Topics Index

TOPIC : Amphetamines
DISCUSSION :

Amphetamines are sympathomimetic agents that stimulate the central nervous system (CNS) causing a release of norepinephrine from the nerve endings. Originally, amphetamines were used for the treatment of depression and fatigue, to increase alertness, and to suppress the appetite. It was found that the medical uses for amphetamines did not outweigh their risk of dependence. Presently, amphetamines are used to treat hyperkinesias (increased muscular movement and physical activity), attention-deficit disorder (ADD), narcolepsy (uncontrolled episodes of daytime sleepiness), and when all else fails - obesity. The use of amphetamines is not recommended to treat depression and can exacerbate a schizophrenic episode.
As drugs of abuse, CNS stimulants produce a sense of exhilaration, improved mental and physical performance, increased confidence, or are used “get high” (Videbeck, 2004). The potential for abuse is high and drug dependence develops after prolonged periods of use. Amphetamines “uppers” produce a heightened sense of alertness and increased energy, feelings of euphoria and decreased fatigue; causing a psychological habituation to the drug. Due to the rapid development of tolerance requiring increases in doses, dependence is common (Herfindal & Gourley, 1996).
Types of amphetamines:
Adderall, Adderall XR used to treat attention-deficit disorder, narcolepsy
Dextroamphetamine (Dexedrine) used for weight management, narcolepsy, and ADHD
Methamphetamine (commonly called ice or crystal meth) is particularly dangerous and highly addictive, causes psychotic behavior and brain damage.
MDMA (3,4-methylenedioxymethamphetamine, XTC, or Ecstasy) a stimulant and hallucinogen
MDA (3,4-methylenedioxymethamphetamine) stimulant and hallucinogen called the love drug
DOM (2,5 dimethoxy-4-methamphetamine) hallucinogen used at rave parties also called STP
Symptoms:
Signs of amphetamine use include increased motor activity, pupil dilation, increased respirations, heart rate, and blood pressure, insomnia, irritability, tremor, dizziness, and palpitations. Gastrointestinal symptoms include anorexia, constipation, cramps, dry mouth, nausea, and vomiting. Amphetamines can cause impotence or increased libido. It can inhibit growth in children. Malnutrition and dehydration can occur from anorexia or nausea and vomiting.
Overdose-toxicity may result if the individual has lost tolerance to amphetamine. Toxicity can develop if administration is too rapid, referred to as “overramping”. Symptoms include high blood pressure, very fast pulse, intense pain, increased temperature, severe agitation, and insomnia. Higher doses of amphetamines can produce cardiac arrhythmias, seizures, hallucinations, or death from cardiovascular collapse (Herfindal & Gourley, 1996; Videbeck, 2004).
Treatment:
Withdrawal from amphetamines is not life threatening and does not require gradual tapering of doses. However, abrupt cessation from chronic or high-doses may produce symptoms of dysphoria that last for one week. These symptoms include mood disorder with restlessness, anxiety, discomfort, fatigue, and unhappiness. Marked withdrawal is referred to as “crashing”. Psychiatric treatment is necessary for the rebound depression and suicidal ideation that can occur after the effects of the medication have worn off (Videbeck, 2004).
Treatment for amphetamine withdrawal is not routinely treated with pharmacology. Treatment for overdose is supportive in nature: benzodiazepines for mild to moderate symptoms and haloperidol if sedation is needed. Strategies should be incorporated to address substance abuse.
Recommendations for management of ADD with Adderall are available at ADD (hyperlink). Care should be exercised with the use of Adderall during adolescence and young adulthood due to the addictive nature and potential for dependence.
Counseling is available to help the individual to counteract addiction’s powerful disruptive effects and regain control. Behavioral therapy approaches are effective to address the abuse pattern and to manage medical, psychiatric, and social problems. The goal is to sustain recovery, prevent relapse, and live without drug use/abuse.
Recognize that relapse does not indicate failure but rather that treatment should be adjusted or an alternate treatment may be necessary to regain control and recover (http://www.nida.nih.gov/Infofacts/understand.html)

Amphetamines are sympathomimetic agents that stimulate the central nervous system (CNS) causing a release of norepinephrine from the nerve endings. Originally, amphetamines were used for the treatment of depression and fatigue, to increase alertness, and to suppress the appetite. It was found that the medical uses for amphetamines did not outweigh their risk of dependence. Presently, amphetamines are used to treat hyperkinesias (increased muscular movement and physical activity), attention-deficit disorder (ADD), narcolepsy (uncontrolled episodes of daytime sleepiness), and when all else fails - obesity. The use of amphetamines is not recommended to treat depression and can exacerbate a schizophrenic episode.

As drugs of abuse, CNS stimulants produce a sense of exhilaration, improved mental and physical performance, increased confidence, or are used “get high” (Videbeck, 2004). The potential for abuse is high and drug dependence develops after prolonged periods of use. Amphetamines “uppers” produce a heightened sense of alertness and increased energy, feelings of euphoria and decreased fatigue; causing a psychological habituation to the drug. Due to the rapid development of tolerance requiring increases in doses, dependence is common (Herfindal & Gourley, 1996). 

Types of amphetamines: 

Adderall, Adderall XR used to treat attention-deficit disorder, narcolepsy Dextroamphetamine (Dexedrine) used for weight management, narcolepsy, and ADHD Methamphetamine (commonly called ice or crystal meth) is particularly dangerous and highly addictive, causes psychotic behavior and brain damage. MDMA (3,4-methylenedioxymethamphetamine, XTC, or Ecstasy) a stimulant and hallucinogen MDA (3,4-methylenedioxymethamphetamine) stimulant and hallucinogen called the love drug DOM (2,5 dimethoxy-4-methamphetamine) hallucinogen used at rave parties also called STP Symptoms:Signs of amphetamine use include increased motor activity, pupil dilation, increased respirations, heart rate, and blood pressure, insomnia, irritability, tremor, dizziness, and palpitations. Gastrointestinal symptoms include anorexia, constipation, cramps, dry mouth, nausea, and vomiting. Amphetamines can cause impotence or increased libido. It can inhibit growth in children. Malnutrition and dehydration can occur from anorexia or nausea and vomiting. 

Overdose-toxicity may result if the individual has lost tolerance to amphetamine. Toxicity can develop if administration is too rapid, referred to as “overramping”. Symptoms include high blood pressure, very fast pulse, intense pain, increased temperature, severe agitation, and insomnia. Higher doses of amphetamines can produce cardiac arrhythmias, seizures, hallucinations, or death from cardiovascular collapse (Herfindal & Gourley, 1996; Videbeck, 2004).

Treatment:

 Withdrawal from amphetamines is not life threatening and does not require gradual tapering of doses. However, abrupt cessation from chronic or high-doses may produce symptoms of dysphoria that last for one week. These symptoms include mood disorder with restlessness, anxiety, discomfort, fatigue, and unhappiness. Marked withdrawal is referred to as “crashing”. Psychiatric treatment is necessary for the rebound depression and suicidal ideation that can occur after the effects of the medication have worn off (Videbeck, 2004).
Treatment for amphetamine withdrawal is not routinely treated with pharmacology. Treatment for overdose is supportive in nature: benzodiazepines for mild to moderate symptoms and haloperidol if sedation is needed. Strategies should be incorporated to address substance abuse. 

Recommendations for management of ADD with Adderall are available at ADD (hyperlink). Care should be exercised with the use of Adderall during adolescence and young adulthood due to the addictive nature and potential for dependence. 

Counseling is available to help the individual to counteract addiction’s powerful disruptive effects and regain control. Behavioral therapy approaches are effective to address the abuse pattern and to manage medical, psychiatric, and social problems. The goal is to sustain recovery, prevent relapse, and live without drug use/abuse. 

Recognize that relapse does not indicate failure but rather that treatment should be adjusted or an alternate treatment may be necessary to regain control and recover (http://www.nida.nih.gov/Infofacts/understand.html)
RESOURCES :

Herfindal, E. T. G., D. R., Ed. (1996). Textbook of therapeutics: Drug and disease management. Baltimore, MD: Williams & Wilkerson. National Institute on Drug Abuse. (2009, May 6). Infofacts: Methamphetamine. Retrieved on June 3, 2009 from http://www.nida.nih.gov/Infofacts/methamphetamine.html National Institute of Drug Abuse. (2009, May 6).

"NIDA InfoFacts: Understanding drug abuse and addiction." from http://www.nida.nih.gov/Infofacts/understand.html Videbeck, S. (2004). Psychiatric mental health nursing. Philadelphia, Lippincott Williams and Wilkins.

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