Amphetamines: Difference between revisions
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==Clinical Features== | ==Clinical Features== | ||
=== | {| class="wikitable unsortable center" style="margin: 1em auto;" | ||
* | |+ Overdose symptoms by system | ||
* | ! 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]] | |||
* [[Kidney failure]] | |||
|- | |||
! scope="row"| Other | |||
| | |||
* [[Hyperthermia]] | |||
* Mydriasis | |||
| | |||
* [[Hyperkalemia]] or [[hypokalemia]] | |||
* [[Hyperpyrexia]] | |||
* [[Metabolic acidosis]] | |||
|} | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
Revision as of 03:26, 6 September 2019
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
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