Cocaine: Difference between revisions
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**Sympathomimetic qualities | **Sympathomimetic qualities | ||
***Tachycardia | ***Tachycardia | ||
Revision as of 19:27, 18 February 2017
This page is for the drug cocaine; for clinical effects see cocaine toxicity
Background
- A sympathomimetic stimulant derived from an alkaloid paste made from the leaves of the coca plant
- Both a legitimate medical drug and a drug of abuse
Forms of Abuse
- Cocaine can be smoked, snorted, injected or ingested
- Smoked form is often in a free-base or crack form
Detection
- Unreliable in very acute intoxication[1]
- Qualitative urine detection of cocaine metabolite benzoylecgonine at cut-off of 300 ng/ml
- On average, shows up in urine 24-48 hrs after use
- Up to 22 days in chronic users
Adverse effects
- Acute
- Cocaine-associated chest pain
- Sympathomimetic qualities
- Tachycardia
- Fever
- Agitation
- Diaphoresis
- Pulmonary Complications:
- "Crack lung"[2]
- Diffuse alveolar hemorrhage[3]
- ARDS
- Acute eosinophilic pneumonia
- Pneumothorax
- Pneumomediastinum
- Thermal epiglottitis - hot cocaine
- Chronic
- Atherosclerosis
- Cardiomyopathy
- Nasal Septum damage
- Up to 70% of US cocaine tainted with levamisole, potentially leading to neutropenia, vasculitis
Mechanism of action
- Blocks reuptake of serotonin, dopamine and norepinephrine
- Anesthetic effects achieved through sodium channel blockade
Differential Diagnosis
Sympathomimetics
- Cocaine
- Amphetamines
- Synthetic cathinones (khat)
- Ketamine
- Ecstasy (MDMA)
- Synthetic cannabinoids
- Bath salts
See Also
References
- ↑ McCord J, et al. Management of Cocaine-associated chest pain and myocardial infarction. Circulation. 2008; 117: 1897-1907.
- ↑ Forrester, J. M., Steele, A. W., Waldron, J. A. and Parsons, P. E. (1990) ‘Crack Lung: An Acute Pulmonary Syndrome with a Spectrum of Clinical and Histopathologic Findings’, American Review of Respiratory Disease, 142(2), pp. 462–467. doi: 10.1164/ajrccm/142.2.462.
- ↑ Ettinger, N. A. and Albin, R. J. (1989) ‘A review of the respiratory effects of smoking cocaine’, The American Journal of Medicine, 87(6), pp. 664–668. doi: 10.1016/s0002-9343(89)80401-2.