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Questions and Answers
What is a common clinical manifestation of cocaine poisoning that can lead to death?
What is a common clinical manifestation of cocaine poisoning that can lead to death?
Which of the following routes of administration for cocaine is associated with the use of adulterants?
Which of the following routes of administration for cocaine is associated with the use of adulterants?
What mechanism of action does cocaine have in the central nervous system?
What mechanism of action does cocaine have in the central nervous system?
In the context of cocaine use, which cardiovascular complication can lead to serious outcomes?
In the context of cocaine use, which cardiovascular complication can lead to serious outcomes?
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What effect does cocaine have on blood pressure?
What effect does cocaine have on blood pressure?
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Which of the following is NOT a use of cocaine in medical practice?
Which of the following is NOT a use of cocaine in medical practice?
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What can happen as a result of chronic sniffing of cocaine?
What can happen as a result of chronic sniffing of cocaine?
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What type of metabolic change may result from cocaine-related renal failure?
What type of metabolic change may result from cocaine-related renal failure?
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What is the principle metabolite of cocaine that is detected for diagnosis?
What is the principle metabolite of cocaine that is detected for diagnosis?
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Which treatment is recommended to address hyperthermia in cocaine overdose?
Which treatment is recommended to address hyperthermia in cocaine overdose?
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How long can benzoylecgonine be detected in urine after cocaine use?
How long can benzoylecgonine be detected in urine after cocaine use?
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What is a potential complication of forced acid diuresis in cocaine overdose treatment?
What is a potential complication of forced acid diuresis in cocaine overdose treatment?
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Which of the following symptoms is NOT a result of cocaine dependence?
Which of the following symptoms is NOT a result of cocaine dependence?
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Which of the following is considered a psychological change in cocaine dependence?
Which of the following is considered a psychological change in cocaine dependence?
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What is one of the physical effects commonly seen in individuals with cocaine dependence?
What is one of the physical effects commonly seen in individuals with cocaine dependence?
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Which agent is used for symptomatic treatment of cocaine psychosis?
Which agent is used for symptomatic treatment of cocaine psychosis?
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Study Notes
Plant Poisons: Cocaine
- Cocaine is a bitter white crystalline alkaloid
- Found in the leaves of the Erythroxylon coca plant
- Contains 0.5-1% cocaine
- Used by South American natives for 1200 years
- One of the most popular abused drugs
Cocaine Uses
- Local anesthetic (Marcaine)
- Antiarrhythmic (Xylocaine)
- Drug abuse
- Sports doping
- Anorexigenic
Cocaine Poisoning
- Accidental overdoses, especially in addicts
- Medical overdoses (anesthetics)
Cocaine Routes of Administration
- Sniffing (often adulterated with theophylline, quinine, or talc)
- Smoking (free base, "crack")
- Inhalation
- Intravenous (often with heroin)
Cocaine Mechanism of Action
- Sympathomimetic and potent CNS stimulant
- Interferes with the reuptake of epinephrine and norepinephrine
- Blocks the reuptake of dopamine
- Interferes with serotonin activity
- Local anesthetic: Blocks fast inward Na+ channels
Cocaine Causes of Death
- Hyperthermia
- Central asphyxia and/or circulatory collapse
Cocaine Clinical Presentations: CNS Manifestations
- Euphoria, agitation, insomnia, and talkativeness
- Headache, mental confusion, and hallucinations
- Exaggerated reflexes, convulsions (possibly status epilepticus)
- Hyperthermia (major cause of death)
- Increased respiratory depth and rate
- Loss of reflexes, irregular respiration, cyanosis, coma, and death
Cocaine Clinical Presentations: CVS Manifestations
- Elevated blood pressure (can cause hemorrhagic stroke)
- Arrhythmias (sinus tachycardia, ventricular tachycardia, or fibrillation)
- Coronary artery spasm or thrombosis causing myocardial infarction
- Circulatory collapse
Cocaine Clinical Presentations: Other Manifestations
- Renal failure from shock and reduced renal perfusion, or rhabdomyolysis and myoglobinuria
- Perforation of the nasal septum (chronic snorting)
- Accidental subcutaneous injection causing localized necrotic ulcers ("coke burns")
Cocaine Investigations
- Routine tests (CBC, ABGs, kidney function tests, electrolytes)
- Serum enzymes (CPK, AST, ALT)
- Detection of benzoylecgonine (cocaine metabolite) in urine (thin layer chromatography, HPLC, or GC; detectable up to 2-3 days)
Cocaine Treatment
- Supportive (ABCs - airway, breathing, circulation)
- CNS stimulation: chlorpromazine
- Seizures: diazepam
- Hypertension: alpha-blockers (e.g., sodium nitroprusside)
- Hyperthermia: chlorpromazine + salicylate
Cocaine GIT Decontamination
- Emesis and gastric lavage, only if no seizures
- to prevent further absorption
Cocaine Enhanced Elimination
- Forced acid diuresis increases urine excretion of the drug, but carries the risk of metabolic acidosis
Cocaine Symptomatic Treatment
- Cool, quiet environment to minimize stimuli
- Lithium for cocaine psychosis
- Propranolol for hypertension and tachycardia
Cocaine Dependence ("Cocainism")
- Prepared from cocaine hydrochloride; creates a popping or cracking sound when heated (hence "crack")
- Mixed into tobacco for smoking or inhaled directly, heated
- Euphorant; decreases physical/mental fatigue; increases sex drive
- Rapid development of tolerance and physical dependence
Cocaine Dependence: Clinical Picture
- Mental changes: lack of concentration, dementia
- Physical effects: anorexia, progressive weight loss, facial pallor(vasoconstriction), dilated pupils, tremors, insomnia, hypertension, lost sense of smell, and perforated nasal septum
- Moral changes: aggressiveness, dangerousness
- Psychological changes: hallucinations (Magnan's symptoms - feeling of sand or insects under the skin, severe itching)
- Withdrawal symptoms: less severe than opiates, includes irritability, neurological pain in arms and legs, and tendency to violence
Cocaine Dependence: Treatment
- Abrupt withdrawal in a facility
- Psychological care & tranquilizers
- Symptomatic treatment
- Hypertension and arrhythmias: beta-blockers
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Description
This quiz explores the properties, medical uses, and the effects of cocaine. It covers its historical background, routes of administration, mechanism of action, and the dangers associated with cocaine poisoning. Test your knowledge on this potent alkaloid and its implications in medical practice and drug abuse.
