CNS STIMULANTS

1. AMPHETAMINES
2. ANTIDEPRESSANTS
3. COCAINE
4. METHYLPHENIDATE
5. CAFFEINE
Amphetamine (speed, uppers, dexies, bennies and
whizz)

 a psychostimulant that is
known to produce
increased wakefulness and
focus in association with
decreased fatigue and
appetite.
 Uses of Amphetamine:
 Initially, amphetamine was more popularly used to i.
Diminish the appetite
ii.control weight.

 commonly used to treat

i..Attention-Deficit Hyperactivity Disorder (ADHD) in
children,
ii. Daytime drowsiness symptoms of narcolepsy.
iii.Chronic fatigue syndrome.

 The drug is also used illegally as a

i. Recreational drug
ii. Performance enhancer.
Mechanism of action of amphetamine: dopamine plays
an important role in the regulation of pleasure. Amphetamine
intensifies the pleasure by stimulating the release of excess
dopamine from the nerve cell.
Physical effects:
 reduced appetite, insomnia,
 hyperactivity, restlessness,
 dilated pupils, blurred vision,
 dry mouth, impaired speech,
 erectile dysfunction,
 headache,
 fever, sweating,
 diarrhoea/ constipation,
 increased BP, HR, RR,
 palpitations,
 arrhythmia.
 Psychological effects:
 anxiety and/or general nervousness
 euphoria,
 feeling of power or superiority,
 creative or philosophical thinking,
 increased confidence,
 increased sense of well being,
 talkativeness
 increased goal-orientated thoughts/ organized
behaviour,
 increased concentration/mental sharpness, alertness,
 Increased aggression,
 emotional liability, excitability,
Withdrawal effects:(Withdrawal from chronic
recreational use of amphetamines can include )

 anxiety,
 depression,
 agitation,
 fatigue,
 excessive sleeping,
 increased appetite,
 short temper,
 Psychosis,
 suicidal thoughts.
 FATAL DOSE: 120-250mg

 FATAL PERIOD: Death has followed 5 days

after ingestion of 140mg.
 Treatment:
1) Chlorpromazine – for sedation & amphetamine
psychosis.

2) B-adrenergic blockers – antagonizes peripheral

sympathomimetic action.

3) Acidification of urine – increases renal excretion

of methamphetamine.

4) Supportive measures as per circumstances

PM appearance:
 Particles of unabsorbed drugs may be found in
the stomach.

 Generalised oedema of lungs.

 Pulmonary petechial haemorrhages.

 Adrenals may show haemorrhagic reaction.

 MLA:
1. Synthetic amphetamines (Designer drugs) are abused by
youngsters:
i. Love drug–methylenedeoxyamphetamine (MDA)
ii. Ecstasy– methylenedeoxymethamphetamine (MDMA)
iii. Eve-- methylenedeoxyethamphetamine (MDEA)

2. Suicide / Homicide – uncommon.

3. Intermittent abuse – characteristically seen in athletes who

wish to enhance their performance & endurance.

4. Common cause of poisoning is overdose.

Tricyclic & related antidepressants

 Used as antidepressant for

treatment of clinical
depression.

 acts primarily as serotonin-

norepinephrine reuptake
inhibitor.
 Signs & symptoms of antidepressant poisoning:
 Features of poisoning starts within an hour after
ingestion.

 MILD POISONING:
i. drowsiness
ii. Tachycardia
iii. Dry-mouth
iv. Dilated pupils / blurred vision
v. urinary retention
vi. Extensor-planter response

 SEVERE INTOXICATION: Arrhythmia, Convulsions,

Respiratory depression & Coma.
FATAL DOSE: 2-5gm

Treatment of Antidepressant poisoning:

1. Gastric lavage.

2. Oral administration of Activated charcoal.

3. Sodium Bicarbonate i.v – to correct Acidosis.

4. Sedation with oral / i.v Diazepam – controls

convulsions & delirium.

5. Supportive treatment.
Caffeine
 found naturally in coffee, tea and to
a lesser degree in chocolate.

 is included in many soft drinks,

particularly energy drinks.

 world's most widely used psychoactive drug and by far the

most common stimulant.

 also included in some medications,

i. usually for the purpose of enhancing the effect of the
primary ingredient, or
ii. reducing one of its side effects (especially drowsiness).
 Caffeine is a physically addictive drug.

 Low Doses: 50-250mg (Oral Doses) Increase mental

alertness, decrease drowsiness, Lessen fatigue

 Larger Doses: 250-600mg – Irritability, restlessness,

tremor, insomnia, headache, palpitations, hyperesthesia,
GIT upset.

 Large Doses: 1000 mg – Overt excitement, delirium and

clonic seizures.

 FATAL DOSE: 8-10gm (cardiorespiratory arrest)

 Treatment of Caffeine poisoning:
 gastric decontamination by lavage or induced
vomiting if the caffeine overdose was recent.

 Activated charcoal.

 Maintain the airway and provide ventilation.

 Treat any seizures and hypotension that occurs,

and monitor the vital signs.
MLA:
 Death from caffeine is extremely difficult
as the fatal dosage is equivalent to 40
cups consumed in a short period of time.
THANK YOU