Consistent with 交大附小

Stimulants

---

Warning

Stimulants can trigger substance-induced psychosis, especially in individuals with high-dose, daily use, and/or other risk factors for psychosis.

Decreased appetite and insomnia are the most common adverse effects of stimulant medications

Caffeine

• Has MAOI effects → ↑ levels of epinephrine, norepinephrine, serotonin, and dopamine

Nicotine

• Effects of caffeine + opioids receptor

Smoking cessation

• Varenicline
  • Nicotine receptor (alpha-4-beta-2 nACHR) partial agonist
  • Reduces positive symptoms, cravings, and withdrawal symptoms
• Bupropion
  • Reduces craving and withdrawal symptoms

Mnemonic

Varenicline helps to quit nicotine.

Amphetamines

• Substances
  • Alpha-methylphenethylamine (“speed”)
  • Methamphetamine (“meth,” “crank”)
  • 3,4-Methylenedioxymethamphetamine (“MDMA,” “ecstasy,” “molly”)
  • Cathinone (“bath salts”)
• Mechanism of action: ↑ release and ↓ reuptake of presynaptic monoamine neurotransmitters (e.g., adrenaline, norepinephrine, serotonin, and dopamine)
  • Central effect: CNS sympathetic stimulation and hallucinogenic effects

Cocaine

• Famously was the “Coca” in Coca-Cola
• Clinical features
  • Clinical features of stimulant intoxication, e.g., sympathomimetic toxidrome, euphoria
  • Chest pain and/or angina due to cocaine-induced coronary vasospasm
• Complications
  • Nasal pathology
    • Nasal inhalation can damage nasal blood vessels and result in epistaxis.
    • Chronic local vasoconstriction may cause ischemic necrosis and perforation of the nasal septum.

Tip

Withdrawal from stimulants will not cause morbidity or morality. However, withdrawal from depressants like benzodiazepines or alcohol will. Common withdrawal symptoms:

• Increased appetite, hypersomnia, fatigue, intense psychomotor retardation, severe depression (“crash”)

Depressants

---

Alcohol

Alcohol use disorder Alcohol withdrawal

Opioids

Opioid withdrawal

Benzodiazepines

• Benzos increase the FREQUENCY of chloride channel opening
• Barbiturates increase the DURATION of chloride channel opening

Mnemonic

Ben wants it to happen more often (frequency) Barbie wants it to last longer (duration)

Inhalants

Hallucinogens

---

Cannabis

Phencyclidine (PCP)

• Street names: angel dust, peace pill, elephant tranquilizer, hog
• Mechanism of action
  • Inhibits dopamine, serotonin, and norepinephrine reuptake
  • Antagonizes NMDA receptors → stimulant or depressive neurological effects (dose dependent)
• Clinical features
  • Violence
    • K 粉 → Kick
  • Rotary nystagmus
  • impulsivity, psychomotor agitation, tachycardia, hypertension, analgesia, psychosis, delirium, seizures.

Mnemonic

Phencyclidine → Rotary nystagmus