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Amphetamine is a medication used in the management and treatment of ADHD and narcolepsy. It is classified as a central nervous system stimulant. This activity reviews the indications, action, and contraindications for amphetamine as an agent in treating ADHD and narcolepsy. This activity will highlight the mechanism of action, adverse effect profile, and other key factors (e.g., dosing, monitoring, toxicity) pertinent for members of the interprofessional team in the treatment of patients with ADHD and narcolepsy. Objectives: Explain the mechanism of action of amphetamine. Describe the potential adverse effects of amphetamine. Identify signs and symptoms of amphetamine toxicity. Review the importance of collaboration and communication amongst the interdisciplinary team to properly monitor for adverse effects in patients receiving amphetamine treatment. Access free multiple choice questions on this topic.

Due to their ability to produce powerful euphoric effects, amphetamines are common drugs of abuse. All major drugs of abuse increase dopamine concentrations in the mesolimbic pathway, but amphetamines, because of their direct effects on DAT and VMAT2, can increase dopamine concentrations far beyond the concentrations seen for natural rewarding stimuli. Chronic exposure to amphetamine, particularly methamphetamine, at recreational doses has shown to destroy dopaminergic terminals in the striatum through a variety of mechanisms, including oxidative stress and excitotoxicity. The resultant blunting of the physiological dopamine response can further potentiate abuse.[15][16] Common signs and symptoms of acute amphetamine intoxication include hypertension, tachycardia, tachypnea, hyperthermia, mydriasis, tremors, agitation, and psychosis. The presentation can be highly variable depending on the amphetamine analog used as well as the simultaneous use of other substances. Dextroamphetamine and methamphetamine have a higher affinity for DAT, and intoxication can cause psychiatric disturbances resembling a manic episode or an acute psychotic break. Other illicit amphetamine analogs such as MDMA have a higher affinity for NET and SERT and are potentially more likely to cause hyperthermia, serotonin syndrome, and rhabdomyolysis. The risk of hyperthermia and rhabdomyolysis may become compounded by the association of MDMA use in dance clubs.[15][17] Management of amphetamine intoxication generally involves the use of benzodiazepines and antipsychotics to control agitation and psychotic symptoms. Beta-blockers can also help to control hypertension and tachycardia. Intravenous nitrates may be necessary in cases of severe hypertension. Severely agitated patients may require paralysis and intubation, and hyperthermia is manageable with ice packs and evaporative cooling techniques.[18]

Amphetamine has high misuse/abuse potential. All interprofessional team members (clinicians, nurses, pharmacists, behavioral therapists) involved in the care of a patient taking amphetamines should monitor closely for signs of medication misuse. As a schedule II controlled substance, there are no refills for amphetamine, which may necessitate monthly appointments with the prescribing physician. A cardiologist consult may be necessary for evaluating patients with potential cardiac concerns before the initiation of amphetamines. A pediatrician should monitor growth charts for children taking these medications. Pharmacists should monitor prescribing patterns and warn clinicians of potential doctor shopping". Nursing staff can counsel the patient on proper dosing and administration, warn about side effects, and answer patient questions, which the pharmacist can also reinforce. Interprofessional coordination and open information sharing will optimize amphetamine therapy for those patients who need it, prevent drug abuse and misuse, and prevent adverse outcomes. [Level 5]