Stimulants
|
Cocaine (blow, C, coke, snow), Crack - cocaine (rock,
dime), Amphetamines, Ephedrine, Methamphetamine (ice, crystal-meth), MDA- methyldioxyamphetamine,
MDMA- methyenedioxymethamphetamine
(ecstasy), Methylphenidate (Ritalin®), Nicotine, Caffeine |
|
|
Routes |
·
Oral (amphetamines, MDMA,
methylphenidate, caffeine) ·
Intranasal (cocaine, methylphenidate,
amphetamines,) ·
Smoking (crack, nicotine) ·
Intravenous (cocaine/crack, amphetamines,
methylphenidate) |
|
Psychoactive Effects |
·
First few uses: euphoria, sense of sensuality,
power and energy ·
Chronic use: brief sense of euphoria, followed
by anxiety, agitation, paranoid thoughts |
|
Acute Complications |
·
Hallucinations (especially tactile), delirium,
seizures (typically grand-mal), intracerebral and subarachnoid hemorrhages, coma, hyperthermia,
tachycardia, tachyarrhythmias, acute MI |
|
Symptoms and Management of Withdrawal |
·
Primarily psychological ·
Fatigue, nightmares, insomnia, increased
appetite, psychomotor agitation or restriction and dysphoric
mood ·
Safe to stop abruptly, provide supportive care |
|
Complications of Chronic Use |
·
Depression, suicide, violent behaviour ·
Psychosis (paranoid delusions or
hallucinations that may persist for months) ·
Memory impairment, cortical damage ·
Infections (Hepatitis B and C, HIV, cellulitis, endocarditis) ·
Cardiovascular risks (myocardial infarction,
coronary and aortic dissection, myocarditis, pericarditis, endocarditis) ·
Infertility, galactorrhea,
loss of libido ·
Self-neglect, weight loss |
|
Teratogenicity |
·
Possible genitourinary tract abnormalities |
|
Pain Management |
·
Use of stimulants can lower pain threshold -
provide appropriate care |
|
Obstetrical |
·
Spontaneous abortion ·
Abruptio placenta ·
Placenta previa ·
Premature rupture of membranes (PROM) ·
Preterm labour and
delivery |
|
Fetal |
· Fetal distress · Intrauterine growth restriction · Cerebral infarction in utero has been reported ·
Sudden intra-uterine fetal death (cocaine) |
|
Neonatal |
· Increased risk of neonatal mortality · Low birth weight ·
If mother intoxicated at delivery, neonates may
demonstrate changes in neurobehaviour such as
irritability, tremulousness, muscular rigidity and gastrointestinal symptoms
(vomiting, diarrhea) |
|
Management of |
· Comfort measures are generally sufficient ·
Routine newborn care |
|
Breastfeeding |
· Enters breast milk ·
Advise women not to breastfeed within 3 days
of using (pump and discard milk) |
|
Long-term Effects on Child |
· Studies have found conflicting results ·
Language delays (expressive language and
verbal comprehension) and behaviour problems may become
evident at school age |