Stimulant Use Disorder Flashcards
what are the categories of stimulants and examples?
weak: caffeine, nicotine
mild: ephedrine, pseudoephedrine, phenylpropanolamine, dextromethorphan
moderate: methylphenidate, dextroamphetamine, lisdexamphetamine, mixed amphetamine salts, modafinil, bupropion
strong: cocaine, methamphetamine (crystal meth), MDA, MDEA, MDMA
what is MOA of stimulants?
increase CNS and ANS activity
all effect the reward pathway by increasing DA concentrations at the synapse
what is the most common way that meth is used?
smoking
what effects do stimulants have on the CNS?
intense euphoria
increase alertness
increase concentration
increase talkativeness
decrease fatigue
decrease appetite
decrease sexual behaviour
also: nausea, tremors, tics/twitches, anxiety, agitation
what effects do stimulants have on the ANS?
increase body temp
increase HR
increase BP
increase RR
increase constriction of blood vessels
dilated pupils
what are the complications of stimulant OD?
seizures
coma
cardiac toxicity (arrhythmia, MI)
respiratory arrest
brain hemorrhage
death
what are the immediate complications of stimulant use?
increase risk of violent or illegal behaviours
increase engagement in risky sexual behaviour and HIV
psychosis: paranoia, visual and tactile hallucinations
irritability, anxiety
pregnancy; poor outcome for fetus
what are long term complications of stimulant use?
dental decay, weight loss, picking at skin with scabs, panic attacks
brain changes, memory loss
chronic psychotic disorders
what are the symptoms of acute stimulant intoxication or OD?
mania
psychosis
paranoia
severe delirium
increase BP
chest pain
agitation
sweating
skin-picking
what the management of acute stimulant intoxication?
generally do not require treatment as withdrawal symptoms are not severe or medically complex
mostly supportive unless delusions or autonomic hyperactivity
pharmacological agents only if overtly psychotic and agitated or medical crisis
what is used for agitation in stimulant intoxication?
lorazepam 2-4 mg IM or PO PRN (q30min t0 6h)
incomplete response: may add low dose AP
what is used for psychotic symptoms of stimulant intoxication?
low dose antipsychotic such as risperidone 0.5-2 mg/d, olanzapine 2.5-7.5 mg/d
delusions often self-remitting without treatment
what is used to treat cardiac complications associated with stimulant intoxication?
arrhythmia: anti-arrhythmic agents
tachycardia (+/- HTN): beta blockers (esp. labetalol/carvediolol), clonidine
when are anti-seizure meds given in stimulant intoxication?
if seizing
no role as a preventative
when does stage 1 of stimulant withdrawal start and how long does it last
crash
begins within hours and lasts 4-7 days
what are s/sx of stimulant crash?
agitation
marked dysphoria
fatigue
hypersomnolence
hyperphagia or anorexia
when does stage II of stimulant withdrawal start and how long does it last?
begins after the first week and can last up to 10 weeks
what are the s/sx of stage II of stimulant withdrawal
first week:
- normal sleep
- euthymia
- little anxiety
- minimal craving
subsequent weeks
- anhedonia
- increase anxiety and depression
- fatigue
- extreme craving
what can be used for post-acute hyperarousal/anxiety in stimulant withdrawal?
continue benzos a little longer
mirtazepine
what is the management of stimulant withdrawal
primarily supportive; rarely life threatening
non pharm: addictions counselling support, community supports, rehab options, housing needs
what is the rationale behind using antidepressants in stimulant withdrawal?
5-HT may attenuate reinforcing effects of amphetamine and 5-HT/NE counter withdrawal symptoms as depression
what is the consensus with antidepressant use in stimulant withdrawal?
mostly ineffective with regard to abstinence; may have mood related results
avoid sertraline?
use according to guidelines if indicated
what is the rationale behind antipsychotics in stimulant withdrawal?
counterbalance excess DA activity and restore NT pathways
what is the consensus on antipsychotics in stimulant withdrawal?
no different in any treatment outcomes
avoid aripiprazole?
use according to psychosis guidelines if indicated; review need after 6 months
what is the consensus on prescribed stimulants in stimulant wtihdrawal?
not generally recommended
risks: worsening psychosis, mood lability
what is the rationale behind DA agonists in stimulant withdrawal?
chronic stimulant use leads to DA depletion
what is the consensus on DA agonists in stimulant withdrawal?
general results not promising
some possible benefit in severe withdrawal
what is the consensus on modafinil use for stimulant use in stimulant withdrawal?
mixed evidence of benefit: possibly useful to reduce cocaine use, but 2 neg trials and risk of increase effect of concurrent stimulant use
