Tiêu đề 26. CANNABIS GROUP.pdf ✅

PHARMD GURU Page 1  Cannabis preparations (vide infra) are derived from Indian hemp plant (Cannabis sativa), which is a hardy, aromatic annual herb that grows wild under most climatic conditions.  The plant grows to a height of 5 to 15 feet, and is characterized by an odd number of leaflets on each leaf (varying from 5 to 9), all having serrated or saw-tooth edges, and small, green flowers. The male and female flowers are borne on separate plants. After pollination, the male plants die back. ACTIVE PRINCIPLE:  The main active principle is d9 (delta-9) tetra-hydro-cannabinol (THC) which is a cannabinoid found in both the male and female plants.  THC is a lipid-soluble, water-insoluble compound which can be synthesised in the laboratory. The synthetic form, however, is very expensive to produce, and so frequently, other illicit drugs such as phencyclidine, mescaline, or LSD are sold in the guise of THC. A product called "super weed" or "super grass" is dusted with phencyclidine.  Apart from THC, Cannabis sativa contains a number of other cannabinoids, including cannabidiol, cannabinol, cannabidolic acid, cannabicyclol and cannabigerol. SOURCES: 1. Marijuana: The term "marijuana" refers to any part of the plant or its extract that is used to induce psychotomimetic (or) therapeutic effects. Synonyms include Mary Jane, MJ, maconha, pot, weed, grass, puff, and dagga. 2. Ganja: Although some texts refer to ganja as being synonymous with marijuana, while others consider it to be a resinous mass composed of leaves and bracts, in India (where the term actually originated), it is used to refer to crushed leaves and inflorescences of female plants. It is usually smoked in a pipe ("chillum") or in the form of cigarettes ("reefer or "joint" or "number"). Ganja is said to contain 1 to 2% THC. CANNABIS GROUP
PHARMD GURU Page 2 3. Bhang: Bhang consists of dried mature leaves and flower stems that are ground with water and mixed with milk or fruit juice. It is consumed by Hindus in India during festivals such as Holi and Shiv Ratri. 4. Hashish (Charas): This preparation is made out of dried resin collected from flower tops, and contains varying concentrations of THC up to 10%. It is popular in the Middle East and North Africa. Hashish oil or liquid hashish" is an alcohol or petrol extract which occurs as a dark green viscous liquid with the consistency of tar. It is the most potent of all cannabis preparations and contains 20 to 30% (or more) THC. 5. Sinsemilla: It is the most popular form of cannabis in the USA, and refers to seedless (unpollinated female) plant which averages 5% of THC. 6. Marijuana 'Blunts": This is nothing but cheap cigars sliced open, packed with cannabis, and resealed. The harsh stench of the cigar masks the characteristic sweet smell of cannabis. Blunts are very popular among the youth in some parts of the USA. MECHANISM:  Recently a receptor site has been identified in rat brain that binds reversibly and selectively with cannabinoids.  Receptor binding was also found in the peripheral B lymphocyte-rich areas such as the marginal zone of the spleen, nodular corona of Peyer's patches, and cortex of lymph nodes.  A cannabinoid antagonist was also discovered that antagonises cannabinoid induced inhibition of adenylcyclase and smooth muscle contraction.  It appears that cannabinoids exert many of their actions by influencing several neurotransmitter systems and their modulators. These include GAGA, dopamine, acetylcholine, histamine, serotonin, noradrenaline, and prostaglandins. CLINICAL (TOXIC) EFFECTS:  Euphoria with increased garrulity and hilarity, especially when smoked in a social group setting.  Temporal and spatial disorientation with intensification of sensation.
PHARMD GURU Page 3  At high doses, the user experiences ataxia, dizziness, hallucinations, sedation, and sometimes dysphoria characterised by unpleasant sensations, fear, and panic.  Tachycardia, palpitations, hypertension (high doses). Large doses can also cause postural hypotension.  Bloodshot eyes due to conjunctival congestion.  Reduced bowel motility and urinary retention have occasionally been observed.  Pupils are usually not affected. Occasionally, mydriasis and nystagmus may occur.  Amotivational Syndrome: Chronic indulgence is said to induce an amotivational syndrome characterized by apathy, poor concentration, social withdrawal, and lack of motivation to study or work.  Heavy cannabis users demonstrate an increased tendency to develop manic, schizophreniform, and confusional psychoses over a period of time.  Medical complications: Chronic lung disease and carcinogenesis, Cancers of mouth and larynx, Aspergillosis, Non-specific ST wave, Gynaecomastia and mild abstinence syndrome. INVESTIGATIONS:  Identification of suspected specimen: Suspend leaf or stern fragments in several drops of chloral hydrate (10%) on a microscope slide and examine under low power for characteristic "cystolith hairs". Add a drop of 20% HCI and note the gentle effervescent release of carbon dioxide gas in tiny bubbles.  Urine levels of cannabinoids: THC is hydrophobic and accumulates in adipose tissue. Screening tests may be positive for up to 70 or more days, depending on the cut-off levels used and the individual's lipid stores of THC. False positive results may occur with therapeutic use of ibuprofen, fenoprofen, and naproxen.  Screening tests usually employ EMIT or RIA, while confirmation is done by using GC-MS.
PHARMD GURU Page 4 MANAGEMENT:  Decontamination measures in cases of ingestion. Activated charcoal is beneficial,  Acute psychotic reactions respond to benzodiazepines. 5 to 10 milligrams of diazepam orally is usually sufficient,  Psychosocial therapy consisting of attempts to promote realistic and rewarding alternatives to the drug and associated life styles, along with a commitment to abstinence from self-administered or unprescribed psychotropic drugs,  Drug-focussed group therapy comprising strategies such as social pressure to reinforce abstinence, teaching socialization and problem solving skills, reducing stress and the sense of isolation common with drug abuse, relapse prevention exercises and varying degrees of confrontation.  Short-term use of antipsychotic medication may be required if there are persistent delusional ideas or frightening flash backs.