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REFERAT

INTOXICATION AND WITHDRAWAL ON

AMPHETAMINE

Compiled by:

Deby Ariandiny NIM: 108103000024

Disca Ariella Rucita NIM: 108103000042arida Nur Aini NIM: 1081030000!3

"eliana #ale$ NIM: 108103000008

Mu$ammad I$san #asranin%rat NIM: 10810300001&

CLINICAL WORK ADDICTION

HOSPITAL DRUG DEPENDENCE (RSKO)

MEDICAL EDUCATION STUDY PROGRAM

FACULTY OF MEDICINE AND HEALTH SCIENCES

SYARIF HIDAYATULLAH STATE ISLAMIC

UNIVERSITY

JAKARTA

2014


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PREFACE

' Dru%s (Narcotics) *syc$otropic and Addicti+e ot$er

$a,ardous materials- are materials . substances /$ic$)

/$en inserted in t$e $uman body) eit$er orally . drun)

in$aled) or inected) can c$an%e minds) moods or

eelin%s) and be$a+ior Dru%s can cause dependence(addiction- p$ysical and psyc$olo%ica


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PREFACE

'Accordin% to 56) substance abuse is t$e use o

continuous or inre7uent but ea%%erated to a substance

or dru% 9a% absolutely not$in% to do /it$ medical t$erapy

#ubstance is adalala$ psyc$oacti+e substances t$at

aect t$e central ner+ous system (brain- and can aecta/areness) be$a+ior) t$ou%$ts) and eelin%s $ile dru%

dependence is a state /$ere t$ere $as been a p$ysical

and psyc$olo%ical dependence) so t$at t$e body re7uires

a %ro/in% number o dru% (tolerance-) i use is reduced orstopped t$ere /ill be /it$dra/al symptoms


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PREFACE

' ased on data rom NN) t$e current number o dru%

users in Indonesia reac$ed 4 million people /it$ t$e

$i%$est number o users comin% rom ;aarta In t$e

capital) till No+ember 2013 t$e number o dru% users

reac$ed 4&2 t$ousand people) or < percent o t$e totalpopulation o ;aarta

' Dru% use /ill be ound intoication is a transition state

arisin% rom use o alco$ol or ot$er psyc$oacti+e

substance resultin% in disturbances o consciousness)co%niti+e unctions) perception) aect or be$a+ior) or

response unction and psyc$op$ysiolo%y


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PREFACE

' 6ne eample o *syc$oacti+e #ubstances t$at cause

addiction or eample is amp$etamine or better no/n as

#$abu=#$abu

'Amp$etamines are a type o dru% t$at is made

synt$etically and is no/ /ell no/n in t$e #out$east

Asian re%ion Amp$etamines can be /$ite po/der) yello/)

or bro/n) or /$ite crystalline po/der small


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DRUGS

' Narcotics, Psychotropic and Addictive otherhazardous materials

' materials / substances which inserted in thehuman body, either orally / drunk, inhaled, orinjected, can change minds, moods or feelings,and behavior.

' rugs can cause dependence !addiction" physicaland psychological


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In!n"#$%n Law No. 22 of 1997 onNarcotics' Narcotics are substances or drugs derived from plant or notplant either synthetic or semisintetis which can causedegradation or alteration of consciousness, loss of taste,reduce to eliminate pain, and can lead to dependency

In!n"#$%n L%& N!' ! 1**+ !n

P#,-.!/!$-

' psychotropic substances or drugs are eithernatural or synthetic non Narcotics, are e#caciouspsychoactive through selective e$ect on thecentral nervous system that causes typical

changes in mental activity and behavior


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DRUG DEPENDENCE

' rug dependence is a state where there has beena physical and psychological dependence, so thatthe body re%uires a growing number of drug!tolerance", when use is reduced or stopped there

will be withdrawal symptoms !withdrawalsymptoms".


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DRUG DEPENDENCE

'A maladapti+e pattern o substance use t$at causes

intererence or clinically si%niicant distress as maniested

by t$ree (or more- o t$e ollo/in%) occurrin% at any time in

t$e same 12=mont$ period:> ?olerance

> it$dra/al

> #ubstances are oten used in lar%er 7uantities

> ?$ere is a constant desire or unsuccessul attempts to stop or

control substance

> #pent a lot o time in acti+ities to obtain t$e substance) use t$esubstance) or reco+er rom its eects

> #ocial) occupational) or recreational important terminated or

reduced because o use t$e substance

> Continued use t$e substance despite no/in% $as particularly

p$ysical or psyc$olo%ical problems t$at persist or recurrent


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CLASSIFICATION OF

PSC!OACTI"E' Psychoactive substances are classi&ed accordingto how the drug a$ects'' (timulant !stimulates activity of the nervous system"

' epressants !reducing the activity of the nervous system"

' )allucinogens !hallucination e$ect"


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CAUSES OF SU#STANCE

DEPENDENCE' (ubstance' *ndividual

+ncouragement or motivation to use drugs

predisposes' +nvironment

Availability of situations permissive !allow" to putdrug in his spare time, in recreational areas such

as diskostik.


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THE DIAGNOSTIC CRITERIA FOR

SUSTANCE INTOXICATION (DSM3IV)'-he development of a reversible substancespeci&c syndrome due to ingestion of !or eposureto" a substance that has recently occurred.

' 0aladaptive behavior or psychological changes

are clinically signi&cant due to the e$ects ofsubstances on the central nervous system !eg,childish, mood lability, cognitive impairment,impaired judgment, impaired social functioning, orwork" and develop during or shortly after use ofthe substance.

'-he symptoms are not caused by a generalmedical condition and are not better eplained byanother mental disorder.


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THE DIAGNOSTIC CRITERIA FOR

WITHDRAWAL (DSM3IV)

' ?$e de+elopment o a substance=speciic syndrome due

to t$e cessation o (or reduction in- substance use t$at

$as been used lon% and $ea+y

' #ubstance=speciic syndrome causes clinically si%niicant

distress or disturbance in t$e unctionin% o social)

occupational) or ot$er important unctions

' ?$e symptoms are not caused by a %eneral medical

condition and are not better eplained by anot$er mental

disorder


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T!E DIAGNOSTIC CRITERIA FORSU#STANCE INTO$ICATION %PPDG&' III('-ransition state arising from the use of alcohol orother psychoactive substance resulting indisturbances of consciousness, cognitiveperception, a$ect or behavior, or other

psychophysiological functions and responses.'-he intensity of intoication decreases with timeand eventually disappeared when the e$ect ofsubstance use did not occur again.


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T!E DIAGNOSTIC CRITERIA FOR)IT!DRA)AL %PPDG& ' III(

' Physical (ymptoms vary according to thesubstance used.

' Psychological disorders are common

circumstances of the withdrawal state.' 1hich is typical of patients will report that thewithdrawal symptoms will subside with thecontinuing use of substances


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DEFINITION OF AMPHETAMINES

'Amp$etamine is a synt$etic compound t$at is classiiedas a substance stimulatin% t$e central ner+ous system)suc$ as ep$edrine) caeine) nicotine and @atin

' ?$ree types o amp$etamines:

= lae+oametamin (ben,edrin-

= destroametamin (desedrin-

= metilametamin (metedrin-


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HISTORY OF AMPHETAMINES

' In 188< Amp$etamine /as irst synt$esi,ed inermany

' In 18&3 po/der met$amp$etamine'In 1&18.1&

crystal met$amp$etamine' In 1&30s ?$e /idespread use o t$e dru% in

Burope' ?$is substance is /idely distributed to t$e troopsdurin% orld ar II

' In t$e 1&40s and 1&!0s countries try to reducet$e a+ailability o amp$etamine by main% t$esesubstances as prescription dru%s


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HOW TO USE AMPHETAMINES

'Amp$etamines can be used by means o oral)inection) in$alation and snortin%

' $en consumed by /ay o oral) amp$etamines

/ill be entirely absorbed into t$e blood I by /ayo inection) amp$etamines /ill be up to t$e brain/it$in seconds Amp$etamines are used by /ayo in$alation) steam /ill settle in t$e lun%s and

t$en rapidly absorbed into t$e blood Mean/$ile)amp$etamines /ere used by /ay o snortin% beabsorbed t$rou%$ t$e mucous membranes$idun%


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MECHANISM OF AMPHETAMINE

'Amp$etamines /ill interact /it$ t$e transporter) causin%release o norepinep$rine) dopamine and serotonin rompresynaptic neurons In addition) amp$etamine alsoin$ibits t$e re = uptae o norepinep$rine and dopamine

and in$ibits MA6 system in t$e presynaptic neuron ?$is/ill lead to an increase in dopaminer%ic neuronspascasinaps

' Researc$ s$o/s MDMA and met$amp$etamine dama%eneuron is serotoner%ic and dopaminer%ic neurons is

irre+ersible'Amp$etamine is metaboli,ed in t$e li+er and ecreted in

idney


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AMPHETAMINE EFFECTS

' ?$e eects o amp$etamine use depends on t$e type)amount used and $o/ to use

'A small dose /ill raise blood pressure) pulse 7uicen)dilate bronc$i) impro+in% alertness) cause eup$oria)

dro/siness eliminate) easily moti+ated) relie+e ati%ue and$un%er) increase motor acti+ity) talati+eness and eelstron%

' Moderate doses /ill stimulate breat$in%) mild tremor)aniety) increase motor acti+ity) insomnia) a%itation)pre+entin% ati%ue) suppress appetite) eliminatesleepiness and reduced sleep

' ?$e use o amp$etamines or prolon%ed periods and $i%$doses /ill induce stereotyped be$a+ior t$at is repeatedact aimlessly) suddenly a%%ressi+e) committin% acts o+iolence) suspicion suspicious and anoreia


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AMPHETAMINE EFFECTS

' Met$amp$etamine $as a ser+ice lie o =8 $ours

?$e eup$oria reac$ed /it$in a e/ minutes to use

by /ay o smoed or inected intra+enously) 3=!

minutes on $o/ to use t$e aspirated t$rou%$ t$enose and 1!=20 minutes on t$e use o oral

manner

' MDMA as muc$ as

s$o/ symptoms /it$in 30 minutes ) peasymptoms o 1=1! $ours and ended ater 3=4

$ours


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EFFECT OF AMPHETAMINE

#$ort term eect

' Increase attention

' Decrease ati%ue

' Increased Acti+ity and/aeulness

' Bup$oria and rus$

' Increase Respiratory

' Ble+ated body temperature' Increase blood *ressure

' Irre%uler $eartbeat

' Rapid 5eart Rate

"on%term eect

' Addiction' *syc$osis (*aranoia)

$allucinations) repetiti+e motoracti+ity-' C$an%e in brain structure and

unction' Deicits in t$inin% and motors

sills

' Increase distractibility' Memory loss' Mood Disturbances' #e+eral dental problems' ei%$t loss


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STI*ULAN

' *ntoication !Acute"

Psylogical and physical signs

+uphoria, enhanced vigor, gregariousness,

hyperactivity, interpersonal sensitivity, aniety,tension, anger, impared judgement, paaranoia

-achycardia, papillary dilation, diaphoresis,chills, weight loss, chest pain, cardiac arrhytmia,confusion, seizure, coma


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STI*ULAN

' 2hronic intoication

A$ective 3lunting, fatigue, sadness, socialwithdrawl, hypotension, bradicardia, muscleweakness

1ithdrawl

not severe but have ehaustion with sleep!crash"


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DIAGNOSTIC CRITERIA FORA*P!ETA*INE INTO$ICATION


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CO*PLICATION

' 0ental disorder !schizophrenia paranoia, tentamensuicidum"

' )epatitis and )*4/A*(

'

0alnutrition


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MANEGEMENT OF AMPHETAMINE

INTOXICATION

1 Bamination o +ital si%ns

2 atc$ or si%ns o intoication

3 #ymptomatic depend on t$e clinical

condition) or oral use) induce +omitin%

activated charcoal or gastric drain is

important

4 Antipsyc$otics: 5aloperidol 2=! m% orC$lorproma,ine 1 m%.%) orally) e+ery

4= $ours

! Anti$ypertensi+e i necessary (blood

pressure abo+e 140.100 mm5%-

$en t$ere are symptoms o aniety%i+en aniolytic) class o

en,odia,epines: Dia,epam 3 ! m%

or C$lordia,eposid 3 2! m%


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MANAGEMENT OF AMPHETAMINE

WITHDRAWAL SYNDROMES

1 6bser+ation (24 $ours-

to assess p$ysical and

psyc$iatric conditions

2 5ospitali,ation isre7uired i

accompanied by se+ere

psyc$otic symptoms)

se+ere depressionsymptoms or suicidal

tendencies) and ot$er

p$ysical complications

5. -herapy'antipsychotics!)aloperidol 5 6,7 to7 mg or 8isperidone 9 6,7 to 5 mg",

antianiety!Alprazolam 9 :,97to :,7 mg oriazepam 5 7 to 6:mg or 2lobazam 9 6: mg" or

abtidepressant !((8*or tricyclic/tertracyclic"appropriate clinicalconditions.


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PROGNOSIS OF AMPHETAMINE INTOXICATION

' ?$e most common complication is r$abdomyolysis /it$

acute renal ailure) t$e ailure o many or%ans causin%

$eatstroe is a maor cause o deat$ amp$etamine

intoication

' Indicators or poor pro%nosis patient o amp$etamine

intoication are coma) s$oc) sei,ures) oli%uria) and

$yperpyreia

'Acidosis) $ypo+olemia) renaldama%e and isc$emia arepotential ris actors or de+elopin% to acute renal ailure


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PROGNOSIS OF AMPHETAMINE WITHDRAWAL

SYNDROMES

' (ome symptoms !dysphoric or fatigue" can beseen in a few days after using a rather large dose.

' uring the break up phase of amphetamine,patients can eperience severe depression.

epression can be cured even without treatmentwhen sleeping is normal.


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CONCLUSION

' Amphetamine is a synthetic compound that is classi&ed ascentral nervous system stimulant.

'-here are 5 types of amphetamines, namely';aevoamfetamin !benzedrin", ekstroamfetamin!deksedrin", and 0etilamfetamin !metedrin".

'0any kinds of amphetamine derivatives createdintentionally by the laboratory with the purpose ofrecreational use, for eample, are widely abused in*ndonesia today is 5,


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CONCLUSION' +$ect of amphetamine to amphetamine users depend on

the type, amount of using, and how to use it.' (mall doses of all types of amphetamines would increase

blood pressure, pulse %uicken, dilate bronchi, improvingalertness, cause euphoria, drowsiness eliminate, easilymotivated, relieve fatigue and hunger, increase motor

activity, talkativeness, and feel strong.' 0oderate doses of amphetamine !9:7: mg" stimulates

respiration, causing mild tremors, restlessness, increasedactivity montorik, insomnia, agitation, preventing fatigue,suppress appetite, eliminate sleepiness, and reduced sleep.

' ;ongterm use of amphetamines by high doses can lead tostereotypical behavior, the act which is repeatedcontinuously without purposes, suddenly aggressive,violent acts, suspicious delusions, and severe anoneia.


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CONCLUSION' Amphetamine intoication is characterized by' !a" -he use

of amphetamines recently occurred. !b" -achycardia orbradiakrdia. !c" 2hanges in maladaptive behaviors areclinically signi&cant. !c" dilatation of the pupil. !e" -heelevation or decrease in blood pressure. !f" (weating orchills. !g" Nausea or vomiting. !h" -he signs of weight loss.

!i" agitation or psychomotor retardation. !j" muscleweakness, respiratory depression, chest pain, or cardiacarrhythmias. !k" convulsions, seizures, dyskinesia, dystonia,or coma.

' Amphetamine withdrawal symptoms characterized by' !a"

-ermination !or decrease" amphetamines have a long timeor heavy. !b" depression. !c" =atigue. !d" -he dream is vividand unpleasant. !e" *nsomnia or hypersomnia. !f" *ncreasedappetite. !g" retardation or psychomotor agitation.


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CONCLUSION

' 0anagement of amphetamine intoication includes eaminingvital signs, see the signs of intoication, symptomatic dependon the clinical condition, induce vomiting with activatedcharcoal for oral use, antipsychotics, antihypertensives, ifnecessary, aniolytic if there are symptoms of aniety, therapyfor seizures !if any", therapy for cardiac arrhythmias !if any",

temperature control, and observation for 6 9< hours, whencalm conditions can be forwarded outpatient.

' 0anagement of amphetamine withdrawal syndromes includesobservation !9< hours" to assess physical conditions andpsychiatric hospitalization !if there is severe psychotic

symptoms, symptoms of severe depression or suicidaltendencies", and medical treatment !antipsychotics,antianiety or antidepressant" according to the clinicalcondition.


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CONCLUSION

'-he most common complication of amphetamineintoication is rhabdomyolysis with acute renal failure,the failure of many organs causing heatstroke is amajor cause of death amphetamine intoication.*ndicators of poor prognosis patient of amphetamine

intoication are coma, shock, seizures, oliguria, andhyperpyreia.

' =or the condition of amphetamin withdrawalsyndromes, some symptoms !dysphoric or fatigue" canbe seen in a few days after using of a rather large dose.

uring the break up phase of amphetamine, patientscan eperience severe depression. epression can becured even without treatment when sleeping is normal.


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REFERENCES' Perhimpunan okter (pesialis >edokteran ?iwa. @angguan 0ental dan

Perilaku Akibat Penggunaan at Psikoaktif. *n' Pedoman NasionalPelayanan >edokteran !PNP>" ?iwa/ Psikiatri. PP P(>?*' ?akarta. 9:69.p95esehatan 8*. irektrat ?enderal Pelayanan medik. Pedoman-erapi Pasien >etergantungan Narkotika dan at Adiktif lainnya. 9:::.?akarta' epartemen >esehatan.


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