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New psychoactive substance (NPS) 新興精神活性物質 :
沒有在1961年麻醉藥品單一公約或1971年影響精神物質公約附表中所列管的濫用物質
2008-2017 一共出現130種 NPS, 其中合成卡西酮就有42種 (佔32%)
* 中樞神經興奮作用為主的新興毒品涵蓋 :
1) 苯乙胺類(Phenethylamine)
2) 哌嗪類(Piperazines)
3) 氨基茚滿類(Aminoindanes)
4) 合成卡西酮類(Synthetic cathinones)
5) 植物類物質(Plant-based substance)中的恰特草(Khat)
* 合成大麻類(Sythetic cannabinoids)新興毒品
* 幻覺劑類新興毒品 :
沒有在1961年麻醉藥品單一公約或1971年影響精神物質公約附表中所列管的濫用物質
2008-2017 一共出現130種 NPS, 其中合成卡西酮就有42種 (佔32%)
* 中樞神經興奮作用為主的新興毒品涵蓋 :
1) 苯乙胺類(Phenethylamine)
2) 哌嗪類(Piperazines)
3) 氨基茚滿類(Aminoindanes)
4) 合成卡西酮類(Synthetic cathinones)
5) 植物類物質(Plant-based substance)中的恰特草(Khat)
* 合成大麻類(Sythetic cannabinoids)新興毒品
* 幻覺劑類新興毒品 :
解離類(Dissociatives)及苯環利定類(PCP)與色胺類(Tryptamines)
Synthetic cathinone 合成類卡西酮
俗稱：浴鹽, 喪屍毒, 喵喵, 新喵喵
Cathinone 是天然灌木 (Catha edulis = Khat) 的生物鹼
又稱非洲檳榔或東非罌粟
特色：便宜, 吸食方便
由鼻吸與口服使用占大多數
甲基卡西酮 (Methcathinone) 是第一個人工合成的卡西酮類毒品
其與甲基安非他命相近, 只差一個酮基, 屬於二級毒品
喵喵 (4-甲基甲基卡西酮；Mephedrone) , βk-MDMA (Methylone)
MDPV 是這幾年最為流行的卡西酮類合成毒品
新喵喵 4-MEC (4-甲基乙基卡西酮), 氟甲基卡西酮
氯甲基卡西酮, βk-MBDB (butylone),
其與甲基安非他命相近, 只差一個酮基, 屬於二級毒品
喵喵 (4-甲基甲基卡西酮；Mephedrone) , βk-MDMA (Methylone)
MDPV 是這幾年最為流行的卡西酮類合成毒品
新喵喵 4-MEC (4-甲基乙基卡西酮), 氟甲基卡西酮
氯甲基卡西酮, βk-MBDB (butylone),
βk-DMBDB (Dibutylone), N-Ethylpentylone
< 毒咖啡, 咖啡包, 奶茶包：混合毒品 >
Toxidrome
類似 MDMA 和 Amphetamine
Sympathomimetic toxic syndrome
Dopamine (Major) and Norepinephrine
Serotonin (Minor) release
肝代謝, 腎排出
Clinical features :
- Sympathetic : Tachycardia, HTN, Hyperthermia, Diaphoresis, Mydriasis
- Neuro : Agitated, Delirium, Violent behavior, Seizure, Hallucination
- Secondary complications : AKI, Hepatic injury, Rhabdomyolysis,
Arrhythmia, Myocarditis, ICH, DIC
Different from amphetamine :
The most distinguishing feature of overdose with a synthetic cathinone
is the prolonged duration of effect lasting for days to even weeks
- Sympathetic : Tachycardia, HTN, Hyperthermia, Diaphoresis, Mydriasis
- Neuro : Agitated, Delirium, Violent behavior, Seizure, Hallucination
- Secondary complications : AKI, Hepatic injury, Rhabdomyolysis,
Arrhythmia, Myocarditis, ICH, DIC
Different from amphetamine :
The most distinguishing feature of overdose with a synthetic cathinone
is the prolonged duration of effect lasting for days to even weeks
Managements :
General approach : Hydration
Psychomotor agitation :
- Lorazepam 2-4 mg IV or diazepam 5-10 mg IV 1st line
may be repeated every 3-5 minutes until agitation is controlled.
Large cumulative doses of benzodiazepines (hundreds of milligrams) may be required
- Haloperidol 2nd line : be ware of QTc prolong
Hyperthermia :
- 1st line : Aggressive sedation with BZDs
- 體外冷卻
- Nondepolarizing agents：Rocuronium and Vecuronium
- Avoid syccinylcholine: due to risk of rhabdomyolysis and hyperK
General approach : Hydration
Psychomotor agitation :
- Lorazepam 2-4 mg IV or diazepam 5-10 mg IV 1st line
may be repeated every 3-5 minutes until agitation is controlled.
Large cumulative doses of benzodiazepines (hundreds of milligrams) may be required
- Haloperidol 2nd line : be ware of QTc prolong
Hyperthermia :
- 1st line : Aggressive sedation with BZDs
- 體外冷卻
- Nondepolarizing agents：Rocuronium and Vecuronium
- Avoid syccinylcholine: due to risk of rhabdomyolysis and hyperK
Hypertension：
- BZDs 1st line
reduction in CNS catecholamine release
nitroprusside, nitroglycerine, and phentolamine as 2nd line
Avoid beta-blocker
- BZDs 1st line
reduction in CNS catecholamine release
nitroprusside, nitroglycerine, and phentolamine as 2nd line
Avoid beta-blocker
ex : trandate (both alpha- and beta-adrenergic tone)
Sodium bicarbonate :
Sodium bicarbonate :
may be used to raise the pH above 7.15
in lactic acidosis and to alkalinize the urine
Sinus tachycardia usually does not require specific treatment
in lactic acidosis and to alkalinize the urine
Sinus tachycardia usually does not require specific treatment
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