Ketamine

Major routes of ketamine metabolism.
Preparation of Ketamine.

Medication primarily used for induction and maintenance of anesthesia.

- Ketamine

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NMDA receptor antagonist

NMDA receptor antagonists are a class of drugs that work to antagonize, or inhibit the action of, the N-Methyl- D -aspartate receptor (NMDAR).

Ketamine, one of the most common NMDA receptor antagonists.
Simplified model of NMDAR activation and various types of NMDAR blockers.

Some NMDA receptor antagonists, such as ketamine, dextromethorphan (DXM), phencyclidine (PCP), methoxetamine (MXE), and nitrous oxide (N2O), are sometimes used as recreational drugs, for their dissociative, hallucinogenic, and euphoriant properties.

WHO Model List of Essential Medicines

The WHO Model List of Essential Medicines (aka Essential Medicines List or EML ), published by the World Health Organization (WHO), contains the medications considered to be most effective and safe to meet the most important needs in a health system.

2017 marked the 40th anniversary of the WHO Model List of Essential Medicines.
A skeletal model of the chemical structure of aspirin
A skeletal model of the chemical structure of albendazole
Pure crystals of ethambutol
Two capsules of atazanavir
Bag containing one unit of fresh frozen plasma
A vial of oral cholera vaccine

Ketamine

Dissociative

Dissociatives are a class of hallucinogen which distort perception of sight and sound and produce feelings of detachment – dissociation – from the environment and/or self.

One "Blotter" sheet of 900 LSD doses.

Both Pender (1970) and Johnstone et al. (1959) reported that patients under anaesthesia due to either ketamine or phencyclidine were prone to purposeless movements and had hallucinations (or "dreams" ) during and after anaesthesia.

Hallucinogen

Hallucinogens are a large and diverse class of psychoactive drugs that can produce altered states of consciousness characterized by substantial alterations in thought, mood, and perception.

One "Blotter" sheet of 900 LSD doses.
Salvia divinorum
Datura innoxia in flower.
Attractive but highly toxic berry of Atropa belladonna
Flowers and foliage of Nicotiana tabacum, the cultivated tobacco.
Single fruiting body of Amanita muscaria
Myristica fragrans fruit, halved, showing within the red seed (nutmeg) enclosed in its brown aril (mace).

Antiglutamatergics (NMDA receptor antagonists or classical dissociatives) such as "laughing gas" (nitrous oxide) and ketamine

Propofol

Short-acting medication that results in a decreased level of consciousness and a lack of memory for events.

A 20 ml ampoule of 1% propofol emulsion, as sold in Australia by Sandoz

It is also often used in combination with ketamine with minimal side effects.

General anaesthesia

Medically induced coma with loss of protective reflexes, resulting from the administration of either intravenous or inhalational general anaesthetic medications, often in combination with an analgesic and neuromuscular blocking agent.

Equipment used for anaesthesia in the operating theatre
Syringes prepared with medications that are expected to be used during an operation under general anaesthesia maintained by sevoflurane gas:
 - Propofol, a hypnotic
 - Ephedrine, in case of hypotension
 - Fentanyl, for analgesia
 - Atracurium, for neuromuscular block
 - Glycopyrronium bromide (here under trade name Robinul), reducing secretions
Anaesthetized patient in postoperative recovery.

Halothane has been found to be a GABA agonist, and ketamine is an NMDA receptor antagonist.

Treatment-resistant depression

Term used in clinical psychiatry to describe a condition that affects people with major depressive disorder (MDD) who do not respond adequately to a course of appropriate antidepressant medication within a certain time.

Sorrowing Old Man (At Eternity's Gate)
by Vincent van Gogh (1890)

Some off label antidepressants are low dose ketamine and highly serotonergic catecholamines (including very controlled use of MDMA in the treatment of PTSD and crippling depression/anxiety).

Sedation

Reduction of irritability or agitation by administration of sedative drugs, generally to facilitate a medical procedure or diagnostic procedure.

Examples of drugs which can be used for sedation include isoflurane, diethyl ether, propofol, etomidate, ketamine, pentobarbital, lorazepam and midazolam.

Intraocular pressure

Fluid pressure inside the eye.

A patient in front of a tonometer
Diaton transpalpebral tonometer

Ketamine also increases IOP.

Recreational drug use

Use of a psychoactive drug to induce an altered state of consciousness either for pleasure or for some other casual purpose or pastime by modifying the perceptions, feelings, and emotions of the user.

Adriaen Brouwer, TheSmokers (1636)
Edgar Degas, L'Absinthe (1876)
Bhang eaters from India c. 1790. Bhang is an edible preparation of cannabis native to the Indian subcontinent. It has been used in food and drink as early as 1000 BCE by Hindus in ancient India.
A man smoking cannabis in Kolkata, India
A rational harm assessment of drugs<ref>{{Cite journal|last1=Blakemore|first1=Colin|last2=Saulsbury|first2=William|last3=King|first3=Leslie A.|last4=Nutt|first4=David|date=2007-03-24|title=Development of a rational scale to assess the harm of drugs of potential misuse|url=https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(07)60464-4/abstract|journal=The Lancet|language=en|volume=369|issue=9566|pages=1047–1053|doi=10.1016/S0140-6736(07)60464-4|issn=0140-6736|pmid=17382831|s2cid=5903121}}</ref>
This 1914 photo shows intoxicated men at a sobering-up room
alt=A chart showing dependence potential versus safety ratio.|An analysis of the dangers of drugs<ref>{{Cite book|url=https://books.google.com/books?id=xpZhjBuDkuwC&pg=PA149|title=Drugs and Society: U.S. Public Policy|last=Fish|first=Jefferson M.|date=2006|publisher=Rowman & Littlefield|isbn=9780742542457|language=en}}</ref>
Total recorded alcohol per capita consumption (15+), in liters of pure alcohol
Caffeinated alcoholic beverages, such as Vodka Red Bull, are widespread and legal routes of administration for multiple drugs.
Insufflation of powdered drug
Injection of heroin
Cocaine is a commonly used stimulant
alt=A chart showing relative drug harm.|A chart showing relative drug harm.

Since the early 2000s, medical professionals have acknowledged and addressed the problem of the increasing consumption of alcoholic drinks and club drugs (such as MDMA, cocaine, rohypnol, GHB, ketamine, PCP, LSD, and methamphetamine) associated with rave culture among adolescents and young adults in the Western world.