1.3. Psicotógenos.pdf
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DROGAS ALUCINOGENAS O
SICOTOGENAS, SICOTOMIMETICAS o
SICODELICAS36Grupo de sustancias naturales, sintticas o semisinteticas
que producen cambios: conductuales, mentales, emocionales, del comportamiento, de aprendizaje,
sensoperceptivos.
Acompaandose de trastornos motores (= sicoticos).
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(alertex, curam)
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PSICOFARMACOLOGIA
Subespecialidad medica de la Psiquiatria. Estudio de drogas q tienen q ver con los procesos mentales superiores como del
pensamiento, afectividad, memoria, aprendizaje.
Psicofarmacos: Clasificacion:
- Sicotogenos o sicodislepticos
- Antisicoticos o neurolepticos
- Ansioliticos o tranquilizantes
- Antidepresores.
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PSICOTOGENOS O ALUCINOGENOS
1. NATURALES (Plantas)
- Erytroxilon coca = cocaina- rawolfIa = reserpina- mezcal o peyote = mezcalina- harmala, ayahuasca = harmina- cornezuelo centeno = LSD.- Psilocibe mexicana (hongos magicos) =
psilocibina y psilocina
- Salvia divinorum = salvinorin A- Cannabis sativa = 9-THC
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PSICOTOGENOS O ALUCINOGENOS
2. Sinteticos:
- Fenciclidina (PCP),
- Derivados de anfetaminas:
MDMAext, MDEAeva y MDApild
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1. PSICOTOGENOSo DEFINICION
Drogas q`realizacion inmediata y +intensa de las func N o procesos
siquicos superiores. Cambios mentales, perceptuales, emocionales
y del comportamiento.
Modificaciones del pensamiento = trastornos sicoticos.
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Origen AYAHUASCA
Y HARMALA
Celebraciones mgico-religiosas
Tomar contacto con espritus de sus antepasados
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Produce:
. vrtigo
. embriaguez
. alucinaciones
Estructura quimica parecidasimpaticomimeticos.
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Hoffman-Sandoz `43. Alcaloide del cornezuelo de centeno. peculiar sensacion de vertigo e inquietud que me obligo y cai en una singular
embriaguez en la q predominaba mi imaginacion q se habia hecho exagerada. Al cerrar los ojos surgian hacia mi figuras fantasticas, de plasticidad
extraordinaria e intensos colores.
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Obtenida: MEZCAL O PEYOTE (apaches)
(Lophophora williamsii)
Peyotismo (rito religioso)
alivia todos los males de los mortales
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Origen: hongo mgico
Psilocibe mexicana,
MEXICO y USA
Son sicodislpticos
1.000 < potente que LSD
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Origen: Planta+ Salvia divinorum . hierba Mara u hojas de la pastora
Usadas por Mazatecas OAXACA de Mxico
Practicas espirituales
200-10000 mcg = 50-250 mcg LSD. Efecto dura < 1ho
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Origen: Cannabis sativa.
Viene del Medio Oriente y la India.
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ANFETAMINAS y FENCICLIDINA:
1. XTASIS (MDMA)
5metoxi,3,4metilenodioxianfetamina
2. PILDORA DEL AMOR (MDA)
Metilenodioxianfetamina
3. EVA (MDEA)
Metilenodioxietil anfetamina
4. DOB
Bromodimetoxipropalamina
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Anestsico veterinario
Consumo epidmico en USA `50
Anestsico general, pero abandonado por delirio al salir de la anestesia
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FARMACOS PSICOTOGENOS
EFECTOS FARMACOLOGICOS:
3: Siquicos, neurovegetativos y motores.
1. ALT. SIQUICAS:
sensibilidad para la percepcion de estimulos. Fase excitacion psiquica con SS neurovegetativos:sensacion de tension internamal viaje:.
Fase alucinogena: visuales, maravillosos paisajes
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FARMACOS PSICOTOGENOS
+Sensible al arte, musica, creacion literaria, pensamientos nobles y elevados
sentimientos humanos (placentera).
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FARMACOS PSICOTOGENOS
2. Trastornos Personalidad:
despersonalizacion (no ser el mismo.. Su imagen humana distorcionada,
personalidad desdobla).
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PSICOTOGENOS
Efecto tardio:
Aparicion de trastornosvisuales o retrospecciones- (destellosde color, percepcionesfalsas, seudoalucinaciones).
Uso prl trastornos psicoticospersistentes =esquizofrenia.
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PSICOTOGENOS
2. TRAST. MOTORES:
-LSD = siquicos;
-Harmina = motores
Temblores extremidades, contraccionesespasmodicas, exageracion de reflejos.
Animales: saltos, ataxia, marcha atras (raroH).
Temblores y piloereccion (LSD)
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PSICOTOGENOS
3. TRAST. NEUROVEGETATIVOS:
- Tipo simpaticomimeticos:
Harmina PA; mezcalina y LSD PA.
- LSD broncorelajacion.
- LSD: midriasis, temperatura, salivacion,
bochornos.
- Todas; taquicardia, somnolencia, debilidad,
parestesias.
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PSICOTOGENOS
Aterrizaje:
ansiedad, angustia, soledad=gritosdesesperados, panico.
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triptofano
Alterando la transmisin SEROTONINERGICA en mesencefalo:
1. Agonistas de R presinapticos 5HT 2
2. Inhibiendo la liberacin de serotonina
3. Antagonistas de R 5HT 2Ay 2C
(en SUEO inductores y prl)
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5HT-2C
SEROTONINA. EFECTOS FISIOFARMACOLOGICOS
3.
5-HT en todo el SNC
A. SUEO
INDUCTORES y PRL
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5HT-1B5HT-1A (presinap)
HIPOFUNCION= DEPRESION ENDOGENA
SEROTONINA. EFECTOS FISIOFARMACOLOGICOS
3. SNC
B. AGRESIVIDAD Y VIOLENCIA C. CONTROL ANSIEDAD
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PSICOTOGENOSEFECTOS ADVERSOS
Panico temporal mal viaje
NO teratogenia / aberrac cromosomicas.
SI tolerancia a siquicos.
NO Sd retirada. NO dependencia fisica.
Muerte por insuficiencia respiratoria o suicidio.
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PSICOTOGENOSUSOS CLINICOSTRATAMIENTO
Experimental en animales
Psicosis experimental en H con 50-100 mcg de LSD o 500 mg de mezcalina.
TX de la intoxicacion:
Diazepan o fenotiazinas (haloperidol 5 mg IM).
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MARIHUANA o hachis(Cannabis sativa)
>Consumo en Mundo (250-320 millones).
China 2.700 AC.I
Actividad farmacologica x d9-THC
EFECTOS FARMACOLOGICOS
SIQUICOS: Sedacionexcitacion y desinhibicion(alcohol). alucinogeno ligero: fantasear, crear, locuaz.
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MARIHUANA
Espectro amplio reacciones : euforia o desorientacion; bienestaro apatia, llanto o risa.
Fumar por 1ra vez o : reacciones sicoticas con despersonalizacion, perdida de la razon, alucinaciones.
OTROS: Percepcion alterada del tiempo, apetito, audicion +fina,imagenes visuales vividas. Congestion conjuntival.
Mal viaje
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MARIHUANAIntoxicacion CRONICA
*memoria, deterioro procesos perceptivos y discernimiento, percepcion alterada tiempo.
Sindrome amotivacional.:
SS MOTORES
Temblor muscular y ataxia.
Deterioro de la coordinacion
Deprime los reflejos medulares polisinapticos anticonvulsivante.
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MARIHUANAIntoxicacion CRONICA
OTROS:
Bronquitis y enfisema, EPOC, laringitis.
Ca pulmonar (humo).
Afecta aprendizaje en nios.
conc testosterona con contage espermatozoides. Menstruaciones anormales y falta de ovulacion.
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CB1
CB2
9-THC. MECANISMO DE ACCION
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SISTEMA CANNABINOIDE
Marihuana Tetra-Hidro-Cannabinol (THC)
9-THC marcado demostraron Recps diferentes a los conocidos.
2 Receptores: CB1 y CB2
En todo SNC (+hipocampo, cerebelo, hipotlamo, medula).
CB1: Inhibe liberacin de NA, GABA, Acth. Facilita libracin de NO.
CB2: relacionado con sistema inmune. En linfocitos, Mo y bazo.
Ligando anandamida apetito y tolerancia alcohol Antagonista Rimonabant xa Tx hiperfagia.
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MARIHUANA
FARMACOCINETICA.
Fumar THC x alveolos sangre y tejido (adiposo x semanas) Metaboliza higado y plasma x orina (metabolitos inactivos).
Efectos inmediatos (10-20m).
Accion: 2-3 horas!. Deposito en TCS x sem
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Primeras
experiencias
causan:
Nuseas Vomito
Congestin de las
conjuntivas
En fumadores de hierba
pertinaces a dosis alta
produce S. RETIRADA
Inquietud, Irritabilidad
Agitacin, Insomnio
Nusea, Clicos
Si Tolerancia
No dependencia Fsica
TX sintomatico, diazepam.
Teratogenica en animales (h,?)
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MARIHUANA
USOS
Expectativas:
- Nausea-vomito
- Dolor cronico,
- Espasticidad o esclerosis multiple,
- Glaucoma,
- Adiccion a otras drogas (alcohol)
- peso
- SIDA (apetito y s. inmune).
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Sanidad aprueba un medicamento con cannabis para la esclerosis
Sativex est indicado para pacientes con espasticidad que no mejoran con su medicacin habitual
Barcelona - 28/07/2010
El cannabis acaba de ganar parte de su espacio legal como sustancia teraputica. Dos de sus principios activos (entre ellos el THC) forman parte de la composicin de Sativex. Este extracto de cannabis, que se administra con un aerosol bajo la lengua, ha recibido hoy la autorizacin de las autoridades sanitarias espaolas para paliar la espasticidad en los enfermos de esclerosis mltiple.
Se trata de un medicamento complementario, que no sustituye a los antiespasmdicos orales actuales, pero que s mejora su respuesta. "Son muchos los pacientes que no reaccionan ante la medicacin habitual, cerca de un 60%", explica Xavier Montalbn, director del Centro de Esclerosis Mltiple de Catalua (Cemcat), que ha participado en los ensayos del frmaco. Sin embargo, s que hay mejora en los enfermos a los que, adems del antiespasmdico, se les administra el Sativex. En concreto, en las investigaciones se ha comprobado que aadiendo el compuesto de cannabis la mitad de estos pacientes resistentes logran controlar la espasticidad asociada a su enfermedad.
Colectivos de enfermos crnicos a los que no les han funcionado los tratamientos convencionales defienden el consumo del cannabis para mitigar los sntomas de la enfermedad o los efectos secundarios de otros tratamientos como nuseas o vmitos.
Enfermos de cncer, SIDA o fibromialgia son consumidores teraputicos de algunas de las asociaciones de usuarios de cannabis que hay en Espaa. As se aseguran la calidad de la marihuana que consumen.
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USOS 3. ANTIINFLAMATORIOESCLEROSIS MLTIPLE
DRONABINOL (Marinol)
NABILONA (Cesamet)
C. AJULNICO2. Tx OBESIDAD
RIMONABANT
(Antag CB1)
1. NAUSEA Y VOMITO (en Tx anti-Ca)
(derivado del 9-THC) en esclerosis multiple y anti-inflamatorio.
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CONTRARESTAR ALCOHOL
SR 141716para contrarrestar adiccion alcohol.
USOS
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Se la conoce:
PCP, polvo de los ngeles, pldora de la paz.
-Se presenta en forma de
polvo, inyecciones, tabletas.
Derivado ARILCICLOHEXILAMINAS
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DOSIS MENORES DOSIS ALTAS 5-10 mg
DOSIS TXICAS+ 20 mg
DOSIS MODERADA
Viaje de placer con sentimientos de tranquilidad
Percepcin > de estmulos externos
Excitacin
Alucinaciones
Apata.
Agresiva
Confusin
Estupor
Mirada extraviada
Postura catatnica
Convulsiones
Somnolencia
Deprime el centro respiratorio
Muerte
=sicotico-esquizofrenico--suicidio
Hipertensin
Taquicardia
Hipertonicidad
Contracciones mioclnicas
Nistagmus
Ataxia
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FENCICLIDINA
1er Trimestre embarazo:
abortos espontaneos y defectoscongenitos!!.
MEC ACCION.
Bloqueo R NMDA de glutamato. ?
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GLU
GLU
x
TERMINAL PRESINPTICA
TERMINAL POSTSINPTICA
NMDAAMPA ACPD
GLU
KAINATO
GLU
GLU .- GlutamatoAMPA .- Ac. aminometilisoxazolpropinicoACPD .-Ac. AminociclopentanodicarboxilicoNMDA .- N- metil-d- aspartato
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DEPENDENCIA
sicolgica pero NO
fsica
(=Anfet, 9-THC y coca).
Fenciclidina
TOLERANCIA
100 mg-1g/d !!.
Succin de
secreciones
Ventilacin x
depresin
respiratoria.
- Haloperidol 5 mg IM
en sicticos.
- Diazepam 10 mg IM
- Hidralazina en el caso
de hipertensin
arterial.
Intoxicacin Aguda
Medidas generales: proteccion de conducta irregular (lesiones, suicidio y muerte).
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Medical Marijuana and the Law
Diane E. Hoffmann, J.D., and Ellen Weber, J.D.
NEJM, Volume 362 (16):1453-1457, April 22, 2010
From the University of Maryland School of Law, Baltimore.
The U.S. legal landscape surrounding "medical marijuana" is complex and rapidly changing. Fourteen states California, Alaska, Oregon, Washington, Maine, Hawaii, Colorado, Nevada, Vermont, Montana, Rhode Island, New Mexico, Michigan, and most recently, New Jersey have passed laws eliminating criminalpenalties for using marijuana for medical purposes, and at least a dozen others are considering such legislation.1 Medical experts have also taken a fresh look at the evidence regarding the therapeutic use of marijuana,2,3 and the American Medical Association (AMA) recently adopted a resolution urging review of marijuana as a Schedule I controlled substance, noting it would support rescheduling if doing so would facilitate research and development of cannabinoid-based medicine. Criticizing the patchwork of state laws as inadequate to establish clinical standards for marijuana use, the AMA has joined the Institute of Medicine, the American College of Physicians, and patient advocates in calling for changes in federal drug-enforcement policies to establish evidence-based practices in this area.
States have led the medical marijuana movement largely because federal policymakers have consistently rejected petitions to authorize the prescription of marijuana as a Schedule II controlled substance that has both a risk of abuse and accepted medical uses. Restrictive federal law and, until recently, aggressivefederal law enforcement have hamstrung research and medical practice involving marijuana. The federal Controlled Substances Act (CSA) classifies marijuana as a Schedule I drug one with a high potential for abuse and "no currently accepted medical use" and criminalizes the acts of prescribing, dispensing, and possessing marijuana for any purpose. Although physicians may recommend its use under First Amendment protections of physicianpatient communications, as set forth in the 2002 federal appeals court decision Conant v. Walters, they violate federal law if they prescribe or dispense marijuana and may be charged with "aiding and abetting" violation of the federal law if they advise patients about obtaining it. A 2005 Supreme Court decision (Gonzales v. Raich) made clear that regardless of state laws, federal law enforcement has the authority under the CSA to arrest and prosecute physicians who prescribe ordispense marijuana and patients who possess or cultivate it.
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Most of the statutes also limit the amount of marijuana that patients or caretakers can possess or cultivate, although thequantities allowed are not derived from clinical trials or pegged to a medical condition. The amounts range from 1 oz and 6 plants in Alaska to 24 oz and 15 plants in Washington, an amount that Washington considers to be a "60-day supply."California's original medical-marijuana ballot initiative did not specify an allowed quantity, instead permitting an amountreasonably related to the patient's medical needs. Subsequent legislation set limits, which apply to individuals who register and thereby gain protection from arrest, but the California Supreme Court recently struck down the limits as they apply to unregistered patients who possess amounts of marijuana acceptable under the original ballot initiative. Such patients can be arrested, but if prosecuted can assert that the quantity they possess is reasonably related to their needs. Under the New Jersey law, physicians must provide patients with written instructions specifying the amount of marijuana to be dispensed by legally sanctioned treatment centers, but the maximum amount for a 30-day period is 2 oz making a "60-day supply" in New Jersey just 4 oz, one sixth of that in Washington, a disparity that underscores the absence of standards.
The laws also vary in terms of whether they establish a registry and issue identification cards for qualifying patients. Eleven of the 14 states have a registry, and Maine and New Jersey will soon. In most states where patients have identification cards, they are protected from arrest and prosecution. In some states, however, registered patients with identification cards may bearrested but can use the defense that they have a demonstrated medical need for marijuana. And in a few states, unregisteredbut "qualifying" patients who meet other requirements of the law may also use this defense.
Missing from many state laws is a requirement that physicians recommending medical marijuana to adult patients provide therudimentary disclosure of risks and benefits necessary for informed consent, although such disclosure is generally required forpatients who are minors. In Canada, the first country to decriminalize medical marijuana, regulations require that physicians discuss the risks with their patients, yet the lack of relevant clinical trials of smoked cannabis makes it difficult for physicians to comply with the law.
In states debating new legislation, policymakers are grappling with questions that only scientific research can answer: For what conditions does marijuana provide medicinal benefits? Are there equally effective alternatives? What are the appropriate doses for various conditions? How can states ensure quality and purity?
Although state laws represent a political response to patients seeking relief from debilitating symptoms, they are inadequate to advance effective treatment. Medical experts emphasize the need to reclassify marijuana as a Schedule II drug to facilitaterigorous scientific evaluation of the potential therapeutic benefits of cannabinoides and to determine the optimal dose anddelivery route for conditions in which efficacy is established. This research could provide the basis for regulation by the Food and Drug Administration. Current roadblocks to conducting clinical trials, however, make this more rational route of approvalunlikely and perpetuate the development of state laws that lack consistency or consensus on basic features of an evidence-based therapeutic program.
Reliance on state laws as the basis for access to medical marijuana also leaves patients and physicians in a precarious legal position. Although the current Justice Department may not prosecute patients if they use marijuana in a manner consistent with their states' laws, the federal law remains unchanged, and future administrations could return to previous enforcement practices.
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Nevertheless, in October 2009, the Department of Justice issued a memorandum to U.S. Attorneys stating that federal resources should not be used to prosecute persons whose actions comply with their states' laws permitting medical use of marijuana. This change in the Justice Department's prosecutorial stancepaved the way for states to implement new medical-marijuana laws, and states are now attempting to design laws that balance concerns about providing access for patients who can benefit from the drug with concerns about its abuse and diversion. Although the current state laws facilitate access, they do little toadvance the development of standards that address the potency, quality, purity, dosing, packaging, and labeling of marijuana.
All the state laws allow patients to use and possess small quantities of marijuana for medical purposes without being subject to state criminal penalties. They also allow a patient's "caregiver" an adult who agrees to assist with a patient's medical use of marijuana to possess, but not use, marijuana. Most laws protect "qualifying" patients, who are variously defined as those who have received a diagnosis of a debilitating medical condition and have written documentation (or, in one case, an oral recommendation) from their physician indicating that they might or would "benefit from the medical use of marijuana" orthat the "potential benefits of medical use of marijuana would likely outweigh the health risks." Definitions of "debilitating medical condition" vary by state but typically include HIVAIDS, cachexia, cancer, glaucoma, epilepsy and other seizure disorders, severe nausea, severe and chronic pain, muscle spasms from multiple sclerosis or Crohn's disease, and other conditions. All but two states allow additions to this list if approved by the state health department.
Virtually all permit patients or caregivers to cultivate marijuana. New Jersey's new law prohibits such cultivation but provides for the establishment of alternative treatment centers that will "fill" a physician'swritten instruction for a certain quantity of marijuana. Most laws are silent on whether patients or their caregivers may buy or sell marijuana or whether dispensaries are permitted. California permits dispensing through cooperatives or collectives, but until recently most other states did not a situation that is changing with the enactment of some recent laws and amendments.