title: Synthetic cathinones ("bath salts").
abstract: BACKGROUND
  Synthetic cathinones are popularly referred to in the media as "bath salts." Through the direct and indirect activation of the sympathetic nervous system, smoking, snorting, or injecting synthetic cathinones can result in tachycardia, hypertension, hyperthermia, myocardial infarction, and death.
  
  
  OBJECTIVE
  The chemical structures and names of bath salts identified by the Ohio Attorney General's Bureau of Criminal Investigation are presented. Based on their common pharmacophores, we review the history, pharmacology, toxicology, detection methods, and clinical implications of synthetic cathinones. Through the integration of this information, the pharmacological basis for the management of patients using synthetic cathinones is presented.
  
  
  CONCLUSIONS
  Synthetic cathinones activate central serotonergic and dopaminergic systems contributing to acute psychosis and the peripheral activation of the sympathetic nervous system. The overstimulation of the sympathetic nervous system contributes to the many toxicities reported with bath salt use. The pharmacological basis for managing these patients is targeted at attenuating the activation of these systems.
  
  
  CONCLUSIONS
  Treatment of patients presenting after using bath salts should be focused on reducing agitation and psychosis and supporting renal perfusion. The majority of successfully treated synthetic cathinones cases have used benzodiazepines and antipsychotics along with general supportive care.
authors.affiliation: Department of Pharmacology and Toxicology, Virginia Commonwealth University, Richmond, Virginia.
authors.forename: Matthew L
authors.initials: ML
authors.lastname: Banks
authors.affiliation: Ohio Attorney General's Bureau of Criminal Investigation, London, Ohio.
authors.forename: Travis J
authors.initials: TJ
authors.lastname: Worst
authors.affiliation: Departments of Emergency Medicine and Pharmacology and Toxicology, Indiana University School of Medicine, Indianapolis, Indiana.
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Rusyniak
authors.affiliation: Department of Pharmaceutical Sciences, College of Pharmacy, Ferris State University, Big Rapids, Michigan.
authors.forename: Jon E
authors.initials: JE
authors.lastname: Sprague
mesh_terms: D000470:Alkaloids / Q000009:adverse effects* / Q000737:chemistry; D000697:Central Nervous System Stimulants / Q000009:adverse effects* / Q000737:chemistry; D015198:Designer Drugs / Q000009:adverse effects* / Q000737:chemistry; D006801:Humans; D011619:Psychotropic Drugs / Q000009:adverse effects*; D019966:Substance-Related Disorders / Q000175:diagnosis / Q000628:therapy
chemical_list: D000470:Alkaloids; D000697:Central Nervous System Stimulants; D015198:Designer Drugs; D011619:Psychotropic Drugs; C023665:cathinone
keywords: amphetamine; bath salts; phenethylamine; sympathomimetic; synthetic cathinones