Amphetamines

(Methamphetamine)

Amphetamines are sympathomimetic with CNS stimulant and euphoric properties, their toxic side effects delirium, hypertension, seizures and hyperthermia (rhabdomyolysis and renal failure caused) are. Intoxication is treated with supportive, inter alia, with i.v. Administration of benzodiazepines (when energized, hypertension, and convulsions) and cooling measures (for hyperthermia). There is no stereotypical withdrawal symptoms.

The original member of the class, amphetamine was modified by various substitutions on its phenyl ring, which has led to many variants, including methamphetamine, Methylenedioxymethamphetamine (ecstasy, MDMA), Methylenedioxyethylamphetamin (MDEA) and many others.

Amphetamines are sympathomimetic with CNS stimulant and euphoric properties, their toxic side effects delirium, hypertension, seizures and hyperthermia (rhabdomyolysis and renal failure caused) are. Intoxication is treated with supportive, inter alia, with i.v. Administration of benzodiazepines (when energized, hypertension, and convulsions) and cooling measures (for hyperthermia). There is no stereotypical withdrawal symptoms. The original member of the class, amphetamine was modified by various substitutions on its phenyl ring, which has led to many variants, including methamphetamine, Methylenedioxymethamphetamine (ecstasy, MDMA), Methylenedioxyethylamphetamin (MDEA) and many others. Some amphetamines, including Dextraomamphetamin, Metampethamin and the related methylphenidate, are widely applied in the treatment of attention deficit hyperactivity syndrome, obesity and narcolepsy. These medical applications lead to general availability, which can be exploited for illegal use. Methamphetamine can be illegally manufactured easily. Pathophysiology amphetamines increase the release of catecholamines, which increase the intrasynaptic levels of norepinephrine, dopamine and serotonin. The resulting strong alpha- and beta-receptor stimulation and general CNS stimulation lead to the “desired” effects such as increased attention, euphoria and loss of appetite, as well as the negative effects such as delirium, hypertension, hyperthermia and seizures. The effects of amphetamines are similar, they differ only in the intensity and duration of psychoactive effects; MDMA and its relatives have stronger stimulant properties, probably because they have a greater effect on serotonin. Amphetamines can be taken orally as tablets or capsules, nasal inhalation or smoking or by injection. Chronic effects Repeated use of amphetamines may lead to dependence. Although the development of tolerance is slow, but can be taken or injected quantities over time that exceed the initial amount to the several hundred-fold. The tolerances for the different effects develop unevenly. Tachycardia and increased alertness decrease, but hallucinations and delusions may occur. Amphetamines typically cause in men erectile dysfunction increase but at the same sexual desire. The abuse is associated with unsafe sexual practices; Users are at higher risk for sexually transmitted infections, incl. HIV infection. The abuse is associated with a strong risk of accident because the substance of excitement and size feeling, followed by exhaustion and insomnia caused. Necrotizing vasculitis that involves multiple organ systems may occur. The use of certain amphetamine-related appetite suppressant (dexfenfluramine, fenfluramine, phentermine) was associated with valvular disease. Dexfenfluramine and fenfluramine in 1997 from the US market. Phentermine-fenfluramine (Phen-Fen) preparations were similarly removed from the US market, but phentermine alone and in combination with topiramate is an appetite suppressant available. Symptoms and signs Acute effects Many psychological effects of amphetamines are similar to cocaine which, they include increased attention and concentration, euphoria and feelings of well-being and grandiosity. Palpitations, tremors, sweating, and mydriasis may also occur during intoxication. When excessive, paroxysmal use of methamphetamine (binges) there is a fatigue syndrome with intense fatigue and a pronounced need for sleep after Stimulationsphase.Toxizität or overdose tachycardia, arrhythmias, chest pain, high blood pressure, dizziness, nausea, vomiting and diarrhea may occur. CNS effects include acute delirium and toxic psychosis. Overdosing can lead to a stroke (usually haemorrhagic), seizures, muscle stiffness and hyperthermia (> 40 ° C); All these effects may lead to rhabdomyolysis, which in turn lead to kidney failure kann.Chronische effects a paranoid psychosis caused by a prolonged use, it is triggered by a single high dose or by repeated moderate doses. Usually, a psychosis manifests as hallucinations, delusional self-reference (the patient is convinced that everyday events have a special meaning for him, only happened because of him or against him are) or obsessive thoughts. Some users suffer persistent depression with suicidal tendencies. Usually, albeit slowly, occurs even after a prolonged amphetamine psychosis again a normalization. The floristic whose symptoms resolve within a few days or weeks, but confusion, impaired memory and delusions may persist for months. For users, it is very common to severe tooth decay; Causes are less saliva, acidic degradation products and poor Mundhygiene.Entzug when they stop taking methamphetamine and other amphetamines is not it though stereotyped withdrawal symptoms, but it can occur EEG changes that meet according to some experts, the criterion of physical dependence. Abrupt withdrawal may exacerbate an underlying depression or trigger a severe depressive reaction. After a withdrawal often leads to intense fatigue, exhaustion or drowsiness and depressive symptoms that last 2-3 days. Diagnosis Clinical evaluation testing as necessary to exclude serious diseases nichtmedikamentäse (z. B. impaired consciousness trigger) The diagnosis is made clinically in general. However, if a history of substance use is present and the diagnosis is unclear, tests are carried out according to need such. As in undifferentiated patients with altered mental status, high fever or seizures. The evaluation includes a normalerseise a CT, lumbar puncture and laboratory tests to identify infections and metabolic disorders. Amphetamines are generally part of the routine urine test for substances which are performed when the findings are of unknown cause; the specific level of the substance in the blood is not measured. Immunoassay screening urine tests for amphetamines can result in false positives, and can not differentiate between methamphetamine and methylphenidate. Intravenous treatment benzodiazepines Intravenous nitrates in hypertension, which does not respond to benzodiazepines cooling at hyperthermia toxicity or overdose, if a significant amount was taken orally (z. B. <1-2 h) can, of activated carbon are given in order to limit the absorption, although this measure could not show that it can reduce morbidity and mortality. Although an acidification of the urine accelerated renal excretion, but it does not lower the toxicity and may deteriorate the tubular myoglobin Ausällung and is therefore not recommended. Benzodiazepines are the preferred first line treatment of CNS arousal, convulsions, rapid heart rate and high blood pressure. Lorazepam 2-3 mg iv every 5 minutes, titrate the effect can be used. High doses or continuous infusion may be necessary. Propofol in combination with mechanical ventilation may be required in severe agitation. A hypertension does not respond to benzodiazepines can, or other antihypertensives are treated as needed with nitrates (sometimes nitroprusside). Beta-blockers (eg. B. metoprolol 2-5 mg i.v.) can be employed in serious ventricular arrhythmia or tachycardia. Hyperthermia can be life threatening and should aggressively with sedation plus. Evaporative cooling, ice packs and control intravascular volume and urine flow with i.v. saline treatment. Phenothiazines lower the seizure threshold, and their anticholinergic effects can interfere with cooling measures, which is why they are not used for sedation werden.Entzug and rehabilitation There is no specific treatment necessary. First, blood pressure and mood should be monitored. Patients whose depression lasts longer than a short period after cessation of amphetamines, can be treated with antidepressants. In some patients, cognitive behavioral therapy is effective. There is no other proven therapies for rehabilitation and care after the detoxification.

Health Life Media Team

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