pharmacy all semester notes and study material previous year qus

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🧠 Clinical Overview of Selected Psychoactive Substances 1. Heroin (Diacetylmorphine) Class: Semi-synthetic opioid, rapidly metabolized to morphine. ⭕️Mechanism: μ-opioid receptor agonist → strong analgesia, euphoria, respiratory depression. Clinical Concerns: Rapid CNS penetration → intense addiction potential. Overdose: respiratory depression, pinpoint pupils, coma (“opioid triad”). Withdrawal: agitation, mydriasis, rhinorrhea, diarrhea, muscle cramps. 💊Antidote: Naloxone (IV/IM/IN) for acute overdose. Long-term Risks: HIV, HCV (injection use), collapsed veins, endocarditis. 2. Mephedrone (4-methylmethcathinone, "Meow Meow") Class: Synthetic cathinone, stimulant (“bath salts”). ⭕️Mechanism: Increases synaptic dopamine, norepinephrine, serotonin (reuptake inhibition + release). Clinical Concerns: Acute: euphoria, hyperstimulation, increased sociability. Toxicity: tachycardia, hypertension, agitation, paranoia, seizures, hyperthermia. Chronic: neurotoxicity, dependence, psychiatric disorders. 💊No specific antidote → manage supportively (benzodiazepines for agitation/seizures, cooling for hyperthermia). 3. Cocaine Class: Stimulant, local anesthetic. ⭕️Mechanism: Blocks reuptake of dopamine, norepinephrine, serotonin. Clinical Concerns: Acute: intense euphoria, tachycardia, hypertension, mydriasis. Complications: myocardial infarction (coronary vasospasm), stroke, seizures, sudden death. Chronic: septal perforation (snorting), psychiatric effects, strong addiction potential. 💊Treatment of Toxicity: Benzodiazepines (for agitation, hypertension), avoid β-blockers (unopposed α-effect). 4. Caffeine Class: Methylxanthine stimulant. ⭕️Mechanism: Adenosine receptor antagonist → ↑ CNS stimulation, ↑ catecholamines. Clinical Concerns: Moderate dose: alertness, reduced fatigue. High dose: anxiety, tachycardia, insomnia, GI upset. Toxic dose (>1 g): arrhythmias, seizures. Withdrawal: Headache, irritability, fatigue. 5. Dopamine (DA) Class: Endogenous catecholamine. ⭕️Mechanism (dose-dependent): Low dose: D1 receptor → renal vasodilation. Moderate dose: β1 receptor → ↑ cardiac contractility. High dose: α1 receptor → vasoconstriction. 💊Clinical Use: Cardiogenic/septic shock (IV infusion). Adverse Effects: Tachyarrhythmias, extravasation necrosis (treat with phentolamine). 6. Opioids (general, incl. Morphine, Codeine, Fentanyl) Class: μ-opioid receptor agonists. Effects: Analgesia, sedation, respiratory depression, constipation, euphoria. Clinical Concerns: Overdose → respiratory arrest. Dependence & tolerance common. 💊Antidote: Naloxone (short-acting), Naltrexone (maintenance). Clinical Uses: Pain, anesthesia, palliative care, cough, diarrhea. 7. Adrenaline (Epinephrine) Class: Endogenous catecholamine, adrenergic agonist. ⭕️Mechanism: α1 → vasoconstriction, ↑ BP. β1 → ↑ HR, ↑ contractility. β2 → bronchodilation. ✅️Clinical Uses: Anaphylaxis (IM first-line). Cardiac arrest (IV/IO). Added to local anesthetics (vasoconstriction). Adverse Effects: Tachyarrhythmias, hypertension, anxiety, tremor. 🔑 Key Clinical Pearls Heroin & opioids: respiratory depression is the killer → always think naloxone. Mephedrone & cocaine: sympathetic storm → benzodiazepines are first-line. Caffeine: mild compared to others, but toxicity at high doses. Dopamine & adrenaline: dose-dependent receptor activity → lifesaving in shock/anaphylaxis. 📚 References Pharmacotherapy Principles and Practice, 6th Edition American College of Clinical Pharmacy (ACCP) – Toxicology & Critical Care UpToDate (Opioid toxicity, Cocaine, Synthetic cathinones, Caffeine, Dopamine in shock, Epinephrine) Lexicomp (Lexi-Drugs Online) Goodman & Gilman’s The Pharmacological Basis of Therapeutics, 13th Edition

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