31: CNS Stimulants Flashcards
rank the top 3 forms of stimulants people prefer
meth > crack > cocaine
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
list 4 types of stimulants
cocaine, meth, caffeine, prescription stimulants
CV risks of stimulants include
elevated HR/ BP, chest pain, heart attack, risk of stroke
CNS risk of stimulants include
anxiety, hallucinations, paranoia
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)
cocaine is typically cut with
usually cut with cornstarch, talc, anaesthetic (popular b/c same effect), dextrose, etc
what is free base cocaine
HCL group removed = rock form that can be smoked
crack cocaine was developed as
an alternative to free base cocaine due to dangerous manufacturing technique of free base
cocaine powder routes
snorting, PO, INJ
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)
what is the MOA of cocaine
blocks NE, DA, 5HT reuptake
half life of cocaine
50 min
cocaine itnx enzymes
CYP2D6 (strong), substrate of 3A4 (major)
reinforcing effects of cocaine include
alertness, energy, decreased need for sleep, appetite suppression, intense feeling of euphoria
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
1
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
