31: CNS Stimulants Flashcards by Linda Chen

rank the top 3 forms of stimulants people prefer

meth > crack > cocaine

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list 3 reasons for stimulant use

There is no single drug user experience
Increased energy, wakefulness
Euphoria, pleasure
Focus and attention, productivity
Performance enhancement
Confidence
Sexual desire and longevity
Acceptance, stigma suppression, decreased inhibition
Weight management, appetite suppression

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list 4 types of stimulants

cocaine, meth, caffeine, prescription stimulants

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CV risks of stimulants include

elevated HR/ BP, chest pain, heart attack, risk of stroke

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CNS risk of stimulants include

anxiety, hallucinations, paranoia

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overall bodily risks of stimulants include

elevated body temp, weight loss, sleep deprivation, STBBI, wounds, bacterial infections (risk based on injection route, parasitosis and compulsive scratching/ picking)

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cocaine is typically cut with

usually cut with cornstarch, talc, anaesthetic (popular b/c same effect), dextrose, etc

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what is free base cocaine

HCL group removed = rock form that can be smoked

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crack cocaine was developed as

an alternative to free base cocaine due to dangerous manufacturing technique of free base

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cocaine powder routes

snorting, PO, INJ

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describe the onset and duration of free base vs powder cocaine

free base = Faster onset, more intense high, shorter lasting (5-10min)
powder = Slower onset, longer lasting (20-60min)

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what is the MOA of cocaine

blocks NE, DA, 5HT reuptake

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half life of cocaine

50 min

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cocaine itnx enzymes

CYP2D6 (strong), substrate of 3A4 (major)

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reinforcing effects of cocaine include

alertness, energy, decreased need for sleep, appetite suppression, intense feeling of euphoria

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2 therapeutic uses of cocaine

topical anaesthetic, nose bleeds (vasoconstriction)

sx of acute cocaine intoxication

Alertness, restlessness
Euphoria
Insomnia
Irritability, aggression
Anxiety, paranoia, hypervigilance
Increased BP, HR, RR
Sweating, chills
N/V

sx of chronic cocaine use

Nasal sx (congestion, nose bleeds, deviated septum)
Stroke
Reduced blood flow to brain
Memory impairment, reduced attention
Depression, mood swings
Hallucinations, delusions
Arrhythmias, MI
Impotence
Urinary retention
Anorexia
Suppressed immunity (highly dependent on dose + frequency used)

describe the cocaine withdrawal process

Day 1-4 (crash): fatigue, nightmares, increased sleep, depression, increased appetite
Weeks 2-12: low drive, boredom, decreased interest in activities, cravings

meth is often made in ____________ using __________________

Often made in home and mobile labs using ephedrine or pseudoephedrine and solvents

meth MOA

blocks reuptake and enhances release of DA, NE, 5HT in synapses

meth half life

12hrs

meth reinforcing effects include

alertness, ambition, energy, ↓ need for sleep, weight loss/ appetite suppression

meth acute intoxication sx

Alertness, euphoria, confusion, irritability, aggression, anxiety, paranoia, ↑ BP/HR/RR, tremors, ↓ food/ fluid intake, urinary retention

meth chronic use sx

Mouth sores, skin lesions, HPTN, stroke Dental decay: meth = acidic = breaks down enamel, causes dry mouth and ↑ temp = dehydration and ↑ bad bacteria, ↓ self care ↓ cognition and psychosis: may be acute and resolve on d/c in some, may be chronic in others

what is overamping

nonfatal OD

overamping tx

May require more formal support such as in patient hospitalisation with psychiatry if just regular overuse = can use BZDs

stimulant psychosis is 1. common 2. uncommon 3. only common with cocaine use 4. none of the above

what are predictors of more persistent psychosis

length of meth use, severity of psychotic sx, whether pt experienced sustained depressive sx as part of withdrawal

physical sx of overamping include

N/V, passing out (but still breathing), chest pain, high temp/ sweating profusely, fast HR, HPTN, irregular breathing or SOB, tremors, jerking, rigidity, stroke, severe HA, teeth grinding, insomnia

psychological sx of overamping include

Extreme anxiety, panic, paranoia, hallucinations, hypervigilance, aggressiveness, restlessness or irritability Agitation: hyperresponsiveness, racing thoughts, emotional tension, motor/ visual hyperactivity, difficulty communicating feelings, can’t remain still or calm Enhanced sensory awareness potentiates all above sx

3 hallmark sx of meth withdrawal

↓ mood, ↑ sleep, ↑ appetite

describe tx for meth withdrawal

No meds currently approved for tx stimulant intoxication or overamping Trials using prescribed stimulants to manage cravings Contingency management: reinforces positive behaviours based on operant conditioning principles- offers incentives for goals achieved Supportive tx: standard of care = psychiatric tx to decrease use/ abstain

why do contingency managements for meth withdrawal have low uptake

High cost (replenish incentives) Practical concerns: requires high fidelity to protocol to get full benefit Philosophical concerns: may seem like gambling or reinforcing people for not doing drugs

describe motivational interviewing as a supportive tx to meth withdrawal

what benefits do you get from meth use? How can we find these benefits from something else + how can we help you find + support these other activities?

list 2 ways of harm reduction

Safe sex education (condoms, PrEP) Safer equipment (pipes, smoking supplies, syringes, injection equipment) Nutrition, hydration Deescalation Greater inclusivity with supervised consumption sites- currently no inhalation spaces in AB Take home naloxone kits