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).

(alertex, curam)

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.

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

PSICOTOGENOS O ALUCINOGENOS

2. Sinteticos:

- Fenciclidina (PCP),

- Derivados de anfetaminas:

MDMAext, MDEAeva y MDApild

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.

Origen AYAHUASCA

Y HARMALA

Celebraciones mgico-religiosas

Tomar contacto con espritus de sus antepasados

Produce:

. vrtigo

. embriaguez

. alucinaciones

Estructura quimica parecidasimpaticomimeticos.

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.

Obtenida: MEZCAL O PEYOTE (apaches)

(Lophophora williamsii)

Peyotismo (rito religioso)

alivia todos los males de los mortales

Origen: hongo mgico

Psilocibe mexicana,

MEXICO y USA

Son sicodislpticos

1.000 < potente que LSD

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

Origen: Cannabis sativa.

Viene del Medio Oriente y la India.

ANFETAMINAS y FENCICLIDINA:

1. XTASIS (MDMA)

5metoxi,3,4metilenodioxianfetamina

2. PILDORA DEL AMOR (MDA)

Metilenodioxianfetamina

3. EVA (MDEA)

Metilenodioxietil anfetamina

4. DOB

Bromodimetoxipropalamina

Anestsico veterinario

Consumo epidmico en USA `50

Anestsico general, pero abandonado por delirio al salir de la anestesia

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

FARMACOS PSICOTOGENOS

+Sensible al arte, musica, creacion literaria, pensamientos nobles y elevados

sentimientos humanos (placentera).

FARMACOS PSICOTOGENOS

2. Trastornos Personalidad:

despersonalizacion (no ser el mismo.. Su imagen humana distorcionada,

personalidad desdobla).

PSICOTOGENOS

Efecto tardio:

Aparicion de trastornosvisuales o retrospecciones- (destellosde color, percepcionesfalsas, seudoalucinaciones).

Uso prl trastornos psicoticospersistentes =esquizofrenia.

PSICOTOGENOS

2. TRAST. MOTORES:

-LSD = siquicos;

-Harmina = motores

Temblores extremidades, contraccionesespasmodicas, exageracion de reflejos.

Animales: saltos, ataxia, marcha atras (raroH).

Temblores y piloereccion (LSD)

PSICOTOGENOS

3. TRAST. NEUROVEGETATIVOS:

- Tipo simpaticomimeticos:

Harmina PA; mezcalina y LSD PA.

- LSD broncorelajacion.

- LSD: midriasis, temperatura, salivacion,

bochornos.

- Todas; taquicardia, somnolencia, debilidad,

parestesias.

PSICOTOGENOS

Aterrizaje:

ansiedad, angustia, soledad=gritosdesesperados, panico.

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)

5HT-2C

SEROTONINA. EFECTOS FISIOFARMACOLOGICOS

3.

5-HT en todo el SNC

A. SUEO

INDUCTORES y PRL

5HT-1B5HT-1A (presinap)

HIPOFUNCION= DEPRESION ENDOGENA

SEROTONINA. EFECTOS FISIOFARMACOLOGICOS

3. SNC

B. AGRESIVIDAD Y VIOLENCIA C. CONTROL ANSIEDAD

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.

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).

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.

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

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.

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.

CB1

CB2

9-THC. MECANISMO DE ACCION

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.

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

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,?)

MARIHUANA

USOS

Expectativas:

- Nausea-vomito

- Dolor cronico,

- Espasticidad o esclerosis multiple,

- Glaucoma,

- Adiccion a otras drogas (alcohol)

- peso

- SIDA (apetito y s. inmune).

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.

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.

CONTRARESTAR ALCOHOL

SR 141716para contrarrestar adiccion alcohol.

USOS

Se la conoce:

PCP, polvo de los ngeles, pldora de la paz.

-Se presenta en forma de

polvo, inyecciones, tabletas.

Derivado ARILCICLOHEXILAMINAS

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

FENCICLIDINA

1er Trimestre embarazo:

abortos espontaneos y defectoscongenitos!!.

MEC ACCION.

Bloqueo R NMDA de glutamato. ?

GLU

GLU

x

TERMINAL PRESINPTICA

TERMINAL POSTSINPTICA

NMDAAMPA ACPD

GLU

KAINATO

GLU

GLU .- GlutamatoAMPA .- Ac. aminometilisoxazolpropinicoACPD .-Ac. AminociclopentanodicarboxilicoNMDA .- N- metil-d- aspartato

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).

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.

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.

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.