Central nervous system stimulants

Abstract The characteristic response to consumption of a central nervous system (CNS) stimulant is to increase the levels of neurotransmitters including dopamine, norepinephrine, or serotonin or blocking their breakdown or reuptake in the brain. CNS stimulants are also called sympathomimetic drugs that directly or indirectly stimulate adrenergic receptors. Commonly abused CNS stimulants include cocaine and compounds from the phenethylamine family particularly amphetamine and methamphetamine. CNS stimulants are abused by self-administration via oral or intravenous routes. A patient with toxic exposures to a CNS stimulant presents with restlessness, anxiety, irritability, and hyperactivity. During a CNS stimulant overdose, it is not uncommon to encounter aggressive and even bizarre behavior. The symptoms of acute toxicity of amphetamine and cocaine are very similar. Death from overdose usually occurs due to cardiac effects. Clinical laboratories encounter samples from patients exposed to CNS stimulants on a routine basis. The advent of designer stimulants into this realm has challenged the analytical capabilities of toxicology laboratories to promptly identify the culprit stimulant drug. This chapter describes the toxicokinetics, clinical management and analytical considerations for commonly abused CNS stimulant drugs.