- Phencyclidine (PCP) is a dissociative anesthetic structurally similar to ketamine.
- Street names of PCP include angel dust, peace pill, wickey weed, wacky weed, illy, Sherman, monkey tranquilizer, and embalming fluid.
- Bidirectional nystagmus is a classic finding of PCP or ketamine intoxication
- A urine dipstick positive for blood but negative for RBCs should prompt the diagnosis of rhabdomyolysis in PCP intoxicated patients.
- Urinary acidification is contraindicated in PCP intoxication because it can cause precipitation of myoglobin in the tubules.
Phencyclidine (PCP) first came to the market as a surgical anesthetic and sedative in the 1950s. It was introduced as Sernyl by Parke Davis Pharmaceutical Company; however, the drug was removed from the market due to adverse side effects such as hallucinations. In the late 1960s, however, PCP made its return to commercial use as a veterinary tranquilizer. In the same year, PCP was first reported as an illicit drug used for recreational purposes in San Francisco, where it was called the “Peace Pill.” The Controlled Substance Analogue Enforcement Act of 1986 made PCP and its derivatives illegal. Its precursor, piperidine, requires mandatory reporting. According to data collected by the Drug Abuse Warning Network in 2005, there were 7535 emergency department (ED) visits for PCP.1 This places it below cocaine and heroin in frequency of use. The drug carries various street names such as “angel dust,” “hog,” “horse tranquilizer,” “crystal joint,” and “illy.”2
Ketamine is a legal analogue of PCP used in humans for sedation and anesthesia. Ketamine is also a drug of abuse; it is used regularly at raves and nightclubs by adolescents and young adults for its hallucinatory, out of body experiences. In this arena, the drug carries street names such as “Special K,” “K,” “KitKat,” and “Vitamin K.” It has a relatively short duration of action (15–45 minutes) and has only one-tenth the potent toxic effect of PCP. Because of its abuse potential, ketamine is in the Controlled Substance Act of 1999.3
PCP is classically categorized as a dissociative anesthetic because when anesthetized, the patient is conscious, yet experiences a feeling of dissociation from themselves—the “out of body” experience.
After ingestion, absorption occurs in the upper intestine. The drug has an enterogastric circulation such that PCP is secreted by the stomach and then absorbed in the small intestine. Because the drug recirculates in this way, it typically produces a cyclical symptomatology.4
The drug interacts at many receptor sites, including n-methyl-d-aspartic acid type glutamate receptors, the neuronal dopamine/norepinephrine/serotonin (DA/NE/5HT) reuptake complex site, and the sigma opiate receptor complex.5
As mentioned above, ketamine is an anesthetic agent that is commonly used for sedation prior to painful procedures. Because it is a bronchodilator, it is also often used as an induction in the patient with status asthmaticus or COPD exacerbation who requires intubation. The induction dose is 1 to 4.5 mg/kg IV ...