Contributor: Taylor Lynch MD

Educational Pearls:

Overview:
- Sympathomimetic drugs mimic the fight or flight response, affecting monoamines such as dopamine, norepinephrine, and epinephrine
- Limited therapeutic use, often abused.
Types:
- Amphetamines: Methamphetamine, Adderall, Ritalin, Vyvanse
- MDMA (Ecstasy)
- Cocaine (Both hydrochloride salt & free based crack cocaine)
- Theophylline (Asthma treatment)
- Ephedrine (For low blood pressure)
- BZP, Oxymetazoline (Afrin), Pseudoephedrine (Sudafed)
- MAO Inhibitors (treatment-resistant depression)
Mechanisms:
- Act on adrenergic and dopaminergic receptors.
- Cocaine blocks dopamine and serotonin reuptake.
- Methamphetamines increase stimulatory neurotransmitter release
- MAO Inhibitors prevent neurotransmitter breakdown.
Symptoms:
- Agitation, tachycardia, hypertension, hyperactive bowel sounds, diuresis, hyperthermia.
- Severe cases: Angina, seizures, cardiovascular collapse.
Diagnosis:
Treatment:
- Stabilize ABCs, IV hydration, temperature monitoring, benzodiazepines.
- Avoid beta-blockers due to unopposed alpha agonism.
- Whole bowel irrigation for body packers; surgical removal if packets rupture.
- IV hydration for high CK levels.
- Observation period often necessary.
Recap:
- Mimic sympathetic nervous system.
- Key symptoms: Diaphoresis, hyperactive bowel sounds.
- Treatment: Supportive care, benzodiazepines.
- Use poison control as a resource.

References:

Costa VM, Grazziotin Rossato Grando L, Milandri E, Nardi J, Teixeira P, Mladěnka P, Remião F. Natural Sympathomimetic Drugs: From Pharmacology to Toxicology. Biomolecules. 2022;12(12):1793. doi:10.3390/biom12121793
Kolecki P. Sympathomimetic Toxicity From Emergency Medicine. Medscape. Updated March 11, 2024. https://emedicine.medscape.com/article/818583-overview
Williams RH, Erickson T, Broussard LA. Evaluating Sympathomimetic Intoxication in an Emergency Setting. Lab Med. 2000;31(9):497-508. https://doi.org/10.1309/WVX1-6FPV-E2LC-B6YG

Summarized by Steven Fujaros | Edited by Jorge Chalit, OMSIII

Episode 908: Sympathomimetic Drugs

Emergency Medical Minute