Overdose amphetamine

Forced diuresis is occasionally useful. It may cause volume overload or electrolyte disturbances. Forced diuresis is useful for phenobarbital, bromides, lithium, salicylate, or amphetamines overdoses. Do not use for tricyclic antidepressants, sedative-hypnotics, or highly protein-bound medications. The most common agents employed are furosemide and osmotic diuretics with mannitol. 

Chlorpromazine has many actions of which a-adrenoceptor block is a minor one, but sufficient to cause hypotension, and to be clinically useful in amphetamine overdose. 

So the paranoid psychosis produced by cocaine and amphetamine overdose is properh called stimulant psychosis. By the late 1960s, the word was out on the street— Speed kills What was referred to in this slogan was not just death by overdose. Amphetamine overdose deaths did occur, but they were relatively rare. Far more common was the development of a paranoid state that often led to acts of violence. In addition, after a long binge of amphetamine abuse, the user may crash (sleep for an extended period) and then awaken deeply depressed. The depression could last for days and is now recognized as a common withdrawal symptom after hca%7 use of either amphetamine or cocaine. The depression often leads the user back to drugs to try to get up again, and the cycle is repeated. Eventually the user s physical and mental health deteriorates badly unless he or she can break out of the cycle. 

PO. Well absorbed, enters CNS, excreted without undergoing metabolism, half-life = 4-6 hrs. Elimination is slowed by alkalination of urine. Often abused. Severe tolerance and dependence. Methamphetamine ( Speed") acts similarly, but is very addictive and often abused. MAO inhibitors hypertensive crisis, CNS overstimulation. Barbiturates supraadditive mood elevation. Tricyclic Antidepressants potentiate CNS stimulation, inhibit metabolism of amphetamine. Overdose treatment Acidify urine. Give chlorpromazine to treat CNS symptoms and alpha-receptor blocker to lower blood pressure. 

The nurse would not suspect amphetamine overdose with these signs or symptoms. 

A thiazole derivative that incorporates a fragment of the amphetamine molecule shows some CNS stimulant activity more specifically, the compound antagonizes the depression caused by overdoses of barbiturates and narcotics. Reaction of benzalde-hyde with sodium cyanide and benzenesulfonyl chloride gives the toluenesulfony1 ester of the cyanohydrin (141). Reaction of this with thiourea leads directly to aminophenazole (143) It is probable the reaction proceeds by displacement of the tosylate by the thiourea sulfur to give 142 addition of the amino group to the nitrile followed by tautomerization affords the observed product. ... 

The answer is c. (Hardman, pp 574—575.) Phencyclidine is a hallucinogenic compound with no opioid activity Its mechanism of action is amphetamine-like. A withdrawal syndrome has not been described for this drug in human subjects. In overdose, the treatment of choice for the psychotic activity is the antipsychotic drug haloperidol. 

Amphetamine (Benzedrine). Amphetamine was synthesized in 1887. It was quickly found to be a potent stimulant with effects similar to cocaine, which had been discovered over 100 years before. In the subsequent years, amphetamine found a variety of uses. It was used to treat narcolepsy, Parkinson s disease, barbiturate overdose, bed wetting (enuresis), and obesity. It was also used to counteract the sedating effects of other drugs and medications including antiseizure medications and alcohol. 

Acid diuresis may be indicated in overdoses with weak bases (eg, amphetamines, fenfluramine, quinine), but use with caution in patients with renal... 

The risk of tachycardia, hypertension, and cardiotoxicity is increased with coadministration of dronabinol (an antiemetic) and dextroamphetamine. In addition, administration of dextroamphetamine with MAOIs may increase the risk of hypertensive crisis. Al-kalinizing agents can speed absorption (e.g., antacids) or delay urinary excretion (e.g., acetazolamide, thiazide diuretics) of dextroamphetamine, thus potentiating its effects. Gastric or urinary acidifying agents (e.g., ascorbic acid, ammonium chloride) can decrease the effects of dextroamphetamine. Propoxyphene overdose can potentiate amphetamine central nervous system stimulation, potentially resulting in fatal convulsions. 

Previously popular but of unproved value, forced diuresis may cause volume overload and electrolyte abnormalities and is not recommended. Renal elimination of a few toxins can be enhanced by alteration of urinary pH. For example, urinary alkalinization is useful in cases of salicylate overdose. Acidification may increase the urine concentration of drugs such as phencyclidine and amphetamines but is not advised because it may worsen renal complications from rhabdomyolysis, which often accompanies the intoxication. 

The clinical effects of amphetamine and its derivatives are very similar to those of cocaine, although the euphoria they produces may be less intense but last longer than that due to cocaine. Signs of amphetamine intoxication, toxicity, overdose, sensitization by production of an acute paranoid psychosis, and withdrawal syndrome are all similar to those described above for cocaine. 

Amphetamines are often combined with cocaine to extend the high. Cocaine creates a rush but it is short-lived. Adding amphetamines extends the high for up to ten hours. Using these drugs together increases the chances of an overdose and increases toxic effects. 

The report says that the most vulnerable group of users to ketamine overdose are those who take it under the illusion they are taking MDMA or some other stimulant drug. Someone expecting to take MDMA, cocaine, or amphetamine, for instance, may find themselves on a roadway behind the wheel of a car being affected instead by sudden physical incapacity. 

Information on pemoline s tolerance and toxicity is not available. However, as with almost any drag, there is a chance of psychological and/or physical dependence with excessive doses and/or long-term misuse (57). In comparison to methylphenidate and amphetamine, pemoline has the least potential for abuse (39). Benowitz (41) suggests that approximately 3 mg/kg pemoline should be considered life-threatening. Treatment for overdose is similar to what has been recommended for methylphenidate and amphetamine. In cases of overdose, the administration of chlorpromazine has been found useful for decreasing the amount of CNS overstimulation (57). 

Besides the paranoid psychosis associated with chronic use of amphetamines, a specific lesion associated with chronic amphetamine use is necrotizing arteritis, which may involve many small and medium-sized arteries and lead to fatal brain hemorrhage or renal failure. Overdoses of amphetamines are rarely fatal they can usually be managed by sedating the patient with benzodiazepines. 

Cardiovascular toxicity is also frequently encountered in poisoning. Hypotension may be due to depression of cardiac contractility hypovolemia resulting from vomiting, diarrhea, or fluid sequestration peripheral vascular collapse due to blockade of -adrenoceptor-mediated vascular tone or cardiac arrhythmias. Hypothermia or hyperthermia due to exposure as well as the temperature-dysregulating effects of many drugs can also produce hypotension. Lethal arrhythmias such as ventricular tachycardia and fibrillation can occur with overdoses of many cardioactive drugs such as ephedrine, amphetamines, cocaine, tricyclic antidepressants, digitalis, and theophylline. 

---