Amphetamines
Karen Drexler, M.D.
Epidemiology of Amphetamines
In 1997, 4.4% of high school seniors used crystal methamphetamine at least once
2.7% in 1990
In 1996, 2.3% of U.S. population has used methamphetamine at least once.
2.2% in 1995
Pharmacology of Methamphetamine
Street names include "crank", "go", "crystal", "crystal meth"
Synthesized from pseudoephedrine, ephedrine, phenylporpanolamine
Half-life 10 - 12 hours
Lower vaporizing temperature
Neurobiology of methamphetamine
Competitive agonist at the dopamine transporter
Chronic use results in decreased activity at dopamine and serotonin neurons in the mesolimbic-prefrontal pathway.
Due to decrease in dopamine activity in the substantia nigra, Parkinsonism can develop.
Amphetamine abuse
Failure to fulfill major role obligations
Recurrent use in situations in which it is physically hazardous
Recurrent substance-related legal problems
Continued use despite having a persistent or recurrent social or interpersonal problem made worse by amphetamines
Amphetamine Dependence
Tolerance
Characteristic withdrawal
Often taken in larger amounts than intended
Unsuccessful efforts to cut down or control use
Great deal of time spent obtaining, using or recovering from the effects
Important social, occupational activities given up
Continued use despite persistent medical or psychological problem caused by amphetamine use.
Amphetamine Intoxication (DSM-IV)
Tachycardia or bradykardia
Pupillary dilation
Elevated or lowered blood pressure
Perspiration or chills
Nausea or vomiting
Evidence of weight loss
Psychomotor agitation or retardation
Muscular weakness, respiratory depression, chest pain or cardiac arrhythmias
Confusion, seizures, dyskinesias, dystonias, coma
Amphetamine Withdrawal (DSM-IV)
Dysphoric mood and 2 or more:
Fatigue
Vivid, Unpleasant dreams
Insomnia or hypersomnia
Increased appetite
Psychomotor retardation or agitation
Diagnosis: Amphetamine abuse/dependence
History
Physical exam- signs of intoxication or withdrawal, medical complications
Urine drug screen (2 - 4 days)
Medical Complications of Amphetamine use
Cardiotoxicity: AMI, arrhythmias
Pulmonary hypertension
Rhabdomyolysis
Neurotoxicity: Substantia nigra and VTA
Seizures
Psychiatric complications: Methamphetamine
Psychosis
Depression
Mania
Anxiety
Treatment: Methamphetamine
Cognitive-behavioral
Community reinforcement
Twelve-step facilitation
Motivation enhancement
Treatment of comorbid psychiatric and medical conditions
Caffeine and related methylxanthines: Epidemiology
Over 80% of Americans consume caffeinated beverages
Related methylxanthines are present in prescription medications: theophylline, theobromine
Caffeine: Pharmacology
Half-life is 2 - 6 hours
Intoxication lasts 6 - 16 hours
Inhibit c-AMP phosphodiesterase
Augment epinephrine and norepinephrine
Inhibit adenosine receptors
Caffeine Intoxication
Consumption of >250 mg caffeine
- Restlessness
- Nervousness
- Excitement
- Insomnia
- Flushed face
- Diuresis
- GI disturbance
- Muscle twitching
- Rambling speech
- Tachycardia
- Inexhaustability
- Psychomotor agitation
Caffeine: Medical Complications
Overdose: > 10 gms
Arrhythmias
Seizures
Moderate doses:
GI disturbances
Tremor
Insomnia
Caffeine: Withdrawal
Lasts 24 - 72 hours
Lethargy
Hypersomnia
Headache
Irritability
Anabolic Steroids:
Derivatives of the male hormone testosterone
Promote skeletal muscle growth and increase lean body mass
Taken orally or injected
Usually taken in a cycling and stacking pattern
Often used with other drugs
Anabolic steroids: Epidemiology
In 1997, 175,000 teenage girls reported taking steroids within the past year (100% increase from 1991)
In 1997, 325,000 boys used steroids in the past year
In 1998, 2.7 percent of high school seniors reported lifetime use
Anabolic steroids: Effects
Produces an increase in lean body mass and an ability to train longer and harder.
Increases LDL, decreases HDL
Liver tumors, jaundice
Fluid retension
Severe acne
Premature skeletal maturation
Anabolic steroids: Side effects
For men:
- Testicular atrophy
- Reduced sperm count
- Infertility
- Baldness
- Breast development
- For women:
- Growth of facial hair
- Menstrual irregularity
- Deepened voice
- Clitoral enlargement
Anabolic Steroids: Side effects
Psychiatric
Wild mood swings
Mania
Extreme irritability
Violence
Depression (withdrawal)
Paranoia, delusions