Amphetamines: Difference between revisions
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==Background== | |||
[[File:Amphetamine.png|thumbnail|Amphetamine]] | [[File:Amphetamine.png|thumbnail|Amphetamine]] | ||
[[File:MDMA.png|thumbnail|MDMA]] | [[File:MDMA.png|thumbnail|MDMA]] | ||
[[File:Mescaline.png|thumbnail|Mescaline]] | [[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) | *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 | **All have mixed serotonergic and dopaminergic activity | ||
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*[[Hyponatremia]] | *[[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== | ==Differential Diagnosis== | ||
{{Sympathomimetic types}} | {{Sympathomimetic types}} | ||
{{Drugs of abuse types}} | |||
==Evaluation== | |||
==Management== | ==Management== | ||
*[[Benzodiazepines]] | *[[Benzodiazepines]] | ||
==Disposition== | |||
==See Also== | ==See Also== | ||
Latest revision as of 22:01, 26 November 2020
Background
_5_mg_tablets.jpg)
- 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