ࡱ> wyv% 9Abjbj 7~EdEd7tPP8etD>(   D!D!D!D!D!D!D$GJTED- ED  rD&&&   D& D&&6<$@ N $=? DD0DY?K%K8@@BKC & EDED& D K P [: STIMULANTS General Comments Amphetamines Cocaine Caffeine Khat Bath Salts CAT General Comments All major stimulants cause increased alertness, excitation, & euphoria; thus these drugs are referred to as uppers. Frequently given to children for the treatment of ADD/ADHD. Can cause dependence due to their euphoric, ergogenic, & nootropic properties. Can be legally prescribed by physicians. Abuse occurs in people who acquire their drugs by both legitimate & illicit ways (often at the same time). Amphetamines History Methamphetamine Approved Uses Effects on Neurotransmission Summary of the Effects Amphetamine-like Drugs in Use Nasal Decongestants Appetite Suppressants History 1887: Synthesized by L. Edeleano. 1927: G. Alles gave a firsthand account of effects: reduced fatigue, increased alertness, & a sense of confident euphoria. 1932: Marketed as Benzedrine in an OTC inhaler for nasal congestion. Was abused. 1937: Available by prescription as a pill. Bradley found that amphetamines improved functioning in hyperactive kids (called MBD at the time). Also used to treat narcolepsy. 1940s: Was widely used to reduce fatigue in soldiers (still is & note: Provigil). Both dextroamphetamine (Dexedrine) & methamphetamine (Methedrine) became readily available 1971: All potent amphetamine-like compounds in nasal inhalers were withdrawn from the market. Methamphetamine An especially strong amphetamine with a high abuse potential. Meth Mouth - believed to be caused by a combination of drug-induced psychological & physiological changes resulting in dry mouth, extended periods of poor oral hygiene, increased consumption of sugary drinks, & teeth clenching/grinding. Aging of the face Known as speed or crystal when swallowed or sniffed, crank when injected, & as ice when smoked. Currently, 3-6% of U.S. adolescents use it annually. Due to ease of production, it is often clandestinely manufactured. Toxic chemicals in these labs pose a threat to residents, neighbors, & the environment. Approved Uses Narcolepsy Short term weight reduction Hyperkinetic Behavior (ADD/ADHD) Facts Types Used Side Effects ADHD Facts 11% of children 4-17 years of age have been diagnosed with ADHD (2011). Rates have been increasing by about 3-5%/year since 1997. Is 2-3x more common in boys. About 30-50% of people diagnosed in childhood continue to have symptoms into adulthood & between 2-5% of adults have it. ADHD rates by state. In the US, most folks with this diagnosis receive stimulant medication to treat it. Stimulant medication is relatively safe in this population when used in therapeutic doses (with <50 reported deaths in last decade). ADHD Medications Trade Generic Amphetamines Adderall amphetamine (& XR - eXended Release) Dexedrine dextroamphetamine Dextrostat dextroamphetamine Vyvanse lisdexamfetamine (orL-lysine-D-amphetamine) Ritalin Concerta methylphenidate (long acting) Ritalin methylphenidate (& LA=Long Acting) Metadate methylphenidate (& ER=Extended Release) Daytrana methylphenidate (a patch) Focalin dexmethylphenidate Others Cylert pemoline (not 1st line cause liver probs) Strattera atomextine (an SNRI) ADHD - Side Effects Irritability, anorexia, insomnia, tics, psychotic symptoms, & hypertension. Most common side effect of long term concern is growth suppression. Recommend weekend & summer holidays if possible. Effects on Neurotransmission Are NE agonists Stimulates release of monoamines Inhibit MAO Block catecholamine reuptake Nasal Decongestants Generic name Brand name ephedrine Primatene metaraminol Aramine naphazoline Privine oxymetazoline Afrin, Dristan phenylephrine Neo-Synephrine phenylpropanolamine Contac, Dimetapp, etc. pseudoephedrine Sudafed, Comtrex, etc. tetrahydozoline Visine, Tyzine, etc. Several states have banned ephedrine (i.e. IL, CA, NY). Reported adverse effects associated with ephedrine ranged from episodes of high BP, irregularities in heart rate, insomnia, nervousness, tremors & headaches, to seizures, heart attacks, strokes & death. Appetite Suppressants Generic name Brand name diethylpropion Tenuate fenfluramine Pondimin mazindol Sanorex phendimetrazine Bondril, Plegine, Preludin Phentermine Adipex, Suprenza Cocaine Demographics History Pharmacology Cocaine - Demographics UHS Senior use in past year (1975-2015) City house raided, crack cocaine seized (SPJ 7/1/97) - the SP Police Dept. executed a search at a residence in the 2100 block of Strongs Ave. Officers took 2 suspects, both who are currently on probation, into custody & seized a oz. of cocaine & crack cocaine, authorities said. Cocaine History 1 2500 B.C. Coca chewing is practiced throughout South America. Coca is believed to be a gift from God. 1855 Cocaine first extracted from coca leaves. 1870 Vin Mariani is for sale throughout France, containing 6 mg/oz of wine. Exported Vin Mariani contained 7.2 mg/oz to compete with higher content of American competitors. 1884 Cocaine's use as a local anesthetic in eye surgery is popularized. Freud publishes On Coca, which recommends use of cocaine to treat a variety of conditions (e.g., morphine addiction). Also came to be used for toothache & in cigarettes. 1886 Coca-Cola is first introduced by John Pemberton, containing cocaine laced syrup & caffeine. 1901 Coca-Cola removed coca from their formula. 1905 Snorting cocaine becomes popular. 1910 First cases of nasal damage from cocaine snorting are seen in hospitals. 1912 U.S. government reports 5,000 cocaine related fatalities in one year. 1914 Cocaine banned in the U.S. 1976 Freebase cocaine first developed. 1980's Cocaine's popularity rose. While it is an expensive drug, its cost decreased during this decade. Coca-Cola Tired, then drink Coca-Cola. It relieves exhaustion. When the brain is running under full pressure, send down to the fountain for a glass of Coca-Cola. You will be surprised how quickly it will ease the tired brain, soothe the rattled nerves and restore wasted energy to both mind and body. It enables the entire system to cope with the strain of any excessive demands made upon it. Cocaine Pharmacology Forms & Routes Abstinence Phases Forms & Routes Name Form Route Coca leaf (flower, leaves, bushel) chewed Cocaine HCL powder (typically adulterated) orally, snorted, or injected Freebase alkaloid smoked Crack pure rocks smoked Unlike freebase, converting powder cocaine into crack does not involve flammable solvents. The cocaine is dissolved in a solution of baking soda & water & boiled. A solid substance (crack) separates from the boiling mixture. It is removed & allowed to dry, then cut into "rocks," each typically weighing .1-.5 grams. Coca Chewing Coca is chewed by the Aymaras & Quechuas of Bolivia, Peru & other Andean countries. The technique developed over centuries & consists in taking a mouthful of coca leaves (previously stripped of veins) without swallowing them. Chewing is done softly to break the cell membranes. The bolus formed is kept in the mouth lining. When it is sufficiently damp the llijta or other alkaline agent (e.g., sodium bicarbonate) is added. Lllijta is made of several types of vegetal ashes, such as quinoa & plantain & stimulates the action of the alkaloids in the leaf. There is an anesthetic effect on the mucosa next to the bolus, & the mouth/throat. This helps explain the Andean custom of chewing or taking coca infusion to alleviate a number of types of pain. Increased alertness, increased psychomotor action, & mild euphoria appear within 15-20 mins. Sensorial functions become more intense. There is a slight feeling of consciousness expansion (helps explain its use during religious rituals). Effect decreases over time. Carter & Mamani report miners & farmers may chew 2-4 times/day when work is hard. Smoking Description Coca paste, freebase cocaine, & crack are typically smoked in glass pipes. The user heats the side of the bowl which causes the drug to vaporize & inhales the fumes. Cocaine smokers achieve maximum effects (1-2 min after inhalation. Similar to iv administration, the effects of inhaled cocaine last (30 min. Caffeine Demographics Coffee Stats Coffee Drinking & Age U.S. Beverage Consumption Pharmacology Xanthines (or Methylxanthines) Behavioral Effects Physiological Effects Coffee Drinking & Age % of Americans who drink Age 1962 1987 10-19 25.1 5.3 20-29 81.0 33.1 30-59 90.8 67.2 60+ 88.4 77.8 All ages 74.7 52.0 U.S. Beverage Consumption % Drinking Various Beverages Beverage 1962 1987 Coffee 74.7 52.0 Tea 24.7 29.3 Milk 53.6 47.3 Soda pop 32.6 58.1 Juices 41.4 42.8 Xanthines (or methylxanthines) Xanthine Family Content in Various Herbs Content in Various Substances Caffeine & Soft Drinks Content in Common OTC Drugs Xanthine Family Including (in order of stimulant potency): Caffeine or trimethylxanthine. Theophyline - found in tea. Theobromine - found in chocolate. Chocolate Facts Contains phenylethylamine (as do red wines & certain cheeses) which in recent years has been found to be closely linked with amorous activity. Furthermore, biochemists have isolated anandamide from chocolate. This compound is thought to be an endogenous THC-like compound. Content in Various Herbs Herb Form Content Coffee Beans 0.8-2.4% Tea Leaves 3.0-4.0% Cocoa Beans ? Kola Seeds pods or Nuts 1.5-3.5% Gauaran Beans 2.0-6.0% Mat Leaves 1.1-1.9% Ibex Holly 1.0-2.0% Cassina Holly ? Caffeine & Soft Drinks % of market Caffeine Brand name (1992) (mg/12 oz.) Coca-Cola Classic 20.0 45.6 Pepsi-Cola 18.0 38.4 Diet Coke 9.1 45.6 Diet Pepsi 6.1 38.4 Dr. Pepper 5 9 40 0 Mountain Dew 4.1 54.0 Sprite 4.0 none 7UP 2.8 none Others (orange) 26.1 depends Note: Jolt Cola contains 72 mg caffeine/12 oz. (highest amount allowed by FDA). Content in OTC Drugs mg/tablet recod Substance Name or capsule dosage Stimulants NoDoz 100 200 Vivarin 200 200 Pain relievers Anacin 32 64 Excedrin 65 130 Midol 32 64 Cold remedies Coryban-D 30 30 Dristan 16 32 Triaminicin 30 30 Diuretics Aqua-Ban 100 200 Note: Caffeine is also in prescriptions for migraines (Cafergot & Migral) & in pain relievers (Darvon Compound & Fiorinol). Behavioral Effects Low doses enhance mental alertness & reduce fatigue. High doses impair performance because of side effects (restlessness, nervousness, irritability, insomnia, diuresis, muscle twitching, tremors, rambling thoughts/speech, & stomach complaints & headaches). May effect introverts/extroverts differently. Reduces boredom. Stimulant effects are most pronounced in unstimulated drowsy subjects. Effects are more pronounced in children. Acute Effects on Human Performance Caffeine Withdrawal Effects on Human Performance Variable Measure Effect Physical Bicycle ergometer Endurance -Fixed load inc -Progressive load no effect Motor Skills Rapidity & accuracy dec-higher doses inc-lower doses Eye-hand coord. dec Vigilance Visual -Night driving sim. Inc -Target scanning light user-dec hvy user-no effect Reaction Simple dec (speeds up) Time Choice-Decision time inc (slows down) Choice-Motor time dec Verbal GRE Practice Test Tests -Speed/accuracy Extroverts-inc w/ dose Introverts-dec w/ dose Time Stress Accuracy -Extroverts increases -Introverts decreases Accuracy -Low impulsives inc (in a.m.) dec (in p.m.) -High impulsives dec (in a.m.) inc (in p.m.) Caffeine Withdrawal Problem is going cold turkey. Easing back over a few days minimizes the problem. The symptoms reach a peak after a day or two & taper off within a week. A 1992 study, gave 44 women & 18 men (ages 18-50) capsules containing either sugar or the amount of caffeine in 2 cups of coffee. All were average caffeine users. They were asked to avoid consuming anything with caffeine and a variety of other substances. On their caffeine-free days, half the participants suffered moderate to severe headaches. About 10% complained of fatigue, depression, anxiety and moodiness. These symptoms were rare on days when they were getting caffeine. Physiological Effects Diuretic (increases urine output). Increases basal metabolic rate. Alleviates some types of headache pain. Stimulates gastric acid & pepsin secretion. Dilates bronchi of the lungs (especially theophyline) thus causing air passages to open which facilitates breathing. At high doses, it may increase heart rate & BP. LD in humans is believed to be 30-80 cups >500 mg - panic, chills, nausea, clumsiness 5 to 10 gms - seizures, respiratory failure, & death Six overdose deaths have been reported (1976). More recently, Caffeine overdose kills student (1999). Khat Pronounced COT, scientifically known as Catha Edulis. It is a shrub native to E. Africa & Southern Arabia that is chewed, smoked, brewed as a tea, or mixed with soft drinks or alcohol. It's use in this area predates that of coffee. Effects are similar to amphetamines but less potent. Tolerance does not develop & there is no physical dependence. Contains a number of chemicals including the controlled substances: cathinone & cathine. Cathinone is (10x more potent than cathine & is only present in fresh leaves. While leaves <48 hrs old are preferred, it can be preserved by freezing. Bath Salts They have nothing to do with taking a bath. They are stimulant drugs taken orally, snorted, or injected. Is a street name for a family ofdesigner drugs often containingsubstituted cathinones (and are therefore related to Khat). Most varieties contain methylenedioxypyrovalerone (MPDV), mephedrone & pyrovalerone. Since made on the streets, however, exact composition is typically unknown. Side effects are like those experienced by methamphetamine users intense paranoia, hyperthermia & hallucinations. Over 6,100 emergencies involving bath salts were reported by poison-control centers in 2011, up from 303 cases in 2010 (Daily Beast). CAT Or methcathinone is a structural analogue of methamphetamine & cathinone and was made illegal in 1993. It is clandestinely manufactured. It is most commonly snorted, but can be taken orally (by mixing it with a beverage) or diluted in water & injected iv. Has abuse potential equivalent to methamphetamine & produces amphetamine-like effects.     M. 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