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Toxicology – Phencyclidine (PCP) Toxicity
Source
Phencyclidine (PCP) is a synthetically produced drug derived from cyclohexanone and piperidine. It is often applied to plant material such as marijuana, mint, or parsley and then smoked. It is known by various street names including “Sherm,” “Wet,” and “Fry.”
Typical Presentation
Patients may present with fluctuating levels of consciousness. A common pattern includes sudden awakening from an unresponsive state followed by extreme agitation, aggression, and attempts to escape or fight.
Clinical Features
Symptoms range from deep sedation or coma to severe agitation and psychosis. Individuals may exhibit unpredictable behavior, including violent outbursts and reduced sensitivity to pain. Physical findings often include nystagmus, hypertension, tachycardia, and seizures. Rapid shifts between sedation and agitation are characteristic.
Mechanism of Action
PCP is a lipophilic dissociative anesthetic that primarily blocks NMDA receptors in the brain. It also has mild effects on catecholamine reuptake, contributing to its stimulant and psychotropic effects.
Management
Treatment is supportive. Benzodiazepines are used to control agitation and anxiety. In cases of severe agitation or danger to others, physical or chemical restraints may be necessary.
Key Points
Source
Phencyclidine (PCP) is a synthetically produced drug derived from cyclohexanone and piperidine. It is often applied to plant material such as marijuana, mint, or parsley and then smoked. It is known by various street names including “Sherm,” “Wet,” and “Fry.”
Typical Presentation
Patients may present with fluctuating levels of consciousness. A common pattern includes sudden awakening from an unresponsive state followed by extreme agitation, aggression, and attempts to escape or fight.
Clinical Features
Symptoms range from deep sedation or coma to severe agitation and psychosis. Individuals may exhibit unpredictable behavior, including violent outbursts and reduced sensitivity to pain. Physical findings often include nystagmus, hypertension, tachycardia, and seizures. Rapid shifts between sedation and agitation are characteristic.
Mechanism of Action
PCP is a lipophilic dissociative anesthetic that primarily blocks NMDA receptors in the brain. It also has mild effects on catecholamine reuptake, contributing to its stimulant and psychotropic effects.
Management
Treatment is supportive. Benzodiazepines are used to control agitation and anxiety. In cases of severe agitation or danger to others, physical or chemical restraints may be necessary.
Key Points
- PCP intoxication often presents with alternating states of sedation and agitation.
- Patients may exhibit significant strength and decreased pain perception, making management challenging.
- A useful mnemonic for features includes “RED DANES”: rage, erythema, dilated pupils, delusions, amnesia, nystagmus, excitation, and skin dryness.
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