FRCA Notes

Recreational Drug Toxicity

This stunted page contains some brief notes on the effects and management of recreational drug overdose.

The resources below contain more information for the interested party.

Resources

  • Sympathomimetic causing ↑ myocardial oxygen demand, direct coronary vasoconstriction and increased platelet aggregation [not a good combination]
  • Can lead to cocaine-induced ACS, in a fashion that is independent of dose ingested and frequency of use

Management of cocaine-induced ACS

  • β-blockers are relatively contraindicated as their use may lead to unopposed ɑ-agonism and thus increase coronary vasospasm as well as hypertension
  • Thrombolytic therapy has a higher risk of intracranial haemorrhage

  • Manage with benzodiazepines, oxygen, nitrates and aspirin
  • ɑ2-agonists may also be useful

  • A.k.a. MDMA (3,4-Methylene-dioxy-meth-amphetamine)
  • Features are similar for other amphetamines e.g. crystal meth

  • Toxic effects are not dose-related, and can vary from minor to life-threatening
  • Due to increased monoamine release from nerve terminals and inhibition of serotonin reuptake

Clinical features

  • Hyperkalaemia
  • Hyperpyrexia
  • Hypercalcaemia
  • Rhabdomyolysis

  • Serotonin syndrome
  • Hyponatraemia and cerebral oedema (water toxicity due to extreme thirst from ADH release + loss of salt through sweating)
  • Multi-organ failure
  • Sudden death

Management

  • Aggressive cooling ± dantrolene for hyperthermia
  • Careful management of electrolytes and fluid balance