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2C OR NOT 2C: A Discussion of Designer Drugs Patrick Huska, PharmD, BCPS

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2C OR NOT 2CDiscussion of
Disclosure
Objectives
Toxicities
Associated with Designer Drugs
Chemical Structure
“Legal” Drugs
Easy Access
“Non-addictive” Alternative to
10 minutes (IM)
Peak – 5-15 Mins
Half-Life – 2-6 Hours
Depending on Renal
Heroin and Opiate Treatments Ensure Patient’s Ability to Breath
Monitor Depth and Rate of Ventilation Oxygen Intubation
Naloxone (Narcan) Goal Adequate Ventilation (RR - at
least 12) Spontaneous Ventilation – Give 0.04-
0.05mg and Titrate
Cardiopulmonary Arrest Secondary to Opioid Overdose – Minimum 2mg
If Patient Receives Over 5-10mg, may Consider Alternate Cause
Available OTC in Most States
Methamphetamine
Stimulant
and ADHD
Adrenergic Reaction - Hypertension, Tachycardia,
Hunger and Thirst
Changes
Methamphetamine
Onset – Seconds (Smoking/Injection), 5 mins (Nasal), 20
mins (Oral)
Half-Life – 12-34 hours
Psychosis
Seizures
Shock Temp > 39C
Acute Renal Failure
Methamphetamine Complications
Class Phenethylamine
Emerged In US in 2010
Sold with warning “Not for Human Consumption” to
Avoid Violating US Controlled Substances Act
Synthetic Cathinones
IV, IM, Rectal
Metabolism – Hepatic
Elimination - Renal
Inflammatory Properties While Eliminating Psychotropic Effects
Over 100 Synthetic Cannabinoids
Herbal Blends with a Mixture of Plant Matter and Chemical Grade
Synthetic Cannabinoid
Red Clover, Honeyweed and Many More
Limited Literature Regarding Effects
Sold as Incense or Potpourri as “Not for Human Consumption”
Synthetic Cannabinoids
Smoked, Oral or Snorted
Effects will Vary Based on Amount of CB1 and CB2
Agonism
Effects More Intense, Longer Lasting or Paradoxical Effects
Synthetic Cannabinoid Symptoms
2C Agent Effects
MDMA (Ecstasy/Molly)
Methylenedioxymethylamphetamine (MDMA)
Later Used for Psychotherapy and Marriage Counseling
Stimulates Serotonin Receptors
Marketed as “Party Pills” or “Legal Ecstasy”
1-Benzylpiperazine (BZP)
1[3-Trifluoromethylphenyl]piperazine (TFMPP)
Acts on Serotonin Receptors
Labs
Serum Lactate
Pain)
Diazepam 5-10mg IV may repeat every 10 minutes PRN
Second Gen. Antipsychotics – Ziprasidone 10mg IM
Droperidol 2.5-5mg IV/IM or Haloperidol 10mg IV/IM
Avoid Physical Restraints
Coingestion
Hemodialysis
BDZ – IV preferred, IM Effect may be Delayed 10-20 mins
Poison Control (1-800-222-1222)
Overdose
Treatment Goal is 12 Breaths per Minute
No Antidotes for Other Designer Drugs
Maintain Airways
Hyperthermia
Summary
EKG for Chest Pain
Chest X-Ray for Pulmonary Symptoms
References Musselman ME, Hampton JP, “Not for Human Consumption”: A Review of Emerging Designer Drugs,
Pharmacotherapy 2014;34(7): 745-757.
D’Orazio JL, Hallucination Toxicity, http://emedicine.medscape.com/article/814848-overview. Feb 14, 2015
Law R, Schier J, Martin C, Chang A, Worlkin A, Notes From the Field: Increase in Reported Adverse Health Effects
Related to Synthetic Cannabinoid Use – United States, January-May 2015,
https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6422a5.htm, June12, 2015.
cannabinoids-acute-intoxication?source=search_result&search=synthetic+cannabinoids&selectedTitle=1%7E99,
Accessed September 5, 2016.
Arnold TC, Ryan ML, Acute Amphetamine and Synthetic Cathinone (“bath salt”) Intoxication,
http://www.uptodate.com/contents/acute-amphetamine-and-synthetic-cathinone-bath-salt-
and Diagnosis. http://www.uptodate.com/contents/opioid-use-disorder-epidemiology-pharmacology-clinical-
diagnosis?source=search_result&search=heroin&selectedTitle=1%7E150. Accessed Sept 5, 2016.
Dean BV, Stellpflug SJ, 2C or Not 2C: Phenethylamine Designer Drug Review. J Med Toxicol 2013; 9(2) 172-178
Hoffman RJ, MDMA (ecstasy) Intoxication, http://www.uptodate.com/contents/mdma-ecstasy-
intoxication?source=search_result&search=ecstasy&selectedTitle=1%7E88, Accessed Sept 5, 2016
Boyer EW, Hernon C, Methamphetamine Intoxication, http://www.uptodate.com/contents/methamphetamine-
intoxication?source=machineLearning&search=methamphetamine&selectedTitle=5%7E104&sectionRank=3&anch
or=H8#H8. Accessed Sept 5, 2016
Efre A, “Street Drugs: Current Trends, Uppers and Downers and Hallucinogenics”, Presented at NTI 2016.