#38 Ketamine

Ketamine seems to be the new “it” drug. Pharmacist Victoria Arsenault returns to the podcast to discuss how Ketamine’s dissociative properties can be used as an analgesic, anesthetic, and antidepressant.

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There is tons of great information on the internet about Ketamine. The following is what was covered during the podcast episode:

Pharmacology

  • NMDA antagonist. Ketamine interferes with pain transmission in the spinal cord, producing an analgesic and anesthetic effect
  • Ketamine’s mechanisms for anti depression are not well understood. Current theories postulate that Ketamine could be a serotonin-norepinephrine-dopamine reuptake inhibitor or that Ketamine stimulates new synaptic connections.

Indications

  • High dose Ketamine:
    • Complete dissociation i.e. reduction maneuvers, intubation
    • Acute agitation
  • Low dose Ketamine:
    • Treatment of major depressive disorder, PTSD, suicidal ideation
    • Analgesia: acute and chronic pain

Side effects to look out for

  • Laryngeal spasms
  • Increased blood pressure
  • Emergence reactions: hallucinations that can range from joyful or frightening

Contraindications

  • Uncontrolled hypertension, tachycardia, or cardiac ischemia
  • Psychiatric disorders: severe autism, schizophrenia, active psychosis

What’s cool about Ketamine

  • Low risk for respiratory depression (no intubation!)
  • No indication for cardiac monitoring
  • Low risk for psychosis