
Blue
Pale bands on fingernails
Boiled lobster-like
appearance

POISON
Picric acid, nitric acid
Phenol
Mercuric chloride, Physostigmine
Bromine
Sulfuric acid, iodine, silver nitrate
Silver salts
Cyanotics (opium, aniline, sulfides)
Arsenic
Boric acid

BLOOD CHANGES
Decreased blood
coagulability
Cherry red blood
Dark red blood
Chocolate blood

POISONS
Heparin, coumarin, benzene,
F, P
CO, CN
Nicotine
Aniline, nitrates,
nitroderivatives
(nitrobenzene)

URINE CHANGES
Dark yellow
Yellow brown
Odor of violets
Green blue
Wine or red brown

POISON
Picric acid
Aloe, senna
Turpentine
Phenols, methylene blue
Caffeine, lead, mercury, benzene, CCl4,
Rifampicin

DISCOLORATION OF GUMS
POISON
Blue line gum
Bismuth, lead
Black line gum
Mercury
Loose teeth, bleeding gums Arsenic, Mercury

RESPIRATORY
CHANGES
Violent sneezing
Irritation
Dyspnea, Asphyxia
General respiratory
depression

POISON
Veratrine, Strychnine
Sulfur dioxide
CO
Opium, barbiturates,
BZDPN, CN

ODOR OF BREATH
Shoe polish
Fruity odor

POISON

Nitrobenzene
Ethanol, diabetic ketoacidosis, isopropyl
alcohol

Garlic odor

Phosphorus, As, organophosphates,

DMSO

Mouse urine
Stale tobacco
Bitter almonds
Sweet penetrating odor

Coniine
Nicotine
Cyanide
Chloroform

Oil of wintergreen
Rotten eggs
Pears

Salicylates
H2S, SO4
Chloral hydrate, paraldehyde

Mothballs

Camphor

VISUAL DISTURBANCES
Purple vision
Yellow green halos
around dark objects
Blurred vision
Partial or total blindness

Optic neuritis
Blood shot eyes

POISON
Marijuana
Digitalis
Anticholinergics
Methanol, formic acid,
solanine
Ethambutol
Marijuana

GASTRIC CONTENT
(VOMITUS)
Blue green vomitus
Ground coffee vomitus
Luminous vomitus

Yellow green vomitus

POISON

Copper, boric acid

Sulfuric acid
Phosphorus
Chromium

OTHER CHANGES

POISON

Alopecia

Arsenic, thallium

Tinnitus

Salicylates, quinine

Ototoxicity
Xerostomia

Aminoglycosides, loop
diuretics
Anticholinergics

Bloody sputum

Cadmium

Muscular twitching, loss of

voice
Lock jaw

Barium (baritosis)

Blister formation

Cantharidin

Strychnine, tetanospasmin

PARENT COMPOUND
ACETAMINOPHEN

ACETONITRILE
ALLOPURINOL
AMITRYPTILINE
ASPIRIN
AROMATIC HC PESTICIDES
CARBON TETRACHLORIDE
CHLORAMPHENICOL

METABOLITE
N-acetyl-paminobenzoquinone
imine (NAPQI)
Cyanide
Alloxanthine
Nortryptyline
Salicylic acid
Epoxides
Phosgene
Glyoxylic acid

PARENT COMPOUND
CORTISONE
DIAZEPAM
ETHANOL
ETHYLENE GLYCOL
MALATHION

METABOLITE
Cortisol
Desmethyldiazepam,
oxazepam
Acetaldehyde
Oxalic acid
Malaoxon

MEPERIDINE
METHANOL
PARAQUAT

Normeperidine
Formaldehyde, formic acid
Free radicals

Supportive care and ABCDs

Obtaining History of Exposure
General treatment and Decontamination

GENERAL MANAGEMENT OF A POISONED PATIENT

The first priority is to establish & maintain vital

functions. Subsequently, most victims can be
treated successfully using supportive care alone.
ABCs
Airway (by suction or by use of artificial nasal /

oropharyngeal airway)
Breathing (check depth of respiration; place
mechanical ventilator, add oxygen)
Circulation (check pulse rate, BP, tissue perfusion,
constant ECG monitoring)

If comatose, administer:
Glucose

Thiamine
Oxygen

For seizures administer:

anticonvulsants

for hypotensive:
Adults NSS
Children0.3 NaCl

insert IV line

draw blood for laboratory

and toxicology tests

for patients with depressed Mental Status:

to rule out hypoglycemia50 mL of 50% dextrose

Opiate ingestionNaloxone 0.2-0.4 mg IV push

Benzodiazepine ingestionFlumazenil

GENERAL MANAGEMENT OF A POISONED PATIENT

1.
2.

3.

Identify SQuaTS
Check for physical evidences
Assessment

Substance ingested
Quantity
Time since intake
Signs and symptoms of overdose

Presence of Pill containers

Neurologic

Seizures
Confusion
slurred speech
ataxia

Cardiopulmonary
Palpitations
Cough
chest pain

GI examinations
nausea and vomiting
Diarrhea

GENERAL MANAGEMENT OF A POISONED PATIENT

for dermal exposures, or percutaneous

absorption of poison

 What to do????
1.

2.

Remove patients clothing

Using hose or shower irrigated with large
amount of water the affected areas

NOTE:

DO NOT attempt to Neutralize!

Ex. Acid burns + NaHCO3 exothermic
reaction (worsening of condition)

 What to do???
1.
2.

immediately removed from the

contaminated environment
treat with 100% oxygen, artificial air,
hyperbaric oxygen, with intubation, or
bronchodilators

Disadvantage of
100% Oxygen:
highly combustible

1.

2.
3.

Flush eyes with low pressure water for 15

minutes with eyelids opened
Add fluorescein solution to test for
corneal injury ((+): green / yellow)
bring to doctor

1.

Torniquet
do not use on toes and fingers
do not remove until after the administration of

antivenom or antidote

2.

Suction

removes 2% of injected (SC) poison

only effective within 10 minutes after snake bite
snake venom has hyaluronidase enzyme (spreading

factor, rate of distribution)

3.

Snake venom antiserum (specific antidote)

any agent that counteracts the effect of

poison
MOA: Antagonism

based on Action
Physiologic / Functional

Chemical
Mechanical Antidote

based on Site of Action

Local antidote
Systemic antidote

Universal Antidote

Classification of Antidotes

based on Action

those which produce a different effect

(opposite) from that of the poison
they do not target the site of toxicity, but
control the symptoms

Sodium nitrate converts hemoglobin to

methemoglobin
Histamine (vasodilation) Epinephrine
(vasoconstriction)
Ethanol (depressant) Caffeine (stimulant)
Barbiturates (depressant) Epinephrine
(stimulant)
Atropine (antimuscarinic)
Organophosphate (cholinergic - Indirect)

based on Action

agents which change the chemical nature of

the poison
react with the substance
EXAMPLE:
sodium thiosulfate converts CN to non-toxic SCN
protamine sulfate + heparin acid-base neutralization
antitoxin antagonize animal toxin

chelating agents in heavy metal poisoning

aka ligands
flexible molecules with 2 or more electron
donating groups that form stable coordinate
covalent bonds with cationic metal atom
Chelator metal complexes is excreted by
the body

Dimercaprol / British Anti-Lewisite (BAL)

Succimer / Dimercaptosuccinic acid (DMSA)
Ethylene diamine tetraacetic acid (EDTA)
Deferroxamine
Penicillamine
Unithiol

2,3-dimercaptopropanol (bidentate)
MOA: prevents and reverses metal-induced
inhibition of sulfhydryl-containing enzymes
Indication : As, Hg, Pb (+ EDTA), *Co, Bi, Au,
Cu, Zn, Ni, W

oral & water-soluble congener of BAL

MOA: prevents and reverses metal-induced
inhibition of sulfhydryl-containing enzymes
it increases urinary excretion of Pb, decreases
Hg content of kidney
Indication : Pb (children), *As, Hg

Edetate Calcium Disodium (hexadentate)

administered as Ca++ salt to prevent fatal
hypocalcemia
route: slow IV, or IM
Indication : chiefly Pb, *Zn, Mn, Fe, Be, Cd,
Se, Be, Ni, Cr, Co
AE: renal tubular necrosis (remedy: increases
water intake)

Desferal
Source: Streptomyces pilosus
Indication:
DOC for Fe poisoning
*Al toxicity in renal failure

vinn-rose /
pinkish-orange
colored urine

Cuprimine
derivative of penicillin
Indication: Copper poisoning (Wilsons
disease characterized by hepatolenticular
degeneration), *Pb, Hg
AE: fatal hypersensitivity / allergic reaction,
Vitamin B6 deficiency, pancytopenia

Dimercaptopropanesulfonic acid

based on Action

prevent the absorption of the poison,

resulting to decreased toxicity
no chemical reactions with the poison

Lavage (cleaning GIT)

Emetics
Cathartics
Adsorbents
Precipitants
Dilution
Demulcents
Forced diuresis and urinary pH manipulation
Dialysis and Hemoperfusion

Gastric Lavage
Whole bowel irrigation

cleaning up to the level of the stomach only

Indicaton: for patients who are not alert, or
have diminished gag reflex
continuous washing (endotracheal
/nasogastric tube)
administered within 2 - 4 hours of poisoning
use water or saline solution to wash out
poison
do 10-12 times until clear washing is seen
AE: Pneumomediastinumgas in the
peritoneal cavity
Time:

Less effective if passed >4-6hrs

Exception with some drugs that cause BEZOARS

PERSON

Convulsions
Coma
Cardiac dysrythmia
at risk for GI perforation

SUBSTANCE INGESTED

Corrosives
Caustics
Hydrocarbons

cleaning from mouth to anus whole GIT

use isosmotic cathartic solution: polyethylene
glycol (PEG)
indicated for poorly absorbed poisons: Iron,
Lead, Lithium

Whole-bowel irrigation represents a method

of flushing the gastrointestinal tract in an
attempt to prevent further absorption of
drugs

The solution is administered as 0.5 L/h in

children < 5 years & 1-2L/h for adults.
It is administered by nasogastric tube or
orally.
End point is recovery and therapeutic level of
the drug is detected.

Substances poorly adsorbed by AC (iron,

lead).
Sustained-release or Enteric coated tablets.
In cases of body packers (cocaine, heroin).

Extensive hematemesis.
P. Ileus.
Bowel obstruction.
Perforation or peritonitis.

Nausea & Vomiting

Aspiration if patient had vomiting in the loss
consciousness
May decrease effectiveness of charcoal.

Surgery and endoscopy are

occasionally indicated for
decontamination of
poisoned patients if the
other methods were failed.
Generally, this method use
for body packers and
bezoar formation such as:
Salicylate, Iron, Barium
(BETA CHIPS).

Induce vomiting
Types:
local emetics
systemic / central emetic

AE: Risk of Lung aspiration, Diarrhea,

drowsiness, prolonged emesis
Contraindicated in: (Cs)

caustics, corrosives, petroleum distillates / HC, sharp

objects
CNS depression / seizures (convulsing & unconscious)
children < 6 months of age

cause GIT irritation

EXAMPLE:
Tickling of throat
NSS
Syrup of Ipecac

preferred method for GIT

decontamination routinely in
hospitals in the past
Active: Emetine (cardiotoxic) &
Cephalonie
Used as a syrup & never used as
a fluid extract as it is 14 times
more potent & might cause
death.
Time factor: Less effective if >46hrs has been passed since
ingestion

It causes vomiting through 2 phases:

Early vomiting (within 30 minutes): due to the

direct local irritant action of ipecac on gastric

mucosa.
Late vomiting (after another 30 minutes) is the
result of central stimulation of the chemoreceptor
trigger zone.

Dose: 30 ml for adults, 15 ml for children (214y.) & 5- 10 ml for children between 6
months to 2 years
If vomiting does not occur after 30 minutes, the

dose is repeated.
If still no vomiting, gastric lavage should be
carried out to remove ipecac from the stomach
(as it is toxic- emetine).
Cant be given to age below 6 months age

Generally less traumatic than gastric lavage

which is unpleasant to most people and must
be done by qualified trained physician.
Emesis can recover particles that are too
large to pass through the openings of gastric
lavage tube.

PATIENT

Unconscious or comatosed&
convulsing patient.
Infants less than 6 months.
Severe CVS disease or
emphysema.
Unstable patients in shock or
RD
Previous significant vomiting
before this moment.
Hemorrhagic tendencies.
Pregnancy

SUBSTANCE INGESTED

Corrosives Hydrocarbons.
Convulsants
Sharp objects (needle, pin)

stimulate vomiting center in brain / CTZ

EXAMPLE:
Apomorphine IV/SQOverdose: administer

Levallorphan or Nalorphine

induce evacuation of bowels by increasing

peristalsis
TYPES:
ionic cathartics
non-ionic cathartics

NOTE: Irritant cathartics: vegetable

cathartics (Ex. aloes, cascara) are not
recommended for use too drastic!

patients with electrolyte imbalance

poisoning with caustics and corrosives
Children < 5 years due to possible electrolyte
imbalance.

Dehydration.
Electrolyte disturbance, Hypernatremia,
Hyperosmolarity.
Renal failure with Mg catharatics.
Nausea & Abdominal pain.

form physical complexes with poison,

preventing its absorption
EXAMPLE:
ACTIVATED CHARCOAL

product of destructive
distillation
subjected to 200C until
charred, then to high pressure
(steam 1000 psi) under
sulfuric acid, to surface area
1g can adsorb 100-1000mg
poison (not absorbed in GIT)
administered as slurry (100 g in
200 cc saline or water)
AE: Charcoal aspiration,
Empyema, bowel obstruction

alter the poison by forming an insoluble

substance

reduction in concentration of poison,

resulting to decreased potency
EXAMPLE:
Water management of poisoning with caustics

and corrosives

protect area or site by coating the absorbing

surface
EXAMPLE:
Egg whites
Milk
Kaopectate
Sucralfate

enhance elimination of mostly renallyexcreted substances

Disadvantage: fluid and electrolyte
disturbances

A.

Alkaline diuresis (promotes elimination of

weak acids)
agents: NaHCO3, acetazolamide
WA: Phenobarbital, salicylic acid

B.

Acid diuresis (promotes elimination of weak

bases)

agents: Vitamin C, NH4Cl

WB: Amphetamines, Phencyclidine
not really advised because it worsens complications

from rhabdomyolysis, which often accompanies the

intoxication

Dialysis
Hemodialysis

Peritoneal dialysis

Hemoperfusion

Advantage: corrects fluid and electrolyte

imbalance in toxicity

FOR SUBSTANCES THAT ARE:

A.
B.
C.

water soluble
with small Vd (<0.5 L/kg)
not significantly bound to
plasma proteins

FOR LIFE-THREATENING
INGESTIONS OF:

Ethylene glycol
Methanol
Paraquat
Lithium
Theophylline
Valproic acid
Carbamazepine
Salicylates
Ethanol
Phenobarbital

uncoagulated blood is passed through a

column with activated charcoal / resins
Advantage: more rapid than hemodialysis
Disadvantage: does not correct fluid

abnormalities

more effective in removing:

A. Phenobarbital, Phenytoin,Carbamazepine

B. Methotrexate
C. Theophylline

Classification of Antidotes

Local antidote acts on the GIT to prevent

absorption (entrance to the blood stream)
Systemic antidote counteracts the poison
in the blood

Classification of Antidotes

Activated Charcoal
MOA: prevent absorption
Alternative: burnt toast

MgO
aqueous solution: Mg(OH)2 (neutralizing power)
Alternative: Milk

Tannic Acid
alkaloidal precipitants
Alternative: Tea

POISON
Alkaloids
Barium
Phosphorus
Acids and alkali
Silver
Iodine
Copper
Iron
Pb, Cd, Hg, Se, Ra, U
As, Hg, Au, Ni, Bi, W, Zn
Thallium

ANTIDOTE
Activated charcoal, tannic acid
(precipitant)
MgSO4
Copper sulfate (as lavage)
Milk or other protein; Water (dilution)
NSS
Starch or flour
Penicillamine
Deferroxamine, Sodium phosphate
EDTA
BAL
Prussian
blue,
Diphenyldithiocarbamate

POISON
CN
Paracetamol
Petroleum products
Ethanol
Methanol, ethylene glycol
Strychnine
Anticholinergics
Anticholinesterases
Antihistamines
Sulfur dioxides

ANTIDOTE
Nitrites, Sodium thiosulfate
Acetylcysteine
Mineral oil
Caffeine, Disulfiram
Ethanol, Fomepizole
Diazepam, Neuromuscular
blockers
Physostigmine
Atropine, Pralidoxime
Anticholinergics
Oxygen

POISON
CO

Fluoride
Isoniazid
Narcotics (opioids)
Diphenoxylate + atropine

ANTIDOTE
100% O2, hyperbaric O2, O2 +
helium (artificial air)
Calcium gluconate
Vitamin B6 or pyridoxine
Naloxone, Naltrexone
Naloxone, Naltrexone, activated
charcoal

Oxalate
Methemoglobinemic
agents
(nitrite, chlorate, nitrobenzene,
aniline)
Warfarin
Heparin
Formaldehyde

Calcium gluconate
Methylene blue

Ammonia

Formaldehyde

Vitamin K
Protamine sulfate
Ammonia, sodium bicarbonate

POISON
Amphetamine
Paraquat

ANTIDOTE
Chlorpromazine, Vitamin C
Fullers earth, sodium sulfate

Phencyclidine
Barbiturates
Benzodiazepines
Digitalis
Beta blockers

Propranolol, diazepam
Urine alkalinizers
Flumazenil
FAB fragments
Glucagon,
epinephrine
(caution)

Calcium channel blockers

Calcium chloride
Quinidine, other Na+ channel NaHCO3
blockers

DRUG
NOTES
Amphetamines /
MOT:
pep pills / shabu
Direct
Methedrine /
release of
speed
Epinephrine
MDMA / Ecstasy
and
Methylphenidate
Norepineph
(Ritalin)
rine from
Metamphetamine
presynaptic
/ Ice or Crystal
fiber;
Prevent
meth
reuptake of
catecholam
ines

a)
b)
c)

TOXICITY
CF: Sympathetic: HTN, anorexia,
irritability, mydriasis, insomnia
Fatal sign: circulatory collapse
Treatment:
Gastric lavage, emesis
Acidify urine (caution)
Chlorpromazine (antipsychotic)
Chronic use: necrotizing arteritis,
a lesion involving the small and
medium-sized arteries lead to
fatal brain hemorrhage and renal
failure

DRUG
Cocaine / Snow / Coke

NOTES
MOT:
Prevents reuptake

TOXICITY
CNS stimulation:
euphoria, seizures
CV toxicity

DRUG
NOTES
LSD or Lysergic Acid ergot derivative
Diethylamide / Acid
MOT: 5-HT1 agonist
CNS stimulation

Mescaline / Peyote
Psilocybin / shrooms

Lophophora williamsii
Psilocybe mushrooms

TOXICITY
hyperarousal of CNS
(adrenergic)
dizziness, weakness,
paresthesias
blurring of vision,
hallucinations
same as LSD
same as LSD

DRUG
Scopolamine & other
cholinoceptor blocker

NOTES
MOT: blockade of
central muscarinic
receptors

Phencyclidine (PCP) or
Angel Dust

MOT: antagonist on the

NMDA subtype of
glutamate receptors
dissociative
anesthesia

TOXICITY
deliriant hallucinogens
adrenergic toxicity
bizarre delusions, loss
of memory
Treatment:
Physostigmine
numbness, nystagmus,
HR, HTN
acute psychotic
reactions, coma, death
Treatment:
Acidification of urine,
Diazepam (seizures),
antipsychotics

DRUG
NOTES
Cannabinoids Cannabis sativa
Tetrahydrocannabinol
Use: Anti-emetic (CAchemotherapy-induced)

TOXICITY
early: high / euphoria
late: dream-like state
HR, reddening of the
conjunctiva
muscle weakness, tremors

DRUG
-hydroxybutyric acid
(GHB),
Liquid home boy
Roofies (Rohypnol)

NOTES
MOT: enhance GABA
effects; CNS
depression
BZDPN Flunitrazepam

TOXICITY
general anesthesia
respiratory depression
CNS & respiratory
depression

DRUG
Anabolic steroids

NOTES
performance
enhancers
increased muscle mass
and strength
no euphoria

TOXICITY
CV effects: Myocardial
Infarction
hepatic effects: liver
enzymes
Severe acne,
gynecomastia, hirsutism
Behavioral effects:
change in sexual functions
and libido, aggression,
mood changes with
psychotic features