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  1. 1. Cocaine Presented by: Dr.J.A.Dabhi Resident S.B.K.S.M.I.R.C GUJARAT
  2. 2. Cocaine  What is cocaine? It is an alkaloid obtained from the leaves of coca tree, and is a powerful addictive CNS stimulant.
  3. 3. •Cocaine has been classified as a Schedule II drug by the United States. •Cocaine is extracted and refined from the Coca plant.
  4. 4. Cocaine  Coke  Snow  Cadillac  White Lady, etc.
  5. 5. Erythroxylum Coca
  6. 6. Features Plant is 8-12 feet tall. Category: Shrubs Fruits: Red oval shaped, 1 cm size and produces only one seed. Seeds: Brownish oval Stem diameter: 16cms
  7. 7. Coca Fruits
  8. 8. Leaves: Green, smooth, glossy, opaque, oval, tapering at extremities, 2-3 cm wide and 3-11 cm long. Leaves when chewed have pleasant, pungent taste. Poisonous parts: Leaves Toxins: Methylbenzoylecgonine i.e. Cocaine an active principal obtained from leaves (0.5-1% Al.Cocaine)
  9. 9. Geographical Distribution Grows throughout the tropical regions. 1.Whole of Latin American Countries such as Columbia, mexico, ecuador, and other countries such as Chile, Peru, India, Indonesia, Sri Lanka, etc. Bolivia-leading producer-80% world total cocaine producer.
  10. 10. High risk geographical areas: 1. Bolivia 2. Peru 3. Brazil – Amazon region 4. Ecuador 5. Columbia 6. Chile
  11. 11. Cocaine
  12. 12. History 3000 B.C.:Leaves chewed throughot South America. Coca believed to be a gift from Go. 1708 A.D. Coca first time mentioned in materia medica. 1850: Coca tinctures used in throat surgery 1855: Cocaine 1st time extracted from coca leaves.
  13. 13. 1884: Used as local anaesthetic in eye surgery 1886: Cocaine introduced in newly launched soft drink - Coca Cola. 1901: Cocaine removed from Coca Cola. 1905: Snorting cocaine in the form of powder became popular. 1910:1st case of nasal damage seen.
  14. 14. 1912: U.S. Govt. reports 5000 cocaine related fatalities in one year 1914: Banned of cocaine in U.S. Cost of making 1 kg cocaine: $200- $400. Cost of 1 kg cocaine- at present $15000 – 35000.
  15. 15. w Cocaine
  16. 16. Features  White powder or crystals Odourless  numbing taste  slightly volatil melting point 96 degree celsius and should be protected from heat and sunlight.
  17. 17. Forms: 1. Hydrochloride Salt 2. Freebase
  18. 18. Cocaine Hydrochloride
  19. 19. Freebase
  20. 20. Hydrochloride Salt: It is the powdered form of cocaine, dissolves in water and when abused, can be taken i.v. or snorted. Freebase: Compound that has not been neutralized by an acid to make hydrochloride salt. It can be smoked.
  21. 21. Crack: When freebase is heated with sodium bicarbonate it yields crack. Why the word crack? It is smoked.
  22. 22. Principle Routes of Abuse Intravenous Snorting Smoking/inhalation Ingestion: both cocaine and leaves of coca plants What is snorting?
  23. 23. Snorting
  24. 24. Action Desensitizes the terminal nerves and causes vasoconstriction at the site of local application. When taken i.v. or inhaled, stimulates the cerebral cortex .
  25. 25. Metabolism Site: Liver Half Life: 30-90 min.
  26. 26. Detection Metabolites can be detected for varying lengths of time in urine depending upon the dose consumed and sensitivity of the assay. Metabolites in urine is generally detected in urine for 24-72 Hrs. even after brief consumption.
  27. 27. With chronic use it is deposited in body in fats/cns. and is slowly released. Hence, can be detected in urine for even couple of weeks. Metabolites also detectable in blood, saliva, hair and sweat.
  28. 28. Blood and saliva: Provide accurate conc. of the drug consumed. Urine: Provides longer window of opportunity for detection.
  29. 29. Speedball: Mixture of cocaine and heroin. Taken i.v.
  30. 30. Acute Effects Local: Anaesthetic when comes in contact with mucous membrane. Increase energy Euphoria Mental Alertness Increase heart rate/B.P./temp. Dilates pupil Vasoconstriction
  31. 31. Long-term Effects It is powerful addictive drug. Once having tried, an individual may have difficulty in predicting the extent to which he will continue to use the drug. Abusers are of upper class society peoples to enhance self image or improve professional performance.
  32. 32. Reason for addiction? Its stimulant and addictive effects are thought to be primarily a result of its ability to inhibit the reabsorption of dopamine by nerve cells. Note: Dopamine is directly or indirectly involved in addictive properties of every major drug of abuse
  33. 33. Cocaine in brain: In normal communication process, dopamine is released by neuron into the synapse, where it can bind with dopamine receptors on neighbouring neurons. Normally dopamine is then recycled back into the transmitting neuron by a dopamine transporter.
  34. 34. If cocaine is present, it attatches to the dopamine transporter and blocks the normal recycling process, resulting in a building up of dopamine in the synapse which contributes to the pleasurable effects of cocaine.
  35. 35. Long term effects of cocaine
  36. 36. Long-term effect of cocaine may lead to:  Irritability Dependency- Discuss that not each and every causes dependency.  Mood disturbances Restlessness Paranoia Auditory hallucinations
  37. 37. Consequences of cocaine abuse Cardiovascular - arrhythmia heart attack Respiratory – Chest pain Resp. failure CNS – stroke seizures headaches
  38. 38. GIT – abdominal pain nausea Tongue and teeth are black Regular snorting can lead to loss of sensation of smell, nose bleeding, problem of swallowing, hoarseness and irritation of nasal septum leading to chronically inflammed running nose
  39. 39. Ingested cocaine can cause bowel gangrene due to reduced blood flow. Many chronic cocaine habitual suffers loss of appetites and can experience significant weight loss and malnourishment.
  40. 40. Cocaine bugs phenomenon: Grains of sand are lying under skin or some small insects are creeping on the skin giving rise to itching sensation – a form of tactile hallucination. Loss of libido Impotence Gynecomastia Irregular menstrual cycle, infertility, amenorrhea
  41. 41. Crack Babies: Increased risk of foetal malformation fo cardiovascular and cerebrovascular system due to chronic abuse of cocaine by the mother.
  42. 42. Treatment Specific antidote-Amyl Nitrate by inhalation. Only symptomatic treatment Consultation with psychiatric – psychotherapy, and other related counseling.
  43. 43. Symptomatic Treatment Includes Diazepam for seizure. Propanolol for ventricular arrhythmias. Haloperidol for pshchosis.
  44. 44. Fatal dose:1 – 1.5 gram orally. Fatal Period: Few minutes to few hours. Chronic abuser can tolerate up to 10 gms per day.
  45. 45. Autopsy Findings No specific findings Injection marks,  Atrophy, inflammation of nasal mucosa. Endocarditis due to aseptic i.v. infusion of drug. Pulmonary granulomatosis due to infusion of adulterated particles viz. starch, talc, etc.
  46. 46. Endocarditis
  47. 47. CSF rhinorrhoea due to thinning of cribriform plate. Cocaine can be recovered by sampling from recent injection sites or by swabs from the nasal mucosa. Brain is the excellent source.
  48. 48. Circumstances of Poisoning Generally accidental overdose. Rarely used for homicide/sucide. Aphrodisiac - to increase the duration of sexual act by desensitizing the sensory nerves of glans penis when applied locally. Prostitutes injects cocaine solution into the vagina to produce local anaesthetic effect during coitus.