S15C181 - Cocaine, methamphetamines, other amphetamines

Question 1

Cocaine

Answer 1

• CNS stimulant and local anaesthetic
• blcks presynaptic reuptake of NE, dopa and serotonin leading to sympathetic activation
• Sx: mydriasis, tachy, HTN, diaphoresis, dysrhythmias, seizures, hyperthermia
• local anaesthetic part of it blocks the Na channels leading to wide QRS and long QT (negative inotropy, bradycardia, HoTN)
• causes vascoconstriction and angina, coranary dissection

Question 2

Amphetamine examples

Answer 2

• methamphetamine (ice)
• MDMA
• methylphenidate, dextroamphetamine (ADD meds)
• mescaline
• ephedrine, pseudoephedrine

Question 3

Amphetamine Tx

Answer 3

-benzos: ativan 2mg IV
-avoid antipsychotics (lower Sz threshold)
-hyperthermia: cool-mist spray, fans
-rhabdo: fluids
-Sz: benzos, barbs
-MI/ACS: benzo, ASA, nitroglycerin
-AVOID BB - unooposed alpha effects
do not use thrombolytics if severe HTN, vasospasm, coronary artery diessection, instead to PCI
-wide QRS: alkalanize the urine to >7.45
-HTN: nitroprusside or phetnolamine

• body packers: WBI
• body stuffers: charcoal, WBI

Question 4

Meth w/d

Answer 4

-drowsy, lethargy, hunger, tremor, chills