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Increases duration of chloride channel opening of GABA-A receptors
0%
0/3
Alpha-2 and H1 receptor antagonist
67%
2/3
Competitive opioid receptor antagonist
Antagonist of D2 receptors
33%
1/3
Mu-opioid receptor partial agonist
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The patient's clinical presentation is highly suggestive of phencyclidine (PCP) intoxication. Methods to achieve sedation include benzodiazepines or haloperidol, though benzodiazepines are preferred. Haloperidol has antagonistic effects on D2 receptors. PCP is a psychedelic agent that has dissociative anesthetic properties. PCP has the ability to antagonize N-methyl-D-aspartate (NMDA) receptor, and impairs dopamine, norepinephrine, and serotonin re-uptake. These mechanism of action play a role in producing psychosis, agitation, and even seizures. Sedatives used in PCP intoxication include benzodiazepines and haloperidol. Haloperidol is a butyrophenone antipsychotic. It appears to be a nonselective D2 receptor antagonist in postsynaptic neurons. Giannini present a paper on the approach to drug abuse, intoxication, and withdrawal. Drug abuse alter acetylcholine, dopamine, y-aminobutyric acid, norepinephrine, opioid, and serotonin neurotransmitters or their receptors. The neurotransmitters and receptors affected cause the patient to present with specific signs and symptoms. MacNeal et al., present a retrospective review on the use of haloperidol in the treatment of PCP-intoxicated patients. Patients who are intoxicated on PCP are often violent, and thus are difficult to physically control. Therefore, in order to protect the patient and staff, chemical restraints are needed. The use of haloperidol appears to not be harmful to patients in the management of PCP-intoxication. Incorrect Answers: Answer 1: Increases duration of chloride channel opening of GABA-A receptors is the mechanism of action shared by barbiturates, such as phenobarbitol. This is not commonly used in the management of PCP-intoxication. Answer 2: Alpha-2 and H-1 receptor antagonist describe some of the properties of mirtazapine, an atypical anti-depressant. This medication would be ideal for depressed patients with insomnia, or anorexic patients. Answer 3: Competitive opioid receptor antagonist properties are seen in naltrexone. Naltrexone is used in the treatment of alcohol dependence. Answer 5: Mu-opioid receptor partial agonist describe buprenorphine. This medication is used as maintenance therapy for opioid addicts.
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