Notes

Clinical manifestations

Acute effects

The effects of cocaine administration can vary depending on the mode of use. When injected or smoked, cocaine causes hyperstimulation, alertness, euphoria, feelings of increased energy, and feelings of competence and strength. These highs are similar to the effects of injecting amphetamines. Addicts who inhale cocaine powder via the nose feel less intense but more devastating.

Addicts who smoke the drug may develop pneumothorax or pneumomediastinum, causing chest pain, shortness of breath, or both. Cocaine use can also cause "cocaine chest discomfort" but myocardial inflammation due to cocaine use can also cause myocardial damage. This mechanism is not clear. A variety of conduction abnormalities and arrhythmias have been documented. Cardiac effects can lead to sudden death. "Marathon" (continuous usage), which can last for many days, can cause exhaustion, or "exhaustion", which includes extreme fatigue and the need to sleep.

Toxicity and overdose

Overdose can cause anxiety, panic and aggression, agitation. The symptoms include sweating, mydriasis and an increase in blood pressure. Death may occur as a result of myocardial infarction or arrhythmia.

Acute psychosis syndrome can be caused by severe overdose. This includes hypertension, hyperthermia (resembling schizophrenia symptoms), coagulopathy and renal failure. On a genetic basis, patients with extreme clinical toxicities may have reduced (atypically high) serum cholinesterase levels, which is an enzyme required to clear cocaine.

Inhaling cocaine can lead to acute pulmonary syndrome (crack lungs) that includes fever, hemoptysis and hypoxia. This condition can eventually lead to respiratory failure.

Cocaine and alcohol can be combined to produce cocaethylene, a condensate product that has stimulant properties. It can also cause toxic effects.

Chronic effects.

Compulsive heavy cocaine users experience serious toxic effects. Left ventricular hypertrophy, cardiomyopathy and myocardial fibrosis are all possible. In rare cases, repeated nasal retraction of cocaine causes perforation of the nasal septum due to localized ischemia. Some addicts experience cognitive impairment, which can include impaired attention span or verbal memory. The usual infectious complications may be experienced by addicts who inject cocaine.

Withdrawal Syndrome


Depression, difficulty concentrating and drowsiness are the main signs of cocaine abuse. The appetite is increasing.

Diagnosis

Clinical evaluation.

The clinical diagnosis of cocaine addiction is made most often by a physician. It is not possible to measure the levels of the drug. The most common routine urine drug screening tests determine whether benzoylecgonine is a cocaine metabolite.

Treatment

Intravenous benzodiazepines.

Avoid beta-blockers

If hyperthermia is required, refrigeration

Toxicity or overdose

Due to the drug's short acting, mild cocaine intoxication usually does not require treatment. Benzodiazepines, which are preferred as an initial treatment, are best for most toxic effects. These include central nervous system agitation (and seizures), tachycardia, hypertension, and seizures. Lorazepam can be given intravenously in doses of 2-3 mg every 5 min, and titrated until desired effects are observed. It is possible to require continuous infusion and higher doses. Propofol can be used infusively in conjunction with artificial lung ventilation in persistent cases.

For arterial hypertension resistant to benzodiazepines, intravenous nitrates (e.g., nitroprusside) or phentolamine are indicated; beta-blockers are not recommended because they allow prolonged alpha-adrenergic stimulation.

Hyperthermia may be fatal and should be treated aggressively using sedation with evaporative cool, ice bags and intravenous administrations with saline.

They are best not used for sedation because of the lower threshold of seizure activation of phenothiazines and their anticholinergic effect.

Occasionally, patients with severe agitation should be given pharmacologic paralysis and mechanical ventilation to improve acidosis, acute skeletal muscle necrosis, and multiorgan dysfunction.
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