Sympathomimetics abuse

Keogh AM, Baron DW. Sympathomimetic abuse and coronary artery spasm. Br Med J 1985 291 940. 

Amphetamine and related compounds are indirect acting sympathomimetic agents that are frequently abused due to their stimulant properties on the central nervous system. Amphetamines act by inducing the... 

B. Indirect sympathomimetics with centrai stimuiant activity and abuse potentiai... 

Advanced arteriosclerosis symptomatic cardiovascular disease moderate to severe hypertension hyperthyroidism hypersensitivity or idiosyncrasy to the sympathomimetic amines glaucoma agitated states history of drug abuse during or within 14 days following administration of monoamine oxidase (MAO) inhibitors (hypertensive crises may result). 

The sympathomimetic drugs are discussed in Chapter 10. In brief, the most commonly abused of these drugs, such as cocaine, work primarily as indirect agonists of the catecholamine neurotransmitter systems via inhibitory actions upon the transmitter reuptake system. Considerable evidence supports a role for dopamine in mediating the rewarding effects of cocaine. There is also evidence that blockade of serotonin uptake may contribute to cocaine s actions. 

I Contraindications Advanced arteriosclerosis, agitated states, glaucoma, history of drug abuse, history of hypersensitivity to sympathomimetic amines, hyperthyroidism, moderate to severe hypertension, symptomatic cardiovascular disease, within 14 days following discontinuation of an MAOI... 

Contraindications Agitated states, use of MAOIs within 14 days, glaucoma, history of drug abuse, hyperthyroidism, advanced arteriosclerosis or severe cardiovascular disease, severe hypertension, and hypersensitivity to sympathomimetic amines... 

As noted above, large doses of amphetamine, cocaine, and other sympathomimetics can cause acute paranoid reactions, either spontaneously in abusers or experimentally in normal volunteers. An injection of a large amphetamine dose, for example, often produces a paranoid psychosis within hours. Frequent smaller doses over several days can also produce a paranoid psychotic reaction. An episode s duration usually parallels the length of time the drug remains in the body. 

D-Methamphetamine, the AZ-methyl derivative of amphetamine, was first synthesized in 1919. Methamphetamine is available in the d- and l-forms. The D-form has reportedly greater central stimulant activity than the L-isomer, which has greater peripheral sympathomimetic activity. The D-form is the commonly abused form while the L-isomer is typically found in nonprescription inhalers as a decongestant. 

Sympathomimetic drug overdose. A person who abuses drugs is at risk of an overdose. Symptoms... 

Sympathomimetics can be physically addictive and should not be prescribed to people with a history of drug abuse. A person may develop a tolerance to the drug and attempt to increase the dosage. The person may develop intoxication symptoms such as insomnia and severe skin diseases. 

B. Indirect sympathomimetics with central stimulant activity-and abuse potential... 

Tachycardia, dysrhythmias, and a rise in blood pressure have been described after the administration of centrally acting sympathomimetic amines. Amfetamine acutely administered to men with a history of amfetamine abuse enhanced the pressor effects of tyramine and noradrenaline, while continuous amfetamine led to tolerance of the pressor response to tyramine. As with intravenous amphetamines, cardiomyopathy, cardiomegaly, and pulmonary edema have been reported with smoking of crystal metamfetamine (15-17). 

The anorectic agents produce adverse effects mainly of the central nervous system sympathomimetic type. Therapy should therefore only be allowed under strict medical supervision, to ensure the earliest possible detection of any signs of drug abuse. Long-term drug treatment of obesity should be avoided altogether. 

O Connor AD, Rusyniak DE, Bruno A (2005). Cerebrovascular and cardiovascular complications of alcohol and sympathomimetic drug abuse. Medical Clinics of North America 89 1343-1358 O Laoire SA, Crockard A, Thomas DGT et al (1982). Brain-stem hematoma. A report of six surgically treated cases. Journal of Neurosurgery 56 222-227 Plant GT, Revesz T, Barnard RO et al (1990). Familial cerebral amyloid angiopathy with... 

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