CNS Stimulants Flashcards
Stimulants
A category of drugs that stimulate/activate the CNS
Cocaine
Methamphetamine
Caffeine
Prescription stimulants
Why do people use stimulants?
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
Risks of using stimulants
Elevated HR, BP
Chest pain
Heart attack
Risk of stroke
Anxiety
Hallucinations
Paranoia
Elevated body temperature
Weight loss
Sleep deprivation
STBBI
Wounds, bacterial infections
in terms of wounds and or bacterial infections. There’s kind of 2 main pathways in which that can kind of present itself. So one depends on the root of administration. So we know that if people are injecting substances. There is a high risk here of creating a wound and or a bacterial infection. If there’s perhaps improper technique when we’re piercing the skin, we’re introducing bacteria into the bloodstream, which can then cause an infection.
But we also see that people who use stimulants in high rates, or frequently, or sometimes experience a psychiatric phenomenon known as parasitosis.
And so this is a phenomenon where people believe that there is perhaps bugs or worms under their skin which that men can cause compulsive scratching or picking, which then creates these lesions that we see sometimes in the media.
We also know that people who use stimulants often very acutely will report anxiety, hallucinations, and paranoia. And while these symptoms can resolve, once the substance has cleared from the system, these symptoms may also persevere and be unresolving.
Cocaine
Other names: “coke”
,”snow”
,”blow”
,”crack”
, “rock”
,”free base” , etc.
pharmacology
reinforcing fx
therapeutic use
Pharmacology Reinforcing effects
Potentiates dopamine,
norepinephrine, serotonin
in the brain
Blocks reuptake from
synapses
Half life: 50 minutes
Interactions: CYP450-2D6
(strong), substrate of 3A4
(major)
Alertness
Energy, decreased need for sleep
Appetite suppression
Intense feeling of euphoria
Therapeutic use
Topical anesthetic
Nose bleeds
So the intense feelings of euphoria, that cocaine that are a result of cocaine use are the potentiation of dopamine, norepinephrine, and serotonin in the brain, and it works by blocking the reuptake of these neurotransmitters from the synapse
Snorted –>there’s a less intense but longer effect up to 30 min, and when we inject or smoke, we have a more instant effect, but a much shorter period, like last of effect, which is anywhere from 5 to 10 min.
Cocaine
Acute intoxication
chronic use
Acute intoxication
Alertness, restlessness
Euphoria
Insomnia
Irritability, aggression
Anxiety, paranoia, hypervigilence
Increased: BP, HR, RR
Sweating, chills
N/V
Chronic use
Nasal symptoms (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
Cocaine
Withdrawal
Days 1-4 (“crash”)
Fatigue, nightmares, increased sleep, depression, increased appetite
Weeks 2-12
Low drive, boredom, decreased interest in activities, cravings
People have very low moods, because they’re kind of coming down from this like very intense state of euphoria that they had, and people are often very hungry, and this is because they’ve had this appetite suppressant on board, and they haven’t been eating. So what we see with both cocaine and methamphetamine is that people need to sleep a lot, and they would like to eat a lot.
And then in the weeks after that there can be this kind of extended effect. Where people have low drive low energy, they have decreased interest in the activities that they’re usually involved in, and they can have persistent cravings
generally. There is no treatment recommended for the management of cocaine withdrawal.
and it’s important to emphasize here that stimulate withdrawal in and of itself is not light, threatening like we talked about with opioid withdrawal where people then can have such high previews, and this decreased tolerance, which can then put them at higher risk of death or with alcohol withdrawal,
so generally with stimulant withdrawal, our approach is for supportive measures that can help manage people’s discomfort,
Methamphetamine
Other names: “speed”
,
“meth”
,
“crank”
,
“ice”
,
“crystal”
,
“glass”
,
“pint”
, etc
Often made in home and
mobile labs using ephedrine
or pseudoephedrine and
solvents
Rise of P2P method of
production
When we look at Amphetamine, which is a prescription product, and we look at methamphetamine. They’re extremely similar. Often in the literature they’re referred to as cousins, and really they only differ by a single methylation, and this additional methyl group is thought to increase the lipo felicity of methamphetamine. Helps cross BBB faste, greater reinforcing fx than amphetamine
Amphetamine does have some therapeutic usage. So we see it in the treatment of Adhd. We sometimes see it in the treatment, in some treatments for obesity, and sometimes in certain treatments for depression
Methamphetamine
Pharmacology Reinforcing effects
Pharmacology
Potentiates dopamine,
norepinephrine, serotonin
in the brain
Enhances NT release
and blocks reuptake
from synapses
Half life: 12 hours
Differs from amphetamine
by one methyl group -
thought to speed entry
into the brain
Reinforcing effects
Alertness
Ambition
Energy, decreased need for
sleep
Weight loss/appetite
suppression
So it’s significant to point out that methamphetamine, while it works similarly to cocaine, has a much longer half light. And so for some people this is a very desirable effect. But then, when they use this methamphet, I mean they’ll kind of be have that acute intoxication for a longer period of time than what they would receive from using cocaine.
and so due to the fact that it has this longer effect, and that the cost point for methamphetamine is much lower than what we see with kind of pure cocaine or cocaine powder. This becomes a preferred choice for a lot of people who use stimulants, which is what we saw in that initial survey people accessing harm reduction services.
Methamphetamine
Acute intoxication
Chronic use
Acute intoxication
Alertness
Euphoria
Confusion
Irritability, aggression
Anxiety, paranoia
Increased: BP, HR, RR
Tremors
Decreased food/fluid intake
Urinary retention
Chronic use
Mouth sores
Skin lesions
Dental decay
Hypertension, stroke
Decreased cognition
When we think about chronic use, we know that people who use methamphetamines are an increase risk of experiencing psychosis or symptom psychotic symptoms, and this can result in things like hallucinations, paranoia, parasitosis, which we talked about earlier and delusions.
this can increase people’s risk of meeting to be hospitalized, but it can also increase their intersections with the criminal justice system.
People who use stimulants is dental to decay.
and this is more commonly seen with chronic use, less obvious, with like kind of acute or sporadic use.
And this again happens by a couple of different mechanisms. So one methamphetamine in and of itself, is an acidic product. So it has the potential to break down the enamel, especially if people are perhaps taking it orally, then it’s like kind of directly exposing that substance to their enamel.
it can cause dry mouse; and this again happens by a couple of different mechanisms, one when people are kind of acutely activated, acutely intoxicated, they’re maybe not thinking about drinking water or eating food, staying hydrated.
and they’re also increasing their body temperature. So all of these things kind of work together to, you know, promote dehydration, which then creates dry mouth and can then promote growth of harmful bacteria
it can also contribute to neglect of oral hygiene
Overamping
Physical
Psychological
Overamping
Physical
Nausea and/or vomiting
Passing out (but still breathing)
Chest pain
High temperature/sweating profusely
Fast heart rate, racing pulse;
hypertension
Irregular breathing or shortness of
breath
Tremors; limb jerking or rigidity
Stroke
Severe headache
Teeth grinding
Insomnia
Psychological
Extreme anxiety
Panic
Extreme paranoia; hallucinations
Hypervigilance
Increased aggressiveness
Restlessness or irritability
Enhanced sensory awareness
acutely intoxicated, and perhaps those symptoms for them have moved from being beneficial and enjoyable to that more kind of anxious, agitated, hyper, vigilant state. Or if someone’s experiencing agitation, then some of the best things we can do is bring them into a low stimulus environment, and depending on the setting that we’re in, offer Benzodiazepines as needed to kind of help, calm them down and give them the opportunity to rest and have that substance cleared
Overamping picture which then kind of puts people at higher risk of symptoms of psychosis like hallucinations, delusions, delirium. Then we may need, like kind of more formal support, and that might include psychiatry and inpatient hospitalization.
Methamphetamine withdrawal
Symptoms
Depression
Altered mental status
Cravings
Dysomnia
Chronic fatigue, excessive sleeping
Cognitive decline
Increased appetite
Heightened anxiety
Paranoia
Psychosis
Management
No medications currently approved for treating stimulant
intoxication or overamping
Contingency management
Supportive treatment
psychological treatment is currently the standard of care for people who are looking to reduce their stimulant use, or have abstinence from stimulants.
Contingency management:
incentives or prizes are offered either in a systematic way, or in a randomized way, to people who are able to achieve certain goals.
and those goals might include treatment, participation. They might include abstinence. So to kind of
give a really solid example of that, an example of contingency management could be, if I use stimulants, and I’m. Part of a contingency management program. Every time I have a negative year and drug screen, I get to put my name on a piece of paper into a fish bowl, and every week everyone in my group who has been able to have a negative year and drug screen puts their name into that fish bowl, and then a random prize is like they randomly draw someone from that fish bowl, and then I get to choose a prize.
and those prizes can range in like kind of a small quantity to a relatively large quantity, and it’s kind of those operant conditioning principles where the prize could be small. But the price could be big, which kind of reinforces and incentivizes people to maintain their absence. And so there is actually good evidence to support that this does work. It helps to reduce people stimulate, use. It helps them to kind of meet other care goals within their spectrum, like their kind of treatment goal plan.
Harm reduction
Safe sex education (condoms, PrEP)
Safer equipment (pipes, smoking supplies, syringes,
injection equipment)
Nutrition, hydration
De-escalation
Greater inclusivity within SCS (specifically
incorporation of inhalation spaces)
Take home naloxone kits
