Stimulants adverse effects

The FDA s cowardly retreat on the issue of stimulant adverse effects took place under fire from the psychiatric establishment. Earlier, in February 2006, the FDA s panel of advisors had shocked the agency and medical authorities by recommending a black-box warning for all stimulant drugs used in the treatment of ADHD concerning cardiovascular risks, including heart attack, stroke, and sudden death. 

The Class I agents have many similar side effects and toxicities. The anticholinergic side effects include dry mouth, constipation, and urinary hesitancy and retention. Common gastrointestinal (GI) side effects include nausea, vomiting, diarrhea, and anorexia. Cardiovascular adverse effects are hypotension, tachycardia, arrhythmias, and myocardial depression, especially in patients with congestive heart failure. Common central nervous system (CNS) side effects are headache, dizziness, mental confusion, hallucinations, CNS stimulation, paraesthesias, and convulsions. 

The interactions may be physicochemical without the participation of biological mechanisms for example, deep lung exposure to highly soluble irritative gases, such as sulfur dioxide, may become enhanced due to adsorption of the gas onto fine particles. Biological interactions may occur at all stages and body sites. For example, toxicity is increased when adverse effects are due to some reactive metabolic intermediate and exposure to another agent stimulates its metabolic activation (enzyme induction). 

True. Caffeine is a mild stimulant that in moderate dosage does little harm and provides a lift . When taken in excess it can have an adverse effect on heart rate. 

Extensive investigations have been performed related to the synthesis of new adamantane derivatives with better therapeutic actions and less adverse effects. For example, it has been proved that adamantylamino-pyrimidines and -pyridines are strong stimulants of mmor necrosis factor-a (TNF-a) [132]. TNF is a substance that can improve the body s namral response to cancer by killing cancer cells. Another example is 1,6-diaminodiamantane [87], which possesses an antitumor and antibacterial activity. Also, many derivatives of aminoadamantanes have antiviral activity like 3-(2-adamantyl) pyrolidines with two pharmacophoric amine groups, which have antiviral activity against influenza-A virus [133]. 

The higher than expected frequencies of alcohol PCP - and heroin PCP-related deaths also would have occurred if the combinations were preferred by the users. The motivation may involve the injection of heroin to moderate the adverse effects of PCP, or the use of PCP to ease the pain of heroin withdrawal. Another explanation assumes a stimulant effect of PCP. The use of stimulants, especially cocaine, with heroin is increasingly popular among heroin users (Kozel et al. 1982). 

P2-Agonists cause airway smooth muscle relaxation by stimulating adenyl cyclase to increase the formation of cyclic adenosine monophosphate (cAMP). Other non-bronchodilator effects have been observed, such as improvement in mucociliary transport, but their significance is uncertain.11 P2-Agonists are available in inhalation, oral, and parenteral dosage forms the inhalation route is preferred because of fewer adverse effects. 

Tegaserod maleate (Zelnorm) stimulates 5-HT4 receptors in the GI tract, thereby increasing intestinal secretion, peristalsis, and small bowel transit. It also reduces sensitivity related to abdominal distention. It has been shown to be more effective than placebo in improving global IBS symptoms and altered bowel habits in constipation-predominant IBS.21 Diarrhea is a possible adverse effect. 

Adverse effects of stimulants can be generalized to the whole class (Table 39-3). Most of these side effects can be... 

Short-term adverse effects from corticosteroids include fluid retention, hyperglycemia, central nervous system stimulation, weight gain, and increased risk of infection. Patients with diabetes should have blood glucose levels monitored carefully during the corticosteroid course. 

Common adverse reactions seen with phentermine use include heart palpitations, tachycardia, elevated blood pressure, stimulation, restlessness, dizziness, insomnia, euphoria, dysphoria, tremor, headache, dry mouth, constipation, and diarrhea. Phentermine should be avoided in patients with unstable cardiac status, hypertension, hyperthyroidism, agitated states, or glaucoma. In combination with fenfluramine or dexfenfluramine, pulmonary hypertension and valvular heart disease have been reported. The risk of developing either serious adverse effect cannot be ruled out with use of phentermine alone. Since phentermine is related to the amphetamines, the... 

Adverse effects of high-dose MDMA intoxication, including cardiovascular stimulation and elevated body temperature, are thought to involve monoamine release from sympathetic nerves in the periphery or nerve terminals in the CNS.48 MDMA increases heart rate and mean arterial... 

Microbial activity can also be stimulated by mineral colloids through their ability to sorb metabolites that would otherwise have an adverse effect on microbial growth (Filip et al. 1972 Filip and Hattori 1984) This may be due to the toxicity of metabolites, and their feed back repression and, encouraging competitors. Predictably, montmorillonite (CEC —100 cmol kg-1 and specific surface of 800 m g 1) is more effective than kaolinite and finely ground quarts. Other substances, such as antibiotics and pesticides that are toxic to some microorganisms, can also be adsorbed by the surfaces of mineral colloids (Theng and Orchard 1995 Dec et al. 2002). 

Phentermine (30 mg in the morning or 8 mg before meals) has less powerful stimulant activity and lower abuse potential than amphetamines and was an effective adjunct in placebo-controlled studies. Adverse effects (e.g., increased blood pressure, palpitations, arrhythmias, mydriasis, altered insulin or oral hypoglycemic requirements) and interactions with monoamine oxidase inhibitors have implications for patient selection. 

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