Acute reactions to drugs of abuse

Article Abstract:

Acute toxic reactions to drugs of abuse, last reviewed in The Medical Letter in 1987, continue to be important problems. Cocaine is taken orally, nasally, or injected (IV); its crack version can be smoked. It generally has an adrenalin-like effect on the circulatory system, and may cause severe heart arrhythmias, heart inflammation, heart attack, rupture of the aorta, and severe hypertension. Ischemia (poor blood flow) in the extremities, internal organs, and spinal cord may occur, as well as pulmonary edema (fluid in the lungs) and hemorrhage. Central nervous system (CNS) effects range from anxiety and migraine to delirium, stroke, and seizures, which may not respond to treatment. Hyperthermia (elevated body temperature) may also occur. Maternal cocaine use is associated with placental detachment, stroke and heart arrhythmias in the newborn. As cocaine is excreted rapidly, only the symptoms can usually be addressed. Cocaine-related CNS effects are treated with benzodiazepines, hyperthermia is treated with rapid cooling plus benzodiazepines, hypertension can be treated with vasodilators, and arrhythmias with beta-blockers (which may increase blood vessel constriction). Lidocaine is contraindicated for cocaine-related arrhythmias. Amphetamines are usually swallowed or injected, but a new smokeable form, ''ice'' or ''crystal'' (analogous to crack) is being used. Amphetamine toxicity resembles that of cocaine, but lasts longer. Systemic and brain blood vessel inflammation, and kidney failure may occur. Treatment may include benzodiazepines or haloperidol for agitated behavior. Heroin and other opioids lead to respiratory depression, coma, low blood pressure and slowed heart rate. Naloxone may reverse these problems, but may precipitate narcotic withdrawal symptoms. Withdrawal can be treated with methadone or clonidine. Sedative-hypnotics, including benzodiazepines, have effects similar to opioids. Treatment of alcohol overdoses should include IV glucose. The various volatile inhalants can lead to liver toxicity, coma, or sudden death; patients should be given supportive treatment. Symptoms and treatment of toxicity due to phencyclidine (PCP), hallucinogens (including ecstasy), marijuana, anabolic steroids, and drug contaminants are discussed briefly. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Opioids, Drug abuse treatment, Drug abuse, Cocaine, Amphetamines

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Drugs for acute spinal cord injury

Article Abstract:

Methylprednisolone and GM-1 ganglioside are two drugs used to treat patients with spinal cord injuries. Methylprednisolone is an anti-inflammatory drug often used to treat transplant rejection and different types of autoimmune diseases. It may increase blood flow and decrease breakdown of lipids in injured spinal cord tissue. Patients with spinal cord injuries may have a better outcome if they are treated with high dosages of methylprednisolone starting within eight hours of the injury. Treatment should be continued for 24 hours. GM-1 ganglioside is not commercially available in the US, but it is available in Italy. Gangliosides occur naturally in the body in the membranes of different types of nerve cells. They have been shown to stimulate growth and regeneration of injured nerve cells in the laboratory. Treatment with GM-1 ganglioside may not improve the outcome of patients with spinal cord injuries significantly.

Drug therapy, Methylprednisolone, Spinal cord injuries, Gangliosides

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