2026-2027 | Live Session | Cocaine, Methamphetamine, and Other Stimulants: Board Review | November 2026-Cocaine, Methamphetamine, and Other Stimulants: Board Review Presentation

Cocaine, Methamphetamine, and Other Stimulants: Board Review Presentation

Pdf Summary

This board-review curriculum surveys stimulant pharmacology, acute toxicity, withdrawal, and treatment across cocaine, amphetamines, methamphetamine, MDMA, synthetic cathinones, khat, anorectics, caffeine, and nicotine.<br /><br />Stimulants increase monoamine signaling through different mechanisms: cocaine blocks dopamine, norepinephrine, and serotonin reuptake; amphetamines promote transporter-mediated release; MDMA preferentially releases serotonin; and some cathinones, such as MDPV and alpha-PVP, primarily block dopamine and norepinephrine reuptake. These differences help explain variations in onset, duration, reinforcement, and toxicity. Chronic use can blunt responses to ordinary rewards while strengthening cue-related craving, contributing to anhedonia and relapse risk.<br /><br />Acute intoxication may cause agitation, paranoia, tachycardia, hypertension, and sweating. Hyperthermia, chest pain, seizures, arrhythmias, severe hypertension, and altered mental status require urgent evaluation. Management prioritizes stabilization, benzodiazepines for agitation or seizures, active cooling for hyperthermia, and assessment for cardiac, neurologic, renal, and other complications. MDMA can cause serotonin toxicity and dangerous hyponatremia; cocaine combined with alcohol produces longer-lasting, cardiotoxic cocaethylene. Stimulant withdrawal is rarely medically fatal, but depression, persistent symptoms, and suicide risk require assessment. Opioid co-use or fentanyl contamination can cause respiratory depression, so naloxone and drug-checking education are important.<br /><br />Contingency management is the recommended foundation of stimulant-use-disorder treatment, often combined with CBT, community reinforcement, or the Matrix Model. No medication is FDA-approved specifically for stimulant use disorder; some off-label options have conditional or limited evidence. Toxicology results must be interpreted cautiously: immunoassays can cross-react, positive results do not prove current intoxication, and routine screens may miss synthetic cathinones.<br /><br />The curriculum also emphasizes harm reduction, coordinated care in pregnancy, integrated treatment of co-occurring ADHD, and choosing care settings according to medical and psychiatric risk.

Keywords

stimulants

cocaine

amphetamine

methamphetamine

MDMA

synthetic cathinones

stimulant toxicity

withdrawal

contingency management

harm reduction