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AA's Thought's Regarding Ecstasy

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JCole View Drop Down
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Joined: 03 Oct 2007
Location: United States
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    Posted: 19 Sep 2009 at 7:26pm
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Ecstasy?

Category:Recreational drugs

'Desired effects'

Euphoria and energy

Chemical

3,4 methylenedioxymethamphetamine (MDMA)

Presentation

Each tablet contains somewhere between 30-150mg of MDMA. Tablets may be adulterated with other drugs including acetaminophen, amphetamine, caffeine or ketamine.

Mechanism of Action

Serotonin, dopamine and norepinephrine release in the central nervous system. It also inhibits reuptake of serotonin.


Active metabolites ( auto-inhibition of metabolism)


Adverse/Side Effects

Cardiorespiratory

Tachycardia, hypertension, hypotension

Central Nervous System

Mydriasis, acute panic disorder, confusion, ataxia, nystagmus, cerebral edema (secondary to hyponatremia), delayed hangover effect, seizures


Other

Bruxism (teeth grinding), trismis, hyperpyrexia, serotonin syndrome, rhabdomyolysis, multi-organ failure, sudden death, hyponatremia (voluntary water intoxication by patient as believed prophylaxis for hyperpyrexia), dry mouth, sweating


Contraindications

Trigger for malignant hyperpyrexia


Overdose

If within 1 hour of ingestion administer activated charcoa 50g

Monitor with ECG, NIBP, Temperature for at least 4 hours

Investigations should include urea, electrolytes and creatinine, creatinine phosphokinase, liver function tests, 12 lead ECG and urinary drug screen.

Consider also coagulation screen and blood gases.

Treat symptoms appropriately:

    * Anxiety, agitation, seizures- diazepam
    * Hyponatremia- fluid restriction, consider hypertonic saline in severe cases
    * Metabolic acidosis with sodium bicarbonate, particularly if prolongation of QT interval is present
    * Hypertension- labetalol
    * Hypotension- Intravenous fluids. Consider invasive monitoring and cardiac output measurement.
    * Hyperpyrexia- Active cooling measures, if unsuccessful consider dantrolene and intubation/ventilation to reduce metabolic thermal produciton

Associated with prolonged QT interval.

Metabolism

o-demethylation and conjugation or N-dealkylation , deamination, and oxidation followed by conjugation.

Excretion

Plasma half life 7.6 hours

Hall A, Henry J. Review article: Acute toxic effects of 'Ecstasy' (MDMA) and related comounds: overview of pathophysiology and clinical management. Br J Anaesth 2006;96:678-685

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