Table Of Contents
Cocaine
Cocaine blocks the uptake of serotonin, norepinephrine, and dopamine in the synaptic cleft (in the reward pathway) causing a stimulant effect.
- Signs and symptoms of short-term intoxication
- Euphoria
- Mydriasis
- Increased motor activity
- Restlessness
- reduced appetite
- Increased body temperature (can lead to deadly hyperthermia, monitor body temp of the patient if suspicious or if urine toxicology comes back positive for cocaine)
- Signs and symptoms of long-term intoxication
- Itching
- Paranoid delusions
- Prolonged tachycardia
- Poor dentition
- Signs and symptoms of withdrawal (post-intoxication depression aka ‘crash’)
- Depressed mood (as opposed to euphoria)
- Increased appetite (as opposed to decreased appetite)
- Anxiety
- Tremors
- Intense psychomotor retardation
- Treatment of intoxication
- Supportive care e.g. cooling for hyperthermia, rehydration, treat electrolyte imbalances
- Benzodiazepines (midazolam, alprazolam) PRN: for mild-to-moderate agitation
- Antipsychotics: for severe agitation, paranoid delusions or psychotic disorders developed on the ward
- Beta-Blocker (Propranolol, pindolol): for tachycardia/palpitations
- Vitamin C: controversial but standard for cocaine/amphetamines (acidifies urine increasing their excretion)
- Treatment of cocaine use disorder
- There is no approved pharmacotherapy
- Off-label use of disulfiram, modafinil and topiramate
- Treatment of withdrawal
- Supportive treatment
- Long-term SSRIs
- Complications of cocaine use
- Nasal septum perforation (from chonically inhaling cocaine)
- Myocardial infarction (from vasoconstrictive effects)
- Intracranial hemorrhage
- Stroke
Amphetamines
Amphetamines block the reuptake and facilitate the release of dopamine and norepinephrine from nerve endings causing a stimulant effect
Classification of amphetamines
| Classification | Description | Examples |
|---|---|---|
| Classic amphetamines | Methamphetamines are easily manufactured in home labs using OTC medication e.g. pseudoephdrine. They are commonly prescribed for narcolepsy, ADHD and occassionally depression | Dextroamphetamine (Dexedrine), methylphenidate (Ritaline), methamphetamine (”ice”, “speed”, “crystal meth”) |
| Substituted amphetamine (”designer”) | Commonly used in clubs and parties. Have both stimulant and hallucinogenic properties. Serotonin syndrome is possible if they are combined with SSRIs | MDMA (ecstasy), MDEA (eve) |
- Signs and symptoms of intoxication
- Similar to those of cocaine
- MDMA and MDEA induce a sense of closeness to others
- Treatment of intoxication
- Rehydration
- Correct electrolyte imbalances
- Treat hypertehrmia
- Complications of amphetamine use
- Overdose can lead to hyperthermia, dehydration, rhabdomyolysis and renal failure
- Psychosis (can be prolonged even during abstinence due to their long half-life)
