Download Effects of Illicit Drugs on the Heart and Brain

2014 Stroke/Cardiac
System of Care
Conference
Effects of Illicit Drugs on the Heart
and Brain
Presented by: Jeffrey Sather, MD, FACEP
Trinity Health
Disclosures
No Financial incentives
 No off label use of any drug or medical
device to be discussed

Case Study
21 Year old male presents to critical access
hospital agitated and confused
 Possibly ingested 2 grams of
Methamphetamine

Extremely agitated
Ativan 2 mg IV
 Ativan 2 mg IV
 Haldol 5 mg IV
 Haldol 5 mg IV
 Ativan 2 mg IV
 Hypertensive
 Labetolol 5 mg IV
 Labetolol 5 mg IV

Extremely agitated
Seizing
 Temperature reaches 104
 All of the above happening over 30 minutes.
 Then intubated to be transferred by fixed
wing aircraft.

Cardiac arrest
Cardiac arrest while being loaded to
airplane.
 Returned to CAH hospital for resuscitation
 About 10 minutes of CPR first arrest
 About 2 minutes of CPR second arrest

Labs
Labs
Drugs of abuse screen
Objectives
What does a drug screen indicate?
 What are common drugs abused?
 What are the effects of drugs on the heart
and brain?
 How does it effect treatment?
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North Dakota:
Leader of the Pack
North Dakota Ranks #1 in
Binge Drinking
Teen Alcohol Statistics
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95% of the alcohol consumed by youth under the age of 21 in the U.S.
is in the form of binge drinks.
Binge drinking is associated with many health problems, including—
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Unintentional injuries (e.g., car crashes, falls, burns, drowning)
Intentional injuries (e.g., firearm injuries, sexual assault, domestic violence)
Alcohol poisoning
Sexually transmitted diseases
Unintended pregnancy
Children born with Fetal Alcohol Spectrum Disorders
High blood pressure, stroke, and other cardiovascular diseases
Liver disease
Neurological damage
Sexual dysfunction, and
Poor control of diabetes.
Drug Use - Study

In 2009, the safety agency issued the
National Roadside Survey of Drug and
Alcohol Use by Drivers:
Alcohol was the most likely intoxicant
 8.6 percent of the total tested had used
marijuana
 3.9 percent had used cocaine
 1.3 percent tested positive for
methamphetamine

Drug Use
 Two
studies (44,000 collisions):
 One
out of four drivers involved in crashes
had marijuana, cocaine, amphetamines, or
some combination of those drugs in their
system
 Approximately 14 percent of all drivers on
the road have an illegal drug in their
system
Marijuana
Marijuana

Raises the heart rate 20-100%

4.8 fold increase in the risk of AMI in the first
hour after smoking.
 This
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risk increases as other risk factors increase.
Effects thinking and memory

Stunts brain development
 Causes
a decrease in IQ in subjects using through
teens and twenties.
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Increased respiratory illness
Marijuana
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Linked to increased mental illness such as:
Depression
 Anxiety
 Suicide
 Psychosis

Impairs judgment and contributes to
increased risk of injury or death.
 Specific link to lung cancer not well
established at this point
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Marijuana
No Specific antidote
 Symptomatic Treatment

Narcotics
One of the oldest pharmacological
substances
 Histamine releasing properties
 Produce bradycardia and hypotension by
increasing parasympathetic and decreasing
sympathetic response
 Strong respiratory depressant
 Can produce coma
 Infection from injection
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Narcotic Treatment
Symptomatic treatment
 Antidote is Naloxone
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Half life can be shorter than the narcotic
Cocaine
Strong central nervous system stimulant that
increases levels of dopamine
 Changes the short and long term reward
system in the brain
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Cocaine Effects
Constricts blood vessels
 Increases heart rate
 Increases blood pressure
 Increases body temperature

Increased risk of AMI and Stroke
 Increased risk of sudden cardiac arrest.
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Cocaine Treatment
No specific antidote
 Symptomatic Treatment
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Synthetic Drugs
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“Fake Substances . . . Real Dangers”
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K2, Spice, Bath Salts, Smiles . . .
Synthetic Drugs
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What are they?
Synthetic marijuana (often known as “K2” or “Spice”) and
bath salts products are often sold in legal retail outlets as
“herbal incense” and “plant food,” respectively, and
labeled “not for human consumption” to mask their
intended purpose and avoid FDA regulatory oversight of
the manufacturing process.
Synthetic Drugs
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How frequently is synthetic marijuana used?
Use of synthetic marijuana is alarmingly high
o
11.4 percent of 12th graders used Spice or K2 in the past year
*second most commonly used illicit drug among seniors
Synthetic Drugs
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What are they?
Bath salts contain manmade chemicals related to
amphetamines, also known as substituted
cathinones.
Cathinone derivatives are claimed to have effects
similar to cocaine, amphetamine or MDMA (ecstasy).
Smiles (not the good kind)

“Designer Drug” – 2CI
The drug, a hallucinogen, has been
linked to two deaths in Grand
Forks, North Dakota. Though
little is known about this drug's
dangers.
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Smile’s effects: combination
of MDMA (ecstasy) and LSD
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“speedy charge along with
intense visual and auditory
hallucinations”
Synthetic Treatment
No specific antidote
 Symptomatic Treatment
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Methamphetamine
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2012
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0.4% of population or 1.2 million report using
103,000 ED visits directly related in 2011
 4th most commonly mentioned abused drug
by ED patients nationally behind Marijuana,
Cocaine, and Heroin
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Methamphetamine effects
Increased attention and decreased fatigue
 Increased activity and wakefulness
 Decreased appetite
 Euphoria and rush
 Rapid/irregular heartbeat
 Vasoconstriction
 Hypertension
 Hyperthermia
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Methamphetamine chronic
effects
Anxiety
 Confusion
 Insomnia
 Mood disturbances
 Violent behavior
 Psychosis
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Hallucinations visual and auditory
 Paranoia
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Effects of Meth on the Brain
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Meth rewires the brain. Prolonged
use not only modifies behavior, but
literally changes the brain in
fundamental and long-lasting ways.
Even while recovery may be
possible, the brain won’t be the
same.
Effects of Meth on the Brain
PET Scan of a
meth user and a
control subject
Face lift courtesy of meth
2 months later
2 years, 5 months later
1 year, 5 months later
1 year, 5 months later
Effects of Meth
Dental Decay
Psychosis
Skin
Lesions
Unnecessary Deaths
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Teenage male
collapses from
unknown causes.
Dies one day later.
Dx: Sudden cardiac
death secondary to
“bad” meth.
Unnecessary Deaths
17-year-old male and 23-year-old female
with AMI. Both heavy meth users.
 19-year-old presents with blood pressure of
290/160. Dies from a stroke after meth
injection.
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Methamphetamine
Treatment
 No
specific antidote
 Symptomatic Treatment
Drugs of Abuse Screen
Screening test not a definitive test
 Must be metabolized and excreted to be
present
 Metabolites present for variable periods
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Most 2-3 days
Does not test for all abused substances
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For example fentanyl a synthetic opiate does not
trigger positive for opiates.
Pearls
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No specific antidote for most abused drugs
except for Narcotics and Benzodiazepines.
Pearls
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Flumazenil should not be given to
benzodiazepine abusers and should only be
used for iatrogenic overdose.
Pearls
Naloxone reverses narcotics
 Reversing narcotic overdose usually results
in “bad behavior”
 Half life is shorter than many abused
narcotics and repeated dosing may be
needed.

Pearls
Gastric lavage has almost no utility
 Treatment is generally symptomatic
 Drug screen utility is to add evidence to
clinical findings
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Case Study
Case Study
Arrives intubated with no neurologic
response.
 In Rhabdomyolysis and has hyperkalemia.
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Case Study
Case Study
Case Study
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Hypothermia protocol for 24 hours
Treated for Rhabdo and hyperklemia
Rewarmed
No neurologic recovery
MRI shows diffuse edema and herniation
Brain death testing protocol
Support pulled and patient died
Diagnosis: Death due to anoxic encephalopathy
secondary to methamphetamine overdose