Cocaine, Amphetamines, and Other Behavioral Stimulants

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Cocaine, Amphetamines, and Other Behavioral
Stimulants

• Chapter 7
• Tamyra Frazier Sarah Massamore

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• Comparison Powerful psychostimulants that
  markedly affect ones mental functioning and
  behaviorThey augment the synaptic action of
  several neurotransmitters (dopamine,
  norepinephrine, and serotonin)Widely known as
  drugs of abuse

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What is Crack? What is ICE?

• Crack is a streetname for a smokeable form of
  potent, concentrated cocaine.
• ICE is a streetname for a smokeable, free-base
  form of potent, concentrated methamphetamine.

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The three major actions of cocaine

• It is potent local anesthetic
• It is a vasoconstrictor, strongly constricting
  blood vessels
• It is a powerful psychostimulant with strong
  reinforcing qualities

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The effects of cocaine and a fetus

• Direct organ toxicity can involve the heart, the
  CNS, the urinary system and the GI tract.
• Increase blood pressure in the fetus which leads
  to intracerebral hemorrhage, thickening of the
  heart muscle and various vascular and structural
  abnormalities
• Destructive lesions on the brain which causes
  neonatal neurological problems

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The behavioral states observed in high-dose
amphetamine users

• Stereotypical behaviors include continual,
  purposeless, repetitive acts, sudden outburst of
  aggression and violence, paranoid delusions and
  severe anorexia

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The effects of amphetamines on neurotransmission,
neurotransmitters and the CNS reward system.

• Exert all their CNS effects by causing the
  release of newly synthesized norepinephrine and
  dopamine from presynaptic storage sites in nerve
  terminals.

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Why use amphetamine like drugs in treating
adults, children and adolescents with ADHD?

• It is used to reduce aggressive behavior and
  activities characteristic of ADHD in children and
  in adults behavioral calming can also occur.

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What is meant by the phrase Speed kills?

• It refers not only to a direct fatal effect of
  single doses of amphetamines but also to the
  deteriorating mental and physical condition that
  occurs in the addicted user

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What is Modafinil? How does is differ from
amphetamines and what are its potential uses?

• It is a nonamphetamine psychostimulant whose
  exact mechanism of psychostimulant action remains
  unclear, but is unique. It may potentiate
  excitatory glutamate neurotransmission and
  inhibit the activity of GABA neurons in the
  cerebral cortex and the nucleus accumbens,
  altering the balance between glutamate and GABA
  transmission.

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Potential uses of Modafinil

• Cognitive improvement in patients with
  Alzheimers disease
• Use in treatment of ADHD
• Potentiation of the action of anitdepressant drugs

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Issues and Therapeutic Approaches to Cocaine
Dependency

• Intensity of both the drug effect and the intense
  behavior-reinforcing action of cocaine.
• Pronounced tendency toward relapse, with
  cocaine-related activities as a cue to an
  increased craving for the drug.
• Most cocaine addicts have a coexisting disorder
  involving drug dependencies and/or psychiatric
  disorders (major depression, anxiety disorder,
  bipolar disorder, borderline personality disorder
  and/or antisocial personality disorder.

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Treatment Approaches to Cocaine Dependency

• Antiwithdrawal agents intended to restore or
  enhance the dopaminergic tone of hypoactive
  limbic system regions. Such agents might be
  beneficial to ameliorate withdrawal depression.
• Anticraving agents that block limbic dopaminergic
  receptors may either reduce cue-induced craving
  or blunt the euphoric effect of subsequently
  administered cocaine.
• Treatment of comorbid psychological disorders may
  help reduce the drive that propels a person to
  self-medicate with cocaine to ameliorate
  psychological distress.

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Treatment Approaches to ADHD

• The management of treatment-resistant youths.
• The combination of drugs in ADHD management.
• The management of adults with ADHD and comorbid
  substance abuse.

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Treatment Approaches to ADHD

• Stimulant Drugs are used primarily used and
  include drugs such as methylphenidate,
  amphetamines, and pemoline other drugs such as
  buspirone (BuSpar) and bupropion (Welbutrin) are
  used in refractory cases.
• Methyphenidates have a rapid onset and short
  duration when compared to amphetamines such as
  dextroamphetamine (Dexedrine) and amphetamine
  mixture (Adderall).
• Sometimes there are treatment alternative such as
  antidepressants (Prozac, BuSpar and Welbutrin)
• Carbamazepine (Tegretol), catecholamine agonists
  (Clonidine) and guanfacine (Tenex) also are
  effective.