Amphetamines: Difference between revisions
No edit summary |
|||
(26 intermediate revisions by 6 users not shown) | |||
Line 1: | Line 1: | ||
==Background== | ==Background== | ||
[[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 | |||
- | ===Methamphetamine=== | ||
*More combative | |||
*Delusions of parasites, formication, self-mutilate | |||
*more dysphoric | |||
- | ===[[Ecstasy (MDMA)|MDMA Ecstacy]]=== | ||
*Increases serotonin, dopamine | |||
*Lasts 3 - 5hrs | |||
*[[Hyponatremia]] | |||
{{Sympathomimetic types}} | |||
- | ==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]] | |||
|} | |||
== | ==Differential Diagnosis== | ||
{{Sympathomimetic types}} | |||
{{Drugs of abuse types}} | |||
==Evaluation== | |||
==Management== | |||
*[[Benzodiazepines]] | |||
=== | ==Disposition== | ||
==See Also== | |||
*[[Sympathomimetic Toxicity]] | |||
==References== | |||
<references/> | |||
[[Category:Toxicology]] | |||
[[Category: |
Latest revision as of 22:01, 26 November 2020
Background
- 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
- Increases serotonin, dopamine
- Lasts 3 - 5hrs
- Hyponatremia
Sympathomimetics
- Cocaine
- Amphetamines
- Synthetic cathinones (khat)
- Ketamine
- Ecstasy (MDMA)
- Synthetic cannabinoids
- Bath salts
Clinical Features
System | Minor or moderate overdose | Severe overdose |
---|---|---|
Cardiovascular |
|
|
Central nervous system |
|
|
Musculoskeletal |
|
|
Respiratory |
|
|
Urinary |
| |
Other |
|
Differential Diagnosis
Sympathomimetics
- Cocaine
- Amphetamines
- Synthetic cathinones (khat)
- Ketamine
- Ecstasy (MDMA)
- Synthetic cannabinoids
- Bath salts
Drugs of abuse
- 25C-NBOMe
- Alcohol
- Amphetamines
- Bath salts
- Cocaine
- Ecstasy
- Gamma hydroxybutyrate (GHB)
- Heroin
- Inhalant abuse
- Hydrocarbon toxicity
- Difluoroethane (electronics duster)
- Marijuana
- Kratom
- Phencyclidine (PCP)
- Psilocybin ("magic mushrooms")
- Synthetic cannabinoids
- Chloral hydrate
- Body packing