Stimulants Flashcards
Has two key physiologic effects
- ) Local anesthetic
- ) Inhibits monoamine reuptake
Cocaine
Cocaine inhibits monoamine reuptake, meaning it increases levels of
Dopamine, serotonin, and NE
Characterized by increased energy, decreased need for sleep, alertness, and euphoria
Cocaine intoxication
Cocaine serves as a local anesthetic by blocking
Na+ channels
The hallucinations seen in cocaine intoxication are classically tactile. I.e.
“There are bugs crawling on my skin”
Cocaine intoxication results in increased muscle activity and central dopamine release, which results in
Fever
Cocaine intoxication may mimic psychosis. How can we treat it?
Benzodiazepines
Cocaine intoxication causes activation of the sympathetic nervous system. This results in
Dilated pupils, tachycardia, and increased BP
Common in cocaine users due to increased O2 demand and decreased O2 supply
Cocaine chest pain
-The O2 mismatch causes angina
The increased O2 demand from cocaine use is the result of the
Tachycardia and elevated BP
The decreased O2 supply in cocaine users is cue to
Coronary vasoconstriction
We can treat the cocaine chest pain with
Benzodiazepines
We need to make sure that if chest pain is due to cocaine intoxication, we DO NOT give
Beta blockers
Occurs with stopping after chronic, heavy use
- Usually not life threatening
- Depression, fatigue, and difficulty concentrating
Cocaine Withdrawal
Modified phenethylamines
-Stimulants
Amphetamines
Amphetamines are indirect sympathomimetics, meaning they increase synaptic levels of
Dopamine and NE
Characterized by hyper-alert state, decreased need for sleep, and sympathetic stimulation
Amphetamine intoxication
Amphetamine intoxication rarely causes
Seizures
How do we treat amphetamine intoxication?
Benzos
An antagonist of adenosine receptors
Caffeine
Caffeine leads to the release of
Dopamine/NE
Caffeine causes a renal adenosine blockade, which leads to
Diuresis
In the chemical stress test, intravenous adenosine is used as a
Vasodilator
The effects of IV adenosine in a chemical stress test are blocked by
Caffeine ( and also theophylline)
A CNS stimulant that activates the sympathetic nervous system
-Addictive substance found in tobacco
Nicotine
Nicotine withdrawal peaks in the
First 3 days after cessation
Nicotine withdrawal subsides in
3-4 weeks
The primary barrier of smoking cessation is
Nicotine addiction
An antidepressant that blocks reuptake of NE and dopamine that can also help with smoking cessation
Bupropion
Parietal nicotinic receptor agonist
- limit withdrawal symptoms (as an agonist)
- blocks nicotine (as an antagonist)
Varenicline
Antagonist of NMDA receptor in the CNS
-Causes hallucination and psychosis
PCP
Classically results in psychomotor agitation with agitated, violent behavior
-Stimulant resulting in altered mental status
PCP
Causes nystagmus, tachycardia, and hypertension
PCP
Fatalities associated with PCP use are most commonly from
-Due to loss of pain sensation
Trauma
Can lead to psychosis with loss of pain/sensation
PCP
What are two ways that we can treat PCP intoxication?
Benzodiazepines and haloperidol
Hallucinogen that binds serotonin 5-HT2A receptors
-NOT a stimulant (contrast with PCP)
LSD
Causes a feeling of expanded consciousness
- Can sense things beyond usual reality
- “Trip”
LSD
Hearing colors or seeing sounds
-Common w/ LSD use
Synesthesia
Feeling disconnected or detached from the body
Depersonalization
May cause “flashbacks” i.e. return of hallucinogen effects after stopping the drug
LSD
An amphetamine that is structurally similar to serotonin and increases release of serotonin
Ecstasy
One of the major things associated with Ecstasy (MDMA) is
Bruxism (grinding of teeth)
MDMA use can result in tachycardia and hypertension as well as hyperthermia, but most importantly, it can result in
Hyponatremia and hepatotoxicity
Causes increased fluid intake and secretion of ADH which can result in hyponatremia
MDMA
What are the three main characteristics of serotonin syndrome?
-The 3 A’s
Agitation, Autonomic hyperactivity, and Neuromuscular hyperactivity
What is the treatment for serotonin syndrome?
-5-HT antagonist
Cyproheptadine
Ecstasy withdrawal is a crash after being high on MDMA that is associated with
Depression, anxiety, and jaw soreness (from bruxism)
Pharmaceutical forms of dronabinol
Synthetic Cannabinoids
