Sympathomimetic Toxidrome

Features: "Fight or flight" = hypertension, tachycardia, sweating, fever, excitation-psychomotor agitation, tremor, seizures, dilated pupils. Causes: Amphetamines/diet drugs, cocaine, theophylline, caffeine, methylphenidate, mono-amine oxidase inhibitors; over-the-counter cold medications, especially those containing phenylpropanolamine (PPA), ephedrine, and pseudoephedrine.

Mechanisms: Increased release of catechol-amines (amphetamines), blockade of cat-echolamine re-uptake (cocaine), inhibition of catecholamine metabolism (monoamine oxidase inhibitors), indirect adrenergic receptor stimulation (ephedrine). Antidote: Beta-blockers.

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