PART 3 / CH 25

Amphetamines and Cocaine

Siobhan O’Neill

	Amphetamines	Cocaine
Urine Levels	>1000ng/ml detectable	Cut-off 300 ng/ml
Duration of (+) result	1-3 days after use	Peaks 4h after use, positive up to 48-72 h after use. Chronic, high dose use, positive up to 7-22 days after use
Serum Levels		T1/2= 30-90 minutes.
Duration of (+) result	Active metabolites in serum prolong	Only hours after use
Lab comment	False (+) (urine): buproprion, chlorpromazine, propranolol, pseudoephedrine, selegiline, tranylcypramine
Acute intoxication	Increased SBP and DBP. Agitation, exhaustion. Psychosis, paranoia.	Pupillary dilatation, diaphoresis/chills, nausea/vomiting. Alertness, euphoria, and well-being. Decreased hunger and need for sleep. Paranoia/ suspiciousness, overt psychosis, delirium. Anxiety, anger, tension, impaired cognition.

(cont.’d)	Amphetamines	Cocaine
Complications	Amphetamine psychosis: paranoia, ideas of reference. Hallucinations may develop. Increased startle response. Heightened awareness of environment, social isolation. Hypertensive episodes with cerebral hemorrhage Ventric. arrhythmias	Cardiovascular arrhythmia, chest pain, MI Pulmonary respiratory depression, pulmonary edema, pneumothorax Neuro confusion, seizure, transient focal deficits vasospasm, stroke, hemorrhage dystonias/dyskinesias
Treatment of acute intoxication	Symptomatic. Recognize potential for violence.	Symptomatic. Recognize potential for violence. Consider medical consult.
Withdrawal	“Crash” phase: depression, agitation, anxiety, anergia, craving, insomnia, then hypersomnolence, hyperphagia. Middle phase: fatigue, anhedonia, intense drug craving. Late phase: brief periods of craving	Dysphoria, anhedonia, depression, fatigue. Vivid and unpleasant dreams, insomnia or hypersomnia. Increased appetite, psychomotor retardation/agitation.
Treatment of withdrawal	Symptomatic. Uncomfortable but not life threatening.	No specific treatment. Uncomfortable but not life threatening.