Methamphetamine Pharmacotherapy
The objectives of pharmacotherapy are to reduce the morbidity and toxic effects of the drug and prevent further complications. Courses of treatment may include gastrointestinal decontamination, sedation, seizure control, and controlling of catecholamine-induced hypertension and tachycardia.
GI decontaminants
Class summary: To minimize the systemic absorption of the toxin.
- Polyethylene glycol (PEG) solution
- A laxative with strong electrolyte and osmotic effects producing cathartic actions in the GI tract. Must administer after activated charcoal.
- This may be also be a course of treatment for people who carry methamphetamine packages in their body
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- Activated charcoal (Liqui-Char)
- A form of carbon that is processed to have excessive amounts of small, low-volume pores to increase surface area available for adsorption or chemical reactions
- Because of the high degree of microporosity, a single gram of activated charcoal has the equivalent surface area of 500 square meters
- Further chemical treatment can enhance adsorption properties
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Sedatives
Class summary: CNS dopamine antagonists, namely neuroleptic agents, are useful for agitated patients. For instance, haloperidol is a D2 receptor antagonist that interferes with dopaminergic neurotransmission in both the cerebral cortex and in the limbic system. Furthermore, benzodiazepines, by increasing the inhibitory neurotransmitter GABA in the brain, depress all levels of CNS, including limbic and reticular function.
- Haloperidol (Haldol)
- CNS dopamine D2 receptor antagonist
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- Lorazepam (Ativan)
- Benzodiazepine. GABA receptor agonist
- Diazepam (Valium)
- Benzodiazepine. GABA receptor agonist
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- Midazolam (Versed)
- Benzodiazepine. GABA receptor agonist
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- Ziprasidone (Geodon)
- Dopamine and serotonin receptor antagonist. It also inhibits the re-uptake of serotonin and norepinephrine in the CNS.
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Cardiovascular Agents
Class summary: Used to control catecholamine-induced hypertension and tachycardia.
- Labetalol (Normodyne, Trandate)
- Blocks alpha-, beta1-, and beta2-adrenergic receptor sites, which decreases blood pressure. Acts primarily as a beta-receptor antagonist when intravenously administered.
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- Metoprolol (Lopressor, Toprol)
- Blocks beta1-adrenergic receptor sites, which decreases heart rate.
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