2.

Face
I. BASIC CONCEPTS Lacrimator ➔ Tear
➔ Ex: Organophosphate
(Parasympathetic agonist)
A. Toxicology Sternutator ➔ Sneezing
● Study of poisons ➔ Ex: Capsaicin, Veratrin
● Poisons – any substance that may cause harm, injury,
damage, or death to an individual 3. Lungs
● Paracelsus – “the dose makes the poison” Asphyxiant ➔ Dyspnea (DOB)
○ True Posion – poisonous regardless of the dose ➔ Ex: Carbon Monoxide
(ex: snake venom)
4. Skin
B. Branches of Toxicology Corrosive ➔ Burns & scaling
➔ Ex:
“MEDFORCE”
Irritant ➔ Rashes, swelling
Mechanistic Mechanism of Toxicity ➔ Ex:
Toxicology
Identify the safety parameters of a certain
5. Muscle
substance
a. Therapeutic Index – marker of Asthenic ➔ Muscle weakness
𝑇𝐷50
relative margin of safety 𝑇𝐼 = 𝐸𝐷50 ➔ Ex: Neuromuscular blockers
(Parasympathetic NM Antagonist)
i. ED50 - the dose that will
produce beneficial effect in 50%
NCRare DINSux
of the population
ii. TD50 - the dose that will Nondepolarizing Depolarizing
produce toxic effects in 50% of Competitive Irreversible
the population Reversible Noncompetitive
Experimental SteROid: Suxamethonium /
Toxicology cuROnium Succinylcholine
If TI is narrow, WTD → Therapeutic Drug
Monitoring ➔ Rocuronium
● Phenytoin ➔ Pancuronium
● Lithium
● Digoxin Isoquinoline:
● Theophylline Curium
● Warfarin ➔ Atracurium
➔ Mivacurium
MOA: Competitively MOA: Phase 1:
b.LD50 – the dose that will produce antagonizes ACh Noncompetitive
lethal effect to 50% of the population binding to Nm binding of S to Nm
➔ ⇩ LD50 = ⇧ deadlier receptor → Na receptor →
Descriptive Identify the safety profile of a specific Channel opening → opening of Na
Toxicology substance nondepolarizing channel →
➔ Drugs: Product insert → Muscle depolarization →
➔ Chemicals: MSDS contraction continuous muscle
Forensic Medicolegal aspect of the poison; contraction
Toxicology investigation of the cause of death of an
individual Phase 2:
Occupational Poisons in the work area; Desensitization →
Toxicology Recall; identification of risk and hazard contraction
➔ Risk - expected frequency that Uses:
something bad will happen Skeletal Muscle
➔ Hazard - ability to cause harm Relaxant during
Regulatory Control the distribution and availability of surgery (for easy
Toxicology of drugs retraction of muscle)
Clinical Different diseases associated with a WOF: WOF:
Toxicology certain poison Anaphylactoid rxn Rhabdomyolysis
Environmental Identify the effect of pollutants in an Seizures Hyperkalemia→
Toxicology individual Heart dx
Myoglobin release→
Acute Kidney Injury
(⇧SCr, ⇩CrCl,
⇩GFR)
C. Types of Poison Malignant
1. Brain Hyperthemia (Tx:
Neurotic ➔ Hallucinogen Dantrolene)
➔ Substances that causes hallucinations Reveral Agents:
➔ Ex: LSD Sugammadex – a
Narcotic ➔ Narcotic cyclodextrin (traps
➔ Altered level of consciousness, stupor, curare drug)
drowsiness
➔ Ex: Opioids
Tetanic ➔ Spastic paralysis heart)
➔ Ex: Tetanospasmin, Strychnine Ethanol Fetal alcohol
syndorme – (+)
Tetanospasmin Strychnine midface hypoplasia,
Clostridium tetani (gram Strychnos nux indistinct philtrum
(+) anaerobic bacilli, vomica
terminal spores) The only cure for Gestational HTN is
ID: Drumstick, tennis DELIVERY. Pregnant px are usually
rakcet, lollipop hypotensive.
Reservoir: soil LMWH – preferred anticoagulant for
MOT: GABA → spastic MOT: pregnancy
paralysis GLYCINE Lamotrigine – anticonvulsant preferred for
➔ (+) Trismus / Lock jaw pregnancy; WOF: SJS (rashes > 10% of
➔ (+) Sardonic smile / BSA)
forced grin Diethylstilbesterol
➔ (+) Opisthotonos /
fully arched back
WTD:
Tetanus toxoid D. Spectrum of Effects
Antiserum
1. Reversible vs Irreversible
Diazepam
Metronidazole ● Reversible: Non-covalent
● Irreversible: Covalent
○ Ex: Aspirin – MOA: irreversibly acetylate COX
in the platelet ∴ Aspirin is discontinued 7 days
6. Carcinogen before surgery because platelet’s lifespan is 7
➔ Cancer or malignancy days.
➔ Ex: Aflatoxin (Aspergillus spp. in
peanuts & soil) 2. Allergic vs Idiosyncratic
◆ WOF: Liver CA ● Allergic: H1 receptor activation
➔ Ex: Nitrates and Nitrites
● Idiosyncratic: Unkown cause (genetics?)
◆ NaNO2 – imparts red color, prevent
growth of C. botulinum
◆ WOF: they will react with Amines → 3. Immediate vs Delayed
Nitrosamines → Esophageal / ● Immediate: Right after exposure
Gastric CA ● Delayed: after some time
○ Ex: Diethylstilbesterol – causes clear cell
7. Teratogen cancer of the vagina (via case control)
➔ Affect fetal development
➔ Most serious: 1st trimester (period of 4. Local vs Systemic
organogenesis) ● Local: limited to site of exposure
➔ FDA Pregnancy Category
● Systemic: entire body
Human Animal
A
B
C
E. Poison-related Factors (ROE)
D Benefit >> Risk 1. Route of exposure
X ● Oral - most common route of exposure
● Inhalation, Dermal – most common route of
ACEI Renal Dysgenesis exposure for OCCUPATIONAL
Thionamides Aplasia cutis
(1st line against
HYPERthyroidism– 2. Duration of Exposure
MOA: ⊖ Thyroid
peroxidase → COC
● Acute – < 24 hrs
Phenytoin Fetal hydantoin ● Subacute – < 1 month
syndrome – (+) ● Subchronic – 1 - 3 months
microcephaly, cleft, ● Subchronic – > 3 months
hypoplastic digit
Valproic Acid Neural tube defect
Carbamazepine (Spina bifida) – take Vit
B9 F. INTOXICATION
Warfarin Nasal hypoplasia –
Thalidomide Phocomelia – hands 1. Toxin vs Toxicant
(for hyperemesis & legs ● Toxin – natural substance
gravidarum)
● Toxicant – synthetic
Diethylstilbeste Clear cell cancer of
rol (prevent stillbirth) vagina
2. Toxikinetics vs Toxidynamics
Lithium (mood Ebstein anomaly –
stabilizer for bipolar abnormally low ● Toxikinetics – [K]atawan body to toxin
disorder)
location of tRIcuspid ● Toxidynamics – [D]rug toxin to body
valve (RIght side of
3. Overdose vs Poisoning for for cardiac arrest / no heart
● Overdose – intentional rate
● Poisoning – accidental ● Respiratory Rate RR (12-20 cpm)
● Temperature
○ Evidences of Poisoning PECCC: ○ Morning: > 37.2 (cut-off)
1. Post-mortem evidence – via autopsy ○ Afternoon: > 37.7 (cut-off)
2. Experimental evidence – via animal assay ○ In real life: > 37.8
3. Chemical evidence – via chemical test ● Oxygen Saturation
4. Circumstantial evidence – via scene of the ○ General: > 94%
crime ○ COPD: > 88%
5. Clinical / Symptomatic evidence – via ○ Apparatus:
symptoms of px ■ Nasal cannula
■ O2 mask

C. TOXIDROMES
II. PRINCIPLES OF MANAGEMENT
● Signs ad symptoms associated with a certain poison

A. Primary Survey 1. SYMPATHETIC SYNDROME / ADRENERGIC

● Goal: stabilize ● Agent: Cocaine
● MOT: Reuptake inhibitors → ⇧NE
1. Airway BP HR Pupillary Sweat Others
2. Breathing ⇧ ⇧ MyDriasis ⇧ Bruxism
● (+) chest rise ● WTD: Supportive treatment
● (+) verbal output (speaks in words, phrases, sentences)
● (+) crying 2. PARASYMPATHETIC SYNDROME / CHOLINERGIC
3. Circulation ● Agent: Organophosphate (Malathion, Parathion)
● (+) cold, clammy extremeties → ⇩BP ● MOT: Acetylcholinesterase Inhibitor → ⇧ACh
4. Disability BP HR Pupillary Sweat Others
● Level of consciousness ⇩ ⇩ MiOsis ⇧ Diarrhea
○ Alert Urine Lungs Emesis Saliva Tears
○ Verbal stimuli ⇧ ⇧ ⇧ ⇧ ⇧
○ Painful stimuli (sternal rub) ● WTD:
○ Unresponsive ○ < 24 hrs: Reversible – Pralidoxime,
5. Exposure Atropine**
● Remove any possible danger to patient ■ MOA: Regenerate
● Step 1 in handling seizures (max: 5 min) Acetylcholinesterase
■ MOA: Cholinergic antagonist**
○ 24 - 48 hours: Irreversible – Atropine
B. Secondary Survey
3. ANTI-CHOLINGERIC TOXICITY
● Investigation
● Agent: Atropine
● WOF
1. History
○ Blind as a bat – Mydriasis
● Substance
○ Dry as a bone – Anhydrosis, ⇩ sweating
● Amount
○ Hot as a hare – hyperthermia
● Time
○ Red as a beet – flushing
● Symptoms
○ Mad as a hatter – agitation
2. Vital Signs
● WTD:
● Blood pressure BP
○ Antidote: Physostigmine
○ HYPOtension (<90/60) → SHOCK
TERTIARY QUATERNARY
(⇩⇩BP requiring Inotrope)
Physostigmine Pyridostigmine
● Heart rate HR (60-100 bpm) Neostigmine
○ Bradycardia Unionized Ionized
■ Symptomatic – Atropine (1st line Can pass through the Cannot pass through
agent for symptomatic BBB the BBB
bradycardia in advanced cardiac
life support) 4. OPIOID TOXICITY
■ Asymptomatic – atheletic (no ● Agent: Morphine
intervention needed) ● WOF:
○ HR = 0 → cardiac arrest, needs ACLS ○ Comatose
■ (+) Chest compression (100 bpm) ○ Pinpoint (miOsis)
■ Epinephrine 1 mg IV/IO every 3- ○ Respiratory depression
5 min – 1st line cardiac stimulant ● WTD: Naloxone
 2. Extracorporeal Methods
D. Ancillary Test
● Hemodialysis
● Hemoperfusion
Marquis Test Ecstasy Purple or Violet HEMODIALYSIS HEMOPERFUSION
Modified Marijuana Red FILTER Semipermeable Column with
Duquenois Test membrane activated charcoal
resin
I AEIOU ➔ Severe
E. Management N ➔ Acidosis infection (which
1. DECONTAMINATION D ➔ Electrolyte triggers a
I imbalance cytokine
● Removal of offensive agent storm→ masive
C (⇧K)
inflammation)
A ➔ Intoxication
a. Decontamination BASED ON EXPOSURE: ➔ Drugs that are
T ➔ Overload of
● Inhalation → 100% O2, SABA highly protein
I fluid bound / High VD
● Ocular – NSS irrigation (0.9% NaCl) O ➔ Uremia ◆ INTRAcellular
b. Decontamination for GASTROINTESTINAL: N ◆ EXTRAvascular
◆ TISSUE
● Done within 1 hour
1. Gastric Lavage – insertion of nasogastric or
orogastric tube via the nose or mouth to the
3. ANTIDOTES
stomach → tip of nasogastric tube is connected
Mechanism of Antagonism
to a syringe → aspirate contents
a. Chemical Antagonism
● WOF: ⇩HR
● Neutralization
● Avoid if: ABCD
○ Heparin + Protamine
○ At risk (Ulcer) → Gastric perforation
● Complexation
○ Base, acid, or hydrocarbon
○ Combative
b. Dispositional Antagonism – affects ADME
○ Decreased gag reflex (at risk of
● Use of Activated Charcoal
aspiration)
● ⇩Absorption, ⇧Excretion

2. Whole Bowel Irrigation – toxin is already in

c. Physiologic / Functional Antagonism
the intestine
● Agonist and antagonist binds to
● Via PEG Polyethylene Glycol
DIFFERENT receptor
● Used if:
● Ex: Histamine & Epinephrine
○ Delayed consult
○ Slow release preparation
d. Pharmacologic / Receptor Antagonism
(modified-release)
● Agonist and antagonist binds to SAME
○ Poorly absorbed substance
receptor
● Ex: Histamine & Diphenhydramine (H1)
3. Syrup of Ipecac → emesis
● Min age of 6 months
● Hydrocarbon ingestion
● Already vomiting
III. SPECIFIC POISONS
4. Activated Charcoal
● Dose: 10:1 (AC:Toxin)
● Adult: 50 - 100 g A. Industrial Poison CACAHO
● Children: 1mg/kg
1. Carbon Monoxide
● Part of the universal antidote – Activated
● Most common IP that can lead to death
Charcoal, Tannic Acid, Magnesium Oxide)
● Product of incomplete combustion
● MOA: Adsorption
● Characteristics: odorless, tasteless, colorless gas
○ ⇩absorption excretion
● MOT: Shift to the LEFT of the O2-Hgb Dissociation
○ ⇧excretion of poison
Curve
● Limitations:
● WOF: Cherry red skin
○ Flouride F
● WTD: Hyperbaric O2 (MOA: competitive
○ Iron Fe
antagonism)
○ Bases / Alkali
○ Ethylene Glycol
2. Acids and Alkali
● Acid:
2. ELIMINATION
○ Coagulative necrosis – cellular structure is
1. Urinary pH Manipulation
intact
● Acidic drug: Urinary Alkalinifier NaHCO3
○ Also seen in heart
● Basic Drug: Urinary Acidifier NH4Cl, Vit C
○ Muriatic Acid
 5. Hydrocarbon Derivatives
● Alkali ● Products of petroleum distillation
○ Liquefactive / Colliquative necrosis – cellular ● MOT: Aspiration → lung injury
structure is destroyed ● Types: Volatility vs Viscosity ⇧Volatility, ⇩Viscosity
○ Also seen in brain Volatility Viscosity Example Mnemonics
○ Liquid sosa High Very Low Methane, MB
Butane
3. Cyanide Int. Low Terpentine, TeleGram
● Toxic metabolite of acetonitrile Gasoline
low Int. Kerosene
● Source: Prunus spp., Cassava, Silver jewelry
Very Low High Mineral Oil, ML
cleaner
Lubricatin
● MOT: Cytochrome oxidase (ETC Complex IV) Oil
● WOF: ● WTD: Mineral oil or Glycerin
○ (+) Bright red venous blood ● Goal: Delay aspiration
○ (+) bitter almond odor
○ (+) dyspnea 6. Others CASH
● WTD: a. CCl4 – Liver, Kidney
○ Administration of Na Nitrite, Amyl Nitrite, ● WTD: NAC
Methylene Blue which causes production of b. Asbestos – Lung → Methothelioma
Methemoglobin: In the presence of ● WTD: Supporive
methemoglobin, CN- wil unbind from c. Sulfur Dioxide – Lung → Bronchospasm
Cytochrome oxidase → Cyanomethemoglobin ● Obtained from fossil fuel
→ *rhodanese enzyme*→ thiocyanate → d. Hydrogen Sulfide H2S
excretable ● Characteristic: Rotten egg odor
○ Administration of Na Thiosulfate: promote ● MOT: Cytochrome oxidase
conversion of Cyanomethemoglobin →
*rhodanese enzyme*→ thiocyanate
○ Alt: Hydroxycobalamin: sequesters CN- →
Cyanocobalamin B. Agricultural Poison
1. Organophosphate
4. Alcohol and Related Compounds ● Malathion, Parathion
a. Ethylene Glycol ● WTD:
● Uses: as anti-freeze–coolant ○ < 24 hrs: Atropine + Pralidoxime
● MOA: Ethylene Glycol *alcohol dehydrogenase* → ○ > 24-48 hrs: Atropine
Glycoaldehyde *aldehyde dehydrogenase* →
Glycolic Acid *Glycolic acid oxidase* → Glyoxylic 2. Insecticide
acid ● Pyrethrin (natural), Preythroid (synthetic)
● Glyoxylic acid – precursor of many substances: ● MOT: ⇧Na, ⇩Cl conductance
○ (+) B6: Glycine (Nontoxic) ● WOF: Seizures
○ (+) B1: 𝝰-Hydroxy-𝞫-Adipate (Nontoxic) ● WTD: Anticonvulsants
○ Oxalic Acid (toxic) → Calcium Oxalate
stones → damage to kidneys 3. Herbecide
○ Formic acid (toxic) → blindness ● Paraquat, Diquat
● Antidote: ● MOT: Superoxide dismutase → ⇧free radicals
○ Ethanol – competitive with EG ● WOF:
○ Fomepizole – Alcohol dehydrogenase ○ Initial: GI Bleeding (hematochezia,
○ Pyridoxine – ⇧ Glycine metabolites melena)
○ Thiamine – ⇧ 𝝰-Hydroxy-𝞫-Adipate ○ Later: Lung hemorrhage
○ Leucovorin / Folinic Acid – Formic acid ● Note: Avoid O2
will be metabolized to Carbon Dioxide 4. Rodenticide
a. Coumarin Derivatives
b. Methanol / Wood Alcohol ● MOT: ⊖ Vit K dependent clotting factors (1972)
● MOA: Methanol *alcohol dehydrogenase* → ● WOF: Bleeding
Formaldehyde *aldehyde dehydrogenase* → ● WTD: Vitamin K
Formic Acid
● Formic acid damages the optic nerve (cranial nerve b. Phosphorus
# 2) → blindness Yellow Red
● Antidote: Spontaneously Flammable
○ Ethanol – competitive with Methanol Poisonous Nonpoisonous
○ Fomepizole – Alcohol dehydrogenase ● WOF: Luminous vomitous, garlic odor of bread
○ Leucovorin / Folinic Acid – Formic acid ● WTD: CuSO4 Lavage
will be metabolized to Carbon Dioxide
 5. Iron
a. Oral
C. Metallic Poison
● Ferrous Sulfate, Fe Fumarate, Fe Gluconate
1. Arsenic = Lewisite Metal ● Used for the mgt of Fe deficiency anemia (3-6
● ArsenITE – trivalent months)
○ MOA: binds to sulfhydryl enzymes → tissue ● WOF: black stools (not melena)
damage ● WTD: Deferoxamine
○ More harmful ○ WOF: Shock if fast admin.
● ArsenATE – pentavalent
○ MOA: Uncouple oxidative phosphorylation b. Parenteral
(mitochondria– primary site of ETC) ● Iron Dextran, Iran Sucrose
● WOF: ● Given if unable to take oral iron or impared
○ Acute: absorption
■ Rice watery stool ● WOF: allergy
■ Garlic odor breath ● WTD: Deferoxamine
○ Chronic: “Milk & Roses Complexion” ○ WOF: Shock if fast admin.
■ Anemia
■ Cutaneous vasodilation 6. Lead
■ Mee’s lines a. Organic
● WTD: ● Gasoline, Pain
○ British Anti-Lewisite / Dimercaprol b. Inorganic
■ Administered as 10% solution in ● Inorganic Salts
peanut oil
■ Via IM (90°) ● MOT: ALA Dehydratase, Ferrochelatase →
■ MOA: Regenerate sulfhydryl enzyme anemia
○ Succimer ● WOF:
■ Derivative of BAL ○ CNS Encephalopathy
■ Forms a water-soluble complex ○ ⇩IQ
○ Altered sperm production
2. Beryllium ○ Lead palsy
● Most toxic NON-radiactive element ○ Burton’s lines (gums)
● WOF: Lung injury → granuloma ● WTD: EDTA (Nephrotoxic)
● WTD: Supportive

3. Cadmium 7. Mercury
● Used to produce stink bombs Elemental Inorganic Organic Mercury
● Source: Cigarette smoke (via inhalation) Lung damage Mercuric (HgCl2) Methyl Mercury
● MOT: Erethism Corrosive Sublimate
○ Bones: (⇧sweating) Mercurous (Hg2Cl2)
■ Displace Ca → ⇩ bone density → Calomel
Nephrotoxicity Minamata Dx –
Osteoporosis (+) fracture, (+) bone Acrodynial (Pink ataxia, cerebral
pain palms & pink soles) palsy-like syndrome
■ “Itai-Itai” ● WTD:
○ Kidney ○ Sodium formaldehyde sulfoxylate – before
■ Nephrolithiasis ○ BAL – present
■ Proteinuria ○ Penicillamine – alternative
● WTD:
○ Acute: EDTA 8. Thallium
○ Chronic: Supportive ● Inheritance Powder
● Posioner’s Poison
4. Copper ● WOF: Hairloss, Mees lines
a. Hereditary ● WTD: Prussian Blue (Ferric Ferrocyanide)
● Wilson Disease– impaired Cu transport due to
⇩⇩Ceruloplasmin → Cu accumulation → hepatitis
● WOF: Kaiser-Fleischer rings

b. Acquired D. Drugs of Abuse

● Contamination of food or water from Cu container 1. Alcohol
● WOF: ● No. 1 coingestants in suicide attempt
○ (+) Blue vomitus ● MOT: ⇧GABA, ⇩Glutamate effects
○ (+) green hair
● WTD: Penicillamine (PCN der., nephrotoxic) a. Toxikinetics
● Absorption: Stomach, Small intestine
● Metabolism: Oxidation
● Excretion: Zero-order kinetics
 ● Source: Cannabis sativa / Hemp
b. Toxidynamics ● MOT: act on Cannabinoid receptor
● Acute: ● Active: Δ-9-Tetrahydrocannabinol (THC)
○ < 100 mg/dL: ⇩anxiety, disinhibition ● WOF:
○ 100-300 mg/dL: ⇩mental acquity, sedation ○ Initial phase: HIGH
○ > 300 mg/dL: Comatose ■ (+) Euphoria
● Chronic: ■ (+) Must odor
○ Brain: Wernicke-Korsakoff Syndrome ■ (+) Red eyes
■ Assoc with Thiamine def ○ Later: MELLOWING
○ Heart: Cardiomyopathy – “Holiday Heart” ■ (+) Sedation
○ Liver: Liver cirrhosis → Liver CA ● Therapeutic Use: ???
● Most common illicit drug
● WOF: Withdrawal (opposite of intended effect) →
Delirium tremens 5. Chloral Hydrate / “Knock Out Drops”
● WTD: Diazepam ● WOF: Mickey Finn Effect

● Interactions:
○ Acute: Inhibitor
E. Others
○ Chronic: Inducer
● WTD:
○ Disulfiram – ⊖Aldehyde dehydrogenase Toxin Source MOT
○ Naltrexone – cravings Latrotoxin Black widow ⇧ Release of Acetylcholine
spider → DUMBBELSS
○ Acamprosate – ⇩relapse
Tetrodotoxin Puffer fish ⊖ Na Channel
Saxitoxin Dinoflagellates ⊖ Na Channel
2. CNS Stimulants (red tide)
a. Amphetamines, Methamphetamines (Shabu, Ciguatoxin Fish organs ⇧Na permeability
Bato) Clupeotoxin Oyster ⇧Na permeability
● MOT: ⇧ Exocytosis enhancer → ⇧NE efect Herring sardines
● WOF: Amatoxin Amanita ⊖RNA plymerase → Liver
○ ⇧BP, ⇧HR, Mydriasis, ⇧Sweating, Weight loss, phaloides (aka toxicity
Meth mouth Destroying
angel)
b. Ecstasy (Methylenedioxymethamphetamine)
Bioterrorism Category
● “X” “Love drug”
● MOT: ⇧ 5-HT release A B C
Public panic ⇧ testing Potential cause of
● WOF: Altered depth & time, ⇧sexual intimacy
Require special ⇧tracing damage due to ⇧
action from the availability
c. Nicotine government
● MOA: Cholinergic Agonist BBATS B C
● Effects: ⇩anxiety, ⇩appetite, ⇧BP Botulism Brucellosis Hantavirus
● WOF: Lung CA, Bladder CA, Prostate CA Bubonic Plague
● WTD: Smoking cessation prorgams Anthrax
○ Nicotine patch Tularemia
Small pox
○ Varenicline
○ Bupropion

3. Hallucinoges
● Substances that causes hallucinogen
● Most common hallucination: Auditory

a. Lysergic Acid Diethylamide (LSD)

● MOT: act on 5-HT Receptor
● WOF: ⇧⇧ sensory awareness, Depersonalization,
mixed senses
● Less likely to cause dependence

b. Phenyclidine / Angel Dust

● MOT: act on NMDA Receptor
● Similar effect to Ketamine (anesthetic)
● WOF: Delirium, disinhibition

4. Marijuana / Mary Jane / MJ / Damo / Grass / Hashish