Page 433 - Veterinary Toxicology, Basic and Clinical Principles, 3rd Edition

400 SECTION | IV Drugs of Use and Abuse

VetBooks.ir in certain products with innocuous sounding names like with less affinity for 5-HT 1 , dopamine, α 1 , and β
receptors.
“bath salts” and “plant food.” Many legally available
Frith et al. (1987) described the effects of MDMA
compounds are commonly used as stimulants and some-
times incorporated into illegal drugs. These include nico- given to dogs in increasing oral doses, and they were sim-
tine from tobacco products, methylxanthines such as ilar to those described for other amphetamines. Clinical
caffeine, theobromine and theophylline, found in common signs began after about 45 min and continued for 6 8h.
food and drink products, and alkaloids of the areca nut, Dogs given low doses (3 mg/kg) most frequently showed
present in betel quid. The latter compounds will be symptoms of hyperactivity and mydriasis. Dogs given
addressed briefly. 9 mg/kg also became tachypneic with hypersalivation and
circling behavior. One of six dogs given 15 mg/kg
MDMA died after showing clinical sings that included
MDMA vocalization, aggression, convulsions, and front limb
MDMA, more frequently known as “ecstasy,” is a paralysis.
Schedule I drug. MDMA was used as an appetite suppres- Onset and duration of clinical signs are similar in
sant and in psychotherapy (Smith et al., 2002). The drug humans, though onset is more rapid with insufflation
has shown some promise in the treatment of Parkinson’s (Smith et al., 2002; Rimsza and Moses, 2005). Mydriasis,
disease and posttraumatic stress disorder, but there are no delirium confusion, agitation, bruxism, tremors, seizures,
accepted medical uses at this time (Morton, 2005). and loss of consciousness have been reported in MDMA
Currently, MDMA is one of the most popular club drugs users, as have hyperthermia and rhabdomyolysis
in the United States and use increased 70% worldwide (Kisseberth and Trammel, 1990; Smith et al., 2002;
between 1995 and 2001 (Anonymous, 2011). Surveys of Liechti et al., 2005; Rimsza and Moses, 2005).
US students found that 5% 6.7% of students had used Cardiovascular changes can include tachycardia, or less
MDMA in high school and 2% of 8th graders had used it commonly bradycardia, AV block, and hypertension. A
(Eaton et al., 2010; Latimer and Zur, 2010). few deaths have been attributed to cardiopulmonary arrest
MDMA has been sold under numerous different names, (Liechti et al., 2005) and liver failure (Andreu et al.,
a short list of which includes “Adam,” “Batman,” “bibs,” 1998; Gable, 2004; Rimsza and Moses, 2005; Liechti
“blue kisses,” blue Nile,” “charity,” “clarity,” “Debs,” “dec- et al., 2005). Onset of liver failure occurs days to weeks
adence,” “E,” “Eve,” “go,” “happy pill,” “hug drug,” after exposure, and the mechanism is not understood,
“lover’s speed,” “M,” “roll” or “rolling,” “Scooby snacks,” though a hypersensitivity reaction has been suggested in
“X” and “XTC.” Tablets containing 50 150 mg MDMA some cases.
are often brightly colored with pressed images such as prod- Treatment of MDMA exposure consists of appropriate
uct logos, butterflies, smiley faces, numbers, or letters. Less gastrointestinal detoxification, as with amphetamines, and
commonly encountered are the powdered or capsule forms. symptomatic and supportive care.
“Ecstasy” tablets tested in Europe during the 1990s only
contained 50% MDMA on average (Libiseller et al., 2005).
Those tested in the US averaged 83% MDMA Khat, Mephedrone and
Methylenedioxypyrovalerone
(Anonymous, 2011). Other common ingredients included
ketamine, methamphetamine, MDA, and MDEA. Khat (C. edulis) is a plant found in East Africa and the
The LD 50 of MDMA in rats is between 160 and Arabian Peninsula. Traditionally, leaves of this shrub
325 mg/kg PO. Dogs given 15 mg/kg MDMA showed have been chewed or consumed as a stimulant, but they
severe clinical signs, and one of six of the dogs died are sometimes smoked. The leaves contain cathinone, a
(Frith et al., 1987). MDMA is metabolized in the liver by DEA Schedule I substance, which breaks down after
N-demethylation to the active metabolite MDA (Smith about 36 h, and the more stable compound cathine, which
et al., 2002). is a Schedule IV substance (Anonymous, 2011). Clinical
MDMA is structurally similar to amphetamines and signs associated with khat use include reduced appetite,
mescaline, which likely explains some of the clinical tachycardia, hypertension, and insomnia.
effects (Lyles and Cadet, 2003). MDMA increases neuro- Bupropion is a synthetic cathinone prescribed for smok-
transmitter release, including serotonin, dopamine, and ing cessation and depression, and diethylpropion is used
NE (Smith et al., 2002; Morton, 2005; Rimsza and for appetite suppression (Rech et al., 2015). Mephedrone
Moses, 2005). Hallucinogenic effects have been attributed (4-methylmethcathinone) and methylenedioxypyrovalerone
to serotonin release and inhibition of reuptake. This drug (MDPV) are compounds related to cathinone that have
also inhibits MAO. MDMA directly binds to certain increased exponentially in popularity as recreational drugs
receptors, including 5-HT 2 receptors, α 2 -adrenergic recep- over the past couple of decades. Mephedrone became ille-
tors, M 1 muscarinic receptors, and H 1 histamine receptors, gal in the United Kingdom in April 2010 where it sold for