Cocaine PDF

 Cocaine The Coca plant had been used by the natives of the South America 1200 years ago. Cocaine is one of the most popular drugs of abuse. Source: Cocaine is a bitter white crystalline alkaloid, which is found in the leaves of Erythroxylon coca plant (0.5-1% cocaine).  Cocaine Uses:...

 Cocaine The Coca plant had been used by the natives of the South America 1200 years ago. Cocaine is one of the most popular drugs of abuse. Source: Cocaine is a bitter white crystalline alkaloid, which is found in the leaves of Erythroxylon coca plant (0.5-1% cocaine).  Cocaine Uses:  Local anaesthetic (Marcaine)  Antiarrhythmic (Xylocaine)  Drug abuse  Sports doping  Anorexigenic Cocaine Conditions of poisoning:- Accidental: * Over dose in addicts * Medical over dose (anesthetic)  Cocaine Routes of administration: Sniffing the powder which is usually adulterated by other less expensive substances as theophylline, quinine, talc powder, Smoking as free base (crack). Inhalation I.V. (usually with heroin).  Cocaine Mechanism of action: Sympathomimetic and a strong C.N.S stimulant Interferes with the reuptake epinephrine & norepinephrine. Blocks the reuptake of dopamine. Interferes with serotonin activity. Local anesthetic: Blocks the fast inward Na-channel.  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 hallucination. - Exaggerated reflexes, convulsions and even status epilepticus. - Hyperthermia, which is the major cause of death in stimulation - Increased respiratory depth and rate. - Loss of reflexes, irregular respiration, cyanosis, coma and death.  Cocaine Clinical presentations: CVS manifestations:  Elevated blood pressure (may precipitate hemorrhagic stroke).  Arrhythmias (sinus tachycardia, ventricular tachycardia or fibrillation).  Coronary artery spasm or thrombosis which may result in myocardial infarction.  Circulatory collapse.  Cocaine Clinical presentations: Other manifestations:  Renal failure may result from shock and decreased renal perfusion or rhabdomyolysis and myoglobinurea.  Perforation of nasal septum after chronic sniffing of adulterated drug.  Accidental subcutaneous injection of cocaine may cause localized Necrotic ulcers “coke burns”  Cocaine Investigations: - Routine investigations ( CBC, ABG, kidney function tests, serum electrolytes) - Serum enzymes (CPK, AST, ALT,..etc.) - Detection of benzoylecgonine ( principle metabolite of cocaine) in urine by thin layer chromatography, high performance liquid chromatography (HPLC) or gas chromatography (GC) is used for diagnosis of cocaine overdose (can detected up to 2-3 days).  Cocaine Treatment: * Supportive (ABCs) - CNS stimulation--chlorpromazine. - Convulsions --- diazepam. - Hypertension-- alpha blocker e.g. Sodium nitroprusside - Hyperthermia--- chlorpromazine + salicylate  Cocaine Treatment: * GIT decontamination: - Emesis and gastric lavage are performed only in the absence of seizures. * Enhanced elimination: - Forced acid diuresis increases urine execration of the drug, but carry the risk of metabolic acidosis  Cocaine Treatment: * Symptomatic: - Cool quite environment---to minimize stimuli - Lithium---for cocaine psychosis - Propranolol---for hypertension and tachycardia. Cocaine dependence “Cocainism” Cocaine Street name: Crack - It is prepared from cocaine hydrochloride in the form of colorless, crystalline substance that makes popping or cracking sound when heated (hence the name crack). It can be mixed into cigarette and smoked or heated on water bath and inhaled. - Cocaine is euphoriant, decreasing physical and mental fatigue and increasing the sex activity. Tolerance and physical dependence to cocaine develop rapidly. Cocaine dependence “Cocainism” Clinical Picture: 1. Mental change: lack of concentration, dementia. 2. Physical effects:  Anorexia, progressive weight loss (wasting).  Pallor of the face due to vasoconstriction (VC).  Dilated reactive pupils, tremors, insomnia, and hypertension  Lost sense of smell.  Perforated nasal septum Cocaine dependence “Cocainism” Clinical Picture: 3. Moral changes: patient becomes aggressive and dangerous. 4. Psychological changes: Hallucinations → the chronic effects on the sensory nerve endings give rise to Magnan’s symptoms which is feeling of sand under the skin or to cocaine bugs, with sensation as if insects creep under the skin with severe itching. Cocaine dependence “Cocainism” Clinical Picture: Withdrawal symptoms: Physical dependence occurs to cocaine but withdrawal symptoms are not serious as that with opiates. It includes irritability, neurological pain in arms and legs and tendency to violence. Cocaine dependence “Cocainism” Treatment:  Abrupt withdrawal in an institute.  Psychological care, tranquilizers.  Symptomatic treatment.  Hypertension & arrhythmias → beta blockers. Thank you