The problems of drug abuse are of epidemic proportions An increasing number of neurological syndromes are recognised

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Cocaine

Metamphetamine and Ecstasy

Heroin

Phencyclidine

Origin

Alkaloid from leaves of ervthroxylon coca plant

Synthetic amphetamines

Alkaloid from poppy -papaver somiferin

Synthetic anaesthetic agent

Clinical use

Narcolepsy

Depression

Pain relief

Anaesthetic agent

Popular name(s)

'Coke', 'Snow', 'Crack' (potent pica base form)

'Speed' 'Uppers'

'Angel dust'

Intranasal Intravenous

Oral

Smoked

Smoked

Intranasal

Mode of action

Blocks reuptake of dopamine and noradrenaline and augments neurotransmission (sympathomimetic)

Increases release of dopamine and adrenaline and augments neurotransmission (sympathomimetic)

Acts as opiate receptors located on the surface of neurons

Interference with multiple neurotransmitter function

Moderate dosage

Alertness | Euphoria Blood pressure f

Alertness f Euphoria Blood pressure f

Pupillary constriction Pleasurable abdominal sensation Facial flushing

Alertness f Sweating Blood pressure t Heart ratet

Excessive dosage

Blood pressure 1 | Temperature f Respiration j Cardiac dysrhythmia and sudden death

Blood pressure f T Temperature } Respiration j. Cardiac dysrhythmia and sudden death

Pin-point pupils Respiration J. Coma

Dysarthria Psychosis Nystagmus Cardiac Ataxia dysrhythmia Vigilant but and sudden unresponsive death

Treatment

Haloperidol (blocks dopamine reuptake) Hypotensive agents Dysrhythmic agents

Anticonvulsants

As for cocaine

Naloxone (opiate antagonist) Clonidine or Methadone (for withdrawal symptoms)

Haloperidol (for psychosis)

Neurological complications

Headache Tremor Myoclonus Seizures

Chorea

Intracranial haemorrhage

(drug-induced vasculitis)

Myelitis

Neuropathies and Plexopathies (immune mediated)

Dystonia Athetosis Seizures Rhabdomyalisis

All recreational drugs are associated with increased risk of cerebral or spinal infarction or intracerebral haemorrhage. (Mechanisms are varied - drug-induced hypertension, coagulopathies, foreign body (talc) embolisation and septic emboli from infective endocarditis.)

All intravenous drug abusers are at risk of HIV infection and its complications (page 495)

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