Cocaine
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
- Chest pain
- Sympathomimetic qualities
- Tachycardia
- Fever
- Agitation
- Diaphoresis
- Pulmonary Complications:
- "Crack lung"[2]
- Diffuse alveolar hemorrhage
- ARDS
- Pneumothorax
- Pneumomediastinum
- Chronic
- Atherosclerosis
- Cardiomyopathy
- Nasal Septum damage
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
- Sympathomimetic Toxicity
- Cocaine Intoxication
- Cocaine Chest Pain
- Cocaine Withdrawal
- Levamisole toxicity
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.