Stimulants

Highly addictive
Increase cardiac activity
Excite CNS by increasing neurotransmitters
- Norepinephrine
- Serotonin
- Dopamine
Toxicity
- Sympathetic overdrive
  - Can be fatal
  - No antidote
  - Emergency management is based on clinical manifestations
  - Supportive care for agitation and cardiovascular symptoms
Withdrawal
- Not an emergency
- Supportive care
  - Quiet environment
  - Sleeping and eating at will
  - Suicide precautions if indicated

Assessment findings	Interventions
Cardiovascular	Ensure patent airway. Establish IV access and initiate fluid replacement as appropriate. Obtain a 12-lead ECG and initiate ECG monitoring. Treat ventricular dysrhythmias as appropriate with lidocaine, bretylium (Bretylol), or procainamide (Pronestyl). Hypertension and chest pain may require administration of nitroprusside (Nipride) or phentolamine (Regitine). Aspirin may be administered to lower the risk of myocardial infarction. Administer IV diazepam (Valium) or lorazepam (Ativan) for seizures. Administer IV antipsychotic drugs for psychosis and hallucinations. Monitor vital signs and level of consciousness. Initiate cooling measures for hyperthermia.
Palpitations Tachycardia Increased BP Dysrhythmias Myocardial ischemia or infarction
Central Nervous System
Feeling of impending doom Euphoria Agitation Combativeness Seizures Hallucinations Confusion Paranoia Fever

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