Amphetamine intoxication

Question 1

Behavioural changes in stimulant intoxication

Answer 1

Euphoria/affective bluncting
Changes in social
Hypervigilant
Interpersonal sensitivty
Anxiety
Tension/anger
Stereotyped
Impaired judgement

Question 2

Signs and symptoms of stimulant intoxications

Answer 2

Tachy/brady
Pupillary dilitation
\+BP, -ve BP
Perspiration
NV
Weight loss
Psychomotor agitation/retardations
Muscle weakness, respiratory depression, chest pain, cardiac arrythmias
Confusion, seizures, dyskinesis, dystonias, coma

Question 3

Mechanism of action

Answer 3

Takes place in VMAT= +dopamine release

Question 4

Effects during pregnancy

Answer 4

Bleeding
Miscarriage
IUGR

Irritable, overactive->withdrawal

Poor breast feeding

Question 5

Imaging of brain in chronic use

Answer 5

Bleeding
Ischemia
Infarction
Impaired blood flow

Question 6

Long term effects

Answer 6

Cardiovascular risks: hypertension, arrythmias, MI, HF
Violence/aggression, psychosis, depression
Brain damage

Question 7

Withdrawal

Answer 7

Crash
Withdrawal
Extinction

1. Sleep
2. Mood
3. Concentration
4. Appetite

Question 8

What is the crash phase: onset, lasts how long, features

Answer 8

12-24 hours after first dose
Last 2-4 days
Fatigue, reduced craving, +sleep

Question 9

What is the withdrawal phase: onset, duration, features

Answer 9

7-10 days, subsiding over 2-4 weeks
+Cravings, disturbed sleep, irritability, poor concentration, fluctuating moods ad disturbed thoughts
Extreme hunger

Question 10

What is the extinction phase: onset, features

Answer 10

Involves weeks-months
Resumption of normal
Fluctuating moods/cravings
Altered irritability, agitation, fatigue, anhedonia.

Question 11

Differential diagnosis

Answer 11

Amphetamine-induced
Cocaine intoxication
Hallucinogen intoxication
PCP

Question 12

Management

Answer 12

Monitor and repeated assessment
No specific pharmacotherapy
Supportive, recovery is time dependant
Antipsychotics may be required if severe psychosis

Question 13

Investigations

Answer 13

Urine toxicology
ECG-> MI, SVT, right heart strain associated with pulmonary HTN
Sodium->low, particularly in ecstasy
CK->elevated if suspect amphetamine induced rhabdomyolysis

Blood toxicology if need forensic confirmations
Echocardiogram

Question 14

Patient instructions

Answer 14

Avoid further doses

Enrol in drug treatment program

Question 15

What is meth mouth

Answer 15

Poor dentition due to lowered salivation and sugar cravings