Systems Effects

Cardiovascular:

The effect of meth on the cardiovascular system is from dopamine stimulation. According to Lynch and House (1992), meth causes arterial and venous vasoconstriction, resulting in positive chronotropic (increasing rate), inotropic (increasing strength of muscle contraction) and dromotropic (increasing nerve fiber conductivity) effects on the myocardium. These effects increase afterload and systemic vascular resistance.

As a result, myocardial oxygen consumption is greatly increased. Clinical manifestations are dose-related, although changes can occur with very small doses as well as with the first time user. Manifestations to assess for include: chest pain, palpitations, dysrhythmias, dyspnea, hypertension, and tachycardia.

• Hypertension is related to vasoconstriction. It is essential to continually monitor blood pressure, neurological status and renal status. Controlling agitation is also necessary to prevent further elevation of blood pressure. According to Goldfrank, et al. (1998) drugs of choice for treating hypertension include phentolamine (alpha-adrenergic antagonist) and nifedipine, nitroprusside, and nitroglycerine (vasodilators).
• Dysrhythmias are related to sympathetic stimulation and/or myocardial ischemia.. According to Lynch and House (1992), atrial dysrhythmias are usually treated with the beta-blocker esmolol because of its rapid onset of action and short half-life.
• Meth can cause acute aortic aneurysm and aortic dissection, resulting in death (Swalwell & Davis, 1999).
• Acute myocardial infarction may be a complication of meth use. The cause is unclear, however sympathetic stimulation, which causes increased coronary artery vasospasm and platelet aggregation is thought to enhance the probability of an MI. Ischemia and necrosis can occur at a young age and be manifested by chest pain, palpitations and dyspnea.
• Cardiomyopathy has been reported in meth users. Hong, Matsuyama and Nur (1991) reported pulmonary edema and a dilated cardiomyopathy associated with smoking meth. At this time there is no consensus as to the specific etiology of the drug-induced cardiomyopathy.

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Pulmonary:

Although most manifestations of meth use are systemic, some pulmonary complications occur. According to Cruz, Davis O'Neil and Tamarin (1998), dyspnea with shallow respirations may be noted within seconds of smoking “ice”. Absence of bronchoconstriction and wheezing may be due to the bronchodilating effect of meth.

• Pulmonary edema according to Cruz et al (1998) may be associated with the use of “ice”.
• Pulmonary hypertension according to Cruz et al (1998) may occur after long-standing use of "crank" (the less pure form of “ice”).

Gastrointestinal:

Many individuals begin to take some form of meth for the appetite suppressing qualities. According to Goldfrank et.al (1998), meth causes an increase of norepinephrine, which causes anorexia. Weight loss may be as great as 50 to 100 pounds. Teenagers are often told that meth is the same type of drug their physician would order and are thus encouraged to try meth. Meth users can become severely malnourished.

Nausea, vomiting and diarrhea may also accompany meth use. Gastric lavage and administration of activated charcoal are recommended if the drug has been ingested, but ipecac-induced emesis should be avoided because of the possibility of inducing seizures, arrhythmias, and hypertensive hemorrhages (Beebe and Walley, 1995).

Central Nervous System:

According to Derlet and Heischober (1990), most patients report to the emergency room because of CNS symptoms. These patients are anxious, volatile, aggressive and may have life threatening agitation.

• Hyperthermia: According to Goldfrank et.al (1998), hyperthermia is a frequent and rapidly fatal manifestation in patients. Temperatures may run as high as 104ºF. External cooling and control of agitation is recommended. Benzodiazepines are recommended for agitation. Goldfrank et al (1998) recommend administering 10mg of diazepam I.V. and repeating until the patient is calm. A cumulative dose of over 100 mg. may be needed.
• Seizures: According to Goldfrank et.al (1998), these are best treated with barbiturates or benzodiazepines.
• Ruptured cerebral (berry) aneurysms: According to Davis and Swalwell (1996), acute intoxication with methamphetamine may contribute to formation and rupture of a berry aneurysm by causing transient hypertension and tachycardia. Their study found the mechanism of death invariably involved subarachnoid hemorrhage, although some cases also had intracerebral hemorrhage.

For more information about berry, and other cerebral anueurysms, visit another "rnceus.com" course called "Caring for the Patient with a Subarachnoid Hemorrhage.

• Athetosis (flailing, jerking or writhing movements, especially severe in the hands)
• Extreme nervousness
• Dilated pupils

Other physical effects:

• Corneal ulceration: Chuck, Williams, Goldberg and Lubniewski (1996) found that the use of “ice” may cause chronic recurrent, bilateral corneal ulcerations.
• Rhabdomyolysis: Richards, Johnson, Stark, and Derlet (1999) found an association between rhabdomyolysis (disintegration or dissolution of muscle, associated with excretion of myoglobin in the urine) and positive urine screens for methamphetamines.
• Dental deterioration: Teeth are often missing or badly decayed
• Depression

This NIDA report mentions another adverse potential effect.

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