OTCs

e.g. diphenhydramine.
- Hot as a hare, dry as a bone, red as a beet, mad as a hatter

Symptom treatment - benzodiazepines and/or physostigmine (but not been
manufactured for a while)

acetylcholinesterase inhibitor; tertiary amine, only one that crosses BBB.
Given by slow push over 5 minutes
Anticholinergic toxicity may last longer than the antidote (short-acting)
Overly rapid administration may result in cholinergic symptoms or seizures

widely available and inexpensive OTC
peripheral mu-opioid receptor activity — used at high doses crosses BBB
and causes euphoria
People used to self-ween off opioids with loperamide due to its action at mu receptors
Has a very high risk of causing arrhythmias (Torsade's de Pointes)

Pgp inhibitor - may help clear the loperamide out of the CNS

classic signs - nausea, headache, malaise; leads to MI, spontaneous abortion
CO binds hemoglobin, leads to hypoxia

Hyperbaric Oxygen to prevent long term effects (most in NJ will not use this for
poisoning)

comes from hemp or marijuana plant
generally non-psychoactive
Must contain <0.3% THC
use/sale legal under 2018 Farm Bill

has THC; main psychoactive component
produces high feeling

Causes:
CNS depression- calming, sedation, sleepy, unconscious
OR
CNS excitation -
Anxiety
Paranoia
Panic attacks
Children- resp depression, seizures

psychoactive; are legal and sold in many convenience stores
may be picked up on a drug screen contrasting from CBD

causes rapid weight loss
increases metabolism via uncoupled oxidative phosphorylation
banned by FDA since 1938

Recommended management: aggressive supportive measures, cooling
(ice or ice water[not ice packs, cooling blankets, or tylenol]), benzodiazepines

Cerbera odollam - suicide tree
kernel contains majority of toxin - Cerberin which causes cardiac glycoside, cardenolide class

causes false positive PCP test
sometimes diphenhydramine does this too
often sold with APAP; need to worry about acetaminophen toxicity dextro isomer of levomethorphan, a semisynthetic morphine derivative.
structurally similar to other narcotics
DXM does not act as a mu-receptor opioid (e.g. morphine, heroin)

DXM and its metabolite, dextrorphan
act as potent blockers of the N-methyl-d-aspartate (NMDA) receptor.
At high doses, the pharmacology of DXM is similar to the controlled
substances
phencyclidine (PCP) and ketamine
At high doses
PCP-like behavioral effects
dissociative anesthetic like properties of PCP
abused for psychoactive effects
"out of body experience" and alteration in sensory perception

Symptomatic supportive care
Benzodiazepines