STIMULANTS
Stimulants sometimes called uppers temporarily increase
alertness and energy. The most commonly used drugs that fall into this category
are cocaine and amphetamines. Prescription stimulants come in tablets or
capsules. When abused, they are swallowed, injected in liquid form or crushed
and snorted. Stimulant increase alertness, attention and energy which are
accompanied by increase in blood pressure, heart rate and respiration.
Historically stimulants were used to treat asthma and other
respiratory problems, obesity, neurological disorders, and a variety of other
ailments
Now stimulants are prescribed for treating only a few health
conditions including narcolepsy, attention deficit hyperactive disorders
(ADHD), and depression that has not responded to other treatment, stimulants
may also be used for short term treatment of obesity and for patients with
asthma.
How they act on the
body
Stimulants have chemical structures that are similar to key
brain neurotransmitters called monoamines. stimulants increase the level of
these chemicals in the brains and body, this in turn, increase blood pressure,
heart rate, constricts blood vessels, increase blood glucose and opens up the
pathways of the respiratory systems. In addition the increase in dopamine is
associated with a sense of euphoria that can accompany the use of stimulant.
Depending on type of stimulant abused and the length of time
it has been abused for, individuals are at risk for a number of dangerous side
effects such as heart attack, seizures and stroke.
At high doses, especially if smoked or injected
intravenously, cocaine and methamphetamine can produce pallor, cold sweat,
rapid pulse, tremors and headache.
Serious medical consequences are relatively uncommon in
stimulant users as opposed for example to alcoholics, Nonetheless, high doses
can cause serious or life threatening problems
Withdrawal typically occurs in 3 phases
· Crash
· Withdrawal
· Extinction
Medical and
psychiatric complications of stimulant use
Body Systems
complication
Cardiovascular
Arrhythmias, hypertension, spasm of arteries, cardiomyopathy
and congestive heart failure
Neurological
Seizures, cerebro-vascular accidents including brain
hemorrhage, neuropsychological changes e.g. deficit in attention, movement disorders
e.g. disturbed gait
Psychiatric
Most common psychiatric disorder mimicked is depression with
changes in mood and disturbed sleep, activity and paranoia.
Anxiety and aggression.
Delirium.
Psychosis characterized by paranoia and anxiety.
Respiratory
Can result in chronic lung damage including pneumonia,
bronchitis, pulmonary edema
Sexuality
Short term stimulant use is often associated with increased
sexual drive and performance.
Chronic use however can result in difficulty in achieving
orgasm, altered menstruation, reduced libido, impotence among other sexual and
reproductive health problems
Hyperpyrexia
Extremely elevated body temperature which can contribute to
seizures, cardiac arrhythmias, acute renal and hepatic failure
Pregnancy
Stimulant use during pregnancy is associated with higher
rates of obstetric complications (spontaneous abortion, miscarriage and
placental abruption) and harm to the fetus
Others
Weight loss ( chronic loss of appetite and increased
metabolism), skin lesions and abscess due to adulterants particularly in
injectors
Treatment
Withdrawal from stimulant drug is not medically dangerous
and no specific treatment has been showto be effective in reducing withdrawal
symptoms. The primary aim of withdrawal management is to attend to complication
and engage the patients in relapse prevention. Managing prolonged withdrawal
typical of psycho stimulant dependence requires careful integration and
coordination between withdrawal and post withdrawal services to provide ongoing
support to the patient. To manage high prevalence of complications in stimulant
users particularly mental state problems) withdrawal services require adequate
resources and coordination with relevant medical and psychiatric services.
Antipsychotic Medication- should be considered for patients
with features of psychosis which are distressing to the patients or others.
Benzodiazepines is useful for anxiety and sleep disturbances but should not be
used for longer than 2 weeks without review. Other ways to manage anxiety and
sleep problems should be encouraged such as sleep hygiene, exercise and
relaxation techniques.
Medication to cocaine for at least 1-2 weeks after symptoms
resolve with careful monitoring for return of symptoms as medications is
withdrawn is also applied.
Antidepressants are helpful in managing clients with
persistent features of depression following stimulant withdrawal. Specialist,
assessment and a treatment plan combining counseling e.g. cognitive behavioral
theory and antidepressants should be considered.
Supportive care
o Providing
information
o Supportive
counseling to help client cope with symptoms and cravings and to maintain
motivation
o Specific
strategies for addressing agitation, anger, perceptual disturbances and sleep
disturbances
o Frequent
orientation, reassurance and explanation of procedures to patients with thought
or perceptual disturbances as they can easily misinterpret actions or events
around them is recommended.
o Crisis
intervention, addressing accommodation, personal safety, or other urgent
welfare issues.
Pharmacotherapy
Medication in managing cocaine or amphetamine withdrawal is
unclear. There are currently no medications to treat stimulant medication misuse.
Examined Treatment for stimulant dependence however include naltrexone, various
antipsychotics, mood stabilizers,and various antidepressants including
bupropion , modafanil, balcofen, ondansetron and dexamphetamine with little to
no effects.
Treatment of
stimulant intoxication
· Supportive
· For Chest
pain; ECG, biomarkers, CXR, benzo and nitro
· Phentolamine
for hypertension
· Treat
stimulant induces psychosis if severe
· Treat any
infections i.e. arising from IV use
Treatment of
stimulant withdrawal
· Supportive
· Suicide
preventions
Treatment of
stimulant use disorders
· SBIRT
(Screening, Brief intervention, Referral
to treatment
· Stages of
change
· Harm
reduction (needle exchange/ crack pipe programs)
· Cognitive
Behavioral therapy
· Motivational
Enhancement therapy
· Contingency
management
· Residential
treatment
· Self help
support
· Matrix model
· Treatment of
underlying mental health disorders.
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