PHARM 445: stimulant use disorder

general mechanism of stimulants

stimulates/activates CNS -- increased catecholamine levels and increased agonistic activity at adrenergic receptors.

why might someone want to 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 associated with stimulant use (8)

- elevated HR/ BP & chest pain

- heart attack & stroke risk

- anxiety, hallucinations, paranoia

- elevated body temp

- weight loss

- sleep deprivation

- STBBI (sexually transmitted and blood borne infe) transmission

- infections

cocaine comes from what plant? and how is it made?

coca shrub -- leaves are soaked in chemical solvent & crushed into a paste; treated with oxidizing agent & acid is added (cocaine hydrochloride -- water soluble)

freebase cocaine

hydrochloric acid group is removed (water insoluble form)

crack cocaine

cocaine is heated with baking soda -- faster more intense high especially when smoked

cocaine MOA

binds & blocks monoamine (dopamine, norepinephrine, epinephrine, and serotonin) and reuptake transporters with equal affinity

what are the possible therapeutic uses of cocaine

- topical anesthetics

- nose bleeds

how dose the route of administration impact the effect felt from using cocaine?

snorting = less intense but longer effects

injection/ smoking = more instant effect but shorter effect

acute intoxication of cocaine

- Alertness

- Euphoria

-Increased: BP, HR, RR

-Anxiety, paranoia,

- Irritability, aggression

-restlessness

-hypervigilance

- Insomnia

- Sweating, chills

- N/V

chronic use sx of cocaine 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

methamphetamine is often made using what?

ephedrine or pseudoephedrine

recently there have been a rise in _________ method of production for meth

phenyl-2-propanone P2P (subs ephedrine or pseudoephedrine with much more toxic chemicals)

what is the main difference between amphetamine and methamphetamine?

1 methyl group on NH group on methamphetamine (cause quicker entry into the brain)

MOA of methamphetamine

enhances NT (DO, NE, 5HT) release & blocks reuptake from synapses

which has a longer 1/2 life cocaine or meth?

meth (up to 12 hours vs cocaine which is 50min-1hr)

reinforcing effects of methamphetamine

- alterness

- ambition

- energy, decreased need for sleep

- weight loss/ appetite suppression

reinforcing effects of cocaine

- Alertness

- Energy, decreased need for sleep

- Appetite suppression

- Intense feeling of euphoria

acute intoxication sx of methamphetamine

- Alertness

- Euphoria

- Increased: BP, HR, RR

- Anxiety, paranoia

- Irritability, aggression

- Confusion

- Tremors

- Decreased food/fluid intake

- Urinary retention

chronic use sx of methamphetamine

- Mouth sores

- Skin lesions

- Dental decay

- Potential neglect of oral hygiene

- Hypertension, stroke

- Decreased cognition

- Psychosis

why might dental decay be a sx of chronic use with methamphetamine?

Acidity compromises enamel and dry mouth promotes harmful bacterial infection

stimulant induced agitation vs psychosis

Agitation → hyperresponsiveness, racing thoughts, emotional tension, motor/verbal hyperactivity

Psychosis → hallucinations, delusions, delirium

what are predictors for persistent symptoms following meth induced psychosis: (3)

- Longer length of time using methamphetamine

- Presentation includes more severe psychotic symptoms

- Sustained depressive symptoms

are there any medications indicated for stimulant intoxication or overdose?

NO -- only supportive therapy (hydration, nutrition, safe place to rest)

what is overamping?

equivalent to stimulant overdose -- not fatal from the substance itself but some of the sx that can develop can become fatal

overamping physical sx

- 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

overamping psychological sx

- Extreme anxiety

- Panic

- Extreme paranoia; hallucinations

- Hypervigilance

- Increased aggressiveness

- Restlessness or irritability

- Enhanced sensory awareness

stimulant withdrawal sx

low mood, excessive sleep, increased appetite, anxiety, paranoia

would tolerance and withdrawal alone for meth meet the criteria for a mild stimulant use disorder diagnosis

YES

what is the current standard of care for management of stimulant use disorder?

psychosocial treatment -- reinforces positive behaviour based on operant conditioning principles