Amphetamines: Difference between revisions

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==Background==
==Background==
- Time- oral- 30min, inhaled instant
[[File:Amphetamine.png|thumbnail|Amphetamine]]
[[File:MDMA.png|thumbnail|MDMA]]
[[File:Mescaline.png|thumbnail|Mescaline]]
[[File:Desoxyn (methamphetamine) 5 mg tablets.jpg|thumb|Desoxyn tablets – pharmaceutical methamphetamine hydrochloride]]
[[File:Blue Crystal Meth.jpg|thumb|Crystal meth – illicit methamphetamine hydrochloride]]
*Class of xenobiotics (Substituted amphetamines) based on a common central structure (ethylamine group attached to a phenol ring)
**All have mixed serotonergic and dopaminergic activity
*Unlike [[cocaine]], duration of action may be 12hr or longer
**Time- oral- 30min, inhaled instant
**hepatic and renal excretion- lasts 6- 24 hrs
**if tolerance developes- physical exam may yield normal findings
**desipramine and amantadine can give false positive for urine amphet test
**hallucinogenic amphetamine derivatives may not show up on tox screen AKA Entactogens- enabling user to touch within


- hepatic and renal excretion- lasts 6- 24 hrs
===Methamphetamine===
*More combative
*Delusions of parasites, formication, self-mutilate
*more dysphoric


- if tolerance developes- physical exam may yield normal findings
===[[Ecstasy (MDMA)|MDMA Ecstacy]]===
*Increases serotonin, dopamine
*Lasts 3 - 5hrs
*[[Hyponatremia]]


- desipramine and amantadine can give false positive for urine amphet test
{{Sympathomimetic types}}


- hallucinogenic amphet deriv may not show up on tox screen AKA Entactogens- enabling user to touch within
==Clinical Features==
[[File:Suspectedmethmouth09-19-05.jpg|thumb|Meth mouth]]
{| class="wikitable"
|-
! scope="col" style="text-align:center"| System
! scope="col" style="width: 40%;"| Minor or moderate overdose
! scope="col" style="width: 50%;"| Severe overdose
|-
! scope="row"|Cardiovascular
|
* Cardiac dysrhythmia
* Hypertension or hypotension
|
* Cardiogenic shock
* Cerebral hemorrhage
* Circulatory collapse
|-
! scope="row"| Central nervous<br />system
|
* Confusion
* Hyperreflexia
* Severe agitation
* Tremor
|
* Acute amphetamine psychosis (e.g., delusions and paranoia)
* Compulsive and repetitive movement
* [[Serotonin syndrome]]
* [[Sympathomimetic toxidrome]]
|-
! scope="row"| Musculoskeletal
|
* Myalgia
|
* Rhabdomyolysis
|-
! scope="row"| Respiratory
|
* Rapid breathing
|
* [[Pulmonary edema]]
* [[Pulmonary hypertension]]
* [[Respiratory alkalosis]]
|-
! scope="row"| Urinary
|
* [[Dysuria]]
* [[Urinary retention]]
|
* Anuria
* [[Acute kidney injury]]
|-
! scope="row"| Other
|
* [[Hyperthermia]]
* Mydriasis
|
* [[Hyperkalemia]] or [[hypokalemia]]
* [[Hyperpyrexia]]
* [[Metabolic acidosis]]
|}


===Meth Amphet===
==Differential Diagnosis==
- more combative- delusions of parasites- formication\ self mutilate
{{Sympathomimetic types}}
{{Drugs of abuse types}}


- more dysphoric
==Evaluation==


- AKA ice crystal speed go crank
==Management==
*[[Benzodiazepines]]


===MDMA Ecstacy===
==Disposition==
- changes 5HT neuroxmitter


- inc dopamine
==See Also==
*[[Sympathomimetic Toxicity]]


- lasts 3 - 5hrs
==References==
<references/>


- usual dose for psychgTx- 50 - 200mg
[[Category:Toxicology]]
 
- cardiac effects
 
- euphoria- interpersonal clgseness- introspection
 
- enhanced socialibility (rave)
 
- deep empathy
 
- severe withdrawal with anxiety and depression
 
- tolerance developes to positve and neg effects with inc use
 
===Theraputic Uses===
# appetite suppression
# inc alertness
# narcolepsy
# adhd
# inc mood
# avoid boredom on repetitive task jobs
 
 
==Diagnosis==
===Alpha===
- pupils dilate
 
- sweat
 
- decrease gi peristalsis
 
- constrict blood vessels
 
===Beta===
- inc HR and contractility
 
- dilate bronchi
 
- dilate muscle beds
 
===Mixed===
- delusions, paranoia, aggression, poor judgement, hallucinate, confusion
 
==Treatment==
Benzos
 
==Source==
MISTRY 6/06
 
[[Category:Tox]]

Latest revision as of 22:01, 26 November 2020

Background

Amphetamine
MDMA
Mescaline
Desoxyn tablets – pharmaceutical methamphetamine hydrochloride
Crystal meth – illicit methamphetamine hydrochloride
  • Class of xenobiotics (Substituted amphetamines) based on a common central structure (ethylamine group attached to a phenol ring)
    • All have mixed serotonergic and dopaminergic activity
  • Unlike cocaine, duration of action may be 12hr or longer
    • Time- oral- 30min, inhaled instant
    • hepatic and renal excretion- lasts 6- 24 hrs
    • if tolerance developes- physical exam may yield normal findings
    • desipramine and amantadine can give false positive for urine amphet test
    • hallucinogenic amphetamine derivatives may not show up on tox screen AKA Entactogens- enabling user to touch within

Methamphetamine

  • More combative
  • Delusions of parasites, formication, self-mutilate
  • more dysphoric

MDMA Ecstacy

Sympathomimetics

Clinical Features

Meth mouth
System Minor or moderate overdose Severe overdose
Cardiovascular
  • Cardiac dysrhythmia
  • Hypertension or hypotension
  • Cardiogenic shock
  • Cerebral hemorrhage
  • Circulatory collapse
Central nervous
system
  • Confusion
  • Hyperreflexia
  • Severe agitation
  • Tremor
Musculoskeletal
  • Myalgia
  • Rhabdomyolysis
Respiratory
  • Rapid breathing
Urinary
Other

Differential Diagnosis

Sympathomimetics

Drugs of abuse

Evaluation

Management

Disposition

See Also

References

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