d-methamphetamine

CAS RN: 537-46-2

Key Info

CLINICAL EFFECTS

0.2.1 SUMMARY OF EXPOSURE

0.2.1.1 ACUTE EXPOSURE
A) USES: Amphetamines and related agents are CNS stimulants. They are sold as commercial pharmaceutical agents to treat medical
conditions (eg, attention deficit disorder, narcolepsy, and obesity). Illicit amphetamines, such as hallucinogenic amphetamines,
methamphetamine, and methylphenidate, are covered in separate managements.
B) PHARMACOLOGY: Amphetamines are sympathomimetic agents structurally related to norepinephrine. They have greater stimulant effects
than other catecholamines. Peripherally, amphetamines promote the release of norepinephrine from stores in adrenergic nerve terminals
and directly stimulate alpha- and beta-adrenergic receptors. They also inhibit catecholamine metabolism by inhibiting monoamine
oxidase enzymes. Centrally, amphetamines stimulate the cerebral cortex, medullary respiratory center, and reticular activating
system.
C) TOXICOLOGY: Overdose or chronic excessive use causes a sympathomimetic toxidrome (eg, tachycardia, hypertension, agitation,
and, in severe cases, psychosis).
D) EPIDEMIOLOGY: Exposures are common. Severe effects are rare but may be seen in large overdoses and chronic exposures. Diversion
and abuse of pharmaceutical amphetamines is common.
E) WITH THERAPEUTIC USE
1) Tachycardia, hypertension, agitation, dyskinesias, psychosis, and seizures. Dose response may be unpredictable. Chronic amphetamine
abuse may result in cardiomyopathy, heart failure, malnutrition, weight loss, cerebral vasculitis, permanent psychiatric illness
including depression and paranoid psychoses, bruxism, and infection. Amphetamine exposure to the fetus may cause neonatal withdrawal
symptoms. An adult withdrawal syndrome has been described in chronic abusers, including severe depression.
F) WITH POISONING/EXPOSURE
1) MILD TO MODERATE POISONING: Hyperactivity, diaphoresis, flushing, mydriasis, nausea, vomiting, abdominal pain, hypertension,
palpitations, tachycardia, chest pain, headache, hyperventilation, and confusion.
2) SEVERE POISONING: Generally only seen after illicit use (usually by injection, insufflations, or smoking) of high doses. May
cause hyperthermia (greater than 40 degrees C can be life-threatening), dehydration, severe hypertension, tachydysrhythmia, myocardial
infarction, vasospasm, aortic dissection, cerebral vascular accidents, sudden cardiac death, pneumothorax, psychosis, seizures,
ischemic colitis, rhabdomyolysis, renal failure, hepatic failure, serotonin syndrome, delirium, paranoia, and coma. Rarely, severe
acidosis, multiorgan failure, and death occur.

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