a) Outline the mechanism of action of 3,4-methylenedioxymethamphetamine (MDMA/“Ecstasy”). (20% marks)
b) List the common features of MDMA toxicity. (30% marks)
c) Outline the management of a patient presenting with MDMA toxicity. (50% marks)
Most candidates did not know mechanism of MDMA toxicity, and many answers were generic and did not address specific therapies. Many candidates listed the features but failed to subsequently address these in the management section.
"Mechanism of action" is different to "mechanism of toxicity" for many drugs, though the Venn diagrams do overlap. For instance, it is not inconceivable that MDMA may be consumed in a dose that has effects that are not necessarily toxic per se, a stance that may vary individually depending on one's level of moral Puritanism. What is presented below hopefully answers the original question as it was asked, as well as the question that wasn't asked but which was clearly still expected to be answered.
Mechanism of action:
Mechanism of toxicity:
Common features of toxicity:
Management:
King, Andrew, Mirjana Dimovska, and Luke Bisoski. "Sympathomimetic Toxidromes and Other Pharmacological Causes of Acute Hypertension." Current hypertension reports20.1 (2018): 8.
Jenner, L., et al. "Management of patients with psychostimulant toxicity: guidelines for emergency departments." Canberra, Australian Government Department of Health and Ageing (2006).
Kalant, Harold. "The pharmacology and toxicology of “ecstasy”(MDMA) and related drugs." Cmaj 165.7 (2001): 917-928.
De la Torre, Rafael, et al. "Human pharmacology of MDMA: pharmacokinetics, metabolism, and disposition." Therapeutic drug monitoring 26.2 (2004): 137-144.
De la Torre, R., et al. "Pharmacology of MDMA in humans." Annals of the New York Academy of Sciences 914.1 (2000): 225-237.
Capela, João Paulo, et al. "Molecular and cellular mechanisms of ecstasy-induced neurotoxicity: an overview." Molecular neurobiology 39 (2009): 210-271.
Green, A. Richard, Esther O'shea, and M. Isabel Colado. "A review of the mechanisms involved in the acute MDMA (ecstasy)-induced hyperthermic response." European journal of pharmacology 500.1-3 (2004): 3-13.
Rusyniak, Daniel E., et al. "The role of mitochondrial uncoupling in 3, 4-methylenedioxymethamphetamine-mediated skeletal muscle hyperthermia and rhabdomyolysis." Journal of Pharmacology and Experimental Therapeutics 313.2 (2005): 629-639.