{"id":5383,"date":"2011-07-14T20:26:01","date_gmt":"2011-07-14T20:26:01","guid":{"rendered":"http:\/\/crashtext.org\/misc\/5383.htm\/"},"modified":"2014-10-10T11:17:46","modified_gmt":"2014-10-10T15:17:46","slug":"cocaine-amphetamines-sympathomimetics","status":"publish","type":"post","link":"https:\/\/crashingpatient.com\/toxicology\/cocaine-amphetamines-sympathomimetics.htm\/","title":{"rendered":"Cocaine, Amphetamines, and other Sympathomimetics"},"content":{"rendered":"

<\/span>Amphetamines<\/span><\/h2>\n

<\/span>Methamphetamines<\/span><\/h3>\n

Crystal, ice, tina, crank, meth<\/p>\n

Heavy users are \u0091tweakers\u0092<\/p>\n

Synthesized from ephedrine<\/p>\n

formication (bugs under skin), bruxism (jaw grinding)<\/p>\n

Benzedrine-ice is the smoked form. Causes release of serotonin and dopamine in the CNS, periphral norepi release.<\/p>\n

<\/span>Cocaine<\/span><\/h3>\n

(Comprehensive Review Crit Care Med 2003 31:6)<\/p>\n

 <\/p>\n

Cocaine+Alkaline Solution+Ether=Freebase which can be smoked<\/p>\n

Crack=extracted c sodium bicarb and water.<\/p>\n

Blocks reuptake of biogenic amine neurotransmitters (NE, DA, 5-HT)<\/p>\n

Reverse tolerance for seizures and paranoid ideation<\/p>\n

Hyperthermia, Lung sx in smokers, DIC, Rhabdo<\/p>\n

Can cause acute abd from intra-abd hemorrhage or ischemia (~19 hrs after use)<\/p>\n

Mydriasis, Grinding of teeth (Bruxism), AMI, SAH, Seizures, Mesenteric Ischemia, Placental abruption.<\/p>\n

Use bicarb for ventricular dysrhythmias.\u00a0 Do not use Lido as increases seizure potential<\/p>\n

Crack Lung-acute pulmonary infiltrates<\/p>\n

Can cause widened QRS<\/p>\n

Use benzos then nitroprusside<\/p>\n

Crack dance-hemiballismus from same<\/p>\n

Neuro-Can cause stroke:\u00a0 ischemic from cocaine vasospasm, thrombotic, or hemorrhagic from cocaine hypertension causing the rupture of an aneurysm.\u00a0 Can precipitate tonic\/clonic as well as focal seizures.\u00a0 This can be from direct CNS stim or hyperthermia.\u00a0 Can also cause seizure kindling.\u00a0 Cocaine related accumulation of dopamine in the basal ganglia can lead to tourette’s, tardive dyskinesia, choreoathetosis, dystonia, and the classic akathisia\/chorea known as the crack dance.<\/p>\n

Pulmonary-epistaxis and nasal septal perfs.\u00a0 Bronchospasm and asthma exacerbation.\u00a0 Can act as a hapten leading to hypersensitivity pneumonitis (crack lung)\u00a0 Pulmonary hemorrhage.\u00a0 Noncardiogenic pulmonary edema.\u00a0 Chronic cocaine use can lead to pulmonary hypertension and cor pulmonale.\u00a0 Pneumomediastinum and pneumothorax are well known complications of cocaine use.<\/p>\n

Cardiac-increased heart rate\/bp and svr can lead to ischemia.\u00a0 Chronic cocaine use accelerates atherosclerotic disease.\u00a0 Dilated cardiomyopathies.<\/p>\n

GI-mesenteric ischemia or ischemic colitis from vasospasm\u00a0 Pyloric and prepyloric ulcers.<\/p>\n

Renal-can cause acute renal infarction from vasospasm<\/p>\n

Vascular-can lead to arterial thrombosis due to decreased protein C and antithrombin III levels.\u00a0 Aortic dissection<\/p>\n

Pyschiatric-cocaine associated delirium<\/p>\n

 <\/p>\n

Chest Pain<\/h4>\n

Cocaine-induced is within approx. 1 hr of cocaine use. Pt intoxicated with sympathomimetic toxidrome. B-blockers contraindicated. Phentolamine 1-2 mg aliquots if nitro and ativan do not work<\/p>\n

alt dosing: 5-10 mg Q 15 minutes<\/p>\n

 <\/p>\n

Cocaine-assoc. is a patient who uses cocaine and has chest pain, but not within acute intox. B-blockers are probably fine in these patients<\/p>\n

 <\/p>\n

cocaine may accelerate athero by 20 years. Shown in rabbits to cause plt aggregation.<\/p>\n

 <\/p>\n

1 of every 4 nonfatal MIs in patients aged 18-45 is related to frequent cocaine use. Approximately 6% of patients with cocaine-associated chest pain sustain an acute MI (Am J EM, 11\/07, pg. 1015).<\/p>\n

Dysrhythmia from Cocaine Review Art<\/a><\/p>\n

<\/span>Amphetamine Analogues<\/span><\/h3>\n

Methylenedioxymethamphetamine (MDMA)<\/h4>\n

X, Ecstasy, E, XTC, Adam<\/p>\n

Peaks in 90 minutes, lasts 4-6 hours<\/p>\n

75-150 mg normal dose<\/p>\n

Causes serotonin release and block of reuptake, also alpha\/beta adrenergic.<\/p>\n

Hyperthermia (Up to 43) probably from central serotoninergic mechanism as well as increased muscle activity, hyponatremia if increased free water uptake (also possibly ADH effect from serotonin effects), possibly rhabdomyolysis.\u00a0 HTN, Narrow Complex tachycardias (procainamide)<\/p>\n

Though more likely it is a B3 receptor effect from released and no uptake of norepi. In animal model, carvedilol was able to both prophylax and treat this effect. (Crit Care Med 2005;33:1314)<\/p>\n

Liver failure can also be seen.\u00a0 It is unknown if NAC has a role in treatment.<\/p>\n

Benzos, active cooling<\/p>\n

If patient is taking MAOIs can provoke hypertensive crisis, Agony after Ecstasy<\/em><\/p>\n

MDA (Love Pill)\/MDEA (Eve)<\/h4>\n

Also cause norepinephrine release, very similar to MDMA<\/p>\n

MPH (Methylphenidate, Ritalin)<\/p>\n

Associated c fatalities when tabs are crushed then drug is injected or sniffed<\/p>\n

Can also cause talc emboli when injected<\/p>\n

Metcathinone (Cat, Khat, Jeff)<\/p>\n

Naturally contained in leaves of catha edulis in Arabia<\/p>\n

Synthetic version is #1 drug of abuse in Russia, Seen in US in Michigan<\/p>\n

Similar effects to meth<\/p>\n

Ephedrine<\/p>\n

Naturally found in Chinese herbal medicine \u0091ma-huang\u0092<\/p>\n

Similar to methamphetamines except peripheral effects are much more prominent than central, hence users may use life threatening amounts in the attempt to get same high.<\/p>\n

<\/span>Arylhexamines<\/span><\/h3>\n

Phencyclidine (PCP)<\/p>\n

P<\/strong>eaC<\/strong>eP<\/strong>ill, aka Sherman, dust, soma, goon<\/p>\n

When mixed c pot=killer weed, diluted in embalming fluid (formaldehyde)=wet or illy<\/p>\n

Nystagmus, groucho eyes (dilated, staring, roving pupils)<\/p>\n

Hypoglycemia<\/p>\n

Hypethermia, diaphoresis not common, Muscle rigidity, can lead to rhabdo<\/p>\n

give haldol and ascorbic acid<\/p>\n

Give activated charcoal no matter the route of use, as PCP accumulates in the stomach<\/p>\n

Ketamine can test false positive on urine screen.\u00a0 Test will stay positive for 4 weeks<\/p>\n

Ketamine<\/p>\n

Special K, Vitamin K, Fort Dodge<\/p>\n

Anxiety, chest pain, and palpitations are most common presenting symptoms.\u00a0 Tachycardia and HTN from sympathomimetic effects are most common signs.<\/p>\n

Dextromethorphan<\/p>\n

DM, Robo<\/p>\n

In cough suppressants<\/p>\n

Bizarre movements<\/p>\n

CNS depression<\/p>\n

 <\/p>\n

From the Poison Review:<\/p>\n

\n

<\/span>TPR Podcast Episode #6<\/span><\/h2>\n

<\/span>New Club Drugs<\/span><\/h2>\n

<\/span>October 6, 2014, 11:52 pm<\/span><\/h3>\n
\n

TPR Podcast Episode 6: I\u2019ve Tripped and I Can\u2019t Get Down <\/strong><\/p>\n

Written by Theresa Kim, MD<\/p>\n

Synthetic Cathinones<\/strong><\/p>\n