Amphetamines

Amphetamine

MDMA

Mescaline

Background

• Class of xenobiotics (Substituted amphetamines) based on a common central structure (ethylamine group attached to a phenol ring)
  • All have mixed serotonergic and dopaminergic activity
• Unlike cocaine, duration of action may be 12hr or longer
  • Time- oral- 30min, inhaled instant
  • hepatic and renal excretion- lasts 6- 24 hrs
  • if tolerance developes- physical exam may yield normal findings
  • desipramine and amantadine can give false positive for urine amphet test
  • hallucinogenic amphetamine derivatives may not show up on tox screen AKA Entactogens- enabling user to touch within

Methamphetamine

• More combative
• Delusions of parasites, formication, self-mutilate
• more dysphoric

MDMA Ecstacy

• Increases serotonin, dopamine
• Lasts 3 - 5hrs
• Hyponatremia

Evaluation

Alpha

• pupils dilate
• sweat
• decrease gi peristalsis
• constrict blood vessels

Beta

• increase HR and contractility
• dilate bronchi
• dilate muscle beds

Mixed

• delusions, paranoia, aggression, poor judgement, hallucinate, confusion

Differential Diagnosis

Sympathomimetics

• Cocaine
• Amphetamines
• Ketamine
• Ecstasy (MDMA)
• Synthetic cannabinoids
• Bath salts

Management

• Benzodiazepines

See Also

• Sympathomimetic Toxicity

References

Authors

Ross Donaldson