special subjects
Amphetamines
Treatment ofAmphetamineUse
IV benzodiazepines IM or IVketaminefor acute agitation IV nitrates for hypertension unresponsive to benzodiazepines as needed Cooling for hyperthermia as needed When a significant amount of amphetamines has recently been taken orally (eg,<1 to 2 hours), activatedcharcoalmay be given to limit absorption, although this intervention has not been shown to reduce morbidity or mortality. Urinary acidification hastensamphetamineexcretion, but it does not decrease toxicity and may worsen myoglobin precipitation in the renal tubules and thus is not recommended. , with Overview of Mechanical Ventilation , may be required for severe agitation. Hyperthermia can be life threatening and should be managed aggressively with sedation plus evaporative cooling, ice packs, and maintenance of intravascular volume and urine flow with IV normal saline solution. Phenothiazines lower seizure threshold, and their anticholinergic effects can interfere with cooling; thus, they are not preferred for sedation. No medication is proven to be effective to treatamphetaminewithdrawal. No specific treatment is needed when patients stop taking of amphetamines. Blood pressure and mood should be monitored initially. Patients whose depression persists for more than a brief period after amphetamines are stopped may respond to antidepressants. Cognitive-behavioral therapy (a form of psychotherapy) is effective in some patients. There are no proven pharmacologic treatments for rehabilitation and maintenance after detoxification. 