STIMULANT USE AND CARDIOVASCULAR CONSEQUENCES Arthur Westover, MD, MSCS UT Southwestern Medical Center © AMSP1.

Slides:



Advertisements
Similar presentations
Stimulants “Chemical Uppers”.
Advertisements

Prescription Drugs. What is prescription drug abuse? Taking a prescription drug that is not prescribed for you, or taking it for reasons or in dosages.
Think you need a pill to study for exams? What is Adderall?? Adderall is used to treat ADHD and narcolepsy. It contains a combination of amphetamine.
Stimulants: Cocaine, Amphetamines, and Caffeine
CNS STIMULANTS SAMUEL AGUAZIM. What is the definition of a CNS stimulant? A CNS stimulant is a drug that increases motor activity, causes excitement and.
Chapter 23 Lesson 4.
Chemically Modifying Behaviors Copyright 2010:PEER.tamu.edu.
Lincoln County School District Nurses Julie Turner RN Betsy Brooks RN Drug and Alcohol Awareness.
Stimulants are drugs that cause alertness. * Caffeine is the mildest stimulant * Other stimulants such as cocaine and amphetamines are stronger and can.
ADHD MEDICATION THE NEXT “PILL TO POP”. ATTENTION DEFICIT HYPER-ACTIVITY DISORDER  Origins  First described in 1798 by Alexander Crichton as a “morbid.
Amphetamines (Please select Slide Show on the PowerPoint toolbar and then select Start Slide Show From the Beginning. The links will not function otherwise.)
Beyond Dieting: New Weight Loss Medications & Treatments on the Horizon Daniel Bessesen, MD.
LEGAL AND ILLEGAL SUBSTANCES. LEGAL DRUGS Legal drugs are considered permissible for use, and are either prescribed by a physician (prescription medications)
Face Stroke, Before it Faces You Welcome. Introduction Do you know a friend or relative who has had a stroke, or have you ever had a stroke yourself?
20 Cardiovascular Disease and Physical Activity chapter.
And Alzheimer’s Disease
20th Century World War 1 (soldier’s relief) 1920’s beginning of heavy marketing World War II Marlboro Man 1964 Smoking linked to cancer 1971 advertisements.
8 th Grade Illegal Drugs Stimulants, Depressants, and Narcotics.
Dan Gormley.  Brand names: Adderall, Adderall XR  Chemical Structures: Amphetamine and Dextroamphetamine mixed salts  Street Name: Beans, Black Beauties,
STIMULANTS. What Are They? Defintion: Stimulants are a class of drugs that elevate mood, increase feelings of well-being, and increase energy and alertness.
Chapter 8: Stimulants Their Effects & Common Types NEONS Names of Team Members April 6, 2005.
Intro to Drugs. What is a drug? Any substance, other than food that when taken into the body alters the structure in some way.
Stimulants By: Ginny Strother. What is a stimulant?  Stimulants are substances that stimulate the activity of the central nervous system. They increase.
Illegal Drugs 12 th Grade Health. Marijuana Dried up leaves of the ____________ plant. Harms the immune system by not letting the body be able to ___________________________________________.
CENTRAL NERVOUS SYSTEM. CENTRAL VS. PERIPHERAL Central Nervous System- Brain and spinal cord only Peripheral Nervous System All of the nerves that branch.
90% of adult smokers start as teens Reason teens have declined smoking is: antismoking campaigns, financial cost, societal pressures, and family influence.
What is Addiction? Addiction is a chronic relapsing condition characterized by compulsive drug seeking and abuse, in spite of negative health, social and.
Opioid Use: What are the technological, clinical, ethical, and regulatory issues? Michael Von Korff Group Health Research Institute.
Legal and Illegal Substances Module A: Lesson 2 Grade 11 Active, Healthy Lifestyles.
BELL WORK Write about 1 of the drugs we talked about yesterday and tell me how that drug would alter your life.
1 DRUGS OF ABUSE Given a drug select from a list the drug classification.
Psychoactive Drugs Chapter 4.
1 Copyright © 2012, 2009, 2006, 2003 by Saunders, an imprint of Elsevier Inc. Chapter 20 CENTRAL NERVOUS SYSTEM STIMULANTS.
Drugs An overview.
Stimulants. Caffeine It is a natural& mild stimulant present in: Coffee; Coffee; Tea; Tea; Chocolate& Chocolate& Cola drinks. Cola drinks.
 Some drugs are more harmful than others  If you use a drug, over time you can develop a tolerance to it.  Tolerance- body’s need for larger and larger.
Chapter 23 Lessons 3 and 4 Warm Up: Make a list of at least 5 illegal drugs that you know of.
Prescription Drugs This Lesson Plan Produced By Your Drug Demand Reduction Program 1.
LEADING RESEARCH… MEASURES THAT COUNT Challenges of Studying Cardiovascular Outcomes in ADHD Elizabeth B. Andrews, MPH, PhD, VP, Pharmacoepidemiology and.
Amphetamine Michelle Lubrano Teaching Concepts of Health Education I Drug Investigation Assignment Spring 2010.
Stimulants Ana Baird CHM
Substance abuse. Substance abuse, dependence, withdrawal, tolerance, and demographics Substance abuse, dependence, withdrawal, tolerance, and demographics.
 Stimulants are drugs that exert their action through excitation of the central nervous system. Psychic stimulants include caffeine, cocaine, and various.
Chapter 14 Drugs Lesson 3 Narcotics, Stimulants, and Depressants Next >> Click for: >> Main Menu >> Chapter 14 Assessment Teacher’s notes are available.
Used for the treatment of ADHD. Ritalin  Generic name: Methylphenidate  Prescribed for the treatment of ADHD and Narcolepsy  Stimulant Ritalin allows.
STRESS AND DEPRESSION.
By Maria Garcia Power point Adderall
Chapter 29 Central Nervous System Stimulants Used to Treat Attention Deficit Hyperactivity Disorder and Agents Used to Treat Alzheimer’s Disease.
Coca is grown most in South America, specifically Colombia.
Stimulants By Samantha M. and Drumil B UCLA 2014.
PRESCRIPTION DRUG ABUSE Part 2. LEARNING GOALS  I will be able to identify the pitfalls of prescription drug use.  I will be able to use the information.
DRUGS: MISUSE & ABUSE Objective: At the end of the unit you should be able to explain the difference between drugs & medicine, list ways people misuse.
OVER THE COUNTER DRUGS Drugs and Alcohol. What is a Drug? Definition: A substance that has a physiological effect when ingested or otherwise introduced.
Illegal Drugs Stimulants, Depressants, Hallucinogens, Narcotics, Marijuana, Inhalants & Club Drugs.
CHEST 2013; 144(3): R3 김유진 / Prof. 장나은. Introduction 2  Cardiovascular diseases  common, serious comorbid conditions in patients with COPD cardiac.
Drugs An overview. Psychoactive Drugs Chemicals that affect our nervous systems; and, as a result, may alter consciousness and awareness, influence how.
Substance related disorders
Chapter 23 Lesson 4 Mr. Martin
Drugs.
Heroin is an illegal, highly addictive opioid drug
Chemicals that affect the CNS and alter activity in the brain
Drug Abuse.
CHEMISTRY MEDICINES AND DRUGS
The Good, the Bad and the Ugly
How Body Systems are Connected
CNS Stimulants Defination
Statement on Concerta and Methylphenidate for the June 30, 2005 Pediatric Advisory Committee The FDA has identified two possible safety concerns with.
Great Times Crystal Meth, Great Times NOT. Crystal meth, Street names :Speed,crank,tweak,Chalk,tina and or gak By,Gael Zavala,Eduardo Garcia.
Presentation transcript:

STIMULANT USE AND CARDIOVASCULAR CONSEQUENCES Arthur Westover, MD, MSCS UT Southwestern Medical Center © AMSP1

Classes of drugs Stimulants Depressants (alcohol, diazepam) Opioids (morphine, heroin) Hallucinogens (LSD) Others (e.g., cannabis, inhalants) © AMSP2

Stimulant misuse carries risks Overdose –Seizures –↑ body temp –CV events –Death © AMSP3

This lecture covers Description of stimulants Patterns of stimulant use Physiological effects of stimulants Cardiovascular (CV) effects at high doses Possible effects of low/moderate doses © AMSP4

This lecture covers Description of stimulants Patterns of stimulant use Physiological effects of stimulants Cardiovascular (CV) effects at high doses Possible effects of low/moderate doses © AMSP5

Types of stimulants Cocaine –Powder –Crystalline (“crack”) Amphetamines –Powder –Crystalline (“crystal meth”) –Tablets/capsules © AMSP 6

Stimulants Characterized by: –Euphoria –↓ Need for sleep –↓ Appetite –↑ Focus/attention © AMSP7

Dangers of stimulant misuse ↑ BP Grand mal seizures ↑ Pulse Arrhythmias ↑ Body temperature © AMSP8

This lecture covers Description of stimulants Patterns of stimulant use Physiological effects of stimulants Cardiovascular (CV) effects w/ high doses Possible effects of low/moderate doses © AMSP9

Rates of illicit use (US) Cocaine (12+yo in 2012) –~40 million lifetime –~5 million past-year Amphetamines –~12 million lifetime –~1 million past-year © AMSP10

Increased Rx use in US 5 million insured users in 2012 Stimulant use ↑’d from 2008 to 2012 –Children: ↑ 19% –Adults: ↑ 53% –Women 26-34yr: ↑ 85% © AMSP11

Prescription (Rx) amphetamines FDA approved indications –Attention Deficit Hyperactivity Disorder –Narcolepsy –Obesity Off-label use © AMSP12

Attention Deficit Hyperactivity Disorder Definition: ↓attention ± hyperactivity→ learning/behavior problems Rates of ADHD –Children (≤18yo) 5% ♂ taking stimulants 1.5% ♀ –Adults (18-44yo) 5% ♂ meet ADHD criteria, 3% ♀ A lower percentage are treated © AMSP13

ADHD Treatment Stimulants first-line: –Methylphenidate (Ritalin) 20mg 3x/day –Amphetamine (Adderall) 15mg 2x/day © AMSP14

Narcolepsy Definition: –Sudden disabling daytime sleepiness –Fast onset dream sleep Rate: 1 in 2000 persons Treatment: daytime naps and medications –Methylphenidate (Ritalin) 20mg 2x/day –Amphetamine (Adderall) 20mg 2x/day © AMSP15

Obesity Definition: Body Mass Index ≥ 30 Rate: > 1/3 rd US adults Treatment with stimulants : –Dextroamphetamine (Dexedrine) –Methamphetamine (Desoxyn) –Benzphetamine (Didrex) Uncommon: –↓ Weight only seen first 3 weeks and returns –Safer options (example: orlistat [Xenical]) © AMSP16

Off-label use Likely frequent; anecdotal evidence Example conditions: –Depressive symptoms –Dementia –Stroke recovery –“Neuroenhancement” (↑ cognition?) Risks present No clear benefit © AMSP17

This lecture covers Description of stimulants Patterns of stimulant use Physiological effects of stimulants Cardiovascular (CV) effects at high doses Possible effects of low/moderate doses © AMSP18

Endogenous vs. Exogenous Endogenous stimulants –Body produces naturally –Example: norepinephrine Exogenous stimulants –Chemicals that are ingested –Examples: cocaine, amphetamine © AMSP19

Endogenous stimulants “Catecholamines” –Nerve tissue –Brain –Adrenal glands Exist as neurotransmitters –Epinephrine (i.e. adrenaline) –Norepinephrine –Dopamine © AMSP20

Physiological effects Endogenous: “Fight or flight” Exogenous: “Hijack” endogenous © AMSP21

Fight or flight Stress response –↑ Heart rate –↑ Release of glucose (energy) –↑ Blood flow to skeletal muscles –↓ Blood flow to other parts of body –↓ Digestion; dilation of the pupil –↓ Salivation → dry mouth © AMSP22

Hijack endogenous Mechanism : –Direct release of catecholamine –↓ Reuptake from space between neurons Neuron stuck in stimulated position © AMSP 23

Stimulant intoxication CNS effects – Euphoria, ↑wakefulness –↑ Sex drive –↓Appetite, ↑ energy Peripheral effects –Hand tremor, restlessness –↑ Muscle tension –↑ body temperature © AMSP 24

This lecture covers Description of stimulants Patterns of stimulant use Physiological effects of stimulants Cardiovascular (CV) effects at high doses Possible effects of low/moderate doses © AMSP25

Cardiovascular dangers High dose stimulants –Illicit use –Non-medical use Low dose stimulants –Medical use –Prescribed doses © AMSP 26

High dose stimulant CV problems Stroke –Ischemic –Hemorrhagic Heart attack Sudden cardiac death Aortic dissection (tearing of the aorta) © AMSP 27

Mechanisms of CV problems Vasospasm arteries in brain/heart ↑ BP → bleeding ↑ Oxygen demand ↓ Perfusion heart muscle ↑ Clots from activation of platelets Arrhythmia Inflammation arteries brain/heart © AMSP 28

Serious CV events Cocaine –25% non-fatal MI in adults (18-45yo) –3% sudden death Amphetamines –2% bleeding-related strokes in adults Cocaine and Amphetamines –3% aortic dissections in adults © AMSP 29

Risk of serious CV events Cocaine: 7x ↑ non-fatal MI Amphet: 3x ↑ hemorrhagic stroke Amphet: 3x ↑ aortic dissection © AMSP 30

Mechanisms of low-dose CV dangers Blood pressure ↑ 2-4 mm Hg Heart rate ↑ 6 beats/min QT Prolongation → arrhythmias → death © AMSP 31

BP and CV events Linear relationship Important on population scale © AMSP 32 Psaty et al., 2001 ≤ 125 mmHg >160 mmHg

CV events & Rx stimulants Efficacy RCT too small Observational studies: –Children –Adults © AMSP 33

Studies in children 20% ↑ risk of CV ER visit + ↑ risk sudden death Best: NO ↑ risk serious CV events –Cooper et al., NEJM 2011 © AMSP 34

Studies in adults 3x ↑ “mini-stroke” (not stroke) ~2x ↑ sudden death/ventricular arrhythmia © AMSP 35

Studies in adults Best: no ↑ serious CV events ? Selection bias: –Users healthier –More educated Median use 4 months © AMSP 36 Habel et al., JAMA 2011

Remaining questions Other variables (e.g. lifestyle factors) High risk populations underrepresented? –Elderly –Adults with multiple CV risk factors © AMSP 37

Public health considerations Baseline rates of serious CV events –Children: 3/100,000 person-years –Adults: 220/100,000 person-years Doubling risk? –Children: 6/100,000 person-years –Adults: 440/100,000 person-years © AMSP 38

Government regs of Rx stimulants 2006 US: avoid use if heart disease American Heart Association: –< age 18 –Careful health history –Physical exam American Academy Pediatrics: –EKG not mandatory © AMSP 39

Conclusions Stimulants commonly misused Rx stimulants: use increasing Dangers associated with misuse CV safety: a concern with Rx use –Children: minimal concern –Adults: no definite risk; safety signal present Caution Rx’ing to high risk CV patients © AMSP 40